Biostatistics course. Reporting a systematic review or meta-analysis.
trapaga23
Badu2020.pdf
SPECIAL ISSUE
Workplace stress and resilience in the Australian nursing workforce: A comprehensive integrative review
Eric Badu,1 Anthony Paul O’Brien,2 Rebecca Mitchell,3 Mark Rubin,4 Carole James,5
Karen McNeil,6 Kim Nguyen7 and Michelle Giles7 1School of Nursing and Midwifery, 2Faculty Health and Medicine, School Nursing and Midwifery, The University of Newcastle Australia, Callaghan, 3Faculty of Business and Economics, Macquarie University, Sydney, 4School of Psychology, 5Faculty of Health and Medicine, 6Faculty of Business and Law, The University of Newcastle, Australia, Callaghan, and 7Hunter New England Local Health District, Newcastle, New South Wales, Australia
ABSTRACT: This integrative review aimed to identify and synthesize evidence on workplace stress and resilience in the Australian nursing workforce. A search of the published literature was conducted using EMBASE, MEDLINE, CINAHL (EBSCO), PsycINFO, Web of Science, and Scopus. The search was limited to papers published in English from January 2008 to December 2018. The review integrated both qualitative and quantitative data into a single synthesis. Of the 41 papers that met the inclusion criteria, 65.85% (27/41) used quantitative data, 29.26% (12/41) used qualitative data, and 4.87% (2/41) used mixed methods. About 48.78% (20/41) of the papers addressed resilience issues, 46.34% (19/41) addressed workplace stress, and 4.87% (2/41) addressed both workplace stress and resilience. The synthesis indicated that nurses experience moderate to high levels of stress. Several individual attributes and organizational resources are employed by nurses to manage workplace adversity. The individual attributes include the use of work–life balance and organizing work as a mindful strategy, as well as self-reliance, passion and interest, positive thinking, and emotional intelligence as self-efficacy mechanisms. The organizational resources used to build resilience are support services (both formal and informal), leadership, and role modelling. The empirical studies on resilience largely address individual attributes and organizational resources used to build resilience, with relatively few studies focusing on workplace interventions. Our review recommends that research attention be devoted to educational interventions to achieve sustainable improvements in the mental health and wellbeing of nurses.
KEY WORDS: Australia, coping strategies, mental health nursing, resilience, stress, workplace.
INTRODUCTION
Resilience has historically been defined and measured using several theoretical and conceptual approaches (Aburn et al., 2016; Delgado et al., 2017). Resilience is a dynamic and adaptable concept, especially in the context of overcoming adversity within the parameters of the individual developmental and transformative continuum (Aburn et al., 2016; Scoloveno, 2016). In addition, resilience is defined as the ability to bounce back, overcome adversity, adapt, and adjust, as well as
Correspondence: Eric Badu, School of Nursing and Midwifery, The University of Newcastle (UON), University Drive, Callaghan, NSW 2308, Australia. Email: [email protected] Declaration of conflict of interest: The authors declare that there is no conflicts of interest.
Eric Badu, BA, MSc. Anthony Paul O’Brien, BA, MA, PhD. Rebecca Mitchell, MBS, PhD. Mark Rubin, BSc, MSc, PhD. Carole James, BSc, MSc, PhD. Karen McNeil, MBA, PhD. Kim Nguyen, GradDipPH, GradDipStratLDRSHP, DipHRMgt, BAppSc(OT). Michelle Giles, RN, CM, BBus MIS, PhD.
Accepted August 28 2019.
© 2019 Australian College of Mental Health Nurses Inc.
International Journal of Mental Health Nursing (2020) 29, 5–34 doi: 10.1111/inm.12662
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maintain good mental health (Aburn et al., 2016; Ear- volino-Ramirez, 2007; Garcia-Dia et al., 2013). Specifi- cally, Scoloveno (2016, p. 3) described resilience as ‘the ability of individuals, families and groups to suc- cessfully function and adapt and cope in spite of psy- chological, sociological, cultural and/or physical adversity’.
During past decades, considerable global attention has been drawn to resilience employed to mitigate the negative effects of workplace stress and to prevent poor psychosocial outcomes among nurses (Delgado et al., 2017; Garcia-Dia et al., 2013; Turner, 2014). Several studies have identified significant outcomes or consequences of resilience. The outcomes are largely related to effective coping, mastery of positive adapta- tion (Earvolino-Ramirez, 2007; Garcia-Dia et al., 2013), sound mind and body, personal control, psycho- logical adjustment, and personal growth (Garcia-Dia et al., 2013). Specifically, some studies have recom- mended that resilience is not only significant for enhancing the psychological wellbeing of individual nurses, but also for improving mental health service delivery – particularly in ensuring the longevity and retention of the nursing workforce (Kim & Windsor, 2015; Turner, 2014).
Consequently, several studies have developed theo- retical models to facilitate understandings of resilience among workplace nurses (e.g., nurses working in health facility setting; Cusack et al., 2016; Earvolino- Ramirez, 2007; Garcia-Dia et al., 2013; Rees et al., 2015; Scoloveno, 2016; Turner, 2014; Zander & Hut- ton, 2009). The theoretical models have been explained according to different interrelated subcon- structs. Generally, the predicting or protective factors used to build resilience in workplace nursing can be categorized according to individual attributes, organiza- tional (e.g., workplace factors), and external factors (Garcia-Dia et al., 2013; Kim & Windsor, 2015; Scolo- veno, 2016; Yılmaz, 2017). Individual, organizational, and external factors can individually or jointly con- tribute to building resilience among workplace nurses. The individual characteristics, which appear as internal factors, are personality traits, cognitive ability, neuro- plasticity, self-efficacy (self-help skills) (Garcia-Dia et al., 2013; Rees et al., 2015), optimism and hope (Scoloveno, 2016), a sense of humour, mindfulness (control), competence, spirituality, adaptability, and a positive identity (Rees et al., 2015; Yılmaz, 2017). Conversely, the organizational factors are mostly characterized by professional skills development, social support, a supportive workplace environment, work
programmes (bio-psychosocial health programmes), and interventions implemented by workplace organiza- tions (Delgado et al., 2017; Scoloveno, 2016; Yılmaz, 2017). In addition, Yılmaz (2017) recommended that professional attributes associated with cultural generali- ties – such as altruism, mentoring, setting a good example, coaching, leading, and motivating – can be encouraged among the nursing profession to facilitate resilience. Some studies have indicated that external factors – including family, community, and socioeco- nomic resources – can contribute to building resilience in the nursing workforce (Garcia-Dia et al., 2013; Kim & Windsor, 2015).
In Australia, there is growing evidence regarding the effect of stress among workplace nurses. The stressors may be caused by several factors, including organiza- tional and individual factors. Consequently, resilience seems important for nurses, as their organizational environment includes stressors that contribute to psy- chological distress. Resilience and its associated coping strategies may be employed to mitigate the workplace stress faced by nurses. This issue has resulted in grow- ing empirical studies on resilience employed to manage workplace stress. However, only a few studies have attempted to synthesize evidence on the concept. A preliminary search as part of this integrative review identified two papers that sought to synthesize evi- dence on stress and coping mechanisms, as well as models of resilience, among Australian workplace nurses (Lim, Bogossian, & Ahern, 2010; Zander & Hutton, 2009). Of these two studies, one aimed to identify the factors that contribute to stress, the effects of stress on health and wellbeing, and coping strategies to manage stress (Lim et al., 2010), while the other study addressed stress, yet was limited to oncology nurses (Zander & Hutton, 2009). Critically, no study has been undertaken to aggregate a synthesis of both qualitative and quantitative studies regarding resilience displayed by Australian nurses at work.
As such, this study aims to contribute to the research lacuna by conducting an integrative review into the level of stress and the resilience developed by Australian nurses to reduce workplace adversity. The study specifically aims to identify the levels of stress and synthesize evidence on the individual attributes and organizational resources used to build resilience.
The review findings are significant for several rea- sons. The evidence is expected to inform policy deci- sion-making on the wellbeing of the nursing workforce and to strengthen human resource manage- ment for health. The evidence is also considered to
© 2019 Australian College of Mental Health Nurses Inc.
6 E. BADU ET AL.
be valuable to policy makers and managers in pre- venting stress and burnout in the nursing workforce. Finally, the evidence can guide researchers and clini- cians with regard to directions for future research into building resilience among nurses and student nurses.
METHODS
Methodology
The methodology used for this integrative review was conducted according to Whittemore and Knafl (2005). An integrative review is an approach that allows simul- taneous inclusion of diverse methodologies (i.e., experi- mental and nonexperimental research) and varied perspectives to fully understand the phenomenon of concern (Hopia et al., 2016; Whittemore & Knafl, 2005). The integrative review methods aim to use diverse data sources to develop a holistic understanding of resilience in nursing. This review method can con- tribute greatly to evidence-based practice for nursing. The methodology involves five stages:
• problem identification (ensuring that the research question and purpose are clearly defined)
• literature search (incorporating a comprehensive search strategy)
• data evaluation (focusing methodological quality) • data analysis (data reduction, display, comparison, and conclusions)
• presentation (synthesizing findings in a model or the- ory, and describing the implications for practice, pol- icy, and research; Whittemore & Knafl, 2005).
Inclusion criteria
The integrative review included papers that used a qualitative, quantitative, or mixed-methods approach. The quantitative papers targeted studies that used quantitative randomized controlled trials, quantitative nonrandomized designs (analytical cross-sectional), and quantitative descriptive studies. The qualitative papers broadly used phenomenological, grounded theory, nar- rative, ethnography, and participatory methodology. The integrative review included papers that targeted all resilience issues in nursing workforce, papers that assessed workplace stress among nurses, and papers that examined the effect of resilience in mitigating workplace adversity. The included articles were limited to those that targeted Australian nurses.
Exclusion criteria
The review excluded papers that did not address resili- ence in nursing; that targeted resilience in organiza- tions outside a nursing environment; and that focused on nursing students, nurses in an education setting, or new graduates and nursing managers. Nurses working in these environments were excluded because their experience regarding stress and resilience may differ from nurses in the hospital setting. Other general exclusion criteria were conference abstracts, papers that present opinion, book chapters, editorials, com- mentaries, clinical case, and review studies. The review also excluded papers published prior to 2008, as well as non-English-language articles.
Search strategy
The integrative review included all peer-reviewed pub- lished articles addressing resilience and the coping strategies used to manage stress among workplace nurses in Australia. The searches of published articles were conducted from six electronic databases: EMBASE, CINAHL (EBSCO), Web of Science, Sco- pus, PsycINFO, and MEDLINE. The searches of pub- lished articles were conducted according to the Joanna Briggs Institute (JBI) recommended guidelines for con- ducting systematic reviews (Pearson et al., 2014). In particular, a three-step search strategy was used to con- duct the search for information. An initial limited search of MEDLINE and EMBASE was conducted, followed by analysis of the text contained in the title and abstract, and of the index terms used to describe the article (Pearson et al., 2014). A second search using all identified keywords and index terms was then con- ducted across all remaining five databases. Finally, the reference lists of all identified articles were hand- searched for additional studies (Pearson et al., 2014). The review considered only studies published in the English language. Studies published from January 2008 to December 2018 were considered for inclusion in this review.
Search terms and Boolean operators
This study used the following search terms: (‘nurses’ OR ‘nurse resilience*’ OR ‘workplace resili-
ence’ OR ‘team resilience’ OR ‘team effectiveness’ OR ‘employee resilience’ OR ‘organizational resilience’ OR ‘resilience’ or ‘psychological’) AND (‘wellbeing’ OR ‘adaptation’ OR ‘coping behavior’ OR ‘job satisfaction’
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 7
OR ‘job performance’ OR ‘job satisfaction’) AND (‘stress management’ or ‘stress’ or ‘nurse workplace stress’ OR ‘burnout’ OR ‘professional’ OR ‘workplace’ or ‘workplace stress’ OR ‘occupational stress’ OR ‘de- pression’ OR ‘anxiety’).
Selection process
The review used several stages to manage the selection of included articles (Pearson et al., 2014). Two authors independently screened the titles of articles and then approved those that met the selection criteria. All authors reviewed the abstracts and agreed on those that needed full-text screening. Additionally, the authors screened all full-text articles and confirmed that the information and records met the inclusion cri- teria. All authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart for systematic reviews (Moher et al., 2009) to represent the selection processes (see Fig. 1).
