Occupational Distress Research Articles

Occupational distress in nursing: a psychoanalytic reading of the literature

Occupational stress in nursing has attracted considerable attention as a focus for research and as a consequence multiple objects of nurses' stress, or 'stressors', have been identified. This paper puts into question the dominant conceptual and methodological approach to occupational stress in nursing research by both foregrounding the notion of anxiety and juxtaposing it with the notion of 'stress'. It is argued that the notion of 'stress' and the domination of the questionnaire have produced a narrow reading of the topic. Some of the literature on occupational stress/anxiety in nursing is reviewed and our analysis illustrates how the identified objects of stress have a tendency to multiply contingent on the number of studies undertaken. Thus definitive objects of nurses' stress remain elusive. We argue that a return to the notion of 'anxiety' and methodological approaches other than empirical ones can bring both depth and breadth to the consideration of occupational distress in nursing. Further, we argue that the object of 'anxiety' is unconscious, thus unknown, and given this, a more informative approach is to map nurses' response to anxiety, the discursive formations arising out of anxiety, rather than attempt to define those objects of anxiety.

Psychosocial Factors Related to Gambling Abstinence and Relapse in Members of Gamblers Anonymous

Problem gamblers account for almost one-third of the industry's total revenue with the adverse effects of problem gambling including significant financial loss, legal and occupational difficulties, family problems, psychological distress and suicide. As such, it is important to understand the influential factors in gambling abstinence and relapse, which will assist in the development of relapse prevention methods in therapeutic treatment regimes. This paper reported the role of a set of seven predictors in distinguishing between abstinent and relapsed gamblers among 75 Gambling Anonymous (GA) members (55 males; 20 females; Mean age 45 years) in Southeast Queensland. The measures taken were meeting Attendance and Participation, Social Support, God Belief, Belief in a Higher Power, Working the 12-steps of Recovery, Gambling Urges and Erroneous Cognitions. Discriminant analysis revealed that the variables separating the two groups were significant, suggesting that GA members achieving abstinence could be distinguished from those who relapsed, with Attendance and Participation, and Social Support contributing the greatest influence on member's ability to abstain from gambling. The findings suggested that GA member's involvement in meetings, and support from family and friends had significant impact on their gambling abstinence. In contrast, increased gambling urges and erroneous cognitions increased the chance of relapse.

Self‐assessed occupational health and working environment of female nurses, cabin crew and teachers

The aim of this study was to describe and compare the self-assessed occupational health among female nurses, cabin crew and teachers, in relation to their working environment. Similarities between the three occupations, i.e. predominantly female and service-oriented, render them interesting in comparison with respect to health and working environment. The participants were female Icelandic cabin crew, nurses and elementary school teachers. A questionnaire including items on socio-demographics, working environment (addressing work pace, job security, monotonous work, assistance, physically strenuous work and physical environmental factors) and a symptom list was used for data collection. Factor analyses on the symptom list resulted in five symptom scales: Musculoskeletal, Stress and exhaustion, Common cold, Gastrointestinal and Sound perception scale. A total of 1571 questionnaires were distributed. The response rate was 65.7-69%, depending on occupation. Data were collected in 2002. Cabin crew reported worse gastrointestinal, sound perception and common cold symptoms than nurses and teachers. Cabin crew and teachers reported worse symptoms of stress and exhaustion than nurses (p < 0.05). When compared with teachers and nurses cabin crew reported less job security and more physically strenuous and monotonous work. Nurses were likelier to seek assistance from co-workers or patients as well as to take care of an older relative than teachers and cabin crew. Regression analysis found that within each occupation distress from environmental factors resulted in higher score on all the symptom scales. Nurses experience less stress and exhaustion than teachers and cabin crew. In comparison with one or both of the other occupations nurses are more likely to assist each other with their work, experience job security, reporting physically complex work and take care of older relatives. This should be highlighted as positive aspects of nurses' work praised as displaying responsibility and interconnectedness of nurses'.

Predictors of treatment outcome in headache patients with the Millon Clinical Multiaxial Inventory III (MCMI-III)

The objective was to discover possible psychological factors influencing treatment outcome for headache patients referred to psychological treatment in a tertiary headache centre by initial assessment using the Millon Clinical Multiaxial Inventory III (MCMI-III). The MCMI-III was administered to 136 referred patients. Patients with valid protocols who had completed their treatment by October 2003 were included. Multidisciplinary treatment was offered including psychological treatment, mainly pain and stress management, pharmacological treatment and physiotherapy. Medians of MCMI-III scales for patients with and without reduction in headache frequency were compared. All of the eligible 58 patients were included in the study. Patients with reduction in headache frequency after treatment had lower scores on the MCMI-III Somatoform, Major depression and Avoidant personality pattern scales and higher scores on the Alcohol Dependence, Self-Defeating personality pattern, Depressive personality pattern, Drug Dependence, Aggressive personality pattern and Bipolar: Manic scales before treatment compared to patients without effect. Patients with a positive treatment effect reported less symptoms of depression and seemed less inclined to somatisation than non-responders. Responders also appeared more likely to experience increased social or occupational distress and report difficulties with handling emotions and an enduring tendency to focus on negative aspects of the self-image. The results can give valuable information regarding treatment planning and development.

