A Systematic Review of Work Stress and Its Effect on Staff Nurses in the United Kingdom

Abstract 

Introduction: Nursing is plagued with increased professional stressors; nursing shortages and poor staffing – exacerbate the feeling of inadequacy. Long work hours and high patient demands seriously affect nurses’ mental and physical health, increasing the risk of depression, anxiety, burnout and other stress-related conditions. Understanding the effects is a practical approach to fostering evidence-based practices and policies that mitigate work-related stressors and enhance quality-of-care delivery.

Methods: The study conducted a systematic literature review to explore the effect of stress management strategies and mindfulness techniques on job performance indicators among staff nurses in the UK by synthesising available evidence and evaluating their quality

Results: Seven articles were selected and included in the review; mindfulness-based interventions effectively reduce work stress among staff nurses in the UK. The included studies consistently underscore the importance of implementing mindfulness-based strategies to enhance nurses’ ability to handle emotional and patient demands.

Discussion: Implementing mindfulness interventions effectively addresses work-related stressors; the approach is proactive to help staff nurses mitigate and reduce work-related stressors. Mindfulness-based interventions, such as deep breathing exercises, allow nurses better to navigate patients’ demands and high-pressure circumstances with composure. Therefore, interventive strategies are imperative to reduce the exposure of staff nurses to situations that impact patients’ outcomes and job performance.

Conclusion: Implementing mindfulness-based strategies enhances nurses’ ability to handle emotional and patient demands. Participating in stress management workshops enhances the quality of care delivered; mindfulness skills are imperative to reduce the exposure of staff nurses to situations that impact patients’ outcomes and job performance.

Chapter 1. Introduction 

Background Information 

Nursing is perceived to be among the most stressful professions in the UK, owing to the long working hours, the emotional nature of patients’ demands, and interpersonal and interprofessional conflict. According to Almazan et al. (2019), nursing is plagued with increased professional stressors; today and historically, nurses are stressed by witnessing patients suffering and dying patients and have to act as the support system for patients and families. Additionally, budget cuts, new healthcare technologies and changing healthcare environments only continue to increase work and personal stress among nurses; because of the need to remain updated on the current knowledge of ever-changing technologies, nursing shortages and poor staffing – exacerbate the feeling of inadequacy (Gharibi et al., 2016). Prolonged exposure to stressors leads to high burnout among nurses and lower job satisfaction; simultaneously, the mental effects of work stress jeopardise nurses’ coping mechanisms, thereby inducing strains that affect health outcomes (McFadden et al., 2021). These stressors further exacerbate personal and interprofessional conflicts and pressures of work; such conflicts affect nurses’ ability to meet their work roles and job expectations – the inability to work because of depleted energy and dedication to work roles (De Cieri et al., 2019). Overall, through work proliferation, it can be understood that prolonged exposure to work-related stressors results in adverse outcomes that affect nurses’ ability to cope with work pressures and, therefore, their ability to undertake their roles effectively.

The Rationale of the Study 

Nurses in the UK frequently encounter stressful situations in their work environment, such as witnessing patients suffering or dying patients, the need to remain updated to the current knowledge and ever-changing technologies, or having to deal with barriers such as nursing shortages and poor staffing (Khamisa et al., 2015; McFadden et al., 2021). Long work hours and high patient demands seriously affect nurses’ mental and physical health, increasing the risk of depression, anxiety, burnout and other stress-related conditions (Sharma et al., 2014). These health effects further lead to interpersonal and inter-professional conflicts, such as absenteeism, high turnover rates or reduced productivity among the healthcare workforce (Gemine et al., 2021; Gharibi et al., 2016). The high prevalence of work stress among staff nurses also compromises the quality of care; stressed nurses are more susceptible to exhibiting low levels of compassion and empathy, making errors, and experiencing low job satisfaction. Therefore, the study is essential in providing evidence-based insight into specific stressors and how they impact staff nurses; understanding the effects is a practical approach to fostering evidence-based practices and policies that mitigate work-related stressors and enhance quality-of-care delivery.

