Stress and Coping amongst Care Workers in Nursing Homes for the Elderly

Researcher Donna Rishani

Supervisors Dr Graeme Ditchburn

Date: May, 2011

Nine different types of situation have been identified as sources of care worker stress within the nursing home environment including; (1) Having concerns about adequate nursing care, (2) Difficult to manage behaviour exhibited by residents, (3) Workload/overload, (4) Environmental conditions within the work setting, (5) Interpersonal conflict with other staff members, (6) Unrealistic demands/expectations from residents and/or their families, (7) Care of the dying patient, (8) Interpersonal conflict with patients and/or their families, and finally (9) Fear of failure/lack of professional confidence.

As can be seen, having ‘Concerns about adequate nursing care’ was rated as the most stressful type of situation for this group of care workers. Although this was not expected, it was not surprising that this stressor would be considered the most stressful type of situation when one stops to consider the likely issues that surround it. Firstly, it seems that this kind of situation could have potentially serious or even lethal consequences if not dealt with in an appropriate manner. When dealing with the health, comfort, safety and overall wellbeing of highly vulnerable and frail individuals, appropriate nursing care is crucial. Apart from the seriousness of this stressor’s potential consequences, the issue of how difficult it might be for a care worker to deal with such issues must be considered. Many care workers may feel intimidated by the prospect of confronting higher ranking staff or management with ‘Concerns about adequate nursing care’. It is likely that many would fear identification and repercussions in the workplace. It is also possible that care workers may fear that their opinion or observations may not be taken seriously as they are not ‘qualified’ to make such judgments.

‘Difficult to manage behaviours’ and ‘Workload/overload’ were equivalently rated as the second most stressful situations in the nursing home environment. These stressors were expected to rate highly. The most common types of ‘Difficult to manage behaviour’ were identified as intrusive wandering, disruption of the physical environment (moving furniture and other items), verbal and physical aggression and calling out. With regard to ‘Workload/overload’, it was described how on morning and afternoon shifts there is ‘simply too much that has to be done’ and that the work is very physically demanding.

Coping Styles – Frequency of Use

‘Positive reinterpretation and growth’, ‘Planning’ and ‘Instrumental social support’ were found equally to be the most commonly utilized styles of coping amongst this sample. The next most frequent was found to be ‘Active coping’. Problem-focused styles of coping therefore were most frequently used by this sample in the workplace. According to previous research on the use of emotion and problem-focused coping in this work field, these findings are positive as problem-focused coping has been found to be more effective in reducing workplace stress and susceptibility to occupational burnout, and less related to negative health outcomes in care workers. Another positive finding here was the absence of any maladaptive coping styles being used most frequently by the care workers, as these are by definition ineffective and often dysfunctional. The two second least often utilized means of coping were ‘Behavioural disengagement’ and ‘Denial’. The coping style used least frequently was found to be ‘Substance use’. These are positive findings as these styles of coping are all considered ineffective.

Total Stress Scores in Relation to Coping Styles
Significant positive relationships were found between ‘Total stress’ and ‘Venting of emotions’, ‘Humour’ and ‘Mental disengagement’. So, the higher the total stress score, the more the care workers made use of these coping styles. One of these coping styles (‘Humour’) is emotion-focused and the other two (‘Venting’ and ‘Mental disengagement’) belong to the maladaptive coping domain. None of the problem-focused coping styles were positively correlated with ‘Total stress’. These findings have therefore supported the hypothesis that emotion-focused coping styles would be more positively associated with ‘Total stress’ than problem-focused coping styles would be. This finding was expected, as previous findings have found emotion-focused coping to be less effective in the management of stress amongst care workers and therefore have shown positive associations with overall stress levels. Problem-focused coping styles were negatively correlated with ‘Total stress’ (although not at a statistical level of significance), which was expected. Problem-focused coping has been previously found to be most effective in alleviating care worker stress and negatively associated with care worker stress levels. Finally, the expectation that maladaptive coping styles would be positively associated with ‘Total stress’ was supported by the findings. As outlined above, ‘Venting emotions’ and ‘Mental disengagement’ were both found to have a significant positive relationship with ‘Total stress’. In fact these two coping styles were the most strongly associated with ‘Total stress’. Also, although ‘Behavioural disengagement’ and ‘Substance use’ were not significantly correlated with ‘Total stress’, the association was still positive. As maladaptive coping styles are described as ineffective and dysfunctional, the positive relationships with ‘Total stress’ make sense.

Relationships between Specific Stressors and Coping Styles

Several significant relationships were found between specific stressors and coping styles. As these findings are lengthy and difficult to report in a brief manner, it is thought that a verbal explanation or the receipt of a full written copy of this section of the dissertation would be more appropriate.

Thank you to all those who participated in this research

Please feel free to contact me directly via email, or telephone 0447 777 471 with any enquiries.