Gulf war‐related trauma and psychological distress of Kuwaiti children and their mothers

The participants were 111 Kuwaiti boys and girls and 59 mothers assessed in 1993 and 2003 to determine exposure to war-related trauma during the Iraqi occupation and subsequent psychological distress. Children were classified into four groups based on what happened to their fathers during the occupation: killed, missing, arrested, or unharmed. The results indicate that the group whose fathers were arrested had the highest level of posttraumatic stress symptoms and the highest level of depression and anxiety in 2003. In 1993, the highest levels of depression for children and their mothers were observed in those whose fathers-husbands were killed or missing relative to controls. Long-term effects of war-related trauma in children may be influenced by the war experience of their fathers.

Reducing occupational psychological distress: a randomized controlled trial of a mailed intervention

There are increasing levels of psychological distress among general practitioners (GPs). The purpose of this study is to evaluate the effectiveness of a mailed intervention to reduce distress among 'at-risk' GPs. A questionnaire was sent to 1356 GPs from eight Divisions of General Practice. Out of 819 (60%) who responded, 233 GPs were recruited with scores indicative of psychological distress. These GPs were randomized to intervention (n = 120) or control (n = 113). The intervention consisted of a simple letter feeding back and interpreting the psychological score together with a self-help sheet. During the study, an educational program was offered to GPs by Divisions of General Practice. The main outcome measure used was changes in psychological distress (General Health Questionnaire 12) score after 3 months. Significance was set at P < 0.05. Initial analysis of the data showed borderline significance (P = 0.05). However, analysis of the data post hoc excluding GPs who participated in the educational program showed a significant reduction in psychological distress (P = 0.03). It appears that there may have been a dilution of the intervention effect. Mailed interventions are a cost-effective way of reaching at-risk GPs and may contribute to a reduction in psychological morbidity.

The Lived Experience of Moral Distress: Nurses Who Assisted With Elective Abortions

The concept of moral distress has been studied mainly as an occupational issue and has not been developed for use in clinical practice. This study was designed to bridge prior studies of occupational moral distress with future clinical investigations of moral distress. Study aims were to discover the essence, properties, and full content domain of the concept of moral distress in order to develop a universal definition of the concept. A modified phenomenological study of nurses' experience of a particular moral issue was conducted. A maximum variation sampling strategy was used to recruit a final sample of registered nurses (N = 10). Interior aversion is the essential act of moral distress. Five properties of the lived experience of moral distress were identified: perception, pain, valuing, altered participation, and perspective. Three types of moral distress identified in this study were: shocked, muted, and suppressed (persistent). Type of moral distress was related to situational conditions, recognition of moral ends, quality of coping processes, and temporal breadth. Negative outcomes of moral distress, which probably exist, were undetectable with this study design. The definition has been composed in universal terms, but remains tentative, since the full content domain of moral distress was largely but not definitively identified.

MULTIVARIATE ANALYSIS OF PERCEIVED DYSFUNCTION RATINGS OF PERSONALITY DISORDER SYMPTOMS

Dysfunction in personality disorder symptoms was assessed using multivariate techniques to analyse lay judges' (N = 216) ratings of occupational impairment, social impairment, and personal distress. Factor analysis revealed that ratings of occupational impairment and social impairment loaded onto distinct factors. Personal distress ratings loaded onto two separate factors: high distress and low distress. Multidimensional scaling revealed two dimensions for overall dysfunction among personality disorders: severity of dysfunction and internalization-externalization. The dimensions were independence-dependence and severity of dysfunction for occupational impairment, interpersonal involvement and dominance-submission for social impairment, and internalization-externalization and severity for personal distress.

Predictors of job satisfaction and absenteeism in two samples of Hong Kong nurses.

Stress-related outcomes of job satisfaction and absenteeism among nurses should receive more attention in Hong Kong because absenteeism is costly. Many nurses' complaints are due to organizational change in privatization since the establishment of the Hong Kong Hospital Authority in 1991. Organizational climate is found to be an antecedent of job dissatisfaction and absenteeism in many studies in western societies. To investigate the role of organizational climate and psychological distress on job satisfaction; and the role of climate, distress and job satisfaction on absenteeism in Hong Kong nurses, while controlling for demographic variables. A self-administered questionnaire survey method was used to collect data from two samples of nurses within a 8-month period. They are, respectively, 144 (74 general nurses, 70 psychiatric nurses; 47 males, 97 females) and 114 (85 general nurses, 29 psychiatric nurses; 17 males, 97 females) nurses. Multiple regression analyses revealed that occupational type (psychiatric/general), environment (the physical conditions in the work area) and psychological distress were significant predictors of job satisfaction for sample 1; and well-being (social relations, welfare and health issues) was the only significant predictor of job satisfaction for sample 2. However, age, involvement (the degree of commitment displayed towards employees by the organization), psychological distress and job satisfaction were significant predictors of absenteeism for sample 1; and occupational type, organization (the interaction between the worker and the organization), and involvement were significant predictors of absenteeism for sample 2. The empirical findings provide support for the climate-job satisfaction and climate-absenteeism relationships. Psychological distress could be an antecedent of job satisfaction; and job satisfaction could be an antecedent of absenteeism. Certain climate dimensions should be improved to enhance job satisfaction and reduce distress, which in turn will reduce absenteeism.

