| 1. |
- Dahlgren, Anna, et al.
(författare)
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Intensive longitudinal study of newly graduated nurses' quick returns and self-rated stress
- 2021
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 47:5, s. 404-407
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Tidskriftsartikel (refereegranskat)abstract
- Objective Little is known about the relationship between quick returns (QR) - shift combinations that result in inter-shift rest periods <11 hours) and stress. The current study examined whether variations in the frequency of QR, both between and within individuals, were associated with changes in self-rated stress.Methods A questionnaire was sent weekly to newly graduated nurses during the first 12 weeks of work. Stress was measured with four items from the Stress-Energy Questionnaire on a scale from 1 not at all to 5 very much [mean 2.65, standard deviation (SD) 1.08]. Shifts worked in the past week were reported and QR were identified by evening-morning shift combinations (mean 0.98, SD 0.90 per week). In total, 350 persons were included in the analysis (3556 observations). Data were analyzed with a multilevel residual dynamic structural equation model (RDSEM) using Bayesian estimation procedures.Results There was no between-person effect of QR on stress averaged across measurement occasions (0.181, 95% CI -0.060-0.415). However, there was a small within-person effect of QR (0.031, 95% CI 0.001-0.062), meaning that more QR during a given week, compared to that person's average, was associated with an increase in their level of stress during that week.Conclusions Nurses were likely to report increased stress during weeks in which they worked more QR. Intervention studies are needed to determine whether the relationship is causal.
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| 2. |
- Frögéli, Elin, et al.
(författare)
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A randomized controlled pilot trial of acceptance and commitment training (ACT) for preventing stress-related ill health among future nurses.
- 2016
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Ingår i: Anxiety, Stress, and Coping. - : Informa UK Limited. - 1061-5806 .- 1477-2205. ; 29:2, s. 202-18
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Levels of stress and burnout increase during nursing education. This development has consequences for nursing students' health, learning, competence, and interest in quality issues in health care.DESIGN: In a randomized controlled pilot trial with a sample of 113 nursing students the effect of an intervention using techniques from acceptance and commitment training (ACT) to prevent the development of stress and burnout was evaluated.METHOD: The 6 × 2-hour program was compared to standard treatment (reflection seminars) post-intervention and at a three-month follow-up using longitudinal analysis of mean response profiles. Mechanisms of change were investigated using a baseline-post intervention two-mediator model.RESULTS: The intervention resulted in increased mindful awareness and decreased experiential avoidance, as well as decreased perceived stress and burnout. Levels of mindful awareness and perceived stress were sustained at follow-up. The proposed mechanisms of change were partly supported by the data.CONCLUSION: This study shows that techniques from ACT might have the potential to contribute to preventing the development of stress and burnout during nursing education. However, additional studies are needed to validate these results.
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| 3. |
- Frögéli, Elin, et al.
(författare)
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Preventing Stress-Related Ill Health Among New Registered Nurses by Supporting Engagement in Proactive Behaviors : A Randomized Controlled Trial
- 2020
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Ingår i: Worldviews on Evidence-Based Nursing. - : Wiley. - 1545-102X .- 1741-6787. ; 17:3, s. 202-212
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: New registered nurses (RNs) are at risk of developing symptoms of stress-related ill health.OBJECTIVES: To evaluate the effect of a 3 × 3 hour group intervention aiming to prevent symptoms of stress-related ill health among new RNs by increasing engagement in proactive behaviors. The intervention involves discussions and models of newcomer experiences and stress and the behavior change techniques reinforcing approach behaviors, systematic exposure, and action planning.DESIGN: A randomized parallel group trial with an active control condition.PARTICIPANTS: The study sample consisted of 239 new RNs participating in a transition-to-practice program for new RNs in a large county in Sweden.METHODS: Participants were randomized to either the experimental intervention or a control intervention. Data on experiences of stress, avoidance of proactive behaviors, engagement in leisure activities, role clarity, task mastery, and social acceptance were collected before and after the intervention. Effects were evaluated using multilevel model analysis and regression analysis. Missing data were imputed using multiple imputation.RESULTS: The control group experienced a statistically significant increase in experiences of stress during the period of the study (t(194.13) = 1.98, p = .049), whereas the level in the experimental group remained stable. Greater adherence to the intervention predicted a greater effect on experiences of stress (β = -0.15, p = .039) and social acceptance (β = 0.16, p = .027).LINKING EVIDENCE TO ACTION: Transition-to-practice programs may benefit from adding an intervention that specifically addresses new RNs' experiences of stress to further support them as they adjust to their new professional role. However, replication studies with larger samples, more reliable measures, and longer periods of follow-up are needed.