Research Aims and Objectives 

The study aims to examine the effects of work stress on staff nurses concerning the implications of burnout, nurses’ well-being, and job satisfaction to provide insight into the prevalence, consequences, and potential interventions in the UK. The objectives of the study are:

• To assess the implications of work stress and burnout on nurses’ well-being by examining the impact on their mental and physical health.
• To evaluate the effect of work stress on job performance, including the impact of work-related stressors on quality of care, absenteeism, job satisfaction and turnover rates.
• To provide evidence-based recommendations on healthcare practice and policy to reduce work-related stressors and improve staff nurses’ overall well-being.

PICO Question

1. Among UK staff nurses, does implementing interventive strategies and mindfulness techniques help mitigate work-related stressors, leading to increased job performance and satisfaction compared to standard stress management practices?

Expected Results

Work stress affects job performance negatively, leading to lower quality of care, high turnovers and decreased job satisfaction; nevertheless, implementation of interventive strategies significantly reduces the risk of errors, poor nurse-patient interaction and communication breakdown.

Chapter 2. Methodology 

Research Design 

The study conducted a systematic literature review to explore the effect of stress management strategies and mindfulness techniques on job performance indicators among staff nurses in the UK. The research design was deemed ideal because, besides being the most commonly used approach in medical and public health research, systematic literature reviews typically answer posed research questions by synthesising available evidence and evaluating their quality (Borrego, Foster and Froyd, 2014). Additionally, the research design allows the researcher to conduct a thorough and rigorous examination of the current literature evidence; hence, the method is well-suited to provide a complete overview of the study matter (Xiao and Watson, 2019). Okoli and Schabram (2015) further iterated that systematic literature reviews are characterised by a rigorous literature search and selection process; these minimise bias among the included studies and evaluate each study’s relevance and quality, reducing the likelihood of cherry-picking results. Overall, the research design is ideal because it encompasses well-defined and transparent research methods that ensure scientific rigour, reliability and credibility of the evidence.

Literature Search Strategy 

The literature search was conducted on three databases and one search engine: CINAHL, PubMed, PsycINFO and Google Scholar. To establish relevant articles, the following search terms were employed, “staff nurses”, “work stress”, “work-related stress”, “intervention strategies”, “mindfulness techniques”, “stress management workshops”, “job performance”, “quality of care”, “job retention”, and “job satisfaction”. To exhaust and maximise the search results, the Boolean operators “AND” and “OR” were employed to combine the search terms, for example, “staff nurses” AND “work stress” OR “work-related stress” AND “intervention strategies” OR “mindfulness techniques” AND “job performance” OR “quality of care” OR “job satisfaction”. To limit the search results, predetermined inclusion and exclusion criteria were also used to ensure the search outcomes only included peer-reviewed articles published within the past decade, between 2013-2023, and published in English. The limiters ensure the search outcomes are scientific-based and include current and updated evidence – high-quality outcomes.

Selection Criterion 

The search outcomes were limited to only include peer-reviewed articles published in English within the past decade (2013-2023) – this was essential in ensuring only high-quality journals, current and scientific-based, were selected. Additionally, only articles based on primary research qualitative data exploring staff nurses’ experiences (registered nurses, healthcare workers and licensed practical nurses) in the UK were selected. To be selected, the studies also had to focus on evaluating stress management workshops or programs and how they impact quality of care, job satisfaction, absenteeism and retention. On the contrary, all studies based on secondary research methods, including editorial, systematic literature reviews, commentaries, or those not focused on examining the impact of work stress and intervention strategies in the UK, were excluded from the study. Additionally, all articles not available in full-text and not published in English were excluded.

Table 1. Selection Criterion

Data Extraction 

The researcher extracted data by screening the titles and abstracts of the identified peer-reviewed journals to determine eligibility for selection based on the articles’ relevance and focus on the research question. An additional full-text review was conducted on all the eligible articles to extract data and information such as authors’ names, publication year, study design and research methods used, population, interventions, findings and implication of findings. Understanding the research design was crucial in assessing the validity and strength of the evidence while recognising the variations in sample sizes, which allowed the researcher to understand the statistical power and generalizability of the established findings (Papamitsiou and Economides, 2014). The recognition of research designs and sample sizes enabled the researcher to make a more nuanced interpretation of the evidence; for example, extracting information regarding participants’ characteristics aided the assessment of the external validity of the findings (Okoli and Schabram, 2015). Extracting information on work stress measures was central in making comparisons and evaluating associated impacts – it allowed the researcher to capture reported outcomes and implications associated with work stress among staff nurses. Contextual factors were also extracted to understand better the influence of aspects like leadership styles or organisational cultures in the manifestation and consequences of work stress among staff nurses (Moons et al., 2014). In sum, the data extraction process was crucial in ensuring a thorough understanding of the intricacies associated with work stress among staff nurses – the data extraction process facilitated a comprehensive synthesis of current evidence and findings.

