Вы находитесь на странице: 1из 6

Nurses views on workplace wellbeing

programmes
Nicola Wright, Melissa Zakarian and Holly Blake

influence priorities and mean that the nature of nursing work


ABSTRACT is in a constant state of flux (McVicar, 2003).
Workplace stress is prevalent among nurses. Healthcare employers have Given this context, healthcare organisations are increasingly
implemented complementary and alternative therapies (CATs) for relaxation implementing workplace wellness programmes to promote
and stress management within workplace wellbeing programmes. In- health and wellbeing among their employees (Lee and Blake,
depth interviews were conducted with 12 registered nurses to explore the 2009; Lee et al, 2010; Blake et al, 2013). The organisational
perceptions and experiences of nurses towards accessing CATs in and benefits of such interventions have been recognised (Blake
outside the workplace. Interviews were audio recorded and transcribed and Lloyd, 2008; Lee et al, 2010), and evaluations indicate that
verbatim. Data were analysed using conventional, qualitative thematic employees are enthusiastic about workplace interventions for
techniques. Themes identified were perceptions of complementary and health, and perceive benefits from accessing them (Phillipp and
alternative therapies for stress management and engagement with Thorne, 2008; Lee and Blake, 2009; Blake et al, 2014; Blake et
workplace wellness schemes. CATs have a role within workplace wellbeing al, 2015).Although diverse in nature, programmes often include
programmes and nurses are not averse to accessing them, although there are exercise and fitness initiatives, dietary and healthy living advice
barriers to access that need to be addressed. and a range of complementary and alternative therapies (CATs)
Key words: Stress Nurses Complementary therapies Qualitative (Tiran and Chummun, 2004); CATs are the particular focus
research Workplace of this study. The National Centre of Complementary and
Alternative Therapies (NCCAM) (2011) described CATs as:

W
A group of diverse medical and health care
ork-related stress is a challenge to public
systems, practices and products that are not
health (Health and Safety Executive
generally considered part of conventional
(HSE), 2014) and has a significant impact
medicine
on organisations, since work environments
NACCM, 2011
shown to be stressful have higher levels of
presenteeism and absenteeism (Wu et al, 2010) and a higher staff Such therapies may include massage, reflexology, Reiki,
turnover rate (Begat et al, 2005).The NHS Staff Council Health acupuncture and herbal remedies.
Safety and Wellbeing Partnership Group (2014) attributed 30% Despite high stress among nurses, workplace wellbeing
of sickness in the NHS to stress at an estimated cost of 300 initiatives are more commonly accessed by employees in office-
400 million per year. based job roles than by front-line care staff, and evaluations of
Nursing has a high prevalence of work-related stress workplace programmes accessed by nurses are limited. Little
compared with other healthcare professions (Wu et al, 2010; is known about the perceptions of nurses towards the use of
HSE, 2014) and the reasons for this are multifaceted. Nursing CATs for workplace wellbeing, although this knowledge is
demands a high level of skill, provision of 24-hour care and important for workplace health providers to better understand
the input of what is referred to by Phillips (1996) as emotional the needs of this employee group to inform the design of future
labour. Policy and organisational changes within the NHS services offered. Qualitative interviews with service users
have shown that NHS employees (from diverse occupational
groups) appreciate both the accessibility of complementary
Nicola Wright, Assistant Professor in Mental Health, School therapies offered through the workplace and the perceived
of Health Sciences, University of Nottingham, nicola.wright@ benefits they bring to health and wellbeing (Meade et al, 2009).
nottingham.ac.uk However, some nurses have expressed a lack of knowledge
Melissa Zakarin, Tissue Viability Nurse, Nottingham University about CATs coupled with a degree of skepticism towards
2016 MA Healthcare Ltd

Hospitals NHS Trust, Nottingham their use, which may influence their willingness to access
Holly Blake, Associate Professor, School of Health Sciences, them. Other factors may potentially hinder engagement,
University of Nottingham which are not well understood. The aim of this study was to
Accepted for publication: November 2016 explore nurses perceptions and experiences of using CATs
for workplace stress management.

1208 British Journal of Nursing, 2016, Vol 25, No 21


RESEARCH

Methods Findings
An exploratory qualitative research design using in-depth, semi- Analysis identified two key themes that were consistent both
structured interviews was conducted. Data collection took within and across the participant accounts. Identified themes
place between September 2011 and February 2012. All the and subthemes were agreed by a second person. Although
interviews were conducted by the second author, lasted for participants were not given the opportunity to review their
between 20 and 60minutes and were audio recorded.The data manuscripts, lay feedback and overall findings were circulated to
from the interviews were analysed using conventional qualitative all those registered with the service.The identified themes were:
thematic methods.These sought to identify themes both across perceptions of complementary therapies for stress management
and within individual accounts (Ritchie and Spencer, 1994). and engagement with workplace wellbeing initiatives. To
Approval was obtained from the local NHS Research Ethics preserve confidentiality and anonymity, participant numbers
Committee (REF: 11/EM/0081) and research governance have been used for identification purposes.
teams at the local hospital trust where the study took place.
Verbal and written information was provided to all potential Theme 1: perceptions of complementary