Rehabilitation staff stress as it relates to patient acuity and diagnosis

Abstract

Significant concern exists regarding occupational stress among nurses; the present study explored the ways in which nurses' clinical symptoms and coping styles may relate to their working on a brain injury unit or a general rehabilitation unit within an acute physical rehabilitation hospital. A comparison of rehabilitation nurses' responses with those of physical therapists within the same setting was also completed. Staff members completed questionnaires related to job stress and satisfaction, coping (Ways of Coping Checklist) and adjustment (Symptom Checklist-90). Staff groups differed with regard to symptomatology. Brain injury nurses reported higher psychological distress than physical therapists on subscales including depression, interpersonal sensitivity and the global severity index. While brain injury nurses' distress in several areas was higher than other staff groups and than a normal non-patient sample, it did not approach the levels reported by a psychiatric outpatient normative group. Although the three staff groups did not differ notably with regard to most styles of coping, data suggest that work with brain injury patients may foster use of a problem-solving style. Lower physical and cognitive functioning of brain patients as compared with general rehabilitation patients may influence the greater psychological distress reported by brain injury nurses. Job stress appears to relate specifically to the perceived stressfulness of cognitive behavioural aspects of care for all staff groups. Implications of these findings, particularly with regard to support interventions, are discussed.

Psychological stress, work satisfaction, and brain injury nursing

“…While McLaughlin and Erdman (1992) found that psychological distress in a group of nurses working with brain injured clients was greater than for a group of physical therapists whose scores were similar to a normative sample, it was not as great as for a psychiatric outpatient norm group. Moreover, there were no significant differences between the groups in the study on ratings of job stress and job satisfaction, for which there were no normative data.…”

“…However, institutional staff providing care for people with brain injuries have traditionally been nurses who have had very little formal training in how to manage the behavior of such people. The potential importance of training in behavior management has been shown by McLaughlin and Erdman (1992) who have reported evidence which suggests that the cognitive behavioral aspects of such care contribute to higher psychological distress in nursing staff. This distress may arise partly due to lack of behavior management knowledge which results in staff-client interactions which are not conducive to optimal client rehabilitation.…”

“…While some researchers, including McLaughlin and Erdman (1992), have suggested options for reducing nursing staff stress, such as job rotation and further training, these suggestions are frequently based on results from stress and job satisfaction questionnaires and not on direct consultation with the staff themselves. The opinions of nursing staff would seem to be particularly important given that in a review of in-service training, Tannenbaum and Yukl (1992) have included the examination of training needs at an individual level as one of a number of important issues concerning which there has been a lack of empirical research.…”

Grief, Anger, and Relationality

“…[PT Interview] In marked contrast to staff's discomfort with client grief, observations revealed that staff were adept at handling aggression. Nurses in particular demonstrated unique proficiency with the management of aggression through such techniques as bargaining or compromising, which McLaughlin and Erdman (1992) have found typifies the interventions of nurses in brain injury rehabilitation. In the following illustrative examples, nurses utilized behavioural management techniques such as rule explanation, positive reinforcement, limit setting, task redirection, and non-threatening eye contact in order to achieve and sustain therapeutic alliance.…”

“…Nevertheless, these evaluations overlooked many pre-intervention and post-intervention emotion work practices. Such oversight is critical to redress because TBI-associated injuries arguably present among the most profoundly distressing affective challenges for patients, families, and health care providers (Carroll & Coetzer, 2011;McLaughlin & Erdman, 1992). Thus, our objective was to return to the empirical data to analyze previously unexplored emotion work practices by TBI practitioners in the context of our evaluation of After the Crash.…”