Quality Assessment 

For the systematic literature review, the quality assessment of the selected articles was conducted using the Critical Appraisal Skills Program (CASP) tool; the tool is designed to assess the methodological rigour of studies and evaluate the risk of bias in the research design and methods used (Long, French and Brooks, 2020). In the same context, the CASP tool was used for the systematic literature review to assess critical domains in the selected studies, focusing on the study designs, recruited participants, data collection methods and quality of findings and implications. For the qualitative studies, the assessment evaluated the data collection methods used and analysis to evaluate the validity of the studies; the assessment informed the interpretation of the evidence while accounting for the strengths and limitations of each article.

Data Analysis/Synthesis 

The study employed a narrative synthesis approach, summarising findings from selected articles to identify common themes, variations and methodological differences. Linnenluecke et al. (2020) posited that the narrative synthesis, involving the meticulous integration and interpretation of findings, presents a systematic discussion encapsulating the current evidence on work stress among staff nurses in the UK. The analysis approach enabled the qualitative exploration of existing literature and captured the richness of insights beyond statistical aggregations (Siddaway et al., 2019). Additionally, thematic analysis was utilised to identify recurring themes while focusing on commonalities in the manifestation of work stress and similarities in reported impacts – the approach was crucial in distilling overarching patterns and trends within the literature (Ferrari, 2015). Overall, the narrative format was a practical approach that allowed the review to provide a holistic comprehension of work stress and its implications among staff nurses in the UK.

Chapter 3. Results 

Characteristics of Included Studies 

Only seven articles were selected and included in the review; the number of studies included and excluded are depicted in Figure 1 below (See PRISMA flow chart below). The Literature Matrix Tables also present additional information on the study characteristics (See Appendix: Literature Matrix).

Figure 1: PRISMA Flowchart

All the included studies inform that mindfulness-based interventions effectively reduce work stress among staff nurses in the UK; most nurses who actively engage in mindfulness programs reported a significant reduction of work-related stress. For example, Kieft et al. (2014) established that mindfulness-based interventions are effective because the approaches equip nurses with coping skills that foster stress management. Incorporating the strategies results in more positive nursing experiences characterised by competent nursing care, autonomy and control over nursing practice. In the same context, Davey, Jackson and Henshall (2020) further reiterated that mindfulness-based techniques, like deep breathing exercises and meditation, enable nurses to have heightened senses of awareness of the work environment and associated stressors. Consequently, the increased awareness enables nurses to acknowledge and recognise stressors as they emerge while proactively responding to the stressors and challenges (Davey, Jackson and Henshall, 2020). In the same context, Horner et al. (2014) contended that nurses need to learn non-judgemental attitudes and perceptions towards their working environments – this enhances their ability to cope and reduce emotional reactivity despite their demanding nursing role. As such, mindfulness skills enable nurses to disengage from catastrophising and rumination and instead redirect their focus on the present situation while promoting a sense of balance and calmness.

In agreement with the findings, Fisher, Gillanders and Ferreira (2022) further discussed that improved coping mechanisms are a prominent effect of mindfulness-based interventions; as such, nurses who participate in stress management workshops tend to report a heightened capacity to manage the demands associated with the nursing profession effectively. Overall, the literature is indicative that participating in stress management programs enables nurses to develop a resilient mindset that allows them better to navigate patients’ demands and high-pressure circumstances with composure. The same effect, reduced work stress with increased ability to navigate work demands, is also associated with positive impacts on staff nurses’ job performance and job satisfaction.

