Factors Influencing Occupational Stress Perceived by Emergency Nurses During Prehospital Care: A Systematic Review

Overview

Journal Psychol Res Behav Manag

Publisher Dove Medical Press

Specialty Social Sciences

Date 2024 Feb 20

PMID 38374938

Authors

Diego Jose Montero-Tejero

Nerea Jimenez-Picon

Juan Gomez-Salgado

Elena Vidal-Tejero

Javier Fagundo-Rivera

Affiliations

Soon will be listed here.

Abstract

Objective: To assess personal and work-related factors influencing the stress levels of nurses during prehospital care. Specifically, to identify associations between the level of perceived stress, the degree of professional experience, and the level of knowledge. Secondly, to examine the relationship between stress levels and violence in the work environment. And third, to investigate the main protective factors against work-related stress during prehospital care.

Methods: Systematic review in PubMed, WOS, Enfispo, Cochrane, and LILACS databases following the PRISMA methodology (last search 08/Aug/2023). Following the PECO framework, studies on occupational stress factors in ambulance emergency nurses were investigated. Studies in English or Spanish, from 2013 to 2023, and only research articles were admitted, thus excluding reviews, dissertations, and grey literature. Possible bias and level evidence were assessed using critical appraisal tools and GRADE. This protocol was registered in PROSPERO with code CRD42023446080.

Results: Fourteen articles were selected, and n=855 prehospital nurses were identified. One study was a clinical trial, and the others were observational and qualitative. The level of evidence was very low (n=7), low (n=6), and moderate (n=1); any study was excluded due to methodological bias. Five categories of stressors were extracted: the management of the health service (ie, workload organisation, and resources), patient care (mainly paediatric care), interpersonal stressors (relationship with peers), environmental factors (exposure to injuries), and personal factors (training, experience, and coping strategies). Violence at work is frequent for prehospital nurses, implying both verbal and physical aggressions. Support from peers was associated with positive results against stress.

Conclusion: Managing workload and improving resources in the work environment are essential to reduce fatigue and allow emotional processes to be addressed. Providing workers with coping skills also imposes on them the responsibility to cope with stress. Collective awareness is the main element in reducing the incidence of stress.

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References

Dadashzadeh A, Rahmani A, Hassankhani H, Boyle M, Mohammadi E, Campbell S . Iranian pre-hospital emergency care nurses' strategies to manage workplace violence: A descriptive qualitative study. J Nurs Manag. 2019; 27(6):1190-1199. DOI: 10.1111/jonm.12791. View

Jones S . Describing the Mental Health Profile of First Responders: A Systematic Review [Formula: see text]. J Am Psychiatr Nurses Assoc. 2017; 23(3):200-214. DOI: 10.1177/1078390317695266. View

Rajabi F, Jahangiri M, Molaeifar H, Honarbakhsh M, Farhadi P . Occupational stress among nurses and pre-hospital emergency staff: application of fuzzy analytic hierarchy process (FAHP) method. EXCLI J. 2018; 17:808-824. PMC: 6141823. DOI: 10.17179/excli2018-1505. View

Araujo A, Bampi L, Cabral C, Queiroz R, Calasans L, Vaz T . Occupational stress of nurses from the Mobile Emergency Care Service. Rev Bras Enferm. 2020; 73 Suppl 1:e20180898. DOI: 10.1590/0034-7167-2018-0898. View

Forsell L, Forsberg A, Kisch A, Rantala A . Specialist Ambulance Nurses' Perceptions of Nursing: A Phenomenographic Study. Int J Environ Res Public Health. 2020; 17(14). PMC: 7400022. DOI: 10.3390/ijerph17145018. View

Gentil R, Ramos L, Whitaker I . Nurses' training in prehospital care. Rev Lat Am Enfermagem. 2008; 16(2):192-7. DOI: 10.1590/s0104-11692008000200004. View

Aisling M, Aisling D, David C . An Assessment of Psychological Need in Emergency Medical Staff in the Northern Health and Social Care Trust Area. Ulster Med J. 2016; 85(2):92-8. PMC: 4920499. View

Hendel T, Fish M, Aboudi S . Strategies used by hospital nurses to cope with a national crisis: a manager's perspective. Int Nurs Rev. 2001; 47(4):224-31. DOI: 10.1046/j.1466-7657.2000.00046.x. View

van der Velden P, Bosmans M, van der Meulen E . Predictors of workplace violence among ambulance personnel: a longitudinal study. Nurs Open. 2016; 3(2):90-98. PMC: 5047336. DOI: 10.1002/nop2.38. View

10.

