Stress In Clinical Settings Research Articles

The Impact of a Mindfulness-based Intervention on Stress and Self-compassion among Nurses: A Quasi-experimental Study

Abstract Background: Nurses play a vital role in hospitals as well as other medical settings. They often deal with a lot of stress and effort. Clinical posting at the hospital has been linked to adverse health and work outcomes for many staff nurses due to stress, worry, pressure, and exhaustion. Reduced stress, anxiety, and discontent are the stated goals of this study, which assesses the efficacy of a mindfulness intervention for pediatric nurses. Methodology: This research adopted a quantitative evaluative approach and employed a quasi-experimental, nonrandomized comparison group design, and a purposive sampling technique was used to draw the samples. The investigation was conducted at selected pediatric hospitals within Vijayapura, Karnataka, among the 96 pediatric nurses. Results: The research findings indicated a significant increase in the mean posttest self-compassion score compared to the pretest score, with a t-value of 152.24 at a significance level of P = 0.05. The study demonstrated that mindfulness-based training effectively enhanced self-compassion among experimental staff nurses, as evidenced by a significant improvement at a 5% significance level and 94° of freedom. Furthermore, the Chi-square test revealed a strong association between stress levels and posting area in the interventional group, with a χ2 = 10.725 and 2° of freedom at a significance level of 0.05%. Specifically, a significant correlation was found between family type and the number of children in the family in the interventional group (χ2 = 6.883 with 2° of freedom; χ2 = 9.063), whereas no other variables significantly impacted self-compassion in this group. In contrast, none of the demographic variables had a significant effect on self-compassion in the comparison group. Conclusion: The researcher showed that the mindfulness stress reduction intervention decreased stress and increased self-compassion among pediatric hospital staff nurses. Nursing administrators could use this cost-effective solution to reduce nurse stress in clinical settings.

Investigating the Relationship between Clinical Self-Efficacy and Psychological Stress in Clinical Setting in Nursing Students

Introduction: Nursing students in clinical setting are faced with various stressors that can affect their performance and clinical self-efficacy and create problems in training skilled and self-efficacious nurses. Therefore, the present study was conducted with the aim of determining the relationship between clinical self-efficacy and psychological stress in nursing students of Hamedan University of Medical Sciences in 2022. Methods: In this descriptive cross-sectional correlational study, from 350 nursing students of Hamadan University of Medical Sciences in 2022, 218 of them were selected by stratified sampling method. Data collection tools included: demographic characteristics checklist, clinical self-efficacy questionnaire and Cohen's psychological stress in clinical setting questionnaire. Data were analyzed by descriptive statistics, Pearson correlation coefficient, one-way ANOVA and independent sample t-test in SPSS. Results: According to the results, the mean ± standard deviation scores of clinical self-efficacy of students, was 65.81±11.05 and their psychological stress in clinical setting was 63.92±13.70. It was also found that there is a reverse and significant statistical relationship between clinical self-efficacy and psychological stress in clinical setting (r = - 0.25, P < 0.001). Conclusion: Clinical self-efficacy can play a significant role as a protective factor on the level of psychological stress of nursing students in clinical settings. Considering that a significant part of nursing students' learning takes place in clinical settings, paying attention to reducing students' psychological stress in these settings and subsequently improving their clinical self-efficacy is particularly important.

Metformin Reverses the Effects of Angiotensin 2 in Human Mammary Arteries by Modulating the Expression of Nitric Oxide Synthases