Data management and extraction
Two reviewers independently managed the data extraction process. Endnote X8 software was used to manage the search results, screening, review of arti- cles, and removal of duplicate references. The authors developed a data extraction form to handle all aspects of data extraction (Appendix 1). The data extraction form was developed according to Cochrane and the JBI manuals (Pearson et al., 2014) for conducting sys- tematic reviews, as well as consultation with experts in methodologies and the subject area. The authors extracted the results of the included papers in numeri- cal, tabular, and textual format (Pearson et al., 2014). Categories that were extracted included the study details (citation, year of publication, author, contact details of lead author, and funder/sponsoring organiza- tion), publication source, methodological characteris- tics, study population, subject area (e.g., nurses’ workplace stress, effect of nurses’ workplace stress,
Records identified through database searching (n = 406)
Duplicates records removed (n =83)
Records after duplicates removed (n = 323)
Records screened (n = 323)
Records excluded (n = 266)
Full-text articles assessed for eligibility
(n = 57)
Full-text articles excluded, with reasons (n = 17)
• Reviews (n = 6) • Home and Community
Care workers (n = 1) • Focused on other
settings (Singapore and Iran, China, UK) (n = 4)
• Protocol (n = 1) • Not focusing on
resilience (n = 4) • No full text available
(n = 1)
Studies included in quantitative and
Qualitative synthesis (n = 41)
Full text articles included from reference list
(n = 1)
Sc re
en in
g In
cl ud
ed El
ig ib
ili ty
Id en
tif ic
at io
n
FIG. 1: legend: Flow chart of included papers. [Colour figure can be viewed at wileyonlinelibrary.com]
© 2019 Australian College of Mental Health Nurses Inc.
8 E. BADU ET AL.
concept of resilience, antecedents to resilience, and effect of resilience on workplace nurses’ stress), exist- ing interventions and outcomes, additional information on resilience, recommendations, and other potential references to follow up.
Assessment of methodological quality
The methodological quality of all included papers was independently assessed or appraised by two reviewers. The authors also developed a critical appraisal check- list using the Mixed Methods Appraisal Tool (Hong et al., 2018) and JBI (2017) critical appraisal tool. The critical appraisal tool was subdivided into sec- tions. The sections included reviewers’ details, study details (methods, study design, data, and analysis), screening questions (categorized according to qualita- tive, quantitative randomized controlled, and quantita- tive non-randomized trials, including cohort study, case-control study, analytical cross-sectional study, quantitative descriptive study, systematic review, and mixed-methods study), and overall quality score. Each of the subsections had specific questions related to methodological and reporting quality (Appendix 2). The appraisal was conducted to assess the method- ological quality of the included papers and to further determine whether to include or exclude articles, or to seek further information from authors. The methodological quality scores were categorized into low quality (a score below 25%), medium quality (a score of 50%), and high quality (a score of 70% or above). The scores were computed by summing the number of ‘yes’ occasions for each subsection of the questions related to the methodological criteria, and further expressing them as a percentage (Hong et al., 2018).
Data synthesis
The extracted data were analysed using a mixed-meth- ods synthesis (Pearson et al., 2014; Whittemore & Knafl, 2005). The authors coded the quantitative and qualitative data together. Data display matrices were developed to document all the coded ideas from the extracted data (Whittemore & Knafl, 2005). Alphabets and colours were assigned to each of the coded ideas. The resulting codes from quantitative and qualitative data were used to generate a descriptive themes (Pear- son et al., 2014). The themes were consistent with the various concepts and theoretical constructs that facili- tate resilience in workplace – namely, individual
(personal characteristics), organizational (workplace or environmental), and external factors (Cusack et al., 2016; Earvolino-Ramirez, 2007; Garcia-Dia et al., 2013; Rees et al., 2015; Scoloveno, 2016; Turner, 2014; Zan- der & Hutton, 2009). The background information of the included papers and emerging codes were analysed using STATA version 15.
RESULTS
Description of retrieved papers
The study identified 406 papers from all databases searched, after which 83 duplicate records were deleted. Of the nonduplicate records, 323 papers were screened for eligibility, after which 266 were excluded. After data extraction of 57 full-text articles and methodological quality assessment, one paper was iden- tified from the reference list, and 17 papers were excluded. Overall, 41 papers were included in the final synthesis (see Fig. 1). Of the 41 papers, 40 met the cri- teria for high methodological quality assessment, while only one paper had medium quality (see Table 1).
Characteristics of included papers
Most of the included papers reported the study design that was used, while 29.26% (12/41) did not report the study design. Of the papers reporting a study design, more than one-third (12/29; 41.37%) used cross-sec- tional design, 17.24 (5/29) used interpretive phe- nomenological approaches, and 10.34 (3/29) used case studies (see Table 1). Most of the included papers used quantitative data (27/41; 65.85), while 29.26% (12/41) used qualitative data and 4.87% (2/41) used mixed methods. More than one-third of the included papers (20/41; 48.78%) addressed resilience issues, while 46.34% (19/41) addressed stress, and 4.87% (2/41) addressed both stress and resilience. Most of the included papers employed several validated instru- ments, while a few used qualitative data collection approaches, such as in-depth interviews, focus group discussions, and workshops (see Table 1). Most of the included papers (25/41; 60.97%) recruited both males and females, while more than one-third (12/29; 41.37%) targeted only females. The majority of included papers (25/41; 60.97%) analysed the results using descriptive and inferential statistics, while 26.82% (11/41) used thematic analysis, 4.87% used descriptive statistics, and 4.87% used concurrent analy- sis (see Table 1).
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 9
T A B L E
1 : C h ar ac te ri st ic s of
in cl u d ed
ar ti cl es
In cl u d e d
ar ti cl e
O b je ct iv e s
T ar g e t
G e n d e r
S tu d y d e si g n
M e th o d s
D at a co ll e ct io n in st ru m e n t
A n al ys is
Q u al it y
sc o re
A b ra h am
et al .
(2 0 1 8 )
T o d e sc ri b e th e E D
w o rk in g
e n vi ro n m e n t as
p e rc e iv e d b y
m e d ic al
an d n u rs in g st af f
w o rk in g in
tw o d if fe re n t- si ze d
E D s w it h in
th e sa m e
h e al th ca re
se rv ic e .
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• W o rk in g E n vi ro n m e n t
S ca le -1 0 (W
E S -1 0 );
• T h e Ja lo w ie c C o p in g
S ca le
p ar t A (J C S -A );
• w o rk p la ce
st re ss o rs
D e sc ri p ti ve
st at is ti cs
H ig h
A ll e n et
al .
(2 0 1 5 )
T o e xa m in e th e re la ti o n sh ip
b e tw e e n b u ll yi n g an d b u rn o u t
an d th e p o te n ti al
b u ff e ri n g
e ff e ct
p sy ch o lo g ic al
d e ta ch m e n t
m ig h t h av e o n th is re la ti o n sh ip .
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• S ca le
d e ve lo p e d b y
Q u in e ;
• R e co ve ry
E xp e ri e n ce
Q u e st io n n ai re ;
• C o p e n h ag e n
B u rn o u t In ve n to ry
(C B I)
D e sc ri p ti ve
an d in fe re n ti al
H ig h
B o w d e n et
al .
(2 0 1 5 )
T o e xa m in e d so u rc e s o f w o rk -
re la te d st re ss
an d re w ar d
sp e ci fi c to
m u lt id is ci p li n ar y
st af f w o rk in g in
p ae d ia tr ic
o n co lo g y in
A u st ra li a.
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
N o t re p o rt e d
Q u an ti ta ti ve
• W o rk
st re ss o rs
sc al e –
p ae d ia tr ic
o n co lo g y
D e sc ri p ti ve
an d in fe re n ti al
H ig h
C am
e ro n an d
B ro w n ie
(2 0 1 0 )
T o id e n ti fy
th e fa ct o rs
th at
im p ac t th e re si li e n ce
o f
re g is te re d ag e d ca re
n u rs e s,
th at
is th e ir ca p ac it y to
ad ap t to
th e p h ys ic al , m e n ta l an d
e m o ti o n al
d e m an d s o f w o rk in g
in ag e d ca re
fa ci li ti e s.
R e si li e n ce
F e m al e s
In te rp re ti ve
p h e n o m e n o lo g ic al
Q u an ti ta ti ve
• In -d e p th
in te rv ie w s
T h e m at ic
an al ys is
H ig h
C o p e et
al .
(2 0 1 6 b )
T o e xp lo re
w h y n u rs e s ch o se
to
re m ai n in
th e W e st e rn
A u st ra li an
w o rk fo rc e an d to
d e ve lo p in si g h ts
in to
th e ro le
o f
re si li e n ce
o f n u rs e s an d to
id e n ti fy
th e k e y ch ar ac te ri st ic s
o f re si li e n ce
d is p la ye d b y th e se
n u rs e s.
R e si li e n ce
F e m al e s
P o rt ra it u re
Q u al it at iv e
• In -d e p th
in te rv ie w s
T h e m at ic
an al ys is
H ig h
C o p e et
al .
(2 0 1 6 a)
T o e xp lo re
re si d e n ti al
ag e d ca re
n u rs e s w o rk in g in
in te ri m ,
re h ab il it at io n an d re si d e n ti al
ag e d ca re
p e rc e p ti o n s o f
re si li e n ce .
R e si li e n ce
F e m al e s
P o rt ra it u re
an d
In te rp re ti ve
Q u al it at iv e
• F ie ld
n o te s, m e m o s an d
g e st u re
d ra w in g s
in te rv ie w s
T h e m at ic
an al ys is
H ig h
(C on
ti n u ed )
© 2019 Australian College of Mental Health Nurses Inc.
10 E. BADU ET AL.
T A B L E
1 : (C
o n ti n u e d )
In cl u d e d
ar ti cl e
O b je ct iv e s
T ar g e t
G e n d e r
S tu d y d e si g n
M e th o d s
D at a co ll e ct io n in st ru m e n t
A n al ys is
Q u al it y
sc o re
C ra ig ie
et al .
(2 0 1 6 )
T o e va lu at e th e fe as ib il it y o f a
m in d fu ln e ss -b as e d in te rv e n ti o n
ai m e d at
re d u ci n g co m p as si o n
fa ti g u e an d im
p ro vi n g
e m o ti o n al
w e ll b e in g in
n u rs e s
R e si li e n ce
N o t
re p o rt e d
Q u as i-
e xp e ri m e n ts
Q u an ti ta ti ve
• P at ie n t H e al th
Q u e st io n n ai re -9 ;
• S h o rt
S cr e e n in g S ca le
fo r
D S M -I V P T S D ;
• C A G E
q u e st io n n ai re ;
• T h e D e m o g ra p h ic
Q u e st io n n ai re ;
• P ro fe ss io n al
Q u al it y o f
L if e S ca le ; D e p re ss io n
A n xi e ty
S tr e ss
S ca le s;
• S p ie l B e rg e r
S ta te -T ra it
A n xi e ty
In ve n to ry
fo rm
Y 2 ;
• C o n n o r- D av id so n
R e si li e n ce
S ca le ;
• P as si o n fo r W o rk
S ca le
D e sc ri p ti ve
an d in fe re n ti al
st at is ti cs
H ig h
C re e d y et
al .
(2 0 1 7 )
T o in ve st ig at e th e p re va le n ce
o f
b u rn o u t, d e p re ss io n , an xi e ty
an d st re ss
in A u st ra li an
m id w iv e s
W o rk p la ce
st re ss
F e m al e
C ro ss
se ct io n al
Q u an ti ta ti ve
• C o p e n h ag e n
B u rn o u t In ve n to ry
(C B I) ;
• D e p re ss io n , A n xi e ty
an d
S tr e ss
S ca le
(D A S S )
D e sc ri p ti ve
st at is ti cs
H ig h
D o la n et
al .
(2 0 1 2 )
T o u n d e rt ak e an
in d u ct iv e
p ro ce ss
to b e tt e r u n d e rs ta n d
th e st re ss o rs
an d th e co p in g
st ra te g ie s u se d b y re n al
n u rs e s
th at
m ay
le ad
to re si li e n ce .
W o rk p la ce
st re ss
an d
R e si li e n ce
F e m al e s
an d
m al e s
G ro u n d e d th e o ry
Q u al it at iv e
• In -d e p th
in te rv ie w s
• M as la ch
B u rn o u t
In ve n to ry -H
u m an
S e rv ic e s S u rv e y (M
B I)
C o n cu rr e n t an al ys is
H ig h
D o rr ia n et
al .
(2 0 1 1 )
T o d e sc ri b e sl e e p , st re ss
an d
co m p e n sa to ry
b e h av io u rs
in
n u rs e s an d m id w iv e s.
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
N o t re p o rt e d
Q u an ti ta ti ve
• G e n e ra l h e al th
an d sl e e p
q u e st io n n ai re s
• N A S A T as k L o ad
In d e x
w o rk lo ad
sc al e
D e sc ri p ti ve
an d in fe re n ti al
H ig h
D ru ry
et al .
(2 0 1 4 )
T o e xp lo re
th e fa ct o rs
im p ac ti n g u p o n co m p as si o n
sa ti sf ac ti o n , co m p as si o n fa ti g u e ,
an xi e ty , d e p re ss io n an d st re ss
an d to
d e sc ri b e th e st ra te g ie s
n u rs e s u se
to b u il d co m p as si o n
sa ti sf ac ti o n in to
th e ir w o rk in g
li ve s.
W o rk p la ce
st re ss
an d
R e si li e n ce
N o t
re p o rt e d
N o t re p o rt e d
Q u al it at iv e
• In -d e p th
in te rv ie w s
• F o cu s G ro u p D is cu ss io n s
T h e m at ic
A n al ys is
H ig h
(C on
ti n u ed )
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 11
T A B L E
1 : (C
o n ti n u e d )
In cl u d e d
ar ti cl e
O b je ct iv e s
T ar g e t
G e n d e r
S tu d y d e si g n
M e th o d s
D at a co ll e ct io n in st ru m e n t
A n al ys is
Q u al it y
sc o re
F o st e r et
al .