Westphal M, Bingisser M, Feng T, Wall M, Blakley E, Bingisser R . Protective benefits of mindfulness in emergency room personnel. J Affect Disord. 2015; 175:79-85. DOI: 10.1016/j.jad.2014.12.038. View

11.

Gomez-Salgado J, Fagundo-Rivera J, Ortega-Moreno M, Allande-Cusso R, Ayuso-Murillo D, Ruiz-Frutos C . Night Work and Breast Cancer Risk in Nurses: Multifactorial Risk Analysis. Cancers (Basel). 2021; 13(6). PMC: 8004617. DOI: 10.3390/cancers13061470. View

12.

Gomez-Gutierrez M, Bernaldo-de-Quiros M, Piccini A, Cerdeira J . Posttraumatic Stress Symptomatology in Pre-Hospital Emergency Care Professionals Assaulted by Patients and/or Relatives: Importance of Severity and Experience of the Aggression. J Interpers Violence. 2014; 31(2):339-54. DOI: 10.1177/0886260514555370. View

13.

Fagundo-Rivera J, Gomez-Salgado J, Garcia-Iglesias J, Allande-Cusso R, Ortega-Moreno M, Ruiz-Frutos C . [Work, family and nurses perception about their own health: relationship with breast cancer and shift work.]. Rev Esp Salud Publica. 2021; 95. View

14.

Sterud T, Hem E, Lau B, Ekeberg O . A comparison of general and ambulance specific stressors: predictors of job satisfaction and health problems in a nationwide one-year follow-up study of Norwegian ambulance personnel. J Occup Med Toxicol. 2011; 6(1):10. PMC: 3074526. DOI: 10.1186/1745-6673-6-10. View

15.

Romero Saldana M, Moreno Pimentel A, Santos Posada A . Occupational Health Nursing: Competence and experience to achieve the safety, health and well-being of the working population. Enferm Clin (Engl Ed). 2019; 29(6):376-380. DOI: 10.1016/j.enfcli.2019.09.012. View

16.

Olsson M, Svensson A, Andersson H, Dehre A, Elmqvist C, Rask M . Educational intervention in triage with the Swedish triage scale RETTS©, with focus on specialist nurse students in ambulance and emergency care - A cross-sectional study. Int Emerg Nurs. 2022; 63:101194. DOI: 10.1016/j.ienj.2022.101194. View

17.

Vicente V, Jansson J, Wikstrom M, Danehorn E, Wahlin R . Prehospital Emergency Nurses' coping strategies associated to traumatic experiences. Int Emerg Nurs. 2021; 59:101083. DOI: 10.1016/j.ienj.2021.101083. View

18.

Wihlborg J, Edgren G, Johansson A, Sivberg B . The desired competence of the Swedish ambulance nurse according to the professionals - a Delphi study. Int Emerg Nurs. 2013; 22(3):127-33. DOI: 10.1016/j.ienj.2013.10.004. View

19.

Barker T, Stone J, Sears K, Klugar M, Tufanaru C, Leonardi-Bee J . The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evid Synth. 2023; 21(3):494-506. DOI: 10.11124/JBIES-22-00430. View

20.

Mirzaei A, Mozaffari N, Habibi Soola A . Corrigendum to "Occupational stress and its relationship with spiritual coping among emergency department nurses and emergency medical services staff" [Int. Emergency Nurs. 62 (2022) 101170]. Int Emerg Nurs. 2022; 64:101187. PMC: 9148189. DOI: 10.1016/j.ienj.2022.101187. View