Literature Review for Nursing Stress Interventions

Stress is a well-known and identified problem in the nursing profession. According to Atkinson, stress arises when confronted with events or meetings that they perceive as a danger to their physical or psychological well-being (as stated in McGowan, 2001). In addition, stress levels will increase as controllability and predictability in a situation decrease. There is an inverse relationship between stress and job satisfaction, as stress goes up, job satisfaction decreases. As a result, this increased stress can often result in decreased job satisfaction and decreased quality of life. This could potentially contribute to nurses leaving the profession, and as a final consequence, the current disease shortage can be accounted for.

The cause of stress for nurses has been found to be related to the nature of the profession. Included in these stressors is an intensive work environment with extended working hours, weekends, night and holidays. According to Ruggiero (2003), stress may be related to variables in shift work that are both physically and mentally taxing. This study also found varying degrees of depression in nurses ranging from mild to severe. Finally, this study revealed that nurses were indifferent and disconnected from the job by neither feeling satisfied nor dissatisfied with the work. Results like these reveal how much of a problem stress is for the nursing profession.

Factors of the intense emotional support needed for the patient and family are yet another stress burden placed on the nurse. In addition, exposures to pain, suffering, and traumatic life events experienced by the nurse on a daily basis can contribute to stress (Cohen-Katz, Capuano, Baker, & Shapiro, 2005). These concerns can lead to emotional exhaustion for nurses.

The lack of organizational support and commitment, which is beyond the control of nurses, can greatly affect job satisfaction (McGowan, 2001). There is also a lack of control and power in an environment predominantly controlled by doctors. These stressors can contribute to psychological fatigue and increased stress.

Therefore, this leads to the question of what supportive interventions have been implemented for the nurse, in order to reduce their stress and thereby increase their coping mechanisms. Would the availability of stress-reducing programs contribute to coping mechanism and increase job satisfaction? In addition, how effective are these interventions?

In my first search for stress interventions, I came across many studies found in the Ovid database where there is stress on nursing and other related health care. Keywords such as stress management, burnout, job satisfaction, care retention, quality of life, environment and alternative therapies were used for this search. These studies revealed definitions of stress and numerous and diverse causes and explanations for the stress experienced by nurses and other health care workers.

There were comparative studies between different nursing backgrounds and the environment. Eg. Medical-surgical nursing home health nursing (Salmond & Ropis, 2005), who examined and compared the differences in both backgrounds. Ultimately, it found that both practice areas had their own version of stress, and it identified common stressors. Unfortunately, no concrete measures were taken to combat the problem

There were also illustrations comparing different management styles and how nursing stress is affected. Magnetic organizations were compared to traditional organizations (Upenieks, 2003). The results of this specific study showed that positive and supportive administration could make a difference in the levels of stress, but again, no specific stress intervention measures were used.

There is a clear recognition and recognition of the stress problem in the nurse, but there is a significant lack of information that actually solved the problem of potential positive interventions. The few studies discovered turned out to show some positive results. These findings support the positive outcome that the initiation of actual stress interventions or workplace programs can offer.

The first study used the physical intervention of massage therapy over a 5-week period for nurses in a hospital setting (Bost & Wallis, 2006). This intervention was identified to reduce stress as well as support nurses individually and organizationally. The effects measured were physical and psychological. The study found no change in the physical findings of blood pressure and urinary cortisol levels, but there was a decrease in the State-Trait Anxiety Inventory (STAI) in the treatment group compared to the control group. Although no physical benefits were measured, it did reduce the psychological effects of stress. These results suggest that offering massage therapy intervention is beneficial in decreasing anxiety levels, which in turn can reduce stress.

The other interventions investigated involved a more interactive process. These studies encouraged participants or nurses to participate in the intervention. Participation of these nurse participants supports a need to reduce stress by their desire to help make changes internally that will impact them externally.

The use of mantra to relieve stress was one of these interventions. This examined the effectiveness of using a mantra or repeated mantra to influence the level of stress and emotional and spiritual well-being. Mantra utilization was taught to health care workers through a 5-part intervention program offered through the hospital prior to the study (Bormann et al., 2006). This is a good example of a valid and tangible intervention that can be offered to increase the coping mechanism while reducing stress. The results supported the positive results of this study by showing a significant reduction in perceived stress (Perceived Stress Scale), trait anxiety (State-Trait Anxiety Inventory) and trait remorse (State-Trait Anger Inventory) after intervention. There was also an increase in quality of life and existential and total spiritual well-being.

The Mindfulness-Based Stress Reduction (MBSR) program was a series of quantitative and qualitative studies offered and taught within the hospital work environment. This program specifically addressed the issue of nursing stress. MBSR is based on the concept of becoming aware and fully present in the moment without judgment (Cohen-Katz et al., 2005). The study measured levels of burnout, emotional exhaustion, emotional over-extension and psychological distress.

