The Impact of Stress in the Working Environment of Nursing Home Staff - Essay Example

STUDENT FULL NAME PROFESSOR’S NAME INSTITUTION AFFILLIATED DUE DATE OF ASSIGNMENT THE IMPACT OF STRESS IN THE WORKING ENVIRONMENT OF NURSING HOME STAFF RESEARCH METHOD IN A SOCIAL SCIENCE RESEARCH PROJECT The claim that qualitative research involves an interpretive and naturalistic approach meaning studying things in their natural settings, to interpret, attempting to make sense of work related stress in terms of the its impact on performance. (Denzin and Lincoln 2000) Qualitative studies about circumstances associated with occupational stress provide new insights into the dynamics of working environment and mental wellbeing. (Bryman et al 1996) To understand the impact of stress on the performance of nursing home staffs from their own perspective understand complex behaviours that are difficult to analyse quantitatively. The intention of the interviewer is to listen and understand the voice of participants, observe and record them in their working environments to be able to describe work related stress from the participants’ points of view through interviews and observations. (Field and Morse 1992) The in-depth interviews shall be conducted at Nursing Homes, conducted in private room with no others present and where the Nursing Home Staff would feel that there is a complete guaranteed of their privacy. The nursing staffs were informed of the purpose of the interview that it was to study the impact of work related stress in the working environment of Nursing Home staff. It was important that the interviewer be honesty, sincere and maintained the truth, concerning the purpose of the interview, the anticipated outcome to the individual participant and nursing home community. To find a good and conducive room may be difficult in a busy Nursing Home, but every effort was made to protect participants’ privacy to the greatest extent possible by using one of the offices in the Nursing Home. Interviewer is required to move from one nursing home to another, therefore prior arrangement should be made to find a suitable room for the interview to take place the best way is to invite participants to suggest a room where they would feel comfortable. Sampling The staff members of ten nursing homes were recruited to take part in the in-depth interview to assess the impact of stress on the working environment at the nursing home. The interview was documented by writing field notes, tape recordings, and later analysing those notes. The evaluation included proportion, absolute number and representativeness of individual’s staff members who were willing to participate in the study. The RE-AIM framework model was used in the determination of sample size where two levels criteria of evaluation were used that were; the Nursing Home concerned to implement, reach, and effectively maintain stress free working environment. (Glasgow et al 1999) The inclusion and exclusion criteria, for the impact of stress on working environment of Nursing Home Staff was a qualitative research that involved the study of the understanding of work related stress at Nursing Homes, inclusion and exclusion criteria should be broadly defined in order to understand the impact of stress at work, under what conditions it is expressed or exists that is working environment. Sample sizes for qualitative study are typically large to fully understand how work related stress influences the performance of individuals and are based on the principle of data saturation or redundancy. In general, sampling plans for qualitative research are based on identifying Nursing Home Staff who would be good informants of the work related stress. (Whittemore et al 2010) The recruitment methods or individual participants involved eligibility criteria, the sample size enrolled, and the number of participants that completed the study to understand a working related stress. In qualitative studies, considerable thought must go into the determination of the recruitment parameters to obtain the proposed sample size and there should be emphasize on culturally relevant recruitment strategies particularly in reaching vulnerable working staff members. (Newlin et al 2006) This information has important implications for data collection, analysis and interpretation that is now required when reporting results of the study. The Consort Statement provided ideal recommendations for the reporting of study participants from the start of the study to analysis and reporting how stress impacts on individual performance. (Consort Statement 2010) In-depth interviews First, understanding the underlying working conditions and self psyche of an individual in this context means seeing the world from the participant’s point of view, or gaining an empathic appreciation of is working environment. The assumption of in-depth interviewing was that it should be mutually beneficial to the Nursing Home Staff members and the interviewer. In-depth interviewing was chosen, because it was founded on the principle of delving into the participant’s mental emotions, which produced more authentic data on stress related work, it lists some of the assumptions of in-depth interviewing. The purpose of in-depth interviewer was to understand the impact of stress on individuals and how it influenced their performance to penetrate to more