A real-time investigation of nursing tasks and stress

Abstract

Background Stress is a common reason for nurses’ absence from work. It is thought stress is related to the demands associated with nursing tasks. However, little is known about the relative demands or stress associated with particular nursing tasks. Previous studies have relied upon retrospective and observational methods of assessing tasks. We used real-time methods to relate tasks to perception of the task, concurrent mood, heart rate and energy expenditure. Methods 100 qualified ward nurses completed electronic diary (PDA) measures of (i) nursing tasks using the WOMBAT coding system (ii) moods (hedonic tone, tense arousal and energetic arousal) using the UWIST methods (iii) perceptions demand, control and reward every 90 minutes for 2 work shifts. Heart rate (HR) and activity level were recorded continuously using Actiheart monitors, providing measures of physiological arousal and energy expenditure. Data were analysed using multi-level modeling. Results Direct patient care was the most frequent ‘main task’ but the distribution of tasks varied over the working day. Positive mood (hedonic tone) was generally high, while stress (tense arousal) was low. Direct care was the most physically demanding task and also perceived as the most effortful and demanding. HR was highest during direct care. Tense arousal and energetic arousal were greatest during direct patient care which was also perceived as the most rewarding activity. Discussion Generally, nurses’ mood at work is positive and stress ratings are low. The dominant task, patient care, is associated with highest energy expenditure and most stress but is also the most rewarding.