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| 4. |
- Frögéli, Elin, et al.
(författare)
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Preventing stress-related ill health among newly registered nurses by supporting engagement in proactive behaviors : development and feasibility testing of a behavior change intervention.
- 2018
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Ingår i: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Transitioning into a new professional role is a stressful experience with consequences for mental and physical health, job satisfaction, organizational commitment, and turnover. New registered nurses seem to be at particular risk of developing stress-related ill health during their first years in the profession. Previous research indicates that engagement in proactive behaviors may reduce this risk.Methods: With the work presented in this paper, we aimed to test the feasibility of conducting an evaluation of the effect of a behavior change intervention to prevent stress-related ill health among new registered nurses by supporting their engagement in proactive behaviors. Feasibility objectives included recruitment, randomization, data collection and analysis, participation, acceptability, and deliverability.We tested the feasibility of evaluating the effect of the intervention as part of a transition-to-practice program for new registered nurses using a non-randomized design with one condition. The trial included a sample of 65 new registered nurses who had been working for 6 months or less.Results: The feasibility of conducting a full-scale effect evaluation was confirmed for recruitment, data collection and analysis, participation, and acceptability. It was not possible to randomize participants, but analyses of between-group differences revealed no selection bias. The time of the intervention will need to be extended to ensure the deliverability.Conclusion: With some adjustments in the study design, it is feasible to evaluate the effect of a behavior change intervention to support new registered nurses' engagement in proactive behaviors during their transition into the new profession as part of a transition-to-practice program for new nurses.
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| 5. |
- Frögéli, Elin
(författare)
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Testing principles from cognitive behavior therapy for preventing stress-related ill health among newly registered nurses
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Transitioning from education to working life is a challenging endeavor and newly registered nurses are one professional group that report high levels of symptoms of stress-related ill health. Transition-to-practice programs that are developed to support newly registered nurses’ professional adjustment have not been found to be effective in preventing these experiences. Previous research has shown that the development of symptoms of stress-related ill health among newly registered nurses may be modeled as a sequential-developmental process where initial levels of stress develop into symptoms of stress-related ill health through engagement in avoidance strategies when faced with challenging situations. It has been suggested that transition-to-practice programs could be strengthened by adding an element that focuses on proactive behaviors. In contrast to avoidance behaviors, engagement in proactive behaviors when faced with challenging situations at work is expected to contribute to the development of the socialization processes task mastery, role clarity, and social acceptance. The availability of these recourses is assumed to decrease the risk of situations being perceived as unpredictable, uncontrollable, and socially risky. Over time, this is expected to reduce the activation of the stress response and the risk of developing symptoms of stress-related ill health. Building on these previous lines of research, the general aim of this thesis was to investigate the possibility of preventing symptoms of stress-related ill health among newly registered nurses by supporting engagement in proactive behaviors. The overall hypothesis was that increased engagement in proactive behaviors would contribute to the development of the socialization processes, which, in turn, would mediate a reduction of experiences of stress and the risk of developing symptoms of stress-related ill health. The work was developed based on research from the fields of nursing, occupational health, stress, and organizational socialization, as well as theory and practice from cognitive behavior therapy. The methods of the four papers included in the thesis were designed based on guidelines of intervention development that suggest a stepwise procedure from the development of a theoretical understanding of the problem and a model of change, through feasibility testing, to the evaluation of effects. In Study I, using an intensive longitudinal study design with 14 consecutive weeks of data collections and a sample of 264 newly registered nurses, we found that over the first three months in the profession higher levels of the socialization processes were related to lower