Appraisal of Included Studies 

The quality assessment of the included articles was conducted using the Critical Appraisal Skills Program (CASP) tool; the tool is designed to evaluate the methodological rigour of studies and the risk of bias in the research design and methods used (Long, French and Brooks, 2020). The CASP tool was used for the systematic literature review to assess critical domains in the selected studies, focusing on the study designs, recruited participants, data collection methods and quality of findings and implications. For the qualitative studies, the assessment evaluated the data collection methods used and analysis to evaluate the validity of the studies; the assessment informed the interpretation of the evidence while accounting for the strengths and limitations of each article.

Findings From Included Studies 

Enhances Quality of Care

Hugh-Jones et al. (2018) and Wampole and Bressi (2020) highlighted the positive effect of participating in mindfulness-based interventions on care delivery; nurses and patients consistently reported that care provided by nurses who participated in stress management workshops, such as mindfulness programs, tend to be of higher quality. From the same perspective, Fisher, Gillanders, and Ferreira (2022) also established that mindfulness interventions enhance nurses’ communication skills and facilitate better communication between care practitioners and their patients. Mainly, the nurses reported that mindfulness skills allowed them to actively listen to patients’ needs and concerns and resulted in more positive experiences – they were more empathetic and attentive in their interactions (Fisher, Gillanders and Ferreira, 2022).

From a different standpoint, Kieft et al. (2014) found that improved nursing experience is associated with enhanced nursing relationships, adequate staffing, control and autonomous nursing practices. Mindfulness-based interventions increase nurses’ awareness of their situations and, therefore, reduce instances of medical errors. Participating in stress management programs better equips nurses to rectify and detect potential errors before they deteriorate; stress management workshops ensure patients’ safety by minimising the risks of adverse events. Similarly, Davey, Jackson and Henshall (2020) found that mindfulness programs also increased empathy and compassion among nurses, reflected through nurses’ increased sensitivity to patients’ psychological and emotional needs. Compassionate approaches are considered vital elements of high-quality care in the nursing profession (Davey, Jackson and Henshall, 2020;Hugh-Jones et al., 2018). Overall, the reviewed studies underscore the transformative effects of participating in stress management workshops or implementing mindfulness-based intervention on work stress; it reduces work-related stress while improving job performance regarding high-quality care delivery.

Enhanced Job Performance

All the included studies underscored a positive correlation between mindfulness-based techniques and enhanced job performance among UK staff nurses; essentially, the studies indicate that nurses participating in stress management workshops improve various job performance indicators. For example, Wampole and Bressi (2020) reported that participation in stress management programs, particularly mindfulness-based interventions, increased job satisfaction. Given that mindfulness skills alleviate work-related stress, it also fosters resilience by equipping nurses with a more positive perception of their work environment and the demands of the nursing profession (Wampole and Bressi, 2020). In the same perspective, findings by Horner et al. (2014) affirmed that nurses actively engaged in mindfulness-based training tend to express an increased sense of fulfilment and satisfaction in their jobs – they demonstrate an increased ability to manage work stress. From a different standpoint, Fisher, Gillanders and Ferreira (2022) focused on job retention; it was established that mindfulness-based intervention is significantly correlated to reduced turnover rates. Nurses who participated in mindfulness training are more likely to remain in their positions for extended periods – the ability to manage work stress is attributed to the stability of the nursing workforce (Hugh-Jones et al., 2018). Mealer et al. (2017) further highlighted that participating in mindfulness-based training reduced absenteeism; the stress management techniques are practical in managing work stress – as such, nurses who participate in such programs are less likely to avoid coming to work because of workplace stressors. Overall, mindfulness interventions are associated with improved job performance; besides reducing stress levels, they also improve job satisfaction because they foster resilience by equipping nurses with a more positive perception of their work environment. Nurses also tend to express greater fulfilment in their nursing roles. They are less likely to avoid coming to work because of workplace stressors because of their ability to manage work stress effectively.

In summary, the seven reviewed studies provide qualitative insights into understanding nurses’ experiences with participation in stress management strategies, specifically mindfulness-based interventions. The findings consistently underscore the importance of implementing mindfulness-based strategies to enhance nurses’ ability to handle emotional and patient demands. In the same context, the themes of enhancing self-awareness and reducing feelings of burnout are emerging; these themes play a crucial role in promoting a more supportive work environment for staff nurses. The theme is relevant in addressing the research question, mainly because they influence the overall job satisfaction of staff nurses. As such, participation and implementation of stress management workshops and interventions are associated with reducing stress and enhancing job performance and satisfaction.