(2 0 1 8 )
T o e va lu at e th e fe as ib il it y o f a
w o rk p la ce
re si li e n ce
e d u ca ti o n
p ro g ra m m e fo r n u rs e s in
h ig h -
ac u it y ad u lt m e n ta l h e al th
se tt in g s.
R e si li e n ce
F e m al e s
an d
m al e s
N o t re p o rt e d
Q u an ti ta ti ve
• Q u e st io n n ai re
(D e p re ss io n , A n xi e ty
an d
S tr e ss 2 1 sc al e )
D e sc ri p ti ve
an d in fe re n ti al
H ig h
F o u re u r et
al .
(2 0 1 3 )
T o p il o t th e e ff e ct iv e n e ss
o f an
ad ap te d m in d fu ln e ss -b as e d
st re ss
re d u ct io n in te rv e n ti o n o n
th e p sy ch o lo g ic al
w e ll b e in g o f
n u rs e s an d m id w iv e s.
R e si li e n ce
F e m al e s
an d
m al e s
Q u as i-
e xp e ri m e n ts
M ix e d
m e th o d s
• S h o rt
fo rm
o f th e
G H Q -1 2
• S O C
– O ri e n ta ti o n
to L if e
• D A S S
• L o g o f M B S R
p ra ct ic e
• F G D s an d
In -d e p th
in te rv ie w s
D e sc ri p ti ve
an d In fe re n ti al
st at is ti cs
an d co n te n t
an al ys is
H ig h
G ab ri e ll e et
al .
(2 0 0 8 )
T o e xp lo re
th e vi e w s an d
e xp e ri e n ce s o f fe m al e
re g is te re d n u rs e s ag e d 4 0 —
6 0 ye ar s, in
ac u te
h o sp it al
an d
co m m u n it y h e al th
ca re
se tt in g s
W o rk p la ce
st re ss
F e m al e s
N ar ra ti ve -b as e d
Q u al it at iv e
• C o n ve rs at io n al -s ty le
se m i- st ru ct u re d
in -d e p th
in te rv ie w s
th e m at ic
A n al ys is
H ig h
G ao
et al .
(2 0 1 4 )
T o e xa m in e th e st ru ct u ra l
re la ti o n sh ip s am
o n g jo b
d e m an d s, co p in g re so u rc e s,
p sy ch o lo g ic al
h e al th
an d
tu rn o ve r o f re si d e n ti al
ag e d
ca re
n u rs e s
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
N o t re p o rt e d
Q u an ti ta ti ve
• Jo b C o n te n t
Q u e st io n n ai re
(J C Q :
• P sy ch o lo g ic al
h e al th
d o m ai n s o f S F -3 6
D e sc ri p ti ve
an d In fe re n ti al
H ig h
G il le sp ie
et al .
(2 0 0 9 )
T o id e n ti fy
th e le ve l o f
re si li e n ce , an d in ve st ig at e
w h e th e r ag e , e xp e ri e n ce
an d
e d u ca ti o n co n tr ib u te
to
re si li e n ce
in an
A u st ra li an
sa m p le
o f O R
n u rs e s
R e si li e n ce
F e m al e s
an d
m al e s
N o t re p o rt e d
Q u an ti ta ti ve
• C o n n o r– D av id so n
R e si li e n ce
S ca le
(C D -
R IS C )
• C o n n o r– D av id so n
R e si li e n ce
S ca le
D e sc ri p ti ve
an d In fe re n ti al
H ig h
G u o et
al .
(2 0 1 8 )
T o e xa m in e th e d if fe re n ce s in
b u rn o u t, re si li e n ce
an d
tu rn o ve r in te n ti o n in
A u st ra li an
an d C h in e se
n u rs e s an d e xp lo re
th e d if fe re n t e ff e ct
o f re si li e n ce
an d tu rn o ve r in te n ti o n o n
b u rn o u t b e tw e e n n u rs e s fr o m
th e tw o co u n tr ie s.
R e si li e n ce
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• S o ci o -d e m o g ra p h ic
q u e s-
ti o n n ai re
• M B I- G S an d C D -R
IS C
D e sc ri p ti ve
an d In fe re n ti al
H ig h
(C on
ti n u ed )
© 2019 Australian College of Mental Health Nurses Inc.
12 E. BADU ET AL.
T A B L E
1 : (C
o n ti n u e d )
In cl u d e d
ar ti cl e
O b je ct iv e s
T ar g e t
G e n d e r
S tu d y d e si g n
M e th o d s
D at a co ll e ct io n in st ru m e n t
A n al ys is
Q u al it y
sc o re
H ay e s et
al .
(2 0 1 4 )
T o te st
an e xp la n at o ry
m o d e l o f
th e re la ti o n sh ip s b e tw e e n th e
n u rs in g w o rk
e n vi ro n m e n t, jo b
sa ti sf ac ti o n , jo b st re ss
an d
e m o ti o n al
e xh au st io n fo r
h ae m o d ia ly si s n u rs e s, d ra w in g
o n K an te r’ s th e o ry
o f
o rg an iz at io n al
e m p o w e rm
e n t.
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• B ri sb an e P ra ct ic e
E n vi ro n m e n t M e as u re
(B -P E M )
• In d e x fo r W o rk
S at is fa ct io n
• N u rs in g S tr e ss
S ca le
(N S S )
• M as la ch
B u rn o u t
In ve n to ry
(M B I)
D e sc ri p ti ve
an d In fe re n ti al
H ig h
H ay e s et
al .
(2 0 1 5 )
T o e xa m in e th e re la ti o n sh ip s
am o n g n u rs e an d w o rk
ch ar ac te ri st ic s, jo b sa ti sf ac ti o n ,
st re ss , b u rn o u t an d th e w o rk
e n vi ro n m e n t o f h ae m o d ia ly si s
n u rs e s.
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• B ri sb an e P ra ct ic e
E n vi ro n m e n t S ca le
(B -P E M
• In d e x fo r W o rk
S at is fa ct io n
• N u rs in g S tr e ss
S ca le
(N S S ;
• M as la ch
B u rn o u t
In ve n to ry
(M B I)
D e sc ri p ti ve
an d In fe re n ti al
H ig h
H e g n e y et
al .
(2 0 1 5 a)
T o as ce rt ai n if d if fe re n ce s e xi st
in th e p e rc e p ti o n o f th e
p ro fe ss io n al
p ra ct ic e
e n vi ro n m e n t an d p e rs o n al
w e ll b e in g o f n u rs e s ac ro ss
d if fe re n t g e o g ra p h ic al
ar e as
in
Q u e e n sl an d .
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
N o t re p o rt e d
Q u an ti ta ti ve
• D e p re ss io n , A n xi e ty
an d
S tr e ss
S ca le
(D A S S 2 1 )
• P ro fe ss io n al
Q u al it y o f
L if e S ca le
ve rs io n
5 (P ro Q o L 5 )
• C o n n o r– D av id so n
R e si li e n ce
S ca le
(C D R IS C 2 5 )
• P ra ct ic e E n vi ro n m e n t
S ca le
– N u rs in g
W o rk
In d e x R e vi se d
(P E S -N
W I (R
)
D e sc ri p ti ve
an d In fe re n ti al
H ig h
H e g n e y et
al .
(2 0 1 4 )
T o e xp lo re
co m p as si o n fa ti g u e
an d co m p as si o n sa ti sf ac ti o n
w it h th e p o te n ti al
co n tr ib u ti n g
fa ct o rs
o f an xi e ty , d e p re ss io n
an d st re ss .
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• D e m o g ra p h ic
an d
p ro fe ss io n al
d at a
• P ro fe ss io n al
Q u al it y o f
L if e S ca le
ve rs io n 5
(P R O Q O L 5 )
• D e p re ss io n A n xi e ty
S tr e ss
S ca le
(D A S S
2 1 -s h o rt
fo rm
)
• D e p re ss io n A n xi e ty
S tr e ss
S ca le s (D
A S S )
D e sc ri p ti ve
an d In fe re n ti al
H ig h
(C on
ti n u ed )
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 13
T A B L E
1 : (C
o n ti n u e d )
In cl u d e d
ar ti cl e
O b je ct iv e s
T ar g e t
G e n d e r
S tu d y d e si g n
M e th o d s
D at a co ll e ct io n in st ru m e n t
A n al ys is
Q u al it y
sc o re
H e g n e y et
al .
(2 0 1 5 b )
T o d e te rm
in e th e re la ti ve
co n tr ib u ti o n o f tr ai t n e g at iv e
af fe ct
an d in d iv id u al
p sy ch o lo g ic al
re si li e n ce
in
e xp la in in g th e p ro fe ss io n al
q u al it y o f li fe
o f n u rs e s.
R e si li e n ce
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• D e p re ss io n , A n xi e ty , an d
S tr e ss
S ca le
(D A S S
• S p ie l B e rg e r S ta te -T ra it
A n xi e ty
In ve n to ry
fo rm
Y 2 (S T A I- Y 2
• P ro fe ss io n al
Q u al it y o f
L if e S ca le
ve rs io n 5
(P ro Q o L 5
• C o n n o r- D av id so n
R e si li -
e n ce
S ca le
(C D -R
IS C 2 5
D e sc ri p ti ve
an d In fe re n ti al
H ig h
H o ll an d et
al .
(2 0 1 3 )
T o e xa m in e th e si g n ifi ca n ce
o f
e m p lo ye e vo ic e an d m an ag e ri al
re sp o n si ve n e ss
in re d u ci n g th e
le ve ls o f b u rn o u t e xp e ri e n ce d
b y n u rs e s.
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
N o t re p o rt e d
Q u an ti ta ti ve
• C o p e n h ag e n B u rn o u t
In ve n to ry
• Q u e st io n n ai re
fo r
m an ag e ri al
re sp o n si ve n e ss
to
e m p lo ye e n e e d s
D e sc ri p ti ve
an d In fe re n ti al
H ig h
K ar im
i et
al .
(2 0 1 5 )
T o e xa m in e th e d ir e ct
an d
m o d e ra ti n g e ff e ct s o f e m o ti o n al
in te ll ig e n ce
o n th e
p re se n te e is m
an d w e ll b e in g
re la ti o n sh ip .
R e si li e n ce
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• S e lf -R
e p o rt
E m o ti o n al
In te ll ig e n ce
T e st
(S R E IT
)
• G e n e ra l W e ll b e in g Q u e s-
ti o n n ai re
(G W B Q )
• se lf -r e p o rt
sc al e
D e sc ri p ti ve
an d In fe re n ti al
H ig h
K ar im
i et
al .
(2 0 1 4 )
T o in ve st ig at e th e e xt e n t to
w h ic h e m o ti o n al
la b o u r an d
e m o ti o n al
in te ll ig e n ce
ar e
as so ci at e d w it h w e ll b e in g an d
jo b -s tr e ss
am o n g a g ro u p o f
A u st ra li an
co m m u n it y n u rs e s.
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• S e lf -r e p o rt
q u e st io n n ai re
to ca p tu re
• S e lf -R
e p o rt
E m o ti o n al
In te ll ig e n ce
T e st
(S R E IT
)
• E m o ti o n al
D is so n an ce
(E D )
• Jo b -s tr e ss
• G e n e ra l W e ll b e in g
Q u e st io n n ai re
(G W B Q )
D e sc ri p ti ve
an d In fe re n ti al
H ig h
K o rn h ab e r an d
W il so n (2 0 1 1 a)
T o e xp lo re
th e co n ce p t o f
b u il d in g re si li e n ce
as a st ra te g y
fo r re sp o n d in g to
ad ve rs it y
e xp e ri e n ce d b y b u rn s n u rs e s
R e si li e n ce
F e m al e s
In te rp re ti ve
p h e n o m e n o lo g ic al
Q u al it at iv e
• In -d e p th
in te rv ie w s
T h e m at ic
A n al ys is
H ig h
K o rn h ab e r an d
W il so n (2 0 1 1 b )
T o e xp lo re
th e p sy ch o so ci al
n e e d s o f n u rs e s w h o ca re
fo r
p at ie n ts
w it h se ve re
b u rn
in ju ri e s
R e si li e n ce
F e m al e s
In te rp re ti ve
p h e n o m e n o lo g ic al
Q u al it at iv e
• In -d e p th
in te rv ie w s
T h e m at ic
A n al ys is
H ig h
(C on
ti n u ed )
© 2019 Australian College of Mental Health Nurses Inc.
14 E. BADU ET AL.
T A B L E
1 : (C
o n ti n u e d )
In cl u d e d
ar ti cl e
O b je ct iv e s
T ar g e t
G e n d e r
S tu d y d e si g n
M e th o d s
D at a co ll e ct io n in st ru m e n t
A n al ys is
Q u al it y
sc o re
M cD
o n al d
et al . (2 0 1 6 )
T o e xp lo re
th e e xp e ri e n ce s o f
A u st ra li an
n u rs e s an d m id w iv e s
w h o p e rc e iv e d th e m se lv e s as
re si li e n t.
