Chronic Stress, Behavioral Tendencies, and Determinants of Health Behaviors in Nurses: a Mixed-methods Approach

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2022 Mar 31

PMID 35354449

Authors

Luis Heuel

Svea Lubstorf

Ann-Kathrin Otto

Bettina Wollesen

Affiliations

Soon will be listed here.

Abstract

Background: Nurses experience high, and often chronic, levels of occupational stress. As high-quality care requires a healthy workforce, individualized stress-alleviating interventions for nurses are needed. This study explored barriers and resources associated with health behaviors in nurses with different stress levels and work-related behavioral tendencies and identified health behavior determinants based on the Health Action Process Approach (HAPA) model.

Methods: Applying a mixed methods transformative triangulation design, n = 43 nurses filled out chronic stress (SSCS) and work-related behavior and experience patterns (German acronym AVEM) questionnaires, and participated in semi-structured interviews. With content analysis, categories of health behavior-related barriers and resources emerged. Behavior determinants (self-efficacy, outcome expectancies), health behavior, and barriers and resources were quantified via frequency and magnitude coding and interrelated with SSCS and AVEM scores to link level of health behavior with potential influencing factors. Nonparametric tests explored differences in quantified variables for SSCS and AVEM scores and 4-step-hierarchical regression analysis identified predictors for health behavior.

Results: Eighty-four percent of the nurses were chronically stressed while 49% exhibited unhealthy behavioral tendencies at the workplace. 16 personal and organizational themes (six resources, ten barriers) influenced health behaviors. Stress was associated with resource frequency (p = .027) and current health behaviors (p = .07). Self-efficacy significantly explained variance in health behaviors (p = .003).

Conclusion: Health promotion related barriers and resources should be considered in designing nurse health promotion campaigns. Practitioners need to individualize and tailor interventions toward stress and behavioral experiences for sustainable effects on adherence and health.

Citing Articles

Procrastination and Health in Nurses: Investigating the Roles of Stress, Health Behaviours and Social Support.

Sirois F, Biskas M Int J Environ Res Public Health. 2024; 21(7).

PMID: 39063475 PMC: 11277167. DOI: 10.3390/ijerph21070898.

Compensation Method for Missing and Misidentified Skeletons in Nursing Care Action Assessment by Improving Spatial Temporal Graph Convolutional Networks.

Han X, Nishida N, Morita M, Sakai T, Jiang Z Bioengineering (Basel). 2024; 11(2).

PMID: 38391613 PMC: 10886177. DOI: 10.3390/bioengineering11020127.

The Predominance of the Health-Promoting Patterns of Work Behavior and Experience in General Practice Teams-Results of the IMPROVE Study.

Thielmann B, Wagner A, Bozorgmehr A, Rind E, Siegel A, Hippler M Healthcare (Basel). 2024; 12(3).

PMID: 38338184 PMC: 10855740. DOI: 10.3390/healthcare12030299.

Art therapy-based interventions to address burnout and psychosocial distress in healthcare workers-a systematic review.

Tjasink M, Keiller E, Stephens M, Carr C, Priebe S BMC Health Serv Res. 2023; 23(1):1059.

PMID: 37794353 PMC: 10552408. DOI: 10.1186/s12913-023-09958-8.

Facilitators Associated with Nursing Burnout in the Ambulatory Care Setting as COVID-19 Subsides: A Rapid Review.

Lieneck C, Bair J, Ardell S, Aldridge B, Austin B Healthcare (Basel). 2023; 11(15).

PMID: 37570363 PMC: 10418695. DOI: 10.3390/healthcare11152122.

References

Fiabane E, Giorgi I, Sguazzin C, Argentero P . Work engagement and occupational stress in nurses and other healthcare workers: the role of organisational and personal factors. J Clin Nurs. 2013; 22(17-18):2614-24. DOI: 10.1111/jocn.12084. View

Lin L, He G, Yan J, Gu C, Xie J . The Effects of a Modified Mindfulness-Based Stress Reduction Program for Nurses: A Randomized Controlled Trial. Workplace Health Saf. 2018; 67(3):111-122. DOI: 10.1177/2165079918801633. View

Perry L, Lamont S, Brunero S, Gallagher R, Duffield C . The mental health of nurses in acute teaching hospital settings: a cross-sectional survey. BMC Nurs. 2015; 14:15. PMC: 4405850. DOI: 10.1186/s12912-015-0068-8. View