Chapter 4. Discussion 

The Effect of Stress Management Workshops on Staff Nurses’ Job Performance 

According to Hersch et al. (2016), workshop participation has emerged as a valuable proactive strategy towards addressing the challenge of work stress among staff nurses, and it also ensures the professional efficacy of nurses. In support of the findings, Bianchini and Copeland (2021) argued that given that quality of care is a central measurement of job performance in the nursing profession, participating in stress management workshops is positively correlated to the delivery of quality care. Within the UK context, it can be understood that staff nurses attending such workshops are highly likely to demonstrate better coping mechanisms and a heightened ability to manage daily challenges and work stressors effectively. Correspondingly, attending stress management workshops improves job performance mirrored through patient care.

In a comparable study, Guillaumie, Boiral and Champagne (2017) and Wu et al. (2021) focused on exploring the relationship between attending stress management workshops and job retention; it was established that there exists a compelling connection between the two variables. Compared to nurses who do not attend such programs (depending on standard stress management practices), nurses who attend stress management workshops are highly likely to remain in their positions for extended periods (Ramachandran et al., 2023; Nowrouzi et al., 2015). Essentially, the literature informs that by acquiring stress management skills, staff nurses become emotionally resilient because they become better equipped to handle their demanding job roles, make sound clinical judgments, maintain focus and elevate their standards of care. Additionally, considering job retention is a central metric within the healthcare setting, attending workshops would signify the nursing staff’s stability and continuity in care delivery.

Noble et al. (2019) found that participation in workshops is attributed to positive implications on stress management abilities, enhancing nurses’ overall well-being. Debatably, the literature finding is suggestive that as staff nurses develop effective stress coping strategies, they increasingly experience reduced stress levels; accordingly, they tend to have more positive perception and control of their work environment amid patient demands (Janssen et al., 2020; Platis, Reklitis and Zimeras, 2015). In other words, the literature suggests that participation in workshops significantly contributes to higher job satisfaction levels, decreasing the prospect of seeking alternative employment opportunities. In the same context, Labrague et al. (2020) explored the influence of stress management workshop participation and absenteeism among staff nurses. Absenteeism is significantly linked to the inability to cope with stressors, demanding nursing roles and patient demands.

Ramachandran et al. (2023) further reiterated that absence management is attributed to stress-buffering effects that can be enhanced through workshops. In other words, participating in workshops enables staff nurses to access effective stress management techniques and coping strategies, enabling them to better handle work stressors without resorting to absenteeism. In the long run, attending stress management workshops contributes to a more productive and harmonious work environment that guarantees continuity of patient care with alleviated workload burden. Overall, the literature evidence underscores the substantial effects of attending stress management workshops on several jib performance indicators, including absenteeism, quality of care and job retention; participation in such workshops and programs is associated with noticeable enhancements in quality of care delivered, reduced absenteeism and enhanced job retention rates. Likewise, within the UK context, attending stress management workshops is expected to play a pivotal role in fostering staff nurses’ well-being, ensuring continuity in care delivery and boosting job performance.

Effectiveness of Mindfulness-based Programs and Interventions

The systematic review findings corroborate the evidence that mindfulness-based interventions effectively mitigate work stress among staff nurses in the UK. The current evidence reports that actively participating in stress management practices reduces stress levels among nurses; mindfulness techniques, like deep breathing exercises and meditation, enable nurses to have a heightened awareness of the work environment and associated stressors (Burton et al., 2017). Therefore, compared to nurses who depend on standard stress management practices, implementing mindfulness-based stress reduction programs is a proactive approach to help staff nurses mitigate and reduce work-related stressors. Consistent with the findings above, Vivian et al. (2019) affirmed that equipping nurses with mindfulness techniques and strategies to promote self-care significantly contributes to their ability to cope, address and reduce work stress and increase their job satisfaction. In contrast, by recognising the detrimental impacts of work stress among staff nurses, healthcare institutions in the UK have also explored several interventive strategies to mitigate these stressors, aiming to enhance nurses job satisfaction and performance (Ghawadra et al., 2020; McFadden et al., 2021). For example, Almazan et al. (2019) found that in most UK hospitals, mindfulness-based stress reduction programs are widely implemented; nurses who participated in these programs reported significant reductions in stress levels compared to those who implemented standard stress management strategies. Implementing mindfulness-based stress reduction programs is a proactive approach to help staff nurses mitigate and reduce work-related stressors.