R e si li e n ce
F e m al e s
C as e st u d y
Q u al it at iv e
• w o rk sh o p s an d
m e n to ri n g ,
• In -d e p th
in te rv ie w s
T h e m at ic
an al ys is
H ig h
M cD
o n al d
et al . (2 0 1 3 )
T o re p o rt
th e e ff e ct s o f a w o rk -
b as e d , e d u ca ti o n al
in te rv e n ti o n
to p ro m o te
p e rs o n al
re si li e n ce
in a g ro u p o f n u rs e s an d
m id w iv e s w o rk in g in
a b u sy
cl in ic al
e n vi ro n m e n t
R e si li e n ce
F e m al e s
C as e st u d y
Q u al it at iv e
• In -d e p th
in te rv ie w s
T h e m at ic
an al ys is
H ig h
M cM
il la n et
al .
(2 0 1 6 )
T o p ro vi d e a b e tt e r
u n d e rs ta n d in g o f th e fa ct o rs
in fl u e n ci n g b u rn o u t am
o n g st
A u st ra li an
ca n ce r n u rs e s in
o rd e r to
im p ro ve
tr ai n in g an d
w o rk
e n vi ro n m e n ts
to
e n co u ra g e n u rs e re te n ti o n an d
u lt im
at e ly
im p ro ve
p at ie n t ca re .
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
N o t re p o rt e d
Q u an ti ta ti ve
• A re as
o f W o rk
li fe
S u rv e y (A W L S
D e sc ri p ti ve
an d In fe re n ti al
H ig h
M il ls et
al .
(2 0 1 7 )
T o in ve st ig at e n u rs e se lf -
co n ce p t, p ra ct ic e e n vi ro n m e n t
an d re si li e n ce , an d h o w
th e se
th re e fa ct o rs
in fl u e n ce
th e
re te n ti o n o f e ar ly
ca re e r
re g is te re d n u rs e s (E
C R N s)
R e si li e n ce
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• N u rs e S e lf -C
o n ce p t
Q u e st io n n ai re
• P ra ct ic e E n vi ro n m e n t
S ca le
o f th e
N u rs in g W o rk
In d e x,
• C o n n o r– D av id so n
R e si li e n ce
S ca le
• N u rs e R e te n ti o n In d e x
D e sc ri p ti ve
an d In fe re n ti al
H ig h
O p ie
et al .
(2 0 1 0 )
T o id e n ti fy
k e y w o rk p la ce
d e m an d s an d re so u rc e s fo r
n u rs e s w o rk in g in
ve ry
re m o te
A u st ra li a an d m e as u re
le ve ls o f
o cc u p at io n al
st re ss
in th is
p o p u la ti o n
W o rk p la ce
st re ss
F e m al e s
an d
m al e s
C ro ss -s e ct io n al
Q u an ti ta ti ve
• Jo b D e m an d s S ca le
• G e n e ra l H e al th
Q u e st io n n ai re -1 2
• B u rn o u t In ve n to ry
(M B I)
• W o rk
E n g ag e m e n t
S ca le -9
• Jo b sa ti sf ac ti o n
D e sc ri p ti ve
an d In fe re n ti al
M e d iu m
(C on
ti n u ed )
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 15
T A B L E
1 : (C
o n ti n u e d )
In cl u d e d
ar ti cl e
O b je ct iv e s
T ar g e t
G e n d e r
S tu d y d e si g n
M e th o d s
D at a co ll e ct io n in st ru m e n t
A n al ys is
Q u al it y
sc o re
P e rr y et
al .
(2 0 1 7 )
T o u se
a D e lp h i p an e l to
d e te rm
in e th e re la ti ve
im p o rt an ce
an d fe as ib il it y o f
w o rk p la ce
h e al th
p ro m o ti o n
in te rv e n ti o n s to
p ro m o te
an d
su p p o rt
th e h e al th
o f th e
A u st ra li an
n u rs in g an d
m id w if e ry
w o rk fo rc e
R e si li e n ce
N o t
re p o rt e d
M o d ifi e d D e lp h i
d e si g n
M ix e d
m e th o d s
• D e lp h i q u e st io n n ai re
D e sc ri p ti ve
an d T h e m at ic
an al ys is
H ig h
P is an ie ll o et
al .
(2 0 1 2 )
T o in ve st ig at e th e re la ti o n sh ip
b e tw e e n e m o ti o n al
la b o u r an d
e m o ti o n al
w o rk
o n
p sy ch o lo g ic al
w e ll b e in g an d
o cc u p at io n al
st re ss
in 2 3 9
n u rs e s sa m p le d fr o m
a S o u th
A u st ra li an
h o sp it al
W o rk p la ce
st re ss
N o t
re p o rt e d
N o t re p o rt e d
Q u an ti ta ti ve
• S ta te -T ra it A n xi e ty
sc al e
• W o rk
an d F am
il y
D e m an d s sc al e
• M u lt id im
e n si o n al
W o rk – F am
il y S p il lo ve r
sc al e
• M u lt i- D im
e n si o n al
S u p p o rt
sc al e
• E m o ti o n al
L ab o u r sc al e
• E m o ti o n W o rk
R e q u ir e m e n ts
sc al e
• E m o ti o n al
W o rk
In ve n to ry
• N u rs in g S tr e ss
In d e x
• C o p e n h ag e n
B u rn o u t In ve n to ry
• Jo b S at is fa ct io n sc al e
D e sc ri p ti ve
an d In fe re n ti al
H ig h
R o se
an d G la ss
(2 0 0 8 )
T o e xp lo re
th e su b je ct iv e
e xp e ri e n ce s o f 1 5 A u st ra li an
co m m u n it y n u rs e s w h o
p ro vi d e d p al li at iv e ca re
to
cl ie n ts
an d th e ir fa m il ie s li vi n g
at h o m e .
R e si li e n ce
F e m al e s
E m an ci p at o ry
Q u al it at iv e
• In -d e p th
in te rv ie w s/ st o ry -
te ll in g an d re fl e ct iv e
jo u rn al in g .
C ri ti ca l an al ys is p ro ce ss
H ig h
S la ty e r et
al .
(2 0 1 8 )
T o tr ia l th e e ff e ct iv e n e ss
o f a
b ri e f m in d fu l se lf -c ar e an d
re si li e n cy
in te rv e n ti o n fo r
n u rs e s w o rk in g in
an A u st ra li an
te rt ia ry
h o sp it al
co m p ar e d to
n u rs e s in
a w ai t li st
co n tr o l
co n d it io n
R e si li e n ce
F e m al e s
an d
m al e s
W ai t li st
co n tr o l
tr ia l
Q u an ti ta ti ve
• Q u e st io n n ai re s
D e sc ri p ti ve
an d In fe re n ti al
H ig h
(C on
ti n u ed )
© 2019 Australian College of Mental Health Nurses Inc.
16 E. BADU ET AL.
T A B L E
1 : (C
o n ti n u e d )
In cl u d e d
ar ti cl e
O b je ct iv e s
T ar g e t
G e n d e r
S tu d y d e si g n
M e th o d s
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© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 17
Levels of stress among workplace nurses
Most of the studies reported that the majority of Aus- tralian nurses experience a significantly moderate to higher level of stress during their working shift (see Table 2). Some studies categorized the stressors according to job-related issues (such as workload, administrative and budgetary issues, or dealing with
the media; Abraham et al., 2018; Bowden et al., 2015; Gabrielle et al., 2008; Hayes et al., 2015; Karimi et al., 2014; Opie et al., 2010; Teo et al., 2013; Teo et al., 2012). Other studies reported environmental factors (e.g., job tension or role conflict and ambiguity; Abra- ham et al., 2018; Tran, Johnson, Fernandez, & Jones, 2010), patient-related stress (e.g., patient behaviour, interactions with children, or working with critically
TABLE 2: Themes
Themes Subthemes N Papers
Levels of stress among
workplace nurses
Stress level 19 Abraham et al. (2018), Bowden et al. (2015), Dolan et al. (2012), Karimi et al. (2015), Karimi et al. (2014), Opie et al. (2010), Teo et al. (2013), Teo et al. (2012), Rose and Glass (2008), Slatyer et al. (2018), Dorrian et al. (2011), Hayes et al. (2015), Hegney et al. (2014), Hegney et al. (2015a), Tran et al. (2010), Drury et al. (2014), Gabrielle et al. (2008), Hegney et al. (2015b), Creedy et al. (2017)
Causative factor of stress
for nurses
Workplace bullying 3 Dolan et al. (2012), Gabrielle et al. (2008), Allen et al. (2015)
Impacts and outcomes of
stress
Burnout 10 Allen et al. (2015), Creedy et al. (2017), Dolan et al. (2012), Hayes et al. (2015), Hegney et al. (2015a), Holland et al. (2013), McMillan et al. (2016), Guo et al. (2018), Hegney et al. (2015b), Kornhaber and Wilson (2011b)
Psychological distress 10 Allen et al. (2015), Gabrielle et al. (2008), Gao et al. (2014), Hayes et al. (2015), Karimi et al. (2014), Opie et al. (2010), Pisaniello et al. (2012), Kornhaber and Wilson (2011a), McDonald et al. (2016), Rose and Glass (2008)
Depression and anxiety 4 Creedy et al. (2017), Hegney et al. (2015b), Drury et al. (2014), Hegney et al. (2014)
Levels of resilience among
workplace nurses
Resilience level 13 Dolan et al. (2012), Hegney et al. (2015a), Guo et al. (2018), Hegney et al. (2015b), Cameron and Brownie (2010), Mills et al. (2017), Cope et al. (2016a), Kornhaber and Wilson (2011a), Cope et al. (2016b), Slatyer et al. (2018), Guo et al. (2018), Rose and Glass (2008), Gabrielle et al. (2008)
Individual attributes used
to build resilience
Organizing work as
mindful strategy
7 Dolan et al. (2012), Gabrielle et al. (2008), Gao et al. (2014), McDonald et al. (2016), McDonald et al. (2013), Perry et al. (2017), Cameron and Brownie (2010)
Work–life balance as mindful strategy
6 Cope et al. (2016b), Cope et al. (2016a), Kornhaber and Wilson (2011a), McDonald et al. (2013), Rose and Glass (2008), Cameron and Brownie (2010)
Self-reliance mechanism 9 Dolan et al. (2012), Cope et al. (2016a), Cope et al. (2016b), Kornhaber and Wilson (2011a), McDonald et al. (2013, 2016), Rose and Glass (2008), Cameron and Brownie (2010), Slatyer et al. (2018)
Learning as self-efficacy
strategy
6 Drury et al. (2014), Cope et al. (2016a), Cope et al. (2016b), McDonald et al. (2013), Slatyer et al. (2018), Cameron and Brownie (2010)
Positive thinking 4 Abraham et al. (2018), Cope et al. (2016a), Cope et al. (2016b), Kornhaber and Wilson (2011a), Cameron and Brownie (2010)
Emotional intelligence as
self-efficacy strategy
5 Dolan et al. (2012), Karimi et al. (2015), Karimi et al. (2014), Kornhaber and Wilson (2011a), McDonald et al. (2013)
Passion and interest 2 Cope et al. (2016b), Cope et al. (2016a) Resilience intervention Workplace resilience
intervention
6 Foster et al. (2018), Craigie et al. (2016), McDonald et al. (2013), Foureur et al. (2013), Slatyer et al. (2018), (b)
Effectiveness of
resilience interventions
5
Organizational resources
used to build resilience
Informal support services 9 Cope et al. (2016b), McDonald et al. (2016), Kornhaber and Wilson (2011b), McDonald et al. (2013), Cameron and Brownie (2010), Rose and Glass (2008), Drury et al. (2014), Slatyer et al. (2018), Cope et al. (2016a)
Formal support services 4 Drury et al. (2014), Perry et al. (2017), Teo et al. (2012), Kornhaber and Wilson (2011b)
Leadership 3 Drury et al. (2014), Cope et al. (2016b), Perry et al. (2017) Role modelling 2 Drury et al. (2014), Cope et al. (2016b)
© 2019 Australian College of Mental Health Nurses Inc.
18 E. BADU ET AL.
injured and dying patients; Abraham et al., 2018; Bow- den et al., 2015; Dolan et al., 2012; Drury et al., 2014), and professional-related factors (e.g., skills deficit, lack of time, and the role of nursing profession; Drury et al., 2014; Karimi et al., 2015; Teo et al., 2013; Teo et al., 2012; Tran et al., 2010).
Two papers indicated that workplace stress varies according to the time of the work shift and the geo- graphical location of the nurses. For instance, nurses working during workdays or morning/day and night shifts (Dorrian et al., 2011) experience a significantly higher level of stress than do nurses working afternoon shifts. Similarly, Hegney et al. (2015a) reported that nurses in major cities and rural areas have significantly higher stress levels than do nurses working in remote areas. Further, two papers highlighted certain physical and psychological symptoms that demonstrate the pres- ence of stress among nurses (Drury et al., 2014; Gab- rielle et al., 2008). The psychological symptoms are fatigue, frustration, anger, tears, distraction, and defen- siveness, while the physical symptoms are largely asso- ciated with illness or injury, tight muscles, and feelings of physical exhaustion (Drury et al., 2014; Gabrielle et al., 2008).