Abstract Angiotensin 2 impairs vascular function by activation of reactive oxygen species (ROS) production and development of endothelial dysfunction. Metformin, the first-line therapeutic agent for type 2 diabetes mellitus, has vascular protective properties, beyond its glucose lowering effects. The aim of the present study was to investigate the interaction between metformin and angiotensin 2 in human internal mammary arteries harvested from patients with coronary heart disease undergoing revascularization procedure, by evaluation of vascular function, reactive oxygen species (ROS) production and the gene expression of nitric oxide (NO) synthases (endothelial – eNOS, neuronal – nNOS and inducible – iNOS). To this aim, vascular samples were incubated with angiotensin 2 (Ang2, 12 h) with/without metformin (Metf, 10 μM) and used for ROS measurement (FOX assay), vascular reactivity in organ bath (contractility to phenylephrine, relaxation to acetylcholine, contractility to NG-nitro-L-arginine methyl ester/L-NAME) and RTPCT studies. Acute incubation of the vascular rings with Ang2 impaired vascular reactivity (increase contractility, decrease relaxation), increased ROS production, supressed eNOS/nNOS and increased iNOS mRNA expression. Ex vivo incubation with metformin at a clinically relevant concentration reversed all these effects. These data suggest that Metformin might be useful in alleviating endothelial dysfunction by improving the endothelial-dependent relaxation and mitigating oxidative stress in clinical setting associated with cardiovascular disease regardless the presence of impaired glucose metabolism.

Low Subjective Wellbeing Is Associated with Psychological Distress in People Living with Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a common and debilitating disease of the gastrointestinal tract. Psychological distress is highly comorbid to IBD, especially during periods of active disease. However, a controversy exists on how to best manage its symptoms in the IBD population. This study aimed to explore protective and risk factors of psychological distress in IBD. A cross-sectional online survey was conducted via social media and online patient forums. Respondents (N = 235) filled out questionnaires on demographics, health characteristics and a range of psychological variables. Measures of pain, disease activity, comorbid functional symptom severity, social support, subjective wellbeing, sleep quality, fatigue, stress, age, BMI and gender were entered into the Classification and Regression Tree Analysis model. Overall, 87 participants (37%) reported distress. Self-reported stress significantly discriminated between cases of probable psychological distress. In those with high stress, patients with and without probable psychological distress were separated by subjective wellbeing. Among patients with low stress, fatigue was the primary discriminator. Monitoring patients for low subjective wellbeing and high stress in clinical settings could offer an opportunity to engage in early intervention to limit psychological distress development. Monitoring for fatigue in patients who seem otherwise psychologically well could offer preventative benefits.

Perceived Stress Among Iranian Nursing Students in a Clinical Learning Environment: A Cross-Sectional Study.

BackgroundNursing students experience a high level of stress in clinical settings. This study aimed to investigate the stress perceived by Iranian nursing students in the clinical learning environment and its relationship with the characteristics of students.MethodsIn this cross-sectional study, 430 nursing students who had passed at least 1 clinical training unit were recruited from universities in the Southeast of Iran using the census method. Data were collected by administering a demographic and researcher-made questionnaire to assess the perceived clinical stress. Demographic characteristics included age, sex, marital status, year of study, interest in the field, and previous semester average. Data were analyzed using independent t-test, ANOVA, and correlation coefficient test (α < 0.05).ResultsThe mean score of overall stress experienced by the participants was 92.08±16.8 (out of 160), which was at a moderate level. Based on the study results, the most stress-inducing factors for students were instructors’ limited clinical competence and instructors’ inappropriate conduct. Gender (p = 0.01), fathers’ education (p = 0.01), mothers’ education (p = 0.01), interest in the field (p = 0.01), and year of study (p = 0.01) had a significant effect on the mean score of perceived clinical stress.ConclusionThe results of this study showed a moderate level of stress among the students. Also, instructors’ limited clinical competence and inappropriate conduct were 2 factors that caused the highest perceived stress among nursing students more than other factors.

Coping strategies of nursing students for dealing with stress in clinical setting: A qualitative study.