levels of stress. Week-by-week, increased levels of the socialization processes were related to decreased experiences of stress. Similarly, in Study II, using a longitudinal study design with yearly data collections during the first three years in the profession and a sample of 1210 newly registered nurses, we found that higher levels of the socialization processes one year after professional entry were related to lower levels of symptoms of stress-related ill health (i.e. burnout), concurrently. Furthermore, increasing levels of the socialization processes during the first three years in the profession were related to decreasing levels of symptoms of burnout during the same period. In Study III, we analyzed newly registered nurses’ engagement in proactive behaviors using principles from learning theory and data from interviews with 12 newly registered nurses. We interpreted the newly registered nurses’ reports to indicate that they engaged in proactive behaviors when they experienced uncertainty in combination with social support and a perceived ability to execute the given proactive behavior, and that engagement in proactive behaviors was reinforced by increased experiences of task mastery, role clarity, and social acceptance, and reduced experiences of stress. However, in the presence of fear in relation to making a mistake, not living up to role expectations, and not being accepted by peers, proactive behaviors were avoided. We developed an intervention to support engagement in proactive behaviors (by reducing engagement in avoidance behaviors and increasing engagement in leisure activities) using the behavior change techniques systematic exposure, reinforcing approach behaviors, and action planning. Using a non-randomized experimental design with one study condition and a sample of 65 newly registered nurses, we concluded that it would be feasible to evaluate the effect of the intervention as an add-on to a transition-to-practice program for newly registered nurses. Finally, in Study IV, we evaluated the effect of the intervention in a randomized parallel group trial with an active control and a sample of 238 newly registered nurses based on differences in change over time as well as differences in means following the end of the intervention. We found support for a small effect of the intervention on newly registered nurses’ experiences of stress and a small to medium effect on avoidance of proactive behaviors, in line with the study hypothesis. However, the results of different types of analysis were inconclusive. No statistically significant effects of the intervention could be confirmed for engagement in energizing leisure activities or task mastery, social acceptance, and role clarity. In conclusion, the findings suggest that transition-to-practice programs may benefit from adding an intervention that specifically addresses newly registered nurses’ experiences of stress and avoidance of proactive behaviors to further support them as they adjust to their new professional role.
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| 6. |
- Frögéli, Elin, et al.
(författare)
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The Importance of Effective Organizational Socialization for Preventing Stress, Strain, and Early Career Burnout : An Intensive Longitudinal Study of New Professionals
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:12, s. 7356-7356
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Tidskriftsartikel (refereegranskat)abstract
- Burnout was originally conceptualized based on experiences of new professionals. Role clarity, task mastery, and social acceptance are recognized as key resources enabling new professionals’ management of the challenges of the new profession. However, relations between these resources and stress, strain, and burnout have not yet been thoroughly investigated at professional entry. Increased understanding of these relations could have implications for strategies to prevent burnout. The aim of the study was to investigate within- and between-individual effects over the first months and relations to burnout at one-year post-entry. Data (n = 322) was collected weekly over the first 13 weeks and again 9 months later. Relationships were modelled using a multilevel regression model and correlation analysis. Results showed that on weeks when participants experienced higher role clarity, task mastery, and social acceptance, they reported significantly less stress, and that participants who experienced higher levels of the resources in general, reported significantly less strain. Levels of the resources at three months were related to symptoms of burnout at 12 months. The study findings provide support of the role of task mastery, role clarity, and social acceptance as resources buffering the impact of demands at professional entry on experiences of stress, strain, and burnout.
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| 7. |
- Frögéli, Elin, et al.
(författare)
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The relationship between task mastery, role clarity, social acceptance, and stress : An intensive longitudinal study with a sample of newly registered nurses.