Lim J, Bogossian F, Ahern K . Stress and coping in Australian nurses: a systematic review. Int Nurs Rev. 2010; 57(1):22-31. DOI: 10.1111/j.1466-7657.2009.00765.x. View

Stanulewicz N, Knox E, Narayanasamy M, Shivji N, Khunti K, Blake H . Effectiveness of Lifestyle Health Promotion Interventions for Nurses: A Systematic Review. Int J Environ Res Public Health. 2019; 17(1). PMC: 6981404. DOI: 10.3390/ijerph17010017. View

Homan K, Sirois F . Self-compassion and physical health: Exploring the roles of perceived stress and health-promoting behaviors. Health Psychol Open. 2018; 4(2):2055102917729542. PMC: 5779931. DOI: 10.1177/2055102917729542. View

Maneze D, DiGiacomo M, Salamonson Y, Descallar J, Davidson P . Facilitators and Barriers to Health-Seeking Behaviours among Filipino Migrants: Inductive Analysis to Inform Health Promotion. Biomed Res Int. 2015; 2015:506269. PMC: 4561863. DOI: 10.1155/2015/506269. View

Sarkar S, Taylor W, Lai D, Shegog R, Paxton R . Social support for physical activity: Comparison of family, friends, and coworkers. Work. 2017; 55(4):893-899. DOI: 10.3233/WOR-162459. View

Li Y, Zhang J, Wang S, Guo S . The Effect of Presenteeism on Productivity Loss in Nurses: The Mediation of Health and the Moderation of General Self-Efficacy. Front Psychol. 2019; 10:1745. PMC: 6685003. DOI: 10.3389/fpsyg.2019.01745. View

10.

Chen X, Zhang G, Yin X, Li Y, Cao G, Gutierrez-Garcia C . The Relationship Between Self-Efficacy and Aggressive Behavior in Boxers: The Mediating Role of Self-Control. Front Psychol. 2019; 10:212. PMC: 6389640. DOI: 10.3389/fpsyg.2019.00212. View

11.

Levitt H, Bamberg M, Creswell J, Frost D, Josselson R, Suarez-Orozco C . Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA Publications and Communications Board task force report. Am Psychol. 2018; 73(1):26-46. DOI: 10.1037/amp0000151. View

12.

Daigle S, Talbot F, French D . Mindfulness-based stress reduction training yields improvements in well-being and rates of perceived nursing errors among hospital nurses. J Adv Nurs. 2018; 74(10):2427-2430. DOI: 10.1111/jan.13729. View

13.

Sheeran P, Maki A, Montanaro E, Avishai-Yitshak A, Bryan A, Klein W . The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: A meta-analysis. Health Psychol. 2016; 35(11):1178-1188. DOI: 10.1037/hea0000387. View

14.

Williams S, French D . What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour--and are they the same?. Health Educ Res. 2011; 26(2):308-22. DOI: 10.1093/her/cyr005. View

15.

Hapke U, Maske U, Scheidt-Nave C, Bode L, Schlack R, Busch M . [Chronic stress among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013; 56(5-6):749-54. DOI: 10.1007/s00103-013-1690-9. View

16.

Tsai Y, Liu C . An eHealth education intervention to promote healthy lifestyles among nurses. Nurs Outlook. 2015; 63(3):245-54. DOI: 10.1016/j.outlook.2014.11.005. View

17.

Zhang Y, Flum M, Kotejoshyer R, Fleishman J, Henning R, Punnett L . Workplace Participatory Occupational Health/Health Promotion Program: Facilitators and Barriers Observed in Three Nursing Homes. J Gerontol Nurs. 2016; 42(6):34-42. PMC: 5860908. DOI: 10.3928/00989134-20160308-03. View

18.

Park C, Iacocca M . A stress and coping perspective on health behaviors: theoretical and methodological considerations. Anxiety Stress Coping. 2013; 27(2):123-37. DOI: 10.1080/10615806.2013.860969. View

19.

Reyes Fernandez B, Knoll N, Hamilton K, Schwarzer R . Social-cognitive antecedents of hand washing: Action control bridges the planning-behaviour gap. Psychol Health. 2016; 31(8):993-1004. DOI: 10.1080/08870446.2016.1174236. View

20.

Edwards D, Burnard P . A systematic review of stress and stress management interventions for mental health nurses. J Adv Nurs. 2003; 42(2):169-200. DOI: 10.1046/j.1365-2648.2003.02600.x. View