An Integrative Review of Job Stress and Mental Health Intervention Programs for Experienced Nurses

Jinhae Lee; Heejung Kim; Sarah Lim

doi:10.12934/jkpmhn.2019.28.2.190

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Lee, Kim, and Lim: An Integrative Review of Job Stress and Mental Health Intervention Programs for Experienced Nurses

Original Article

J Korean Acad Psychiatr Ment Health Nurs 2019;28(2):190-204.

Published online: 20 June 2019

DOI: https://doi.org/10.12934/jkpmhn.2019.28.2.190

An Integrative Review of Job Stress and Mental Health Intervention Programs for Experienced Nurses

Jinhae Lee¹, Heejung Kim², Sarah Lim^3,

¹Staff Nurse, Severance Hospital ․ Master's Student, College of Nursing, Yonsei University, Seoul

²Assistant Professor, College of Nursing ․ Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul

³Staff Nurse, Severance Hospital ․ Doctoral Student, College of Nursing, Yonsei University, Seoul, Korea

College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-0016, Fax: +82-2-2227-6549, E-mail: srlim342@yuhs.ac

Received 31 May 2019 Revised 14 June 2019 Accepted 17 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to review intervention programs for experienced nurses' job stress and mental health.

Methods

Searches of literature were conducted through four electronic databases (RISS, KISS, PubMed, and CINAHL), focusing on the recent 5-year publications in English or Korean. Thirteen studies were selected for the final analysis and Scottish Intercollegiate Guidelines Network checklist was used to assess methodological rigor and quality.

Results

Randomized controlled trials were used in five studies and quasi-experimental designs in eight studies. Cognitive-Behavioral Therapy (CBT) and group approach were the most frequent types of interventions in six and nine studies respectively. On average, the intervention was required for eight weeks and 60∼120 minutes per session. After evaluating the effects of CBT, complementary alternative therapy, informative training, simulation training and stimuli control, most of the tested interventions reduced experienced nurses' job stress and improved mental health, but informative training did not.

Conclusion

Despite the obvious importance of experienced nurses in quality of nursing care, it has not been well studied due to limited numbers of studies with less rigorous design. Study findings provide a basis for developing intervention programs to reduce job stress and improve mental health for experienced nurses.

Keywords: Nurses, Occupational stress, Mental health, Review

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Figure 1.

Flow chart of study selection.

Table 1.

Quality Assessment of Studies (N=13)

1^st Author (year)	Randomized controlled trial										Overall quality
1^st Author (year)	1.1	1.2	1.3	1.4	1.5	1.6	1.7	1.8	1.9	1.10	Overall quality
El Khamali (2018)	Y	Y	Y	Can't	N	Y	N	Exp.: 3.9	N	Can't	–
El Khamali (2018)			say				Cont.: 12.4		say
Fang (2015)	Y	Y	N	Can't	Y	Y	Y	Exp.: 11.5	N	Can't	+
Fang (2015)			say				Cont.: 13.6		say
Hersch (2016)	Y	Y	Y	Can't	Y	Y	Y	Exp.: 25.0	Y	Can't	++
Hersch (2016)			say				Cont.: 1.9		say
Kubota (2016)	Y	Y	Y	Can't	Can't	Y	N	Exp.: 18.0	Y	Can't	+
Kubota (2016)			say	say			Cont.: 2.2		say
Lee (2014)	Y	Y	N	Can't	Y	Y	Y	Exp.: 7.5	N	Can't	+
Lee (2014)					say				Cont.: 7.5		say
1^st Author (year)	Quasi-experimental study Overall											Overall quality
1^st Author (year)	2.1	2.2	2.3	2.4	2.5	2.6	2.7	2.8	2.9	2.10	2.11	Overall quality
Duarte (2016)	Y	Y	Y	Exp.: 64.4	N	Y	Y	N	Y	Y	Y	++
Duarte (2016)				Cont.: 39.5
Henderson (2015)	Y	Y	Can't say	Exp.: 100.0	N	Can't say	Can't say	N	N	N	N	–
Jang (2015)	Y	Y	Y	Exp.: 100.0	N	Can't say	Y	Can't say	Y	Y	N	+
Jang (2015)				Cont.: 100.0
Kubota (2017)	Y	Y	Y	Exp.: 89.7	N	Y	Y	N	Y	Y	N	++
Kubota (2017)				Cont.: 89.7
Lan (2014)	Y	Y	Can't say	Exp.: 90.2	N	Can't say	Can't say	N	Y	Can't say	N	–
Magtibay (2017)	Y	Y	Can't say	Exp.: 66.0	Y	Y	Can't say	N	Y	Y	Y	++
Riemer (2015)	Y	Y	Can't say	Exp.: 100.0	N	Y	Can't say	N	N	Y	N	–
Seo (2015)	Y	Y	Can't say	Exp.: 100.0 C	Can't say	Can't say	N	Can't say	N	Can't say	N	–
Seo (2015)				Cont.: 100.0

1.1=appropriate & clear question; 1.2=randomization; 1.3=allocation concealment; 1.4=blinding; 1.5=similarity; 1.6=differentiation; 1.7=valid & reliability; 1.8=rate of drop out (%); 1.9=intent to treat; 1.10=similarity between results; 2.1=appropriate & clear question; 2.2=comparable population; 2.3=same criteria; 2.4=participation rate (%); 2.5=comparison with accessible population; 2.6=clear case; 2.7=clear control; 2.8=primary exposure; 2.9=validity & reliability; 2.10=potential confounder; 2.11=confidence interval; Exp.=experimental; Cont.=control; Y=yes; N=no; −=low quality; +=acceptable; ++=high quality.

Table 2.

