Experiences, Perceptions, and Coping Patterns of Emergency Department Nurses with Occupational Stressors in Saudi Arabian Hospitals: Mixed-Method Study.

Extended working hours, a complicated workplace environment, and engagement in numerous physical and psychological stressors have been associated with the stressful nature of the nursing profession. Only a few studies have provided some insight into workplace stress and coping strategies adopted by nurses in Saudi Arabia and neighboring countries. Therefore, this study utilized a mixed-method design to explore the numerous factors that lead to stress among emergency nurses, their experience and perception of stress, and the coping mechanisms they find useful. A survey containing four domains and 86 items was adapted, pilot tested, and validated. The quantitative phase recruited 296 nurses who returned completed questionnaires, and then 21 nurses were interviewed for the qualitative phase. In total, 89.5% (n = 265) of the participants were female, 51% (n = 151) were aged 20-29 years, 83% (n = 246) were non-Saudi nationals, 49% (n = 145) were married, and 82% (n = 245) had a bachelor's degree. The most common causes of occupational stress were work overload, personnel shortages, and inadequate pay. The qualitative phase data revealed five primary themes, including increased workload, rising living costs despite equal compensation, and staff shortages as main stressors. In addition, the study found that praying and spending quality time with friends are the primary coping techniques among nurses. The study results contribute to a better understanding of nurses' working conditions in the emergency department. Additionally, they may contribute to the development of policies and practice reforms to improve Saudi nurses' well-being, health, and overall work experience.

Experiences of mental health nurses working in general practice: A qualitative study.

Background: This paper reports on a qualitative study utilising in-depth interviews of sixteen Australian mental health nurses (MHNs) working in general practice. On 1st July 2015, the commonwealth government of Australia established 31 primary health networks (PHN) to increase the efficiency and effectiveness of medical services for people, particularly those at risk of poor health outcomes, and to improve coordination of care. Aim: This study explores the experiences of Australian MHNs working in general practice. Design: Data were analysed using thematic analysis. Four themes emerged through the data analysis: (1) autonomy and flexibility, (2) opportunity for more clinically focused work, (3) health promotion and preventative health and (4) excited to work in general practice. Findings: Study Participants identified many clinical opportunities working in primary practice and noted that the autonomy and flexibility of their role was quite different from other areas they had previously worked. They reported having more time to spend with the patients and being able to engage in health promotion. Conclusions: In order to make mental health care more accessible it is important to have a well-qualified workforce within primary health care (PHC) settings such as general practice. The participants of this study have identified ways they have been best utilised in the Primary Care workforce. They embrace the autonomy of the role and the ability to engage with consumers by providing clinical interventions that can assess and intervene with people experiencing mental illness.

Improving Care Provision to Older Adults with Dual Diagnosis: Recommendations from a Mixed-Methods Study.

Older adults with dual diagnosis remain an under-diagnosed population in mental health services, with complex needs and high rates of medical comorbidity. Dual diagnosis is a significant challenge to contemporary mental health services, with recognition of the increased rate of relapse and costs of care of poorly managed dual diagnosis identified through comprehensive research. Unfortunately, the research attention paid to those with dual diagnosis in younger age groups has not been replicated in the older adult cohort, with few studies specifically exploring the treatment needs of these individuals. Of the studies that do exist, many identify poor screening and assessment, clinician frustration and a lack of cohesive treatment for co-occurring alcohol and other drug use disorders for older adults. We draw from a mixed methods exploratory study conducted in an inner Melbourne community older adult mental health service providing care to consumers with dual diagnosis to formulate recommendations to improve the care provision to this cohort. We discuss changes to the way older adult mental health services operate that are essential to improve the care and response to consumers presenting with dual diagnosis. Ultimately, we aim to discuss how older adult mental health services can improve to provide timely, responsive care to those with dual diagnosis.

Aggression Management Training in Undergraduate Nursing Students: A Scoping Review.

Recent events and media coverage have put aggression and violence toward healthcare workers on the agenda of many governments and healthcare providers. Shown to cause poor job satisfaction, attrition and higher rates of turnover, aggression and violence toward healthcare workers is a substantial problem in the provision of quality care. We aim to determine the feasibility of providing aggression management training to undergraduate nursing students to better prepare them for the workforce. This review found seven studies utilizing various methods of providing aggression management training to students. Delivery was diverse in terms of format, content and duration, and the efficacy of training was typically determined in a pre- and post-test fashion. The findings in reviewed studies indicate significant improvements in competence and attitudes, however some methodological caveats exist. We conclude that aggression management training for undergraduate nursing students is indeed feasible within certain constraints: methodological approaches to demonstrating efficacy need to evolve beyond pre- and post-test designs and changes in content delivery incorporating new and novel methods, such as simulation, need to be considered and incorporated. Aggression management training should be considered as essential in the nursing curriculum in order to provide neophyte nurses with the skills and capabilities to manage aggression and violence in their future workplaces.

