Fatigues and Demands of Working on Psychiatric

Synthesis of Research Findings

The ‘state of evidence’ suggests that the workplace stressors of

Units: How Nurses’ Mental Health can be Enhanced psychiatric units (Figure 1) negatively affect the mental health of

nurses. In support of this notion, Holmberg et al. (2017) explains

Tricia Grimes UNB,HC NS; Ezinne Obinna- Uma UNB, HC NS that MHNs have a higher tendency to suffer from burnout and a
Understaffing
& Unrealistic
Job Demands

lower tendency to exhibit resilience due to ever-present Limited Health

Background & Safety Harassment
Policies
workplace stressors.
Clinical Issue Mental Health What impacts
Alenezi et al. (2019) recommends the use of booster, repetitive, a MHN’s
Mental
While working in a retirement home and a LTC facility, we found the dementia floor to be fatiguing Health?
and organization-based interventions to prevent burnout while Lack of
Clinical Case and demanding. Our colleagues on the other floors did not voice the same complains. Dealing with Poor
Support & No
Scenario involvement in
Foster et al. (2018) recommends clinical supervision, top-down, communication
Decision
mood disorders, wandering, continuously having to answer repeated questions, short notice
Making
scheduling, and lack of support and communication with supervisor took a toll on our mental health. and social-ecological approach to build resilience.
Inflexible
working hours
The ‘state of evidence’ also suggests the use of two evidenced-
Clinical Question Reflecting upon the fatigues and demands of working on psychiatric units, how can nurses’ mental
health be enhanced? based interventions to build resilience. (1) enhancing autonomy to
Figure 1: Mental Health Workplace Stressors
promote self-care and efficacy, and (2) using a social-ecological
Quantitative Appraisal Qualitative Appraisal (Alenzi et al., 2019; Foster et al., 2018)
approach to promote resilience.
Research Purpose: To find out the level of burnout among Mental Health Nurses
Research Purpose: To explore the perspectives of MHNs participating in a resilience-
(MHN) in Saudi Arabia and the effect of a burnout prevention program to reduce
stress among MHN in Saudi Arabia at 1-,3-, and 6-month intervals post intervention.
building, workplace-initiated program: Promoting Adult Resilience (PAR). The research Next Steps
questions were explicitly stated and appropriately worded. It was also consistent with the The rationale for using a self-care approach in clinical practice is
As such, the research question was explicitly stated, appropriately worded and
literature review and research purpose. Positive Self
consistent with the literature review and conceptual/theoretical framework. Talk justified since Mental Health Nurses stem from a clinical background

which prepared them to exhibit autonomy in addressing burnout

Context/Population: This study was conducted because burnout is a serious Context/Population: The sample and setting were described with details. 29 MHNs from
and building resilience to enhance their own mental health (Byrne et
problem for MHNs working in Saudi Arabia, but healthcare authorities and a metropolitan health service in Australia participated in this study, and two participant Awareness Managing
Self Care
& Mgt of Negative
Practices
Emotions Self Talk al., 2018).
professionals are reluctant to address this issue. This study used an intervention groups were used: participants who completed the PAR program and facilitators who
group of 154 MHNs and a control group of 142 MHNs. Sample was described, chosen delivered it. The sample size was appropriate since the study was exploratory/inquiry. The rationale for using a multifocal, organizational approach is
at random, and enhanced representativeness. Sample size was also adequate as a The use of experienced senior MHNs as facilitators provided great context in
Showing
justified since the social-ecological model allows for the recognition
power analysis was used. investigating the phenomenon. Empathy
of complex interactions between MHNs and their surroundings