This particular intervention program not only reduced post-treatment stress levels, but the control group also experienced a pre-treatment benefit while waiting for the program. This may be related to the desire to reduce stress in anticipation of participating in the program. This further supports the need for nurses to make changes for the better by lowering stress levels.

This MBSR study, in turn, found a reduction in emotional fatigue and an increased sense of personal achievement in the post-intervention treatment group. In addition, these effects led to a decrease in stress that had a lasting effect for a period of three months. This validates the positive effects of using this intervention to reduce stress.

A third positive interactive intervention study was a program that offered a conflict management education class to reduce the potential stress for healthcare organizations. This particular study also supported the need to offer a way to prevent or reduce stress by creating a positive environment through personal empowerment. There was a significant reduction in pre-test and post-test in role overload, interpersonal load, role limits and psychological load. Participants reported that they were better able to find balance in their position and were able to manage the demands of their jobs (Haraway & Haraway, 2005). These findings confirm the need to make even brief interventions such as this available in an effort to reduce conflict. This, in turn, could reduce stress and increase perceived control and empowerment, increasing job satisfaction. Furthermore, this would improve the working environment by making it more supportive

All of these programs discussed offered intervention for at least one aspect of possible stressors. Reducing physical or emotional stress and offering more control and empowerment while creating a more positive work environment are all successful interventions to increase job satisfaction. As a result, increased job satisfaction leads to reduced stress. The results of this study suggest that a strong link was identified between the two subjects (Ruggiero, 2003).

There is a common thread within all these interventions. They are available and effective interventions that can be implemented to become part of nursing practice and other health care workers in many different health care institutions. These actual structured group interventions could be more effective in creating a decrease in stress individually. Programs like these have a proven value and are a simple easy and relatively inexpensive intervention. Offering them to nurses and other healthcare professionals can be considered a preventive measure against potential stress.

In addition, these findings support the need for regular stress reduction programs offered through hospitals and other medical employment organizations. The use of these and similar programs provides a far-reaching benefit to the nursing profession. Anticipatory measures to reduce stress can increase job satisfaction and potentially increase care retention. The goals of these programs may include guidance in stress management techniques, increasing social support, open communication, role reinforcement and empowerment, and individual growth to fully leverage positive interventions (Cohen-Katz et al., 2005).

Future studies in stress intervention programs should include further similar studies that are offered a larger sample with long-term and ongoing evaluation of their effectiveness. Consideration of other alternative supplementary intervention therapies that help with stress reduction could be explored, such as yoga and mediation. The use of these physically and emotionally stress-reducing techniques can also be effective in increasing stress-reducing and coping measures.

It is my hope that, in the future, stress prevention interventions will be offered to nurses and healthcare workers as a standard part of a benefit package within all health care organizations. Stress prevention can be a win-win situation where everyone benefits. Nurses will have reduced stress and increased coping mechanism, which will increase job satisfaction. This can lead to increased nursing retention. Subsequently, as a result of this satisfaction and increased quality of life, the nurse will be a superior staff member and better able to provide care for themselves and their patients.


Bormann, J. E., Becker, S., Gershwin, M., Kelly, A., Pada, L., & Smith, T. L. et al. (2006). The relationship of frequent mantram repetition to emotional and spiritual well-being of health care workers. Journal of Continuing Education in Nursing, 37 (5), 218-224. Retrieved October 3, 2006 from the Ovid database

Bost, N., & Wallis, M. (2006). The effectiveness of a 15 minute weekly massage to reduce physical and psychological stress in nurses. Australian Journal of Advanced Nursing, 23 (4), 28-33. Retrieved September 6, 2006 from the Ovid database

Cohen-Katz, J., Capuano, T., Baker, D. M., & Shapiro, S. (2005). The effects of mindfulness-based stress reduction on the nurse and burnout, Part II. Holistic Nursing Practice, 26-35. Retrieved September 27, 2006 from the Ovid database

Haraway, D. L., & Haraway, W. M. (2005). Analysis of the effect of conflict management and training training on employee stress in a healthcare organization. Hospital Topics: Research and Perspectives on Health Care, 11-17. Retrieved October 28, 2006 from the Ovid database

McGowan, B. (2001). Self-reported stress and its effects on nurses. Nursing Standard, 15 (42), 33-38. Retrieved September 28, 2006 from the Ovid database

Ruggiero, J. S. (2003). Health, work variables and satisfaction among nurses. JONA, 35 (5), 254-263. Retrieved October 3, 2006 from the Ovid database

Salmond, S. & Ropis, P. E. (2005). Job load and general well-being: a comparative study of nurses for medical-surgical treatment and home care. Retrieved September 28, 2006 from the Ovid database

Upenieks, V. V. (2003). The association between organizational characteristics of magnet hospitals, management of nursing and nursing. Health Care Manager, 22 (2), 83-98. Retrieved September 27, 2006 from the Ovid database