Causative factor of stress among workplace nurses
Workplace bullying Three of the included papers reported several situa- tions of workplace bullying among nurses (Allen et al., 2015; Dolan et al., 2012; Gabrielle et al., 2008). Some studies highlighted that workplace bullying occurs through poor therapeutic relationships between nurses and patients, as well as among nurses (Dolan et al., 2012; Gabrielle et al., 2008). In particular, workplace bullying can take the form of physical aggression (e.g., being slapped or a patient attempting to strangle a col- league) and verbal aggression (e.g., being shouted or sworn at or patients directing their frustrations about treatment onto nurses), as well as negative behaviours, such as nurses withholding necessary support and lack of cooperation among nurses (Dolan et al., 2012; Gab- rielle et al., 2008).
Impacts and outcomes of stress
Burnout Ten of the included papers reported the levels of burn- out experienced by the Australian nursing workforce (see Table 2). Several studies suggested that nurses
experience moderate to high levels of personal and work-related burnout (Allen et al., 2015; Creedy et al., 2017; Guo et al., 2018; Hayes et al., 2015; Hegney et al., 2015a; b; Holland et al., 2013; Kornhaber & Wil- son, 2011b). For example, two papers indicated that the mean burnout score among a sample of 762 regis- tered nurses was 54 out of 100 (Allen et al., 2015; Hol- land et al., 2013). The burnout was measured using the seven-item burnout subscale from the Copenhagen Burnout Inventory (CBI). The items are rated on a five-point scale ranging from ‘never’ (or ‘to a very low degree’) to ‘always’ (or ‘to a very high degree’). The responses to each item are re-coded on a scale from 0 to 100 (with higher scores indicating greater work burnout). In addition, about 36.4% (n = 356 of 978 cases) of nurses in a study reported moderate work-re- lated burnout, while 10.4% (n = 102 of 984 cases) reported moderate or higher client-related burnout (Creedy et al., 2017). Moreover, in a sample of 100 Australian nurses, 66.0% and 22.0% suffered burnout symptoms and severe burnout, respectively (Guo et al., 2018). Contrary, two papers reported low levels of burnout (Dolan et al., 2012; McMillan et al., 2016).
Five studies demonstrated that several individual and organizational factors are associated with burnout among nurses (Dolan et al., 2012; Guo et al., 2018; Holland et al., 2013; Kornhaber & Wilson, 2011b; McMillan et al., 2016). The individual factors associ- ated with burnout are the gender, age, and level of the service provider (e.g., primary, secondary or tertiary); years or period of nursing and workload (Dolan et al., 2012; Guo et al., 2018; Holland et al., 2013; Kornhaber & Wilson, 2011b). Specifically, some studies recom- mended that nurses who have higher burnout tend to be younger (Holland et al., 2013), to be men (Dolan et al., 2012), and to have nursed the same patient for long periods (Kornhaber & Wilson, 2011b). Conversely, the organizational factors associated with burnout include the extent at which employees direct voice are considered in organizational decision-making (direct voice is extent at which employees concerns and voices are considered in organizational decision), supervision approaches, rewards, and the adequacy of training and psychosocial care management strategies (Holland et al., 2013; McMillan et al., 2016).
Psychological distress Ten papers described the psychological distress experi- enced by Australian nurses (see Table 2). Several stud- ies highlighted that nurses experience moderate to high levels of psychological detachment from their work
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 19
(Gabrielle et al., 2008; Hayes et al., 2015). Most studies further expressed that nurses’ psychological distress is largely associated with emotional dissonance, emotional labour, and emotional work of the nursing profession (Karimi et al., 2014; Kornhaber & Wilson, 2011a; Opie et al., 2010; Pisaniello et al., 2012; Rose & Glass, 2008). Other organizational factors – such as workload, the limited workforce, responsibilities, and expectations – as well as social issues are significantly associated with psychological distress and emotional exhaustion (Gabrielle et al., 2008; Opie et al., 2010). The increas- ing emotional labour and emotional work of nurses contribute to low wellbeing (e.g., poor mental health wellbeing). Conversely, another study highlighted that emotional work in the form of companionship con- tributes to positive health and wellbeing (Pisaniello et al., 2012).
Two papers reported that the influence of emotional labour and emotional work on psychological health and organizational outcomes differ, particularly according to the geographical setting of nurses (Opie et al., 2010; Pisaniello et al., 2012). For instance, Opie et al. (2010) recommended that nurses working in very remote areas of Australia have significantly higher levels of emotional exhaustion than do other nurses in major cities and rural communities. In some instances, the emotional demand and emotional labour of the nursing profession encourage nurses to leave the profession (Gabrielle et al., 2008).
Depression and anxiety Four papers highlighted that nurses experience moder- ate, severe, and extreme levels of depression and anxi- ety (Creedy et al., 2017; Drury et al., 2014; Hegney et al., 2014; Hegney et al., 2015b). For example, ~20% of nurses in a sample of 1,037 reported a symptom of depression (17.3%) or anxiety (20.4%; Creedy et al., 2017). In addition, the mean depression and anxiety scores of a sample of 1,743 nurses were 4.38 (SD = 6.39) and 5.46 (SD = 7.76), respectively. (The depression and anxiety was measured using a 21-item scale, which is rated on a four-point Likert scale, 0 – not at all, to 3 – very much/most of the time. The responses to each item were re-coded on a scale from 0 to 100. The higher scores indicate higher levels or severe depression and anxiety; Hegney et al., 2015b).
Three studies indicated that individual and environ- mental factors significantly contribute to increasing the burden of anxiety among nurses (Drury et al., 2014; Hegney et al., 2014; Hegney et al., 2015b). Two papers highlighted that the sector of nursing (aged care), as
well as nurses with a very distressed profile, is signifi- cantly more anxious than nurses in other sectors (Heg- ney et al., 2014; Hegney et al., 2015b). In addition, Drury et al. (2014) reported that the work environment can invoke significant anxiety.
Levels of resilience among workplace nurses
Thirteen of the included papers focused on the resili- ence employed by Australian nurses (see Table 2). Specifically, Dolan et al. (2012) reported that Aus- tralian nurses had moderate levels of resilience. Three papers concluded that the mean resilience score ran- ged from 58.22 (SD 16.06) to 70.02. The resilience was measured using 25-item scale, which is rated on a five point response scale, 0 = not true at all, 4 = true all the time. The responses to each item were re-coded on a scale from 0 to 100. The higher scores indicate higher levels of resilience (Guo et al., 2018; Hegney et al., 2015a; Hegney et al., 2015b). Hegney et al. (2015a) reported that the resilience score is similar across geographic area (e.g., mean of major cities = 70.38, mean of rural areas = 69.06, and mean of remote areas = 69.17). However, two papers con- cluded that the resilience scores differed according to the years of working experience (Gabrielle et al., 2008; Mills et al., 2017). For instance, Mills et al. (2017) sug- gested that the resilience score in a sample of 183 nurses was highest in the first year postgraduation, yet slightly declined until stabilizing around three to five years postgraduation.
Individual attributes used to build resilience
Organizing work as a mindful strategy Mindfulness is a trait-like tendency that involves focus- ing on an experience occurring in the present in a non- judgmental way. Mindfulness is important particularly when nurses organize themselves and detach from highly charged emotional situations and reflect, learn, and move on. In particular, nurses who are mindful can organize themselves and step back mentally and think about what is going on and what can be done (Cusack et al., 2016; Rees et al., 2015). Seven of the included papers highlighted that organizing work is used as a mindful strategy by nurses to improve their resilience at work (Cameron & Brownie, 2010; Dolan et al., 2012; Gabrielle et al., 2008; Gao et al., 2014; McDonald et al., 2013, 2016; Perry et al., 2017). Some studies recommended that these mindful approaches take the form of flexible work schedules (reducing
© 2019 Australian College of Mental Health Nurses Inc.
20 E. BADU ET AL.
working hours or refusing to work double shifts or overtime; Dolan et al., 2012; Gabrielle et al., 2008; Perry et al., 2017), lower job demands (moving to phys- ically lighter nursing, limiting exposure to difficult physical work, and deliberate rest and relaxation to recuperate when off duty; Dolan et al., 2012; Gabrielle et al., 2008; Gao et al., 2014), increased personal autonomy (greater control over work; McDonald et al., 2013, 2016), work in interesting and specialized roles, higher coping resources (McDonald et al., 2016), and insight into the ability to recognize stressors (Cameron & Brownie, 2010). Importantly, some studies suggested that lower job demands and higher coping resources have the ability to improve psychological health (Gao et al., 2014), while personal autonomy improves com- petence and control over the job (McDonald et al., 2016). Nurses who have personal autonomy over their work are able to concentrate on providing person-cen- tred care and meaningful professional engagement with their patients, and subsequently achieve higher confi- dence, efficacy, and job satisfaction levels (McDonald et al., 2016).
Work–life balance as a mindful strategy Six of the included papers recommended work–life bal- ance as a mindful strategy employed to reduce work- place stress among nurses (see Table 2). Some of the work–life balance strategies were feeling balance (self- nurturing), regular exercise and taking recreational activities, and setting emotional boundaries. Three papers highlighted that exercise and recreational activi- ties inside and outside the work environment can encompass novelty, fun, joy, laughter, and relaxation (Cameron & Brownie, 2010; Cope et al., 2016b; Korn- haber & Wilson, 2011a). Specifically, Rose and Glass (2008) suggested that balance is associated with self- nurturing and the interconnectedness of body, mind, and spirit to enhance wellbeing. Similarly, emotional boundary strategies include avoiding over-involvement with clients, separating work from home or family life, and obtaining closure following a client’s death (Rose & Glass, 2008). Two papers further highlighted that the ability to maintain work–life balance helped pre- vent feelings of emotional distress and promoted well- being (Cameron & Brownie, 2010; Rose & Glass, 2008).
Self-reliance mechanism as a self-efficacy strategy Nine of the included papers recommended self-re- liance strategies employed by nurses to build resilience to overcome workplace adversity (Cameron & Brownie,
2010; Cope et al., 2016a; Cope et al., 2016b; Dolan et al., 2012; Kornhaber & Wilson, 2011a; McDonald et al., 2013, 2016; Rose & Glass, 2008; Slatyer et al., 2018). Some studies suggested that the self-reliance strategies employed by nurses included self-caring behaviours or self-management skills, self-control, growing through adversity (Cope et al., 2016a, 2016b; Kornhaber & Wilson, 2011a; McDonald et al., 2013; Rose & Glass, 2008), self-confidence, assertive commu- nication, self-validation, self-reflection (McDonald et al., 2013; Rose & Glass, 2008; Slatyer et al., 2018), and having insight into one’s circumstances (Slatyer et al., 2018). Two of the included papers further sug- gested that self-reliance employed by nurses improves the ability to persevere, sometimes over long careers, and to subsequently sustain physical, mental, and emo- tional health among nurses (McDonald et al., 2013, 2016).
Positive thinking as a self-efficacy strategy Four of the included papers suggested that positive thinking could be used to overcome challenging stress- ful situations in the workplace (see Table 2). The posi- tive-thinking mechanisms included the ability to think differently about ways to solve problems (taking action) (Abraham et al., 2018), staying positive in the midst of adversity (Cameron & Brownie, 2010; Cope et al., 2016a, 2016b), optimism (Cameron & Brownie, 2010), and taking on challenges (Cope et al., 2016b).
Emotional intelligence as a self-efficacy strategy Five of the included papers recommended that emo- tional distancing or emotional intelligence (ability to handle emotions) can be used as resilience to handle workplace adversity (see Table 2). Two papers indi- cated that emotional intelligence has the ability to help nurses handle patient care, regardless of stressors (aris- ing from lengthy, painful, and traumatic care) (Dolan et al., 2012; Kornhaber & Wilson, 2011a). Some studies highlighted that emotional intelligence is significantly associated with nurses’ wellbeing (Karimi et al., 2014, 2015). In particular, higher emotional intelligence is significantly associated with higher wellbeing (Karimi et al., 2014, 2015). Some studies identified different levels of emotional distancing among workplace nurses. For instance, Karimi et al. (2014) reported that the mean emotional intelligence in a sample of 312 com- munity nurses were 2.88 and 3.73, respectively (The emotional intelligence was rated on a five-point Likert scale ranging from 1 ‘strongly agree’ to 5 ‘strongly dis- agree. The responses to each item was re-coded on a
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 21
scale from 1 to 5. The higher scores indicate a higher emotional intelligence level for nurses).
Passion and interest as a self-efficacy strategy Some papers highlighted that nurses’ passion and inter- est in nursing motivated them to cope with workplace adversity (Cope et al., 2016a, 2016b). For example, Cope et al. (2016b) concluded that nurses have a sense of pride and value in their professional role and satis- faction with their career choice. The sense of value among the nursing profession significantly influences nurses to cope with workplace adversity.