Study Design of Interventions for Nurses' Job Stress and Mental Health (N=13)

1^st Author (year)	Country	Design	Setting	Sample			Participants
1^st Author (year)	Country	Design	Setting	Exp. (n)	Cont. (n)	Total (N)	Age (year or %)	Career (year or %)	Sex – Female (%)	Complete^† (%)
Duarte (2016)	Portugal	Quasi exp. design	Oncology	45	48	93	30∼51	8∼30	86.9	51.6
El Khamali (2018)	i France	Randomized controlled trial	Intensive care unit	101	97	198	≤30 (48.0%)	≤5 (71.8%)	58.0	91.9
El Khamali (2018)							≥41 (7.5%)	＞5 (28.2%)
Fang (2015)	China	Randomized controlled trial	Unclear	61	59	120	25∼47	5∼23	100.0	87.5
Henderson (2015)	USA	Quasi exp. design	Surgical	50	–	50	NR	≤3 (48.0%)	100.0	100.0
Henderson (2015)								≥20 (12.0%)
Hersch (2016)	USA	Randomized controlled trial	Unclear	52	52	104	22∼65	＜1 (8.0%)	87.5	86.5
Hersch (2016)								＞25 (30.0%)
Jang (2015)	Korea	Quasi exp. design	Oncology	14	15	29	≤30 (37.9%)	＜5 (48.2%)	100.0	100.0
Jang (2015)							＞30 (62.1%)	≥5 (51.8%)
Ji (2017)	Korea	Quasi exp. design	Intensive care unit	29	29	58	23∼33	1∼9	NR	89.6
Kubota (2016)	Japan	Randomized controlled trial	Oncology	50	46	96	33∼46	NR	96.4	85.4
Lan (2014)	Malaysia	Quasi exp. design	Intensive care unit	41	–	41	23∼35	1∼11	100.0	90.2
Lee (2014)	Korea	Randomized controlled trial	Operating room	27	27	54	22∼38	＜1∼14	NR	92.5
Magtibay (2017)	USA	Quasi exp. design	Trans-plantation	50	–	50	24∼63	NR	NR	66.0
Riemer (2015)	USA	Quasi exp. design	Intensive care unit	22	–	22	NR	≤5 (27.0%)	82.0	100.0
Riemer (2015)								＞10 (36.0%)
Seo (2015)	Korea	Quasi exp. design	Psychiatric	6	6	12	NR	NR	66.6	100.0

Exp.=experimental; Cont.=control; Nr.=nurses; NR=not reported;

^† Completion rate of intervention.

Table 3.

Effectiveness of Interventions for Nurses' Job Stress and Mental Health (N=13)

1st Author (year)	Intervention						Effects on outcome
1st Author (year)	Program	Type	Delivery mode	Session/Times per session	Duration (wk)/Frequency	Control/Comparison	Job stress	Mental health	Others
Duarte (2016)	MBI	CBT	Group Offline	6 60 min	6 1/week	Wait-list	–	Burnout^† Stress^† Anxiety^† Depression^† Rumination^† Mindfulness^†	Compassion satisfaction^† Compassion fatigue^† Experiential avoidance^†
El Khamali (2018)	Multimodal program	Simulation training	Group Offline	5 unknown	2 3/1st-wk 2/2nd-wk	No intervention	Significant	–	Isostrain^† Absenteeism^† Decision latitude^† Social support^† Psychological demand^†
Fang (2015)	Yoga	CAT	Group Offline	≥12 60 min	6 ≥2/week	No intervention	Significant	–	Quality of sleep^†
Henderson (2015)	Hardiness program	CBT	Group Offline	1 60 min	one time	–	–	Burnout^† Hardiness^†	–
Hersch (2016)	BREATH program	Inform. training	Indvl. Online	no timeline	12 no timeline	Wait-list	Significant	Distress symptom Coping with stress Anxiety Depression Use substances Drinking	Work limitation Job satisfaction
Jang (2015)	Group art therapy	CBT	Group Offline	8 90 min	8 1/week	No intervention	Significant	Burnout	–
Ji (2017)	Music therapy	CAT	Indvl. Offline	1 30 min	one time	Rest w/o intervention	–	Subjective stress response^†	Salivary cortisol^† Fatigue^†
Kubota (2016)	Psycho-oncology training	Inform. training	Group Offline	2 480 min	2 1/week	Wait-list	Not significant	–	Confidence^† Knowledge Attitudes
Lan (2014)	b-MBCT program	CBT	Group Offline	5 120 min	5 1/week	–	–	Perceived stress^† Stress^† Anxiety^† Depression^† Mindfulness^† Subjective happiness^†	–
Lee (2014)	Foot bath therapy	CAT	Indvl. Offline	12 20 min	3 4/week	Rest w/o intervention	–	Physical stress^† Psychological stress	Ankle edema Calf edema^† Fatigue^†
Magtibay (2017)	SMART program	CBT	Indvl. Online	no timeline	24 no timeline	–	–	Burnout^† Perceived stress^† Generalized anxiety^† Resilience^† Mindfulness^† Subjective happiness^†	–
Riemer (2015)	Quiet time	Stimuli control	Group Offline	1 120 min	one time	–	–	Stress^†	–
Seo (2015)	Group art therapy	CBT	Group Offline	12 90 min	12 1/week	No intervention	Significant	Emotional expression^† Depression^†	–

No.=number; wk=week; m=minute; w/o=without; indvl.=individual; SMART=Stress Management and Resilience Training; CBT=Cognitive-Behavioral Therapy; CAT=Complementary Alternative Therapy; Inform.=Informative; Isostrain=job strain and low social support;

^† Statistically significant.

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