The Experiences of Older Adults with Dual Diagnosis in an Inner Melbourne Community Mental Health Service.

Less is known about the experiences of older adults (65+ years of age) with co-occurring mental health and alcohol and other drug use disorders (dual diagnosis) than is known about the experiences of their younger counterparts. This exploratory qualitative study sought to interview individuals receiving case management from an inner Melbourne community mental health service to determine their experiences of living with dual diagnosis and explore their interactions with mental health and addiction treatment, and general medical services alike. Six older adults with a dual mental health and substance disorder agreed to participate in a semi-structured interview process and provided their perspectives about living with complex mental illness and alcohol and other drug use. Several key themes emerged throughout the interview process, mirroring the notion of dual diagnosis being a complex phenomenon involving a number of interrelated factors: these include medical complexity, poor service engagement and long-term use of alcohol and other drugs. Interviews also demonstrate the challenges inherent in providing care to this cohort, with the participants frequently describing their experiences with services as being fraught with difficulty. The increased understanding of the perspectives of older adults with dual diagnosis provides the foundation for further research into this population in addition to influencing future nursing care provided to this cohort.

The Experiences of Clinicians Caring for Older Adults with Dual Diagnosis: An Exploratory Study.

Dual diagnosis has been identified as a significant challenge to mental health services, resulting in higher rates of psychiatric relapse and greater illness severity. Much research explores dual diagnosis in the adult mental health cohort, however little research attention has been paid to older adults with dual diagnosis. Far from being a trivial issue, preliminary studies have shown that dual diagnosis in older adults is under diagnosed and poorly identified by clinicians with few specific treatment options available. In addition, studies of the ageing baby boomer cohort demonstrate a potential for dual diagnosis presentations to increase in the coming years. This article explores the experiences of a clinical team providing care to older adults with dual diagnosis in Melbourne, Australia, through a semi-structured interview process. The participants described a number of systemic barriers to providing care to the older adults with dual diagnosis presenting to the mental health service, in addition to feeling poorly prepared and expressing a degree of clinical helplessness. Additionally, the participants described service improvement, which included a strong dual diagnosis culture in the leadership team of the mental health service and role modelling dual diagnosis competent practice among clinicians.

Mental health issues and discrimination among older LGBTI people.

LGBT is an acronym used to describe people from diverse sexual orientation or gender identity, people that are gay, lesbian, bisexual, or transgender. LGBT people do not constitute a single group nor does each individual "group" constitute a homogeneous unity. However, as higher rates of depression and/or anxiety have been observed in older LGBT people, compared to their heterosexual counterparts (Guasp, 2011) there is a need to raise the profile of mental health issues amongst these groups. The additional letter I is also often included in the acronym LGBTI as intersex people are often included as another gender diverse group. However, there is very little research that includes intersex people and none on older intersex people's mental health so this editorial is restricted to consideration of older LGBT people.

The impact of role discrepancy on nurses' intention to quit their jobs.

AIMS AND OBJECTIVE: The purpose of this study was to investigate the impact of role discrepancy on nurses' intention to quit their jobs. BACKGROUND: Nurses experience role discrepancy, which refers to incompatibility between the roles nurses desire and expect to take, and the roles they actually engage in at work. However, there is a paucity of information as to how this role discrepancy affects nurses' intention to quit their jobs. DESIGN: A correlational design was used to investigate the impact of role discrepancy on nurses' intention to quit their jobs. METHODS: A total of 346 Australian nurses participated in this study by completing questionnaires. The results were analysed by t-test, polynomial regression and response surface analysis. RESULTS: Nurses tended to experience role discrepancy, in particular, in decision making with hospital policies and provision of patient education. The overall results show that this role discrepancy contributes to nurses' intention to quit their jobs. Nurses' intention to quit their jobs also increased when they had a low desire to engage in nursing roles and when they only performed a few roles. When specific dimensions of nursing roles were examined, a role discrepancy in the use of nursing skills, such as participation in decision making and providing patient education and emotional support, had little impact on their turnover intention. On the contrary, a role discrepancy in task delegation practice showed a significant association with nurses' intention to leave their jobs. CONCLUSIONS: Role discrepancy has been experienced by many nurses, and this discrepancy partially contributes to nurses' intention to quit their jobs. RELEVANCE TO CLINICAL PRACTICE: To reduce nursing turnover, it is important to create a work environment where nurses are inspired to engage in various nursing roles and their work desires are reinforced by existing work opportunities.

Role discrepancy: is it a common problem among nurses?

