The relationship between job-related stressors and stress responses of nurses working in intermediate nursing homes in Japan Y.Momose1, A.Fujino1, N.Amaki1, H.Matsuoka1, M.Watanabe2, S.Okuno3, D,Akatsuka1 1 Aichi Prefectural University, 2 Nagano College of Nursing, 3 Kyoto Tachibana University 26ｔｈ International Conference of Alzheimer’s Disease International 29 March 2011, Toronto, Canada

Introduction As a result of increased life expectancy for both men and women, the fast-growing population of individuals over the age of 75 represents a challenge for health care providers. Currently, only 1% the Japanese population over the age of 65 resides in intermediate nursing homes (Department of Ministry of Health, Labour and Welfare, Japan, 2010).

However, due to increased life expectancy, these numbers are expected to increase. Providing adequate care for the geriatric population will significantly affect overall health care services. Several studies have indicated numerous factors affecting the stress levels and job-related burnout of nursing staff working with geriatric clients in long-term care facilities.

These factors include a general lack of knowledge in providing care for this patient population, stressful work conditions (including inadequate staffing & heavy workloads), and difficulties in taking care of clients with disabilities, excessive agitation, or dementia.

Purpose The purpose of this study was to examine the relationship between stressors and stress responses of nurses working in intermediate nursing homes in Japan.

Methods Subjects and Data collection: In this cross-sectional study, we recruited participants from 399 long-term care facilities housing 70 or more beds throughout Japan. Data were collected by a paper-and-pencil questionnaire via mail. 1,444 nurses in intermediate nursing homes completed the questionnaire.

Measures: Staff: Job-related stressors of nurses were measured by a 38-item questionnaire developed according to our previous research and past literature. Scores ranged between 0 and 228, with higher scores indicating greater stress. Stress responses were measured by a 20-item scale based on physical and psychological symptoms. Biographical details collected included gender, age, marital status, and work experience. Facility: We determined the number of residents, the required care level of residents, and the number of nurses.

Ethical considerations Data analysis: The job-related stressors’ scale for nurses is described, and we conducted exploratory factor and correlative analyses from the collected data . Data were analyzed using PASW18 for Windows. Ethical considerations Respondents participated on a voluntary basis and confidentiality was guaranteed. Return of a completed questionnaire was taken as consent to participate.

Results

Table 1 Characteristics of subjects Age (n=1434) 45.5 (range 21-72; SD:10.05) Gender (n=1444) Male 79 (5.5%) Female 1365 (94.5%) Working experience (years, n=1444) 19.9 (range 51-1; SD10.22) Positions (n=1414) Staff nurse 1101 (76.2%) Assistant head nurse 157 (10.9%) Head nurse 115 (8.0%) Others 41 (2.8%) Employment (n=1442) Typical-employment 1280 (88.6%) Atypical-employment 135 (9.3%) Night shift (n=1439) Existence 965 (66.8%) number of night shifts (n=939) 4.5 (range 1-12; SD:1.67)

Table 2 Seven items with which over 70 % of the Table 2 Seven items with which over 70 % of the respondents agreed or strongly agreed N=1444 item % Worrying about an institutional-acquired infection 97.5 Feelings of anxiety that the nurse has to judge residents’ conditions alone without a doctor 79.6 Difficulty in dealing with BPSD individually 79.0 Lack of confidence in their own ability to discern atypical symptoms (e.g.; infection cases in which the symptoms do not readily appear) 75.7 Feeling burdensome responsibilities related to medication administration 74.6 Feeling nervous about the various emergency treatments of residents 73.4 Difficulties in judgments related to ambulance transportation to hospitals 72.5

Table 3 Correlations between job-related stressors and stress responses Factor Stress responses F(1) Anxiety F(2)Irritation Total Ⅰ Difficulties with judgments concerning sudden condition changes in residents　　　　 .289*** .266*** .290*** Ⅱ Disappointed about the handling of differences between residents’ wishes and their family’s　 .269*** .294*** .297*** Ⅲ Difficulties related to the building of human relationships with other nurses, coworkers, and their administrator　 .377*** .436*** .423*** Ⅳ Discontented with excessive work loads　 .333*** .301*** .330*** Ⅴ Insufficiency of crisis management skills .219*** .200*** .223*** Ⅵ Complicated work　 .259*** .250*** .271*** Ⅶ Difficulties in coordination between residents and their families　 .313*** .323*** Ⅷ Residents’ memory and behavior problems .213*** .270*** .249*** Ⅸ Difficulties handling housekeeping, child-rearing, and work 　 .277*** .291*** *** p<.001

Conclusion These findings suggest that nurses’ stress responses might be minimized by improving labor conditions via methods such as increasing staff and fostering effective stress management strategies in the work environment. Educational programs for improving stress management competence for nurses who work in nursing homes, in order to deal with the types of stress relevant to this line of work, need to be developed.

Thank you for your attention This work was supported by a Grant-in-Aid for Scientific Research (C), 20592675, 2008-2010 If you need any more information regarding this study, please contact us via e-mail: momose@nrs.aichi-pu.ac.jp