BackgroundNursing students in the clinical setting experience a high level of stress. The understanding of people involved in nursing education, from coping strategies of nursing students with clinical stress, is highly important for any kind of planning in this fieldObjectiveTo explore the coping strategies of Iranian nursing students with stress in a clinical setting.MethodsThis qualitative content analysis study was carried out with twenty nursing students who were selected using purposive sampling at the Razi nursing and midwifery school in Kerman, in Iran during a ten-month period in 2016. Data were collected using semi-structured face to face interviews, and analyzed through Graneheim and Lundman’s qualitative content analysis method.Results“Seeking well-being” as the main theme and three categories of “Active confrontation with stress”, “mastering the mind and body” and “avoidance” were obtained from data analysis.ConclusionThe exploration of nursing students’ experiences of coping with clinical stressors, increases students’ awareness of their coping strategy. The academic authorities in recognizing the coping strategies of students with stress in clinical setting, can provide necessary training on effective coping strategies for students.

Nursing students’ perceived stress and influences in clinical performance

Background: It is known that stress related to clinical training among nursing students could contribute to many physical and mental problems. However, little empirical evidence about the influence of stress in nurse students’ clinical performanceObjective: The objective of this study was to assess the association between perceived stresses, stress related factors, and students’ clinical performance.Method: Using the perceived stress scale, 539 Jordanian nursing students from 2 public universities in Jordan participated in the study.Results: The results showed that the mean of stress perceived by students was 45.9. Students’ assignment were perceived as the main source of stress (M= 10.7, SD= 4.5) followed by stress related to patients’ care (M= 10.5, SD= 5.5) and stress from teachers and nursing staff (M= 9.6, SD= 5.3). The lowest source of stress is from students’ lack of professional knowledge and skills (M= 3.96; SD= 2.8). The mean of students’ clinical performance is 73.4%. Students’ perceived stress has a significant negative correlation with students’ clinical performance (r= -.09; p &lt;.05). The results also showed significant negative correlation between stress related to lack of professional knowledge and skills, and stress related to patient care and students’ clinical performance.Conclusion: This study expanded on students’ stress in clinical settings, and warrants further research in assessing its impact on their performance. Teachers should be aware of and help students to overcome and cope with said stress related factors in the clinical settings effectively.

How can we easily measure glycemic variability in diabetes mellitus?

How can we easily measure glycemic variability in diabetes mellitus?

S4-4 - Protein Oxidation Products as Biomarkers

Oxidative stress is associated with aging and most degenerative diseases: it contributes to clinical complications, organ failure and mortality. Furthermore, oxidative damage accumulation in macromolecules has been considered as a cause of cellular damage and pathology. Interestingly, it is unknown whether and to what extent oxidative stress contributes to the clinical worsening and most importantly, no common strategy exists about its measurement. This is partially due to the fact that many methods of measuring oxidative stress have proven unreliable and no single method exists enabling objective determination and characterization of oxidative stress in clinical settings whether in aging or in chronic disease. Some methods basing on the measurement of lipid peroxidation, as the determination of F2-isoprostanes or malondialdehyde, or on the measurement of DNA/RNA damage, as 8-hydroxydesoxyguanosine or 8-hydroxydesoxyguanine, are widely used to determine oxidative stress and gain more and more acceptance or are reliable supportive parameters. A set of methods exists for clinical set-ups based on the measurement of protein oxidation or oxidative protein modification. Some of these methods are gaining more and more acceptance due to the development of easy to use and stable methods. This includes the long known method of protein carbonyl determination in various methodological variations, but also the use of the determination of protein-based nitrotyrosine or HNE-modified proteins. All these methods can be used in clinical set-ups, but special care has to be taken on chemical and biological sample stability. It should be mentioned, that no single method, however, is yet alone able to characterize oxidative stress under clinical conditions and, therefore, various combinations of damage parameters are the most promising tools.