Additionally, Guillaumie, Boiral and Champagne (2017) further noted that in the UK healthcare setting, nurses who engaged in additional stress management strategies also reported lower perceived stress levels, reflected through improved job performance with enhanced patient care quality. The interventions are focused on equipping nurses with mindfulness techniques to improve their ability to manage stress effectively (De Cieri et al., 2019; Wu et al., 2021). Therefore, compared to nurses who depend on standard stress management practices, implementing mindfulness programs has subtle effects mirrored on high job performance and satisfaction levels. Overall, the findings underscore the importance of further implementing mindfulness interventions to address work-related stressors effectively; the approach has been explored in the UK healthcare setting. However, it must still be fully implemented or utilised to enhance job performance among UK staff nurses.

Consequently, the review findings have revealed that mindfulness skills are vital in enabling nurses to disengage from catastrophising and rumination and instead redirect their focus on the present situation while promoting a sense of balance and calmness. Mindfulness-based interventions, such as deep breathing exercises, allow nurses to better navigate patients’ demands and high-pressure circumstances with composure. The findings align with the current evidence that through stress management workshops, nurses are better equipped to become emotionally resilient to handle their demanding job roles, make sound clinical judgments, maintain focus and elevate their standards of care (Wongtongkam et al., 2017). In the same context, participation in these programs is also associated with improved quality of care, job satisfaction and performance–reduced absenteeism; therefore, participating in workshops enables staff nurses to access effective stress management techniques and coping strategies, enabling them to better handle work stressors without resorting to absenteeism (Ramachandran et al., 2023). Accordingly, it can be inferred that participating in stress management workshops enhances the quality of care delivered, mainly because the programs resonate with the research findings that mindfulness skills contribute to more patient-centred care and safer healthcare practices.

Implications on Nursing Practice 

The findings confirm that the healthcare landscape profoundly impacts nursing practice; therefore, mindfulness-based interventions are an indispensable approach to addressing work stress’s pervasive and debilitating issues. In addition, it can also be understood that stress management techniques or workshops give healthcare institutions a unique opportunity to address the effects of work stress while bolstering nurses’ well-being; they can also simultaneously optimise crucial job performance indicators. The findings corroborate with the literature evidence and confirm the understanding that work stress results in increased absenteeism and high turnover rates, active participation in stress management programs is an adequate proactive approach that translates into better experiences for the nurses, mirrored increased job satisfaction and retention (Strauss et al., 2018). For example, McFadden et al. (2021) posited that work-related stressors are pervasive in the healthcare sector in the UK, specifically among staff nurses; the demanding nature of the nursing profession is characterised by the high patient workload, long work hours and emotional toll that comes with patient care – these factors raise stress levels. In agreement, from the nature of work-related stressors, Almazan et al. (2019) affirmed that the healthcare environment in the UK is dynamic and high-pressure; accordingly, nurses frequently experience stressors that negatively impact their ability to undertake their roles, mental and physical well-being and therefore, job satisfaction.

On the contrary, Ghawadra et al. (2020) delved that effective mitigation intervention is imperative to address work-related stressors among staff nurses. In the same perspective, Botha, Gwin and Purpora (2015) reiterated that considering the relentless nature of the demanding nursing work that requires round-the-clock attention to patient care, nurses must implement coping strategies to mitigate the associated emotional strains and fatigue. Work stressors are a prevalent issue in the UK healthcare setting, and work stress stems from the inherent challenges associated with the nursing profession (De Cieri et al., 2019; Siu, Cooper and Phillips, 2014). Accordingly, as healthcare institutions in the UK continue to wrestle with the implication of work stress on their nursing workforce, the focus should shift towards implementing mitigative practices to foster a healthier work environment where nurses can effectively undertake their roles. In sum, the literature evidence suggests that the nature of the nursing profession in the UK is multifaceted, elevates stress levels and increases job dissatisfaction; interventive strategies are imperative to reduce exposure of staff nurses to situations that impact patients’ outcomes and job performance.