reflective understandings about the nature of their stress experience. In addition, to helping the Nursing Home Staff member to uncover suppressed feelings of stress through the interview process and the interviewer also gained knowledge of hidden or conflicting stress emotions of the participants. (Johnson 2002) In-depth interviewing provided a multi-perspective understanding of the impact of stress in the performance of Nursing Home Staff by not limiting participants to a fixed set of answers, in-depth interviewing had the potential to reveal multiple, and sometimes conflicting attitudes about the impact of stress at work. The questions were designed to go beyond the presumed surface level of respondents’ feelings, into the deeper layers of their consciousness; the inquiries were directed at the stress experienced at work. In the unstructured format of in-depth interviewing, participants could place qualifying conditions on their responses and as a whole, the procedural guidelines of in-depth interviewing encouraged mutual self-disclosure in the context of an emotionally charged atmosphere where the interviewer and interviewee freely expressed their views about the impact of stress at nursing homes. (Douglas 1985). Its procedures aimed at uncovering the subconscious through free association, or random expressions of thoughts related to stress. As Holstein and Gubrium (1995) noted, this mode of data collection, analysis and interpretation of results shared was based on positivistic concern of understanding the true impact of stress on the behaviour change of Nursing Home Staff member who took part in the study. The in-depth interviewers ensure by gently probing the participants presumed emotions and suppressed feelings of stress and it is relatively unconcerned about how the interactional aspects of the interview could be constructive of the truths of the impact of stress on work performance, what variables the interviewer encountered and how their influence was articulated by the participants. They claim that through creative and non-traditional techniques they can capture the pure essence of a participant’s emotional stress. This type of interviewing does not forgo the search for a concrete, positivistic truth in regard to the impact of stress on the performance of individuals; instead, it located the source of stress. (Holstein and Gubrium 1997) Ethical considerations The Directors of the participating Nursing Homes gave their permission for the involvement of their staff members in the study. Approvals were obtained from the Ethics Committees of the Area Health Service and the University. A meeting with the nursing home staff was held to go over any queries they may have had regarding the questionnaires. Participants were informed about the voluntary nature of the study and informed consent was sort from the nursing home participants to make ensure that they understood the risks and benefits and how the data collected would be used. In a qualitative research study, this principle is honoured by informed consent that means making a reasonable balance between over and under-informing, it allowed Nursing Home staff to exercise their rights as autonomous individuals to voluntarily accept or refuse to participate in the study and assured them that what they say would be kept in confidence was important for earning their trust and thus for eliciting good responses. The interviewer understood the procedure outlined in the study protocol for protecting participants’ privacy and was able to explain those steps clearly. The interviewer explained to the Nursing Home Staff member how he would protect the confidentiality of the participants by stating not reveal anything learnt to other participants or members of the community. During the interview, in casual conversation beforehand or afterward the interview should be careful not to make incidental comments about other people who had been interviewed as this behaviour might suggest that s/he cannot be trusted. (Kvale 1996) Validity, reliability and rigour Jorgensen (2006) advocated authenticity, credibility, criticality and integrity as primary criteria for evaluating qualitative research (Lincoln and Guba 1985) credibility related to whether the results of the research reflected the experience of the impact of stress at work. The process of participant validation, authenticity was addressed by retaining a reflective awareness of preconceptions and retaining the possibility of being surprised by findings of work related stress. The criteria of criticality and integrity related to the potential for many different interpretations that could be made dependant on the assumptions and knowledge background of the researcher’s understand of stress. The data generated was discussed subsequently with selected Nursing Home Staff participants who had previously indicated a willingness to be involved in further inquiry. (Daly 1997) To address this, the researcher analysed the data generated to establish their credibility, plausibility and their resonance with experiences beyond the confines of the impact of stress on individual performance. (Horsburgh 2003) Screening Instruments The Patient Health Questionnaire-9(PHQ-9) and Patient Health Questionnaire-8(PHQ-8) for stress are a major focus of population survey of mental disorder. To meet the DSM-IV-TR criteria of stress