Workplace resilience interventions for nurses
Six of the included papers identified several interven- tions that have been piloted to reduce stress, burnout, and psychological distress among workplace nurses (Craigie et al., 2016; Foster et al., 2018; Foureur et al., 2013; McDonald et al., 2013; Perry et al., 2017; Slatyer et al., 2018; b). Three of the interventions were mind- ful self-care and resiliency (MSCR) interventions (Crai- gie et al., 2016; Slatyer et al., 2018; b), while the remaining interventions included a work-based educa- tional intervention to promote personal resilience (McDonald et al., 2013), a programme for promoting adult resilience (Foster et al., 2018), a programme for mindfulness-based stress reduction (Foureur et al., 2013; see Table 3).
All the included papers describing mindful self-care and resiliency interventions comprised an average of one to two days of an educational workshop, which was structured into different components. The workshop from all the included papers describing mindful self- care and resiliency interventions was mostly followed by a daily or weekly mindfulness practice session for an average of four to 24 weeks (Craigie et al., 2016; Slatyer et al., 2018; b). Three papers highlighted that the workshop generally focused on modules that included compassion fatigue resiliency (based on Eric Gentry’s Compassion Fatigue Prevention and Resi- liency concepts) and understanding the concept of mindfulness (Craigie et al., 2016; Slatyer et al., 2018; b).
In addition, Foureur et al. (2013) highlighted that the mindfulness-based stress reduction programme (a one-day programme) is taught by an experienced psy- chologist. The programme is followed by daily mindful- ness practice sessions (audio-recorded by the primary workshop facilitator) of 20 min for an eight-week per- iod. Further, McDonald et al. (2013) described that
the work-based educational intervention workshops and a mentoring programme used to promote personal resi- lience are conducted over a six-month period. The workshops were held over a whole day each month, onsite at the hospital, but a place outside their usual work environment. The content of the programme is developed around mentoring and maintaining positive and nurturing relationships and networks, a positive outlook, hardiness, intellectual flexibility, emotional intelligence, life balance, spirituality, reflection, critical thinking, and therapeutic elements (see Table 3; McDonald et al., 2013).
Effectiveness of resilience interventions Five of the included papers revealed that the piloted resilience interventions were effective in mitigating the negative effects of workplace stress (Craigie et al., 2016; Foster et al., 2018; Foureur et al., 2013; Slatyer et al., 2018; b). Most of the papers highlighted that the piloted interventions were practically feasible and posi- tively accepted among workplace nurses (Craigie et al., 2016; Foster et al., 2018; Foureur et al., 2013; Slatyer et al., 2018; b). Two papers concluded that participants in resilience educational workshops felt comfortable devoting resources to their own wellbeing (Slatyer et al., 2018) and had high levels of satisfaction with the intervention (Foster et al., 2018). For example, the level of satisfaction with a promoting adult resilience education programme was very high (range: 4.2–4.7, with the range of values from 0 to 5, where a value of 5 represents absolute satisfaction), while satisfaction with skills learned was high to very high (range = 3.8– 4.5) (Foster et al., 2018). Similarly, 94% of 21 partici- pants who completed a MSCR programme continued to use at least one learned practice in the workplace or at home during the weeks after the programme (Slatyer et al., 2018).
Further, four of the included papers recommended that resilience educational workshops helped mitigate negative effects on nurses’ wellbeing. The educational workshops were reported to have significant reductions on stress, depression, burnout, and trait negative affect (Craigie et al., 2016; Foster et al., 2018; Slatyer et al., 2018; b), as well as improving levels of compassion, sat- isfaction, self-compassion, and subjective quality of life (Craigie et al., 2016; Slatyer et al., 2018). In particular, in a pilot MSCR intervention, 45% of the 21 nurses who had burnout scores in the high range at pre-test reduced to 15% at post-test and in the follow-up stage (Craigie et al., 2016). Similarly, a statistically significant improvement was observed between pre- and post-
© 2019 Australian College of Mental Health Nurses Inc.
22 E. BADU ET AL.
intervention compassion satisfaction scores (t [205] = �2.24, P = 0.026, d = 0.17) and secondary traumatic stress scale (t [205] = 2.43, P = 0.001, d = 0.52) (Slatyer et al., 2018. In addition, some papers highlighted that the educational workshops helped improve the coping self-efficacy and self-regulatory process of the nursing workforce studied (Foster et al., 2018; Slatyer et al., 2018).
Organizational resources used to build resilience
Leadership Three of the included papers outlined organizational leadership factors that help mitigate the negative effects of workplace adversity (Cope et al., 2016b; Drury et al., 2014; Perry et al., 2017). Some papers suggested that leadership practices that influence work- place nurses to resist enduring negative emotional states include positive feedback from leaders (Drury et al., 2014), treating staff with respect, and self-aware leaders (Cope et al., 2016b; Drury et al., 2014). In addition, Perry et al. (2017) concluded in the study that the most highly ranked important health-promotion strategies to promote the wellbeing of workplace nurses are leadership (mean score of 4.1 and 4.3, with the range of values from 1 to 5, where a maximum value of 5 represents highest rank), forming collaborative rela- tionships with organizations (mean score 4.3), ensuring equitable access to interventions for all employees (4.2), and creating opportunities for staff involvement in decision-making (mean score 4.2).
Role modelling and mentorship Two papers suggested that role modelling and mentor- ship are used as resilience motivators to manage endur- ing negative emotional states (Cope et al., 2016b; Drury et al., 2014). For instance, role models and men- tors provide clinical coaching, counsel, and managerial support to nurses. The role modelling and mentorship support help to improve the working environment (Cope et al., 2016b; Drury et al., 2014).
Informal support services Nine of the included papers recommended that infor- mal support services from collegial networks and per- sonal relationships with families and friends outside of work can be used to mitigate the effects of workplace adversity and improve resilience (Cameron & Brownie, 2010; Cope et al., 2016a,b; Drury et al., 2014; Korn- haber & Wilson, 2011b; McDonald et al., 2013, 2016; Rose & Glass, 2008; Slatyer et al., 2018). Two papers
suggested that collegial relationships helped to provide positive communication (McDonald et al., 2013, 2016), reciprocal support, and a sense of belonging in the workplace (McDonald et al., 2013). The collegial net- works helped nurses to share insider knowledge about organizational issues, understand the relationship dynamics within the work department (McDonald et al., 2016), and provide and receive support during complex procedures in their clinical practice (Korn- haber & Wilson, 2011b). Further, two papers high- lighted that informal support from families and friends enabled nurses to undertake informal debriefing, which facilitated their nursing work (Drury et al., 2014; Rose & Glass, 2008). In particular, McDonald et al. (2016) recommended that external supportive relationships from partners, family, and friends are relevant to increasing nurses’ emotional wellbeing and further sus- taining a positive self-concept when dealing with work- place adversity.
Formal organizational support services Four of the included papers for this theme recom- mended that several formal systemic support services have the ability to enhance the wellbeing of workplace nurses (see Table 1). Some studies highlighted that nurses’ wellbeing can be facilitated by health promo- tion (training in mental health, stress management, resilience, and flexible working practice), healthy eat- ing, nutrition, and smoking cessation interventions (Perry et al., 2017), as well as organizational commit- ment (Teo et al., 2012) and multidisciplinary team col- laboration (Kornhaber & Wilson, 2011b). For instance, Perry et al. (2017) concluded that some healthy eating interventions are important and feasible when enhanc- ing nurses’ wellbeing. These interventions include the provision of healthy food options in health facility cafe- terias, healthy food options in on-site vending machi- nes, and food labelling, as well as the development and provision of personalized low-fat dietary plans for staff by dieticians. Similarly, some smoking cessation inter- ventions that seem important and feasible among work- place nurses are the promotion of free telephone counselling, Internet quit support, self-help manuals, cognitive behavioural therapy, and nicotine replace- ment therapy (Perry et al., 2017). Further, Kornhaber and Wilson (2011b) suggested that multidisciplinary team collaboration provides workplace nurses with greater support, direction, and assistance in providing nursing care.
Two of the included papers further recommended some formal support or systemic services – such as
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 23
professional counselling (Kornhaber & Wilson, 2011b), an employee assistance programme, or clinical supervi- sion (Rose & Glass, 2008) – as effective methods for managing workplace adversity. Clinical supervision, in particular, is perceived as valuable to nursing practice and the support of emotional wellbeing (Rose & Glass, 2008).
DISCUSSION
This integrative review was conducted to synthesize evidence into the level of stress and the resilience developed by Australian nurses to reduce workplace adversity. The study specifically aims to identify the levels of stress and synthesize evidence on the individ- ual attributes and organizational resources used to build resilience. The evidence from the review has been discussed according to four themes: (i) levels of stress (causative factors and impacts on workplace nurses), (ii) individual attributes used to build resili- ence, (iii) organizational resources used to build resili- ence, and (iv) workplace resilience interventions for nurses.
Levels of stress (causative factors and impacts on workplace nurses)
The evidence has highlighted that Australian nurses experience moderate to high levels of stress, which are reported to be largely associated with workplace bully- ing. The increasing workplace adversity affecting nurses with low resilience have significantly led to moderate to higher levels of depression and anxiety, psychological detachment, and burnout (Abraham et al., 2018; Gab- rielle et al., 2008; Hayes et al., 2015; Teo et al., 2013). The increasing stress levels and associated outcome are caused by individual and environmental or organiza- tional factors. More specifically, workplace organiza- tional factors (such as workload, administrative, and budgetary issues) and environmental factors (including job tension, role conflict, and role ambiguity) signifi- cantly contribute to increased stress levels. Conversely, individual factors (such as patient behaviour and hand- ing critically injured patients) and professional-related issues account for higher stress levels among nurses (Abraham et al., 2018; Bowden et al., 2015; Dolan et al., 2012; Drury et al., 2014). These individual and organizational factors significantly influence stress levels and contribute to psychological distress and emotional exhaustion. The factors that influence stress level among Australian nursing workforce is consistent with
previous literature (Lim et al., 2010; Turner, 2014; Zander & Hutton, 2009; Zander et al., 2013).
Further, the increasing levels of psychological dis- tress have a significant influence on burnout, anxiety, and depression among nurses at work. In most instances, the burnout, anxiety, and depression experi- enced by nurses differs according to nurses’ individual factors (Delgado et al., 2017; Garcia-Dia et al., 2013). The evidence from this review suggests that individual predisposing factors – such as the gender, age, and level of the service provider (primary, secondary, or tertiary); years or period of nursing; workload; distress level; and turnover intention – influence burnout, depression, and anxiety among nurses. The review find- ings recommend the need to conduct a preventive research and focused interventions into the various predisposing factors influencing burnout, depression, and anxiety among the nursing workforce.
The increasing negative emotional state of nursing workforce has several implications for individual nurses, human resources management for nurses, and subsequently the delivery of health services (Cusack et al., 2016; Zander & Hutton, 2009). The poor emo- tional state of workplace nurses can significantly reduce nurses’ productive work, especially in the provision of patient-centred health services. A distressed nurse is more likely to provide poor services to consumers than is a nurse with improved psychological wellbeing. This review finding is consistent with earlier models that highlight that enduring negative emotional states or emotional affect confronting workplace nurses affect the quality of care provided (Cusack et al., 2016; Rees et al., 2015; Turner, 2014). As such, our review findings recommend that health policy planners and managers should employ workable measures to promote the mental health and wellbeing of workplace nurses. The interventions or mechanisms can be promoted by the Australian healthcare standards authority (Australian Commission on Safety and Quality in Health Care), local health districts, and professional organizations, such as nursing unions and professional colleges.
Individual attributes used to build resilience
The review findings confirm that several individual attributes – such as self-efficacy and mindful strategies – are used to build resilience among workplace nurses. The self-efficacy mechanisms are largely related to self- reliance, positive thinking, emotional intelligence, and passion for and interest in nursing as a profession. The self-reliance mechanisms employed by nurses mostly
© 2019 Australian College of Mental Health Nurses Inc.
24 E. BADU ET AL.
T A B L E
3 : In te rv en ti on
st u d ie s on
w or kp
la ce
re si li en ce
P ap e r
In te rv e n ti o n
O b je ct iv e o f in te rv e n ti o n
M o d e o f d e li ve ri n g
C o n te n t o f in te rv e n ti o n
R e si li e n ce
O u tc o m e
S la ty e r
et al .
(2 0 1 8 )
M in d fu l
S e lf -c ar e
an d
R e si li e n cy
(M S C R )
in te rv e n ti o n s
T o le ar n m in d fu ln e ss -b as e d sk il ls
an d p ra ct ic e s to
su p p o rt
C F
re si li e n cy .
