The design of a stress-management programme for nursing personnel.

This study identifies the stressors and coping strategies of nursing staff (students, trained staff and those who had left the profession before qualification) in a variety of ward specialisms. The research instruments included an open-ended interview concerning pre-nursing experience, perceived stressors and satisfactions, and ways of coping, and psychometric tests of self-esteem, assertion, ways of coping and personality. The five most frequently cited stressors were understaffing, conflict with nurses, dealing with death and dying, overwork and conflict with doctors. Experience of stressors was related to role and seniority of respondents, with different aspects of the same stressor differentially affecting nurses at different levels of experience. Coping strategies also depended on experience. Trained staff showed more use of problem-focused ways of coping, whilst students and leavers relied more on emotion-focused strategies to deal with stressful situations. These differences were related to personality characteristics of respondents and to self-esteem as well as to situational characteristics of the stressful episode. Social support was important in times of work-related stress, with students in particular making good use of peer group support. Respondents were generally lacking in assertiveness and high in anxiety. Although self-esteem was generally high, leavers scored markedly less than other subject groups in the areas of personal and social self-esteem. Leavers had little prior knowledge or experience of nursing before entering training and knew few nurses or doctors: consequently, nursing failed to meet their expectations. Stress was identified as the major cause of attrition and the sources of stress are identified. This study informed a major programme of stress-management training for student nurses which began in 1988 at the North Wales School of Nursing and which is currently under evaluation. It includes relaxation therapy, assertiveness training, and on-going group discussions which foster peer-group support and which explore the stressors and coping strategies relevant to different stages of training and ward specialisms.