• Perceived stress and professional quality of life in nursing staff: how important is psychological flexibility?

      Kent, William; Hochard, Kevin D.; Hulbert-Williams, Nicholas J.; University of Chester (Elsevier, 2019-08-14)
      Objectives: Nurses are at high risk of chronic stress. Tailored, evidence-based stress-management interventions may minimise absenteeism and staff turnover, whilst at the same time promoting good quality patient care. Current literature for nurse-focused stress-management interventions is varied in quality, with little focus on data-driven intervention development. This study explores how process measures related to Acceptance and Commitment Training (ACT) are associated with perceived stress and professional quality of life in nurses, in order to guide intervention development. Design: A cross-sectional, online psychometric survey was implemented using LimeSurvey software. Methods: One-hundred and forty-two nurses were recruited from various specialties across four English National Health Service (NHS) Trusts. Questionnaires assessed demographic and work-related sample characteristics, ACT processes (mindfulness, acceptance, cognitive defusion, self-as-context, values and committed action), and four work-related wellbeing outcomes (perceived stress, burnout, compassion fatigue and compassion satisfaction). Correlation and regression models were used to analyse data. Results: All six ACT processes negatively correlated with perceived stress, burnout and compassion fatigue, and positively correlated with compassion satisfaction (all p<.05). In regression models, these same processes explained significant variance for all outcomes (R2 range=.36-.61), above and beyond that explained by socio-demographic and work-related factors. Acceptance (β range: -.25 to -.55), mindfulness (β range: -.25 to -.39), and values-based processes (β range: -.21 to -.36) were frequent independent contributors to work-related wellbeing. Conclusions: This study demonstrates that the ACT framework provides a promising platform from which to develop nurse-focused stress-management interventions. Interventions focusing on acceptance, mindfulness, and values-linked processes may be most effective.
    • A review of stress-management interventions for the oncology nursing workforce: what do we know and what should we be doing differently?

      Kent, William; Hulbert-Williams, Nicholas; Hochard, Kevin D.; University of Chester
      Oncology nurses are at risk of chronic stress. In this narrative review we provide an overview of stress-management intervention studies for oncology nurses, and suggest that Acceptance and Commitment Therapy/Training (ACT) provides a better intervention framework due to the relevance of underpinning therapeutic processes (e.g. acceptance, mindfulness, values clarification) to the role and stress-related experiences of this workforce population. Current evidence for stress management intervention effectiveness varies, with few studies describing how theory informs intervention content, or justifying why they should benefit this population specifically. ACT lends itself to data-driven intervention development, thus potentially addressing some methodological limitations in this field. Only one trial has tested ACT in this population, reporting only partial effects. Further empirical research is required given (a) the applicability of ACT for this population and context, and (b) the associated advantages of brief and/or group delivery to address known barriers to participating in stress-management interventions.