• a
fu ll -d ay
e d u ca ti o n al
w o rk sh o p
co m p ri si n g
fo u r se ss io n s
• A
d ai ly
o r
w e e k ly
m in d fu ln e ss
p ra ct ic e
as si g n e d as
h o m e -b as e d
e xe rc is e s u si n g a C D
• T h e
w o rk sh o p
fo cu se d
o n
co m -
p as si o n
fa ti g u e
re si li e n cy
an d
m in d fu ln e ss
co n ce p ts
In d iv id u al
re si li e n ce
T h e M S C R
p ro g ra m m e h ad
si g n ifi ca n t re d u ct io n s in
b u rn o u t
an d d e p re ss io n sc o re s as
w e ll as
im p ro ve d le ve ls o f co m p as si o n
sa ti sf ac ti o n , se lf -c o m p as si o n an d
su b je ct iv e q u al it y o f li fe
S la ty e r,
et al .
(2 0 1 8 )
M in d fu l
S e lf -c ar e
an d
R e si li e n cy
(M S C R )
in te rv e n ti o n s
T o le ar n m in d fu ln e ss
to su p p o rt
re si li e n cy
sk il ls
• a
o n e -d ay
e d u ca ti o n al
w o rk sh o p
• F o ll o w e d
im m e d ia te ly
b y
a se ri e s
o f w e e k ly
m in d fu ln e ss
sk il ls
se m i-
n ar s co n d u ct e d
o ve r a
p e ri o d o f 4 w e e k s.
• T h e
w o rk sh o p
fo cu se d
o n
co m -
p as si o n
fa ti g u e
re si li e n cy
an d
in tr o d u ct io n to
m in d fu ln e ss
In d iv id u al
re si li e n ce
T h e M S C R
p ro g ra m m e w as
fe as ib le
an d ac ce p ta b le , p ar ti cu la rl y
d e ve lo p in g fe e li n g s o f in n e r ca lm
an d se lf -c ar e st ra te g ie s
C ra ig ie
et al .
(2 0 1 6 )
M in d fu l
S e lf -c ar e
an d
R e si li e n cy
(M S C R )
in te rv e n ti o n s
T o le ar n m in d fu ln e ss
to su p p o rt
C o m p as si o n fa ti g u e re si li e n cy
sk il ls
• a
1 -d ay
e d u ca ti o n al
w o rk sh o p
• F o ll o w e d
im m e d ia te ly
b y
a se ri e s
o f w e e k ly
m in d fu ln e ss
sk il ls
• T h e
w o rk sh o p
fo cu se d
o n
co m -
p as si o n
fa ti g u e
re si li e n cy
an d
in tr o d u ct io n to
m in d fu ln e ss
In d iv id u al
re si li e n ce
T h e re
w e re
si g n ifi ca n t
im p ro ve m e n ts
ac ro ss
a n u m b e r o f
sy m p to m
d o m ai n s fo ll o w in g th e
M S C R
in te rv e n ti o n
F o st e r
et al .
(2 0 1 8 )
P ro m o ti n g
A d u lt
R e si li e n ce
p ro g ra m m e
T o p ro m o te
ad u lt s’ re si li e n ce ,
in cr e as e th e ir m e n ta l h e al th
an d
w e ll b e in g , im
p ro ve
re la ti o n sh ip s an d
d e cr e as e co n fl ic t b y in cr e as in g
in te rp e rs o n al
an d co m m u n ic at io n
sk il ls , an d d e cr e as e st re ss
b y
p ro m o ti n g st re ss
m an ag e m e n t sk il ls
• T w o fu ll -d ay
w o rk sh o p s
o n
P A R
m o d u le s
w as
d e li ve re d
fa ce
to fa ce
fo r
3 w e e k s
b y
tw o
tr ai n e d
fa ci li ta to rs
in a
p e e r g ro u p se tt in g .
• T w o e m ai l b o o st e rs
in -
b e tw e e n
se ss io n s
an d
o n e
e m ai l p e r
m o n th
fo r 3 m o n th s fo ll o w in g
th e
fi n al
se ss io n
w e re
se n t to
p ar ti ci p an ts
• P A R
co m p ri se s
se ve n
m o d u le s
an d
ad d it io n al
ad ap te d
co m p o -
n e n t
(i d e n ti fy in g
st re n g th s
an d
u n d e rs ta n d in g
re si li e n ce ,
u n d e r-
st an d in g
an d
m an ag in g
st re ss ,
ch al le n g in g an d ch an g in g n e g at iv e
se lf -t al k ,
d ra w in g
st re n g th
fr o m
ad ve rs it y
an d
p ro m o ti n g
p o si ti ve
re la ti o n sh ip s)
In d iv id u al
re si li e n ce
T h e re
w e re
si g n ifi ca n t p o si ti ve
e ff e ct s o f P A R
o n m e n ta l h e al th ,
w e ll b e in g , an d w o rk p la ce
re si li e n ce
(C on
ti n u ed )
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 25
T A B L E
3 : (C
o n ti n u e d )
P ap e r
In te rv e n ti o n
O b je ct iv e o f in te rv e n ti o n
M o d e o f d e li ve ri n g
C o n te n t o f in te rv e n ti o n
R e si li e n ce
O u tc o m e
M cD
o n al d
et al .
(2 0 1 3 )
W o rk -b as e d
e d u ca ti o n al
in te rv e n ti o n
A w o rk -b as e d , e d u ca ti o n al
in te rv e n ti o n to
p ro m o te
p e rs o n al
re si li e n ce
in a g ro u p o f n u rs e s an d
m id w iv e s w o rk in g in
a b u sy
cl in ic al
e n vi ro n m e n t
• S ix
re si li e n ce
w o rk -
sh o p s an d
a m e n to ri n g
p ro g ra m m e
co n d u ct e d
o ve r a 6 -m
o n th
p e ri o d
• E ac h
w o rk sh o p
w as
d e ve lo p e d
ar o u n d tw o o f th e fo ll o w in g ch ar -
ac te ri st ic s
as so ci at e d
w it h
re si li -
e n ce :
p o si ti ve
an d
n u rt u ri n g
re la ti o n sh ip s an d
n e tw o rk s;
m e n -
to ri n g ; p o si ti ve
o u tl o o k ; h ar d in e ss ;
in te ll e ct u al
fl e xi b il it y;
e m o ti o n al
in te ll ig e n ce ; li fe
b al an ce ; sp ir it u al -
it y;
re fl e ct io n ;
cr it ic al
th in k in g ;
an d th e ra p e u ti c e le m e n t
In d iv id u al
re si li e n ce
R e si li e n ce
re p o rt e d ar e se lf -
co n fi d e n ce , se lf -a w ar e n e ss , se lf -c ar e
an d as se rt iv e co m m u n ic at io n .
E n h an ci n g p e rs o n al
re si li e n ce
m ay
in d e e d as si st
in p ro te ct in g n u rs e s
an d m id w iv e s ag ai n st
th e se ri o u s
e ff e ct s o f w o rk p la ce
ad ve rs it y
F o u re u r
et al .
(2 0 1 3 )
a p ro g ra m m e
b as e d o n
m in d fu ln e ss -
b as e d st re ss
re d u ct io n
to p ro vi d e in fo rm
at io n an d
in tr o d u ct o ry
p ra ct ic e in
M B S R
an d
to su p p o rt
p ar ti ci p an ts
w it h p ra ct ic al
st ra te g ie s to
e m b ra ce
m in d fu ln e ss
p ra ct ic e o n a d ai ly
b as is
• o n e -d ay , M B S R
w o rk -
sh o p in vo lv in g m in d fu l-
n e ss -b as e d
st re ss
re d u ct io n
ta u g h t b y an
e xp e ri e n ce d
p sy ch o lo -
g is t (G
B )
• a C D
re co rd e d
b y th e
p ri m ar y w o rk sh o p fa ci l-
it at o r fo r d ai ly
m in d fu l-
n e ss
p ra ct ic e
se ss io n s
o f
2 0 m in
fo r
an 8 -
w e e k p e ri o d
• T h e w o rk sh o p w as
d iv id e d in to
a
co m p o n e n t
(i n tr o d u ct io n
to th e
re se ar ch
an d
w o rk sh o p ,
th e
im p ac t o f st re ss
o n
b e in g in
th e
p re se n t m o m e n t,
an in tr o d u ct io n
to m in d fu ln e ss ,
g ro u n d in g
an d
d e fu si o n
st ra te g ie s
an d
fo rm
in g
h ab it s)
In d iv id u al
re si li e n ce
T h e fi n d in g s re la te d to
th e
ac ce p ta b il it y an d fe as ib il it y o f th e
in te rv e n ti o n – b o th
p ar ti ci p at io n in
th e w o rk sh o p an d in te g ra ti o n o f
re g u la r m e d it at io n p ra ct ic e
© 2019 Australian College of Mental Health Nurses Inc.
26 E. BADU ET AL.
involve self-caring behaviours or self-management skills, self-control, self-confidence, assertive communi- cation, self-validation, and self-reflection (McDonald et al., 2016; McDonald et al., 2013). The self-reliance mechanisms can strengthen workplace nurses’ ability to develop perseverance skills that can help them sustain physical, mental, and emotional health (Garcia-Dia et al., 2013; Scoloveno, 2016). In addition, the positive- thinking mechanisms used to enhance resilience are largely associated with the ability to think differently about ways to solve problems, remain optimistic, and stay positive in situations of adversity and when taking on challenges. The notion of positive thinking as a self- efficacy mechanism is regarded a positive step forward in building resilience (Garcia-Dia et al., 2013; Kim & Windsor, 2015; Scoloveno, 2016; Yılmaz, 2017).
In addition, the review findings confirm that work- place nurses who are able to handle their emotions or who practice emotional distancing are more likely to achieve higher wellbeing and emotional equilibrium (Karimi et al., 2015; Karimi et al., 2014). Further, workplace nurses who demonstrate passion for and interest in nursing have a sense of pride and value in the professional role and are more satisfied with their career choice (Cusack et al., 2016; Rees et al., 2015). Nurses’ passion for and interest in the profession help them build personal resilience (self-efficacy) in manag- ing workplace adversity. The review findings recom- mend that the various self-efficacy mechanisms practiced among workplace nurses should be promoted to address the adversities in the work environment.
Further, the review findings suggest that several mindful strategies are used by individual workplace nurses to promote and learn about resilience. Indeed, mindfulness is a significant construct that can build and sustain resilience among workplace nurses (Cusack et al., 2016; Rees et al., 2015). Individuals who are mindful have greater ability to manage stressful and highly emotional situations, and subsequently improve their psychological wellbeing (Cusack et al., 2016; Rees et al., 2015). Specifically, the mindful practices that are used to reduce workplace stress include organizing work, maintaining a work–life balance, meditation, relaxation, and clinical supervision, which involves criti- cal reflection. In particular, the evidence suggests that workplace nurses who organize their work according to lower job demands and flexible work schedules, increase personal autonomy, and have insight into iden- tifying stressors. These workplace nurses are more likely to achieve higher job satisfaction and psychologi- cal health. Further, workplace nurses who balance their
work and life with exercise and recreational activities and who set emotional boundaries have the ability to manage emotional distress and improve wellbeing. Workplace nurses who separate work from home and family, limit their involvement with clients, and obtain closure from patient death and trauma are reported to better control the negative effects of emotional distress and adversity. The review findings confirm previous evidence that recommends the use of mindful practices to mitigate workplace stress. Our evidence recom- mends that workplace nurses need to be mindful in their workplace, particularly around balancing work with life and family. This is significant when seeking to improve psychological wellbeing and productivity.
Workplace resilience interventions for nurses
The review findings indicated that several interventions have recently been piloted to improve resilience in healthcare facilities in Australia (Craigie et al., 2016; Foster et al., 2018; Foureur et al., 2013; McDonald et al., 2013; Perry et al., 2017; Slatyer et al., 2018; b). The interventions include mindfulness self-care and resiliency, work-based educational interventions, a pro- gramme promoting adult resilience, and mindfulness- based stress reductions. The review findings concluded that piloted resilience interventions are practically feasi- ble and positively accepted to improve the wellbeing of workplace nurses (Craigie et al., 2016; Foster et al., 2018; Foureur et al., 2013; Slatyer et al., 2018; b). The educational interventions are known to be effective in reducing negative outcomes, such as stress, depression, burnout, and trait negative effect. Moreover, the inter- ventions are effective for improving workplace nurses’ level of compassion, satisfaction, self-compassion, and quality of life. However, there have been no evaluation studies investigating the cumulative effect of the resili- ence-based interventions conducted, or any official rec- ommendations regarding how these interventions might be improved or modified to build and sustain resilience among nurses and their colleagues. The review findings endorse that policymakers, including nursing managers, should employ such educational workshop interventions and health-promotion programmes as resilience motiva- tors to manage the psychological and physical wellbeing of nurses. Such interventions can ensure the longevity and retention of the nursing workforce and subsequently improve health service delivery (Kim & Windsor, 2015; Turner, 2014). Further, such interventions can be imple- mented in a sustainable and measurable manner to achieve a long-term effect on the nursing workforce.
© 2019 Australian College of Mental Health Nurses Inc.
