Abstract: Hospital-based health systems have the potential to be high stress environments, as staff work towards meetings the many and varied demands of the patients and their families / whanau in a situation of limited resources and unpredictable workloads. Dealing with physical and emotional trauma, and the 'normal' exigencies of daily life in what may be a far from normal workplace may compound the stresses facing health workers. Nurses, who are often at the interface between patients and other health professionals, may be caught in a cross-fire of transferred stress while also coping with stressors associated with their jobs. As well as being likely to have a negative effect on their well-being and job satisfaction, any such compounding impact of stress and stressors could have adverse impacts on patients and their supporters. The primary focus of this study has been to identify stress levels among nurses in a woman's health service, and to establish the causes of elevated stress. All staff were surveyed (with a 68% response rate). Midwives made up the largest portion, followed by nurses, doctors, therapies, support and clerical groups. The Job Stress Survey (JSS) and the General Health Questionnaire – 12 (GHQ-12) were used to help detect emergent stressors, and stress effects that staff were experiencing at the time. Aggregate data was used, focusing on the six occupational groupings and the nine areas within the health service. Findings from the JSS confirm that the staff had experienced a number of stressors, while indications of deleterious mental health effects in some staff emerged from the GHQ-12 scores. Occupational stress is a subset of general stress, making it difficult to separate one from the other as spheres of our lives overlap and interact. The stressors that were identified should contribute to the discussions and policies that might abet the reduction of stress. On the other hand, it is not possible to attribute the effects describes by the GHQ-12 as being derived primarily from occupational stress. A stressed staff member, no matter what the source of their stress might be, still needs support in order to cope. The author notes that the negative outcomes of occupational stress manifests themselves in many ways such as; mistakes, absenteeism, horizontal violence, burnout and turnover. These all affect the quality of the patient care delivered, leading to decreased patient satisfaction and and need to be addressed for these reasons.

Abstract: In this review, the author illustrates the connection between diabetes, stress and barriers to care, and the impact these have on Maori who have type 2 diabetes. A literature review, which focused mainly on indigenous peoples, and more specifically on Maori was undertaken. The connections between all the factors involved are explored, and combined with reflections from the author's own clinical practice experience. She argues that stress, diet, exercise and barriers to care place a heavy burden on the lives of Maori who live in Aotearoa/New Zealand, suffering from the disease of diabetes. By empowering them to face their situation and see this from a wellness rather than an illness perspective, they can take control of their diabetes and so will live a healthy, longer life, ensuring quality time with their mokopuna/grandchildren.

Abstract: Eighteen months after the first of many large earthquakes, Christchurch-based home health care provider Nurse Maude surveyed staff to identify the impact on the well-being of their mainly elderly clients. Responses from 168 staff identified five key issues. These were: mental health, anxiety, and depression, symptoms similar to post-traumatic stress disorder (PTSD); unsafe environments; loneliness and isolation; difficulty coping with change; and poor access to services. To meet the needs of clients in this challenging environment, staff felt they needed more time to care, including listening to stories, calming clients and dealing with clients who had become slower and more cautious. Damaged and blocked roads, and the fact that many clients moved house without warning, added to the time it took to deliver care in the home. This survey has helped Nurse Maude build on its initial post-earthquake responses to better meet the needs of clients and support health-care workers in this stressful environment.

Abstract: This article reviews the use of cognitive behavioural therapy (CBT) for pregnant women suffering from depressive symptoms. CBT provides a structured, short-term, collaborative process between clinician and client, using strategies and techniques to identify dysfunctional thinking and beliefs, challenge and change these beliefs, then implement new rational beliefs and behaviours. A process of engagement, assessment and conceptualisation is followed by treatment planning and implementation, and modification of dysfunctional thinking and behaviours. Use of CBT to treat depression in women during pregnancy is supported by the literature, especially where pharmacological intervention is declined or contraindicated. Pregnancy can bring stressors that combine with biological factors and core beliefs to contribute to depressive symptoms.

Abstract: The aim of this study was to examine and compare Australian and New Zealand nurses' experience of workplace stress, coping strategies and health status. A postal survey was administered to 328 New South Wales (Australia) and 190 New Zealand volunteer acute care hospital nurses (response rate 41%) from randomly sampled nurses. The survey consisted of a demographic questionnaire, the Nursing Stress Scale, the WAYS of Coping Questionnaire and the SF-36 Health Survey Version 2. More frequent workplace stress predicted lower physical and mental health. Problem-focused coping was associated with better mental health. Emotion-focused coping was associated with reduced mental health. Coping styles did not predict physical health. New South Wales and New Zealand scored effectively the same on sources of workplace stress, stress coping methods, and physical and mental health when controlling for relevant variables. Results suggest mental health benefits for nurses who use problem-solving to cope with stress by addressing the external source of the stress, rather than emotion-focused coping in which nurses try to control or manage their internal response to stress. Cultural similarities and similar hospital environments could account for equivalent findings for New South Wales and New Zealand.

Abstract: Undertakes an evidence-based practice pilot project to examine the effectiveness of simulation-based learning in teaching nursing students to become aware of the role of stress, anxiety and distraction in medication errors. Stresses the importance of medication-error prevention at the pre-licensure level, by increasing awareness of patient safety culture. Notes the need to teach nursing students self-awareness of the distractions and stresses within the clinical environment and therefore the need for self-care to avoid medication error.