Routine occupational stress and psychological distress in police

The relationship between routine work stress and psychological distress was investigated among 733 police officers in three US cities, during 1998‐1999. The Work Environment Inventory (WEI) was developed to assess exposure to routine work stressors, while excluding duty‐related traumatic stressors (critical incidents). The WEI and its general properties are presented. The relationship between routine work stress exposure and psychological distress is then explored. Exposure to routine work stressors predicted general psychological distress (r = 0.46), as well as post‐traumatic stress symptoms following officers’ most traumatic career incident (rs = 0.26 to 0.39). Multivariate analyses found that these effects were independent of, and larger than, the effects of cumulative critical incident exposure. (Time since the most traumatic event, social support, and social desirability effects were also controlled statistically.) Routine occupational stress exposure appears to be a significant risk factor for psychological distress among police officers, and a surprisingly strong predictor of post‐traumatic stress symptoms.

The relationship of child adjustment to husbands' and wives' marital distress, perceived family conflict, and mothers' occupational status.

Measures of marital distress, perceived family conflict, and child adjustment were obtained from 74 pairs of husbands and wives with at least one child age 6 to 12 in order to determine the relationship between wives' occupational status, marital distress, family conflict, and child adjustment. Results revealed a strong and significant relationship between husbands' and wives' perceived family conflict and child maladjustment. No significant main effects or interactions were found between mothers' occupational status, or husbands' or wives' marital distress and child adjustment. The results support the downward extension to children of the previously reported relationship between perceived family conflict and adolescent adjustment.

Self-perceived occupational stress and distress in a Scottish police force

This paper describes an empirical study (n = 699) of occupational stress in a Scottish police force. The self-perceived stress associated with a variety of organizational and opearational stressors was examined along with the associated distress in the police officers in terms of symptoms of anxiety, somatic complaint, severe depression and social dysfunction. The analysis revealed that in spite of the potential that police work offers for exposure to adverse opeational situations such as violence or death, the highest levels of associated stress lie in relation to organizational factors such as officers' perceptions of staff shortages, inadequate resources, time pressures, lack of communication and work overload. Differential rates of perceived stress are reported accordng to gender, rank and working location. This paper further validates previsous research on stress in British police and addresses the situation from a Scottish perspective.

The 'Stably Unstable' Borderline Personality Disorder: History, Theory, and Nursing Intervention

Borderline personality disorder (BPD) is a complicated condition and poses equally difficult treatment issues for nurses and clients alike. People with borderline personalities have inflexible traits that either impair social and occupational functioning or cause distress. Current research findings reflect that many people diagnosed with BPD have indeed been abused either physically or sexually in early childhood. The prevalence of people with BPD is estimated to be between 0.2% and 1.78%. Psychoanalysis, behavioral therapies, and cognitive therapies have been used in the clinical setting for the treatment of clients with BPD. Group and family therapies also are helpful.

Coping with Occupational Problems: The Limits of Individual Efforts

This analysis considers the effectiveness of four occupational coping efforts: direct action, optimistic comparisons, selective ignoring, and restricted expectations. Two criteria for effectiveness are considered: reduction in occupational distress, and reduction in later occupational problems. Data are drawn from two waves of interviews with a large metropolitan sample. Effectiveness is assessed net of age, gender, socioeconomic status, type, of employment, marital status, number of children, and initial level of difficulty. Lesser efforts to restrict expectations and greater use of optimistic comparisons were associated with lower concurrent occupational distress. as well as with reductions in distress over time. However, none of the coping efforts directly affected later occupational problems; rather, the initial level of difficulty, and characteristics of one's work life-full-time versus part-time, occupational prestige, and income level-were the key influences on later problem levels. When these findings are linked to earlier studies of coping effectiveness for marital and parental problems, they suggest that optimistic comparisons and avoidance of resigned, impotent stances are generally beneficial stances. The findings are also considered in light of recent discussions of social status and emotional distress, and it is concluded that neither lower social status nor female gender is consistently associated with less adaptive coping efforts.

Police occupational demands, psychological distress and the coping function of alcohol.

Alcohol use is an important problem among personnel in the high-stress police occupation. The impact of occupational demands, psychological distress, and coping on police alcohol consumption are explored. Results indicate that psychological distress, as an intervening factor between work demands and alcohol use itself, has an important positive effect on alcohol use.