RESILIENCE IN WORKPLACE NURSING 27
Organizational attributes used to build resilience
The synthesized evidence suggests that some organiza- tional or environmental factors are employed by nurses to mitigate the effects of workplace adversity. The orga- nizational attributes used to manage workplace adversity include leadership, role modelling or mentorship, and support services. Specifically, leadership practices – such as positive feedback to nurses and demonstrating respect – help workplace nurses cope with the negative effects of negative emotional states (Cope et al., 2016b; Drury et al., 2014). In some instances, providing role modelling to nurses in areas such as clinical coaching can help improve the nurses’ practice and wellbeing. The organi- zational resources used to manage resilience in Aus- tralian nursing workforce is consistent with previous literature explaining resilience. In particular, previous lit- erature recommend several factors such as professional skills development, professional attributes, and support- ive workplace environment as organizational resources to build resilience (Cusack et al., 2016; Delgado et al., 2017; Scoloveno, 2016; Yılmaz, 2017). The review find- ings recommend that various professional development plan strategies and supportive working environment should be encouraged and promoted in the Australian healthcare setting.
Moreover, the review findings indicated that several informal and formal support services are used by work- place nurses to cope with their stressful working envi- ronment. Informal support – such as collegial networks and personal relationships with families and friends outside work – have the proven ability to improve the mental health and wellbeing of workplace nurses (Cameron & Brownie, 2010; Cope et al., 2016b; Drury et al., 2014; Kornhaber & Wilson, 2011b; McDonald et al., 2016; Rose & Glass, 2008). In most instances, collegial networks promote positive workplace commu- nication, reciprocal support, and a sense of belonging. Informal support from family and friends mostly enables debriefing sessions and enhances positive self- support, which augments nurses’ emotional wellbeing, especially in times of workplace adversity. The informal support used to build resilience in Australian nursing workforce confirms previous literature, which recog- nized informal support as predictive factor (Cusack et al., 2016; Garcia-Dia et al., 2013; Kim & Windsor, 2015; Yılmaz, 2017). In addition, the review findings highlight that formal or systemic support services – such as mental health interventions or training; healthy eating, nutrition, and smoking cessation interventions; organizational commitment; and multidisciplinary
collaboration – can also facilitate the wellbeing of workplace nurses (Drury et al., 2014; Kornhaber & Wilson, 2011b; Perry et al., 2017; Teo et al., 2012). Other formal support such as professional counselling, employee assistance programme, and clinical supervi- sion has proven as effective methods for managing workplace adversity (Kornhaber & Wilson, 2011b; Rose & Glass, 2008). These support services can be used as coping strategies for workplace nurses to allay the neg- ative effects of stress. The support services can nurture and empower nurses to withstand workplace pressures and thus contribute to their mental health and wellbe- ing in the workplace (Cusack et al., 2016; Garcia-Dia et al., 2013; Kim & Windsor, 2015; Yılmaz, 2017). The review findings recommend that the organizational or systematic support services that elevate the resilience of workplace nurses should be promoted to improve the wellbeing of nurses at work.
LIMITATIONS
This integrative review has several limitations that require consideration. The limitations of the integrative review are largely pertinent to the search words, lan- guage limitations, scope (geographical setting), and per- iod of publication of the included papers. The review was only limited to papers addressing workplace resili- ence among nurses in the Australian context. In addi- tion, the included papers were limited to those published in English language and falling within the per- iod January 2008 to December 2018. More importantly, the variation in search terms and keywords regarding resilience and stress may have missed some relevant arti- cles. Moreover, limiting studies to only English-language articles and articles published between 2008 and 2018 could have overlooked relevant non-English-language articles and articles published prior to 2008. However, the combination of clearly articulated search methods, consultation with a research librarian, and reviewing arti- cles with multiple experts, as well as the critical apprai- sal tool used to measure the methodological quality, helped address these various limitations.
CONCLUSION
In summary, the evidence indicates that Australian nurses experience moderate to high levels of stress, which is largely associated with workplace bullying. These nurses also experience moderate to high levels of depression and anxiety, as well as burnout. This review concludes that several individual attributes and
© 2019 Australian College of Mental Health Nurses Inc.
28 E. BADU ET AL.
organizational (environmental) resources are employed as forms of resilience to manage workplace adversity. The individual attributes include self-reliance, positive thinking, emotional intelligence, passion and interest in nursing, maintaining a work–life balance, and organiz- ing work. The organizational resources used to build resilience include support services (formal and infor- mal), leadership, and role modelling. In addition, the review concludes that several interventions have recently been piloted to improve resilience in health- care facilities in Australia. The interventions include mindfulness self-care and resiliency, work-based educa- tional interventions, a programme for promoting adult resilience, and mindfulness-based stress reductions. Piloted resilience interventions are practically feasible and positively accepted to improve the mental health and wellbeing of workplace nurses.
Implications for mental health nursing practice, policy, and future research
This integrative review indicates that there is increasing evidence regarding the resilience strategies employed by workplace nurses in Australia. Of the 41 papers included in this review, 40 met the criteria for high quality and thus can be used to inform policies aimed at managing the nursing workforce. The evidence lar- gely addresses issues related to individual attributes and organizational resources used to build resilience, with relatively few studies addressing workplace educa- tional interventions or health-promotion programmes. In addition, only a few researchers have sought to employ interventional studies to examine the effective- ness of resilience interventions in reducing workplace adversity. There is also a gender bias, with most of the evidence that addresses resilience targeting the female nursing workforce, and limited studies targeting males. Moreover, the existing evidence largely uses quantita- tive methods, with few studies using quantitative meth- ods or a mixed-methods approach. Thus, this paper presents the following recommendations for mental health nursing practice and policy:
• Advocacy for and awareness of individual attributes and organizational resources used to build resilience in nursing workforce should be funded and priori- tized in policy initiatives. In particular, nursing man- agers and health facility managers should promote and encourage the individual attributes and organiza- tional resources used to build resilience among work- place nurses. This can help reduce the negative
effects of enduring negative emotional states and subsequently improve the mental health and wellbe- ing of the nursing workforce.
• Health policy planners and managers should employ workable measures that can promote the mental health and psychological wellbeing of workplace nurses. Specifically, the current interventions piloted for resilience development in health facilities (such as mindfulness self-care and resiliency, work-based educational interventions, adult resilience pro- grammes, and mindfulness-based stress reductions) could be prioritized and implemented to achieve sus- tainable psychological and mental health wellbeing outcomes. The interventions or mechanisms can be promoted by the Australian healthcare standards authority (Australian Commission on Safety and Quality in Health Care), local health districts, nurs- ing managers, hospital administrators, and profes- sional organizations, such as nursing unions and professional colleges.
Moreover, this review presents the following recom- mendations for future research:
• Research on resilience used to manage workplace adversity should be directed toward interventional studies, which can provide sustainable and workable solutions to reduce the stress faced by workplace nurses.
• Resilience research in Australian nursing workforce largely neglects the experiences of males; thus, future research should attempt to explore how men cope with workplace adversity.
• Resilience research in nursing mostly employs quan- titative methods, with relatively few studies using qualitative or mixed methods. Thus, this review rec- ommends that future resilience research attempt to use mixed methods to understand the subjective and objective perspectives of mental health nurses.
ACKNOWLEDGEMENTS
The authors declare no funding support.
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APPENDIX 1: Data extraction form
Study ID Study Details Citation Year of publication(s) Author(s) Contact details of lead author Funder / sponsoring organisation Publication type Example:
• Journal article • Report (specify) • Case study • Other
Publication Source Methodology (if applicable)
• Study design • Type of data • Data collection • Sampling • Data analysis • Participants/No. of
studies included Population Nurses
• Please specify the category of Nurses?
Age range Sex Study setting Objective of the study Subject area The paper may focus on one or more sectors ie
• Nurses workplace stress • Impact of stress • Concept of resilience • Antecedents to resilience • Impact of resilience on
nurses workplace stress Nurses workplace stress Please identify the existing evidence on stress faced
by nurses at work?
Impact of nurses workplace stress
Please describe the impact of stress faced by nurses at work a) at an individual level, in terms of nurse mental health, absenteeism, turnover b) at a team level
Concept of Resilience Please specify the concept of nursing resilience at individual level and team level?
Antecedents to resilience Please specify the antecedents to nurses’ resilience?
Impact of resilience on nurses workplace stress
Please describe the role of resilience in mitigating the negative consequences of workplace stress on nurses (individuals and teams)
Any existing interventions Outcome of intervention Please report on any additional information nurses workplace stress and resilience
Recommendation
Identifiable references to follow up
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APPENDIX 2: Methodological quality assessment criteria
Reviewer 1 Reviewer 2 Author (s) Methods Study design Data Sampling Analysis Types of Study Methodological Quality assessment Criteria Yes No Cant
tell Screening Ques�ons (for all types)
Are there clear research ques�ons or objec�ves? Do the collected data address the research ques�on? Further appraisal is not feasible when the answer is ‘No’ or ‘Can’t tell’ to one or both screening ques�ons
Qualita�ve
1.1 Is there congruity between the stated philosophical perspec�ve and the research methodology? 1.2 Are the sources of qualita�ve data (archives, documents, informants, observa�ons) relevant to address the research ques�on? 1.3 Is the process for analysing qualita�ve data relevant to address the research ques�on? 1.4 Are par�cipants, and their voices, adequately represented? (adequate quotes and text been used to represent the concept discussed) 1.5 Is there a statement loca�ng the researcher culturally or theore�cally? (Are the beliefs and values, and their poten�al influence on the study declared?) 1.6. Is the influence of the researcher on the research, and vice- versa, addressed? (Addressing the poten�al for the researcher to either influence or to be influenced by the study) 1.7. Do the conclusions drawn in the research report flow from the analysis, or interpreta�on, of the data? 1.8. Is the ethical issues adequately addressed? (statement indica�ng appropriate ethics approval)
Quan�ta�ve randomized controlled (trials)
2.1. Is there a clear descrip�on of the randomiza�on (or an appropriate sequence genera�on)? 2.2. Is there a clear descrip�on of the alloca�on concealment or blinding when applicable)? 2.3. Are there complete outcome data (80% or above)? 2.4. Is there low withdrawal/drop-out (below 20%)?
Quan�ta�ve non- randomized
(Cohort study, case-control study, analy�cal cross- sec�onal)
3.1. Are par�cipants recruited in a way that minimizes selec�on bias? 3.2 Were the criteria for inclusion in the sample clearly defined? 3.3 Were the study subjects and the se�ng described in detail? 3.4 Were objec�ve, standard criteria used for measurement of the condi�on? 3.5 Were the outcomes measured in a valid and reliable way? 3.6 Was appropriate sta�s�cal analysis used? 3.7 Is the ethical issues adequately addressed? (statement indica�ng appropriate ethics approval) 3.8 Do the conclusions drawn in the research report flow from the analysis, or interpreta�on, of the data? 3.9 Are measurements appropriate (clear origin, or validity known, or standard instrument; and absence of contamina�on between
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RESILIENCE IN WORKPLACE NURSING 33
groups when appropriate) regarding the exposure/interven�on and outcomes? 3.11 In the groups being compared (exposed vs. non-exposed; with interven�on vs. without; cases vs. controls), are the par�cipants comparable, or do researchers take into account (control for) the difference between these groups? 3.12 Are there complete outcome data (80% or above), and, when applicable, an acceptable response rate (60% or above), or an acceptable follow-up rate for cohort studies (depending on the dura�on of follow-up)?
Quan�ta�ve descrip�ve
4.1. Is the sampling strategy relevant to address the quan�ta�ve research ques�on (quan�ta�ve aspect of the mixed methods ques�on)? 4.2. Is the sample representa�ve of the popula�on understudy? 4.3. Are measurements appropriate (clear origin, or validity known, or standard instrument)? 4.4. Is there an acceptable response rate (60% or above)?
Systema�c Review
5.1 Is the review ques�on clearly and explicitly stated? 5.2 Were the inclusion criteria appropriate for the review ques�on? 5.3 Was the search strategy appropriate? 5.4 Were the sources and resources used to search for studies adequate? Were the criteria for appraising studies appropriate? 5.5 Was cri�cal appraisal conducted by two or more reviewers independently? 5.6 Were there methods to minimize errors in data extrac�on? 5.7 Were the methods used to combine studies appropriate? 5.8 Was the likelihood of publica�on bias assessed? 5.9 Were recommenda�ons for policy and/or prac�ce supported by the reported data? 5.10 Were the specific direc�ves for new research appropriate?
Mixed methods
6.1. Is the mixed methods research design relevant to address the qualita�ve and quan�ta�ve research ques�ons, or the qualita�ve and quan�ta�ve aspects of the mixed methods ques�on? 6.2. Is the integra�on of qualita�ve and quan�ta�ve data (or results relevant to address the research ques�on? 6.3. Is appropriate considera�on given to the limita�ons associated with this integra�on, e.g., the divergence of qualita�ve and quan�ta�ve data in a triangula�on design? Apply the criteria use for qualita�ve data for the qualita�ve component and quan�ta�ve component respec�vely.
Overall Quality Score
Comments on score: Low (25%) Medium (50%) High 70% - 100%
Reviewer 2 Comments: NB: Scoring metrics The score can be computed by coun�ng the total number of “yes” and expressing them as a percentage ie below 25% represent Low Quality, 50% represent Medium Quality, and 70% and above represent high Quality.
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34 E. BADU ET AL.