Accordingly, given that work stress is highly prevalent and pervasive in the nursing profession, the study findings agree that among nurses, stress emerges when demanding situations exceed nurses’ resources to cope effectively (McFarland and Dixon, 2021; Siu, Cooper and Phillips, 2014). Similarly, the findings also underscore that integrating stress management initiatives, such as mindfulness-based approaches, is imperative in enhancing the quality of care. Participating in stress management programs is associated with a cascade of benefits in care delivery; mainly, the current evidence consistently reports that nurses who actively engage in such programs also deliver high-quality care. The findings are consistent with the literature evidence, arguing that, while the findings indicate that work stress reduces the quality of care delivered, stressed nurses are more susceptible to exhibiting low levels of compassion and empathy, making errors, and experiencing low job satisfaction (Gemine et al., 2021; Gharibi et al., 2016). Mindfulness interventions enhance nurses’ communication skills and facilitate better communication between care practitioners and their patients (Guillaumie, Boiral and Champagne, 2017). Therefore, the programs also effectively ensure continuity in care delivery; healthcare institutions can ensure continuity in their nursing staff to maintain reliability and consistency in care services. At the same time, positive patient experiences are significantly correlated with enhanced clinical outcomes, reduced instances of medical errors and increased compliance with treatment regimens (Burton et al., 2017). Consequently, the findings also reflect the potential of these programs to enhance patient experiences and improve clinical outcomes.

Overall, the finding informs that the ripple effect of work stress on nurses is well-documents throughout the literature evidence; nonetheless, from the same evidence, it can also be deduced that nurses who experience reduced levels of stress are associated with improved job performance and satisfaction and are more likely to have a higher sense of empathy, attentiveness and compassion. Notably, the findings underscore the potential of integrating stress management interventions to ensure a more satisfied, effective and stable nursing workforce and ultimately improve the quality of care. Participating in stress management programs is pivotal in fostering patient-centred care, where nurses can meet patients’ demands with responsiveness and sensitivity. As such, within the UK setting, healthcare institutions should prioritise offering stress management workshops, such as mindfulness-based strategies, to ensure their nursing workforces are stable to ensure continuity in care delivery with improved patient outcomes. The implications of the findings are far-reaching, highlighting the importance of integrating stress management interventions in healthcare organisations; the interventions play a pivotal role in addressing the pervasive issues of work stress and its effects among staff nurses.

Limitations of the Study

One of the notable limitations is the inclusion of a few studies that may also be biased towards articles with positive outcomes. At the same time, publication bias is imminent, and it should also be noted that studies with null or negative findings are also underrepresented in the literature. Accordingly, if things were to be done differently, a wide publication date, for example, two decades (2003-2023), would address this limitation by allowing a more extensive search strategy. The homogeneity of the study designs is another limitation; the review only includes primary studies based on qualitative data. In the future, the review should include qualitative and quantitative data with a comparative analysis approach to examine the research question comprehensively. Lastly, the current study has yet to delve much into the specific stress management strategy; future studies should consider a broadened scope to include other stress management techniques like cognitive-behavioural therapy, resilience-building programs and relaxation approaches.

Practice and Research Recommendations 

Practice Recommendations

The review findings have underscored the critical need and importance for healthcare institutions to intervene in work stress proactively and its implications among staff nurses. In the same context, drawing upon the established findings, mindfulness-based strategies are effective methods to mitigate work stress. Accordingly, the review recommends the integration of mindfulness training programs into the development initiatives and organisational culture; this would proactively enable staff nurses to accommodate unique stressors encountered in demanding situations with enhanced resilience and coping mechanisms (Burton et al., 2017; Vivian et al., 2019; Almazan et al., 2019). In future practice, the review also recommended that staff nurses pursue and attend stress management workshops regularly; such platforms are crucial for nurses to reinforce and acquire mindfulness skills and share experiences – and provide accessible mindfulness resources. Overall, adopting these practice recommendations would be a practical approach to ensure that healthcare institutions and staff nurses proactively seek to address stress work within the demanding nursing workplace. The practice recommendations also encourage self-care initiatives, fostering healthier and more resilient workforces capable of coping with demanding situations and contributing to improved patient outcomes, decreased turnover rates and optimal organisational performance.