- 2019
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 91, s. 60-69
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Transitioning into a new professional role is challenging. Unfortunately, little is currently known about how to reduce experiences of stress among new professionals. The socialization processes role clarity, task mastery, and social acceptance are assumed to reduce experiences of stress as they mediate new professionals' acquisition of knowledge, skills, attitudes, and behaviors. However, little prospective data is available on the actual effect of the processes on stress.OBJECTIVES: To prospectively investigate how the socialization processes relate to experiences of stress among new nurses during the first three months of professional working life. Specifically, to investigate development over time, as well as how episodes of increased or decreased levels of the socialization processes relate to concurrent levels of stress. The general purpose of this investigation was to examine the suitability of the socialization processes as targets of an intervention seeking to reduce stress among new professionals.DESIGN: An intensive longitudinal study with weekly data collections over three months.PARTICIPANTS: 264 newly graduated Swedish nurses who started their first job during the period of the study.METHODS: The participants were followed prospectively during 14 consecutive weeks after their professional entry. Data on stress (Stress and Energy Questionnaire), role clarity (General Questionnaire for Psychological and Social Factors at Work), task mastery, and social acceptance (Needs Satisfaction and Frustration Scale) were collected weekly using digital surveys (mean response rate 82.7%). Data was analyzed using a multilevel model for intensive longitudinal data.RESULTS: For the typical nurse, stress decreased by 0.13 units per month, role clarity and task mastery increased by 0.08 and 0.05 units, and social acceptance decreased by 0.08 units. In addition, the slopes of 95 percent of the new nurses varied within 1.18 (stress), 0.72 (role clarity), 0.44 (task mastery), and 0.86 (social acceptance) units of the typical nurse. Most importantly, when the new nurses experienced higher levels of task mastery, role clarity, and social acceptance, they experienced lower levels of stress (within-person parameter estimates: task mastery -0.40, p = .001; role clarity -0.34, p = .001; and social acceptance -0.33, p = .001).CONCLUSIONS: Supporting the development of the socialization processes could be one theoretically based strategy to reduce levels of stress among new nurses. As stress among new professionals is not unique to the nursing profession, and the processes are considered important mediators of new professionals' adaptation in general, the results from this study should likely be generalizable to other professions.
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| 8. |
- Rudman, Ann, et al.
(författare)
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Gaining acceptance, insight and ability to act : A process evaluation of a preventive stress intervention as part of a transition-to-practice programme for newly graduated nurses
- 2024
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 80:2, s. 597-611
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Tidskriftsartikel (refereegranskat)abstract
- Aim:To investigate how NGNs perceived and applied an intervention for preventing stress-related ill health embedded in a transition-to-practice programme when enter-ing their professional life.Design:A qualitative exploratory descriptive design was selected for this study to gain insights and perspectives on the adoption and utilization of the intervention.Methods:In this qualitative methodology process evaluation, semi-structured and audio-recorded interviews were conducted with a sample of 49 nurses. Data were collected between December 2016 and July 2017, and were sorted in NVivo 12 Plus, followed by thematic analysis.Results:The analysis resulted in three change processes stimulated by the intervention: (a) Building acceptance of being new; (b) Gaining insight into professional devel-opment and health and (c) Practical steps for skills development, healthy habits and better-organized work. In addition to the three themes, barriers that hindered the progression of the processes were also described. Each process influenced the development of the others by stimulating a deeper understanding, motivation to change and courage to act. Several barriers were identified, including the use of cognitively demanding intervention tools, fatigue, high work demands, inconvenient work hours and a hostile social climate on the ward.Conclusion:This process evaluation showed that newly graduated nurses used knowledge from the intervention and adopted new behaviours largely in accordance with how the intervention was intended to work.Impact:When entering a new profession, it is crucial to receive a well-thought-out, structured and targeted introduction to the new professional role, tasks and work group. Nurses stated that the intervention increased their understanding of the role as new nurses and their insight into how to develop skills that promoted better functioning and recovery. The intervention also stimulated the development of new health behaviour and some new learning strategies.
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| 9. |
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