Research Process: In this quasi-experimental design, three trained group leaders
conducted a two-day burnout intervention workshop. The highly reliable Maslach
Burnout Intervention (MBI) was used to collect data. Central tendencies and
dispersion measures described the level of burnout. The effectiveness of the
workshop was measured through ANOVA, t-test, multiple linear regression, and chi-
squared.
Findings: Alenezi et al. (2019) presents the research findings in a summarized
manner using text, tables, and figures. Descriptive statistics and standard deviation
were further used to highlight statistical significance. Burnout was prevalent in >50%
of MHNs in both groups. The program was effective since the intervention group
reported a reduction in burnout 1 month after the workshop, but both groups
reported an increase in burnout 3-, and 6-months post intervention.
Figure 2: How to Promote Self Care (Alenezi et al., 2019; which will, in turn, shape the advancement of mental health
Byrne et al., 2018)
Research Process: The method of multiple data collection was well described and
interventions (Ungar & Theron, 2020).
appropriately addressed the research questions. Open-ended written data, individual
Promoting Self- Care Enhancing
semi-structured interviews, and focus groups with facilitators were used to collect data Workplace Team Organizational approaches cater for mental health patients since
Culture
prior to the first workshop, after the second workshop, and three months after the second Social-
Ecological the promotion of self-care, workplace team culture, workplace safety,
Approach
workshop. As such, this triangulated data had sufficient depth and richness. Data was
Ensuring Workplace
and nursing identity culminates to quality patient care (Foster et al.,
analyzed thematically. Developing
Safety Professional Identity
2018).
Figure 3: Use of the Social-ecological Model (Foster et
al., 2018; Ungar & Theron, 2020)
Findings: The researchers found four main themes: (1) being confronted by adversity, (2)
reinforcing understandings of resilience, (3) strengthening resilience, and (4) applying
resilience skills at work. The use of narrative exemplars supported the four themes. References
Triangulation aided to adequately capture the full meaning of the data. As such, a Alenezi, A., McAndrew, S., & Fallon, P. (2019). Burning out physical and emotional fatigue: Evaluating the effects of a programme
aimed at reducing burnout among mental health nurses. International Journal Of Mental Health Nursing, 28(5), 1045-
meaningful picture was yielded as it relates to the PAR program and MHNs. 1055. https://doi.org/10.1111/inm.12608

Strengths: The quasi-experimental design prevented exposing one group of MHNs Byrne, L., Schoeppe, S., & Bradshaw, J. (2018). Recovery without autonomy: Progress forward or more of the same for mental health
Strengths: The use of purposive sampling in this exploratory inquiry provided insightful service users?. International Journal Of Mental Health Nursing, 27(5), 1459-1469. https://doi.org/10.1111/inm.12446
to burnout and accounted for the unmatching nurse characteristics between groups
context of MHNs perceptions (Woo, 2019). Triangulation, peer debriefing, inclusion of a
since most MHNs were expatriates. Integrity was maintained via audio/videotaping Foster, K., Cuzzillo, C., & Furness, T. (2018). Strengthening mental health nurses' resilience through a workplace resilience
post-traumatic growth module, and peer group interaction increased trustworthiness. The programme: A qualitative inquiry. Journal Of Psychiatric And Mental Health Nursing, 25(5-6), 338-
of sessions. Deviations were eliminated via use of a group therapy expert, validity 348. https://doi.org/10.1111/jpm.12467
confirmability of this study was maintained as the study reflected the participants’ voice
was maintained via simultaneous sessions; and reliability was achieved with MBI.
and not the researchers’ biases (Woo, 2019).
Thus, data was sound, replicable, and accurate (Woo, 2019). Holmberg, C., Caro, J., & Sobis, I. (2017). Job satisfaction among Swedish mental health nursing personnel: Revisiting the two-factor
theory. International Journal Of Mental Health Nursing, 27(2), 581-592. https://doi.org/10.1111/inm.12339

Limitations: Lacks international applicability since MBI mostly supports burnout Ungar, M., & Theron, L. (2020). Resilience and mental health: how multisystemic processes contribute to positive outcomes. The
Limitations: Lacks transferability since MHNs were from one organization and only Lancet Psychiatry, 7(5), 441-448. https://doi.org/10.1016/s2215-0366(19)30434-1
prevention programs suited for Middle Eastern practice. Study used a quasi-
worked in inpatient units. Studies need variety in sample and setting to enhance
experimental design but failed to highlight at least one plausible rival explanation of
transferability (Woo, 2019). Woo, K. (2019). Polit & Beck: Canadian Essentials of Nursing Research (Fourth Ed.). Wolters Kluwer.
its findings thus adding to the limited body of knowledge (Woo, 2019).