Research Recommendations

The systematic literature review has provided valuable insight into the effects of work stress on staff nurses and the effectiveness of mindfulness-based strategies to mitigate these effects and improve the quality of care. Nonetheless, from a research perspective, the review was limited to include potential publication bias and homogeneity of study designs (only including qualitative data and findings); more extensive research would help conduct an extensive assessment procedure. Accordingly, the study recommended considering a broader search strategy that includes different study designs and ensuring more critical and rigorous quality assessment procedures to understand the research topic better. The recommendation is to ensure the scope of the systematic literature reviews includes various stress management practices and interventions and explore the findings from a more vigorous geographical context. Mainly, the rationale of the recommendation is based on the understanding that addressing the highlighted limitations would ensure the researcher builds on the strengths of conducting a systematic literature review and, therefore, provide a more robust and comprehensive insight into the impact of work stress and therefore the effective of stress management interventions for nurses and how it ultimately addresses the effects of work-related stress on the nursing profession. Accordingly, to enhance the comprehensiveness and rigour of future reviews, the study recommends a broader search strategy, encompassing unpublished studies and grey literature sources, to mitigate the potential of publication biases; this would ensure the review also considers studies with null and adverse outcomes. Future reviews should also consider exploring interventional context; the current study only focused on the UK; different geographical regions and healthcare settings would result in more valuable insight into the effect of work stress in the nursing profession with greater generalisability. Overall, incorporating the above recommendations would build on the strengths of the current review and, therefore, provide more robust insight into the research topic and the implication on the nursing practice and, ultimately, quality of care.

Chapter 5. Conclusion 

Nurses in the UK frequently encounter stressful situations in their work environment; long work hours and high patient demands seriously affect nurses’ mental and physical health, increasing the risk of depression, anxiety, burnout and other stress-related conditions. Accordingly, the study is essential in providing evidence-based insight into specific stressors and how they impact staff nurses. The study aimed to examine the effects of work stress on staff nurses concerning the implications of burnout, nurses’ well-being, and job satisfaction to provide insight into the prevalence, consequences, and potential interventions in the UK. The study employed a systematic literature review method to thoroughly and rigorously examine the current literature evidence. The literature search was conducted on three databases and one search engine: CINAHL, PubMed, PsycINFO and Google Scholar, where a predetermined selection criterion was used to ensure the inclusion of quality and current evidence on the subject matter. The study utilised a narrative synthesis approach, summarising findings from selected articles to identify common themes, variations and methodological differences. The narrative format was a practical approach that allowed the review to provide a holistic comprehension of work stress and its implications among staff nurses in the UK.

Seven articles were selected and included in the review, consistently suggesting that participating in stress management programs enables nurses to develop a resilient mindset better to navigate patients’ demands and high-pressure circumstances with composure. The same effect, reduced work stress with increased ability to navigate work demands, is also associated with positive impacts on staff nurses’ job performance and job satisfaction. Stress management workshops and interventions reduce stress and enhance job performance and satisfaction. In the discussion, the evidence from the included studies corroborates current literature findings. In most UK hospitals, mindfulness-based stress reduction programs are widely implemented; nurses who participated in these programs reported significant reductions in stress levels compared to those who implemented standard stress management strategies. Implementing mindfulness-based stress reduction programs is a proactive approach to help staff nurses mitigate and reduce work-related stressors. The findings underscore the potential of integrating stress management interventions to ensure a more satisfied, effective and stable nursing workforce and ultimately improve the quality of care. Nonetheless, while the review findings were consistent with literature evidence, the review was limited to potential publication bias and homogeneity of study designs (only including qualitative data and findings); more extensive research would help conduct an extensive assessment procedure. Practice recommendations mainly encourage self-care initiatives to foster healthier and more resilient workforces capable of coping with demanding situations.

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Appendix

Literature Matrix