Occupational Stress Risk Assessment: Assessing the Impact of Health Promotion Lifestyle and Perceived Nature Contact on Nursing Health and Wellness

Abstract

The purpose of the study was to perform a quantitative occupational stress risk assessment (OSRA) to evaluate the impact of health promotion (HP) lifestyle and perceived nature contact on the consequences of perceived stress from exposure to nursing stress risk factors. Perceived stress is defined as the employee’s personal interpretation of his or her work circumstance and any discrepancy between workplace demands (stressors) and individual capacities (resources). Registered nurses (RNs) in patient care settings are prone to high levels of perceived stress, which can cause errors in clinical care giving. High perceived stress is a consequence of risk factors from a nurse’s daily work routine including: workload, death and dying, inadequate preparation for role, staff support, uncertainty concerning treatment, communication with physicians, and communication with other nurses. Mitigating perceived stress improves nursing job performance, job satisfaction, and overall employee health, while reducing mental fatigue, absenteeism, and burnout. Methods performed included: Aim 1) a systematic literature and meta-analysis to establish benchmarks for perceived stress in nursing professionals for comparison of United States (US) and International healthcare settings; Aim 2) a cross-sectional study using a 125-item survey instrument administered online to an RN study population to evaluate relationships between perceived stress, HP lifestyle, and perceived nature contact; and Aim 3) a quantitative OSRA to rank nursing stress risk factors and examine differences by gender, ethnicity, and race. Results were: Aim 1) Perceived Stress Scale 14-item (PSS14) value for International nursing studies was 25.41 (95% CI 21.1 to 29.7), while US PSS14 nursing studies yielded a value of 23.8 (95% CI 19.8 to 27.7). Aim 2) the present study found Southern California RNs (n=161) had the same perceived stress (m = 22.8, 7.06 SD, p=0.082) as other US nursing professionals. RN perceived stress scores were negatively correlated (p<0.001) to HP lifestyle. HP lifestyle was positively correlated (p<0.001) to perceived nature contact. Aim 3) the OSRA model using HP lifestyle for coping exhibited the highest strength (92%) and reliability (90%); this model established RNs' risk factor rankings (RFRs) from high to low as: 1) communication with physicians, 2) workload, 3) uncertainty concerning treatment, 4) death and dying, 5) inadequate preparation for role, 6) communication with other nurses, and 7) staff support. High nursing RFRs were the same by gender. Differences were found with Hispanic RNs who ranked communication with other nurses as RFR 3 compared to non-Hispanic RNs at RFR 7. Also, non-white RNs ranked inadequate preparation for role as RFR 2 compared to white RNs at RFR 5. Although present study results focused on a single health provider RN population using self-reported survey instruments, the OSRA process can be applied to any occupational setting. This study supports introducing a quantitative OSRA process initiated in Europe to US worksites to identify and rank occupational stress risk factors for strategic prioritization and alignment with interventional resources. With continuous replication of OSRA within and between work-sectors, this process could elucidate US industry health and safety best practices. The present study focused on nurses as a first-test-case high-stress occupation. More OSRA nursing studies are recommended across a wider US geographic area to create normative values of comparison including stratum for gender, ethnicity, and race. Intervention, intervention effectiveness, and organizational change studies are needed to mitigate high nursing stress risk factors emanating from healthcare organizational challenges and to emphasize implications for improved patient care outcomes.