Nurses’ occupational stress in primary health care

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Arvo building, Jarmo Visakorpi auditorium, address: Lääkärinkatu 1


Doctoral defence of Master of Caring (Nursing) Nijolė Galdikienė

Nurses’ occupational stress in primary health care. Evaluated in connection to organizational social context

The field of science of the dissertation is Nursing.

The opponent is Professor Arja Häggman-Laitila (University of Eastern Finland). Professor Tarja Suominen acts as the custos.

The language of the dissertation defence is English.

Nurses’ occupational stress in primary health care.  Evaluated in connection to organizational social context

Stress is one of the most severe occupational risks among nurses working in different health care settings, as well for nurses working in primary health care. Most frequently nurses experience stress when they have a heavy workload, experience conflict with supervisors and staff, or undertake work with high emotional demands. Furthermore, researchers have found potential relationships that exist between stress and the organizational social context (i.e. the organizational culture, organizational climate and morale). The purpose of this study was to describe and evaluate nurses experienced stress and its connections with the organizational social contexts in primary health care. The ultimate goal was to add knowledge that may reveal ways of developing organizational culture and climate, so as to protect nurses from stress.

A cross-sectional descriptive study was conducted to offer an empirical representation of nurses’ experienced stress, their organizational culture and climate, and their morale. The Expanded Nursing Stress Scale (ENSS) and the Organizational Social Context (OSC) measurement system were used in this study. Data was collected between August 2009 and January 2010 in one Lithuanian county. In total, 187 nurses completed the ENSS and 344 health care professionals (including nurses) completed the OSC questionnaire. Health care professionals (nurses, physicians and others) from 29 teams in 18 primary health care centers participated in this study.

Nurses working in primary health care experienced stress related to situations when facing death and dying, and when experiencing conflicts with physicians, and when dealing with patients and their families. Older nurses and nurses with longer work experience reported intensive levels of stress in conflict situations with physicians. Nurses working with younger patients experienced higher levels of stress than those working with adult patients.

The investigation of experienced stress among nursing teams shows that stress is relative to the team. The effect of team size is moderate, and the background factors of the teams had little association with the sub-areas of stress. Workload was the factor that tended to cause more stress in larger teams. At the nurses’ team level, a strong positive correlation was found between all of the stress subcategories investigated, except for that of ‘discrimination’. Different teams followed different stress profiles, but based on their common features, various clusters were identified which should be of interest to nursing management.

The social context (organizational culture, organizational climate and morale) varied, depending on the view point of different health care professionals. Different organizational cultures, climates and levels of morale existed at both team and organizational levels. Significant differences between teams were found in their culture rigidity and resistance. At an organizational level, significant variations were found in culture rigidity, resistance and proficiency. Climate differed at team and organizational levels in regard to stress and functionality.

The relationship between organizational culture, organizational climate and nurses’ experienced stress in primary health care centers differed across primary health care teams. Nurses’ stress significantly correlated with a resistant organizational culture and with climate functionality. Nurses working in teams with a resistant organizational culture experienced stress in situations when they had problems with their supervisors, difficult situations with patients and their families, and when they experienced conflicts with physicians. When the climate functionality among team members was low, nurses experienced stress in situations involving problems with their peers and supervisors, and in situations where difficulty was created by some form of inadequate preparation.

The results of this study on nurses’ experienced stress in primary health care may help to identify problems, and to also find ways to protect nurses from stress. Managers should be aware of the variation in experienced stress among nurses who work in different teams, and should also recognize the different social contexts in which teams work in order to identify fixable problems, decrease nurses’ experienced stress, and to promote evidence-based practices which relate to this important area. An evaluation of the organizational culture and climate in primary health care increases our knowledge of the organizational factors that contribute to performance in the field of nursing.

The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2218, Tampere University Press, Tampere 2016. ISBN 978-952-03-0243-6, ISSN 1455-1616. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1718, Tampere University Press 2016. ISBN 978-952-03-0244-3, ISSN 1456-954X.

Additional information

Nijolė Galdikienė, tel. +370 65030857,