AIM: This paper reports a study of nurses' perceptions of the differences between ideal and actual nursing roles, how these perceptions differ according to length of experience and the factors that might contribute to these perceived differences. BACKGROUND: The literature suggests that nurses tend to experience role discrepancy or a mismatch between their ideal and actual roles. Although it has been assumed that experienced nurses perceive less role discrepancy than inexperienced nurses, either because the former adjust themselves to their actual practice or because they have the expertise to improve their practice, this assumption has not been tested. METHODS: A survey design was used and the data were collected in 2003. Selected items from the Jefferson Survey of Attitudes Toward Physician-Nurse Inventory and the Staff Nurse Role Conception Inventory were administered to 216 Registered Nurses in Victoria, Australia to measure their perceptions of ideal and actual nursing roles. Data were analysed using a t-test and regression analysis. RESULTS: Nurses with more clinical experience rated their ideal and actual nursing roles more positively than those with less experience. However, the results showed that both groups of nurses experienced the same degree of role discrepancy. Both groups perceived strong role discrepancy in the areas of organizational decision-making and provision of patient education. Experienced nurses also perceived moderate role discrepancy in developing nursing care plans and in the freedom to initiate referrals. CONCLUSIONS: Role discrepancy cannot be resolved by having more clinical experience. While clinical experience enhances nurses' conceptions of their ideal roles, it can also lead to role discrepancy if there are organizational barriers that prevent nurses from engaging in their ideal roles. It is important to find a way whereby nurses can actualize their ideal views of practice in the current healthcare environment.

Impact of the perceived public image of nursing on nurses' work behaviour.

AIM: This paper reports a study comparing nurses' perceptions of their public image with their self-image, and examining how the relationship between their perceived public image and self-image was associated with their job performance and turnover intentions. BACKGROUND: The stereotypical public image of nursing is a major concern to nurses. However, it is relatively unknown how this image affects nurses. A few studies have investigated how nurses' interpretations of their public image affect their self-image and work behaviour. METHODS: A convenience sample of 346 Australian nurses participated in a questionnaire study in 2003. The results were analysed by t-test, polynomial regression and response surface analysis. Six participants from the survey participated in a focus group to provide further interpretation of the findings. RESULTS: Nurses rated their aptitude for leadership more positively than they thought the public viewed them. In contrast, nurses rated their image as being caring less negatively than their perceived public image. Job performance was predicted by self-image relating to leadership aptitude. On the contrary, the relationship between self-image and perception of the public image as being caring predicted job performance. When nurses perceived their public image as caring less positively than their self-image, their job performance tended to improve. As for turnover intention, both self-image and perceived public images of having an aptitude for leadership and being caring were negatively related to intention to quit the job. CONCLUSION: To enhance nurses' job performance and reduce their turnover intentions, it is important to improve both the public image and self-image of nurses.

Explaining nurses' work behaviour from their perception of the environment and work values.

The present study examined how the relationship between nurses' perception of their environment and their work values could explain their job performance and whether they intended to quit their jobs. A survey (N=346) and a focus group (N=6) were used to collect data. The results revealed that nurses' job performance was maintained in an environment where they received few professional incentives due to their professionalism. In contrast, negative environmental characteristics directly impacted on nurses' intention to quit their jobs. The present study provides new insights into nurses' work behaviour.

Nurses' job dissatisfaction and turnover intention: methodological myths and an alternative approach.

Job dissatisfaction and turnover are recurring themes in nursing. The current international nursing shortage has resulted in increased interest in investigating the causes of nurses' job dissatisfaction and turnover, and in developing countermeasures to address these issues. This paper involves a review of quantitative nursing studies, which investigated the causes of nurses' job dissatisfaction and turnover intention, and identifies commonly held myths that may inhibit more nurse-centered strategies from being developed. These myths are based on an assumption that a nurse-environment relationship is a one-way interaction in which nurses passively respond to their environment. The paper introduces the person-environment fit theory as an alternative framework, which challenges the assumption by suggesting it is the relationship between person and environment, rather than environmental characteristics alone, that affects nurses' occupational behavior. This theory enables nurse researchers to develop a more mutual approach involving the nurse and environment.

Comparison between nurses' professional needs and their perceptions of their job.

OBJECTIVE: The aim of this study was to examine how nurses' professional needs were met in nursing practice. DESIGN: A survey design was used in this study. SETTING: Data were collected from one metropolitan public hospital, one rural public hospital, and from postgraduate students in diploma/certificate course at a university in Victoria. SUBJECTS: Participants consisted of 346 registered nurses (RNs), who had completed either a three-year nursing diploma or a degree course, and were working in hospitals at the time of the study. MAIN OUTCOME MEASURES: Nurses' need to obtain professional rewards, challenges and support for their performance were compared with their perception of how their work environment actually reinforced those needs. In addition, desired nursing roles were compared with perceptions of actual roles carried out in practice. RESULTS: The findings suggest there is a mismatch between nurses' professional needs and the intrinsic/extrinsic rewards they receive for their performance. There is also a mismatch between their desired nursing role and actual roles in practice. These mismatches are prominent in areas such as participation in policy decision-making, professional recognition and opportunity to earn a higher income. CONCLUSION: The findings suggest there is a mismatch between nurses' professional needs and their actual nursing practice. As these mismatches may negatively impact upon nurses' work behaviour, it is important to reduce the gap between professional needs and the experience of actual nursing practice.