disorder, a participant either must have a loss of interest, pleasure or depressed mood in daily activities consistently for at least 2 weeks. This stress must represent a change in social, occupational, or working performance also must be impaired by the change in mental wellbeing. Under the DSM-IV-TR, a stressed mood is caused by substances use or that is part of a general medical condition is not considered major stress disorder. (American Psychiatric Association 2000) One of the most widely used and validated instruments for measuring stress at work was the eight-item Patient Health Questionnaire (PHQ-8), which used to screens for the presence of the eight DSM-IV-TR criteria for acute and clinically significant stress disorders that included stress levels on the Nursing Home Staff. (Kroenke et al 2009) A PHQ-8 score of ≥10.0 has high sensitivity and specificity of about 90.0% when validated against SCID, effectively detected stress symptoms among individuals of various races and ethnicities working at nursing homes. (Huang et al 2001)The PHQ-8 was chosen because it was more flexible and could be useful as a self-administered module on qualitative studies and telephone-administered interviews. (Martin et al 2006) In addition, interviews had used a slightly shorter instru­ment, the eight-item Patient Health Questionnaire (PHQ-8), which omitted the (PHQ-9) question concerning suicidal ideation because interviewer was not able to offer appropriate follow-up interventions encase there was suicidal ideation. The standard PHQ-8 had the following pri­mary question how often have you been bothered by any of the following problems for the last two weeks? 1) Trouble falling, staying asleep or oversleeping; 2) feeling down, stressed or hopeless; 3) little interest or no pleasure in doing things; 4) loose of appetite or overeating; 5) feeling tired; 6) feeling bad about yourself, that you are a failure, have let yourself or your family down; 7) moving or speaking so slowly that other people could have noticed the opposite, 8) trouble concentrating on things such as watching television, reading, being so fidgety or restless that you have been moving around a lot more than usual. Two algorithms will be used to assess the responses, and the scores would be assigned depending on the severity of stress, one algorithm will be based on the DSM-IV and categorized, stressed Nursing Home Staff members according to the severity of stress symptoms as either no sig­nificant stress symptoms, mild, moderate or severe stress symptoms. (Kroenke et al 2001) Works cited American Psychiatric Association (APA) “Diagnostic and statistical manual for mental disorders,” Washington, DC: American Psychiatric Association; (2000) Print Bryman A, Stephen M and Campo C. “The Importance of Context: Qualitative Research and the Study of Leadership.” Leadership Quarterly, 7.3 (1996) 353-370 print CONSORT Statement, C. “Statement.” (2010) Web Daly K. “replacing theory in ethnography.’ Qualitative Inquiry 3.3 (1997) 343–365. Print Douglas D J. “Creative Interviewing,” CA: Sage (1985) print Denzin N and Lincoln Y “Handbook of Qualitative Research,” London: Sage (2000) print Glasgow R E, Vogt T M, And Boles S M. “evaluating the public health impact of health promotion interventions:’ the RE-AIM framework. Am J Public Health (1999) 89:1322 print Field P A and Morse J M. “The application of qualitative approaches” London: Chapman & Hall. Nursing research (1992) print Holstein J and J Curium “The Active Interview” Thousand Oaks, CA: Sage. (1995) print Holstein J and J Curium ‘Active Interviewing.’ in Qualitative Research: Theory, Method, and Practice, edited by David Silverman. London: Sage. (1997) 113–129. Print Horsburgh D, “Evaluation of qualitative research.” Clinical Nursing Journal 12.2 (2003) 307–312. Print Huang F Y, Chung H, Delucchi K L, Kroenke K, Spitzer R L. “Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients.” Gen Intern Med J 16 (2001) 606–13. Print Johnson J M. ‘In-depth Interviewing.’ in Handbook of Interview Research: Context and Method, Sage. (200)103–119 print Jorgensen R. “A phenomenological study of fatigue in patients with primary biliary cirrhosis.” Journal of Advanced Nursing 55.6 (2006) 689–697 print Kroenke K, Williams J B, Strine T W, Berry J T, Mokdad A H. “The PHQ-8 as a measure of current depression in the general popula­tion.” Affect Disorder J (2009) 114. 163–73 prints Koneke K, Williams J B and Spitzer R L, “The PHQ-9 validity of depression severity,” Gen Intern Med J 16 (2001) 606–613print Kale S. “qualitative research interviewing”. CA Sage (1996) print Lincoln Y S and Gobi E G. “Naturalistic Inquiry,” Sage, Newbury Park, CA. (1985) print Martin A, Kleinberg A, Rife W, and Brasher E. “Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population,” Gen Psychiatry 28 (2006) 71–7, print Newlin K, Jefferson V, Melkus G D, Womack J Langerman S, and Chyun, D. “Recruitment of women with type 2 diabetes into a self-management intervention.” Ethn Dis, 16.4 (2006) 956-962. Print Whittemore R, Chase S K, Mandle C L. “Validity in qualitative research.” Qualitative Health Research 11.4 (2001) 522–537. Print Whittemore R, Melkus G D, Alexander N, Zibel S, Visone E, Muench U. “Implementation of a lifestyle program in primary care by nurse practitioners.” Am Acad Nurse Pract J, 22.12 (2010) 684-693. print Read More