Association of the C(−1019)G 5-HT1A promoter polymorphism with exposure to stressors preceding hospitalization for bipolar depression

In animals, a higher density of 5-HT1A receptors has been associated with increased behavioral despair after stress. In humans, the G variant of the C(-1019)G 5-HT1A receptor promoter gene polymorphism (rs6295) has been associated with higher expression of 5-HT1A receptors, increased depression, and lower stress preceding completed suicide. We studied the association of rs6295 with the amount of stress in early life and preceding hospitalization for a major depressive episode in course of bipolar disorder. In 74 consecutively admitted inpatients, early life and recent stressors were rated on the Social Readjustment Rating Scale and on the Risky Family Questionnaire. Homozygote carriers of the rs6295 G variant reported less stressful events before current hospitalization for bipolar depression, but not in early life. The G variant was also associated with a higher overall medication load in naturalistic settings before hospitalization. This is the first study that associated 5-HT1A receptor promoter gene variants with stressors preceding the need of hospitalization for bipolar depression. Our findings support the hypothesis that genetic factors affecting serotonergic neurotransmission might contribute to shape the individual resilience to the depressogenic effects of stress in clinical settings.

Complementary medicine for the management of chronic stress: superiority of active versus passive techniques

Recent epidemiological data indicate that chronic stress is an important component of cardiovascular risk, implicitly suggesting that stress management might offer a useful complement to orthodox medical treatment and prevention of hypertension. In this context, information on mechanisms, such as subclinical increases in arterial pressure and sympathetic drive, is well documented. Conversely, evidence on methodologies and comparative efficacy needs to be improved. Accordingly, this study was planned to test the autonomic and subjective effects of two popular modalities of stress management. We studied 70 patients complaining of stress-related symptoms, avoiding any potential autonomic confounder, such as established hypertension or drug treatment. Patients were divided in three groups: group I (n = 30) followed a breathing-guided relaxation training (active); group II (n = 15) an oriental massage, shiatsu (passive); and group III (n = 25) followed a sham intervention. Subjective effects of stress were assessed by validated questionnaires and autonomic nervous system regulation by spectral analysis of RR interval variability. Factor analysis was used to extract information simultaneously embedded in subjective and functional data. Although the problem of a greater quantity of treatment procedure in the active group than in the passive group existed, results showed that active relaxation, further to slightly reducing arterial pressure, might be more effective in relieving symptoms of stress and inducing an improved profile of autonomic cardiovascular regulation, as compared with passive massage or sham intervention. This active technique seems capable of beneficially addressing simultaneously the individual psychological and physiopathological dimensions of stress in clinical settings, with potentially beneficial effects on cardiovascular risk profile.

Aldose Reductase Inhibitor, Epalrestat, Reduces Lipid Hydroperoxides in Type 2 Diabetes

The increased flux of polyol pathway induced by hyperglycemia is implicated in the pathogenesis of various complications associated with diabetic, which results in increased oxidative stress. Because oxidative stress causes tissue damage in patients with diabetes, searching for an effective strategy to reduce oxidative stress in clinical setting is important in order to prevent diabetic complications. The aim of this study was to evaluate the effects of aldose reductase inhibition on oxidative stress in patients with type 2 diabetes mellitus. The subjects of this study were 21 patients with type 2 diabetes. We compared the levels of various oxidative stress markers and antioxidants including plasma thiobarbituric acid-reactive substances, malondialdehyde-modified low-density lipoprotein, vitamin E, beta-carotene and lipid hydroperoxides in erythrocytes at baseline with those measured after a 3-month course of epalrestat (150 mg/day), an aldose reductase inhibitor. While administration of epalrestat did not result in significant changes in plasma thiobarbituric acid-reactive substances, malondialdehyde-modified low-density lipoprotein, vitamin E, or beta-carotene, it significantly reduced lipid hydroperoxides in erythrocytes. Given the importance of measuring lipid hydroperoxides in erythrocytes as an index of oxidative stress, these results highlight the potential usefulness of epalrestat in reducing oxidative stress in type 2 diabetes mellitus.

Markers of oxidative stress in ICU clinical settings: present and future

Oxidative stress is associated with most conditions requiring intensive care: it contributes to clinical complications, organ failure and mortality. Interestingly, no unique definition exists of oxidative stress, of how it contributes to the clinical worsening and most importantly, no common strategy exists about its measurement. Despite these metrology problems, limiting the intensity of oxidative stress has become a popular therapeutic target. The paper reviews methods used to determine oxidative stress in clinical situations using routine validated methods or those used by research laboratories. Many methods of measuring oxidative stress have proven unreliable and no single method exists enabling objective determination and characterization of oxidative stress in clinical settings whether in critical illness or in chronic disease. Some methods, like determination of malondialdehyde, F2-isoprostanes, or 8-hydroxydesoxyguanosine, are widely used to determine oxidative stress. Other methods - such as the determination of vitamins or micronutrients - are able to determine components of the antioxidant defense. No single method, however, is yet alone able to characterize oxidative stress under clinical conditions. Today, strategies to measure oxidative stress are limited in clinical settings. The most reliable available marker remains malondialdehyde or F2-isoprostanes, in combination with circulating levels of micronutrients.

Localization of distinct F2-isoprostanes in human atherosclerotic lesions.

F2-Isoprostanes are prostaglandin (PG) isomers formed in situ in cell membranes by peroxidation of arachidonic acid. 8-epi PGF2alpha and IPF2alpha-I are F2-isoprostanes produced in humans which circulate in plasma and are excreted in urine. Measurement of F2-isoprostanes may offer a sensitive, specific, and noninvasive method for measuring oxidant stress in clinical settings where reactive oxygen species are putatively involved. We determined whether isoprostanes were present in human atherosclerotic lesions, where lipid peroxidation is thought to occur in vivo. 8-epi PGF2alpha ranged from 1.310-3.450 pmol/micromol phospholipid in atherectomy specimens compared with 0.045-0.115 pmol/micromol phospholipid (P < 0.001) in vascular tissue devoid of atherosclerosis. Corresponding values of IPF2alpha-I were 5.6-13.8 vs. 0.16-0.44 pmol/micromol phospholipid (P < 0.001). Levels of the two isoprostanes in vascular tissue were highly correlated (r = 0.80, P < 0.0001). Immunohistochemical studies confirmed that foam cells adjacent to the lipid necrotic core of the plaque were markedly positive for 8-epi PGF2alpha. These cells were also reactive with anti-CD68, an epitope specific for human monocyte/macrophages. 8-epi PGF2alpha immunoreactivity was also detected in cells positive for anti-alpha-smooth muscle actin antibody, which specifically recognizes vascular smooth muscle cells. Our results indicate that 8-epi PGF2alpha and IPF2alpha-I, two distinct F2-isoprostanes and markers of oxidative stress in vivo, are present in human atherosclerotic plaque. Quantitation of these chemically stable products of lipid peroxidation in target tissues, as well as in biological fluids, may aid in the rational development of antioxidant drugs in humans.

Measurement of stress in clinical nursing

The Nurse Stress Checklist was developed to measure stress in clinical nursing as a multidimensional construct. The instrument was formulated within a transactional model of stress. The items were derived from five domains thought to contribute to nurse stress in clinical settings and were organized into a questionnaire. Holmes Schedule of Recent Events was included as a validity measure. The instrument was tested on 104 staff nurses working in three institutions in an urban community. Exploratory factor analysis was applied to the 74 items presented to subjects in Likert-type format. Five factors were derived and subjected to psychometric evaluation. Internal consistency reliability for the five factors was good, ranging from 0.80 to 0.91. Means and measures of dispersion supported the potential of the five subscales to discriminate among respondents on the attributes being measured. Intercorrelations of the factors provided evidence of the distinctiveness of the five components of stress, although factor loadings showed some overlap between Personal Reactions and Work Concerns and Work Concerns and Work Completion Concerns. Validity of the factors also was supported by correlations with Holmes' Schedule of Recent Events. Content validity was supported by comparison of these results with findings of other investigators. Limitations of the results are discussed, and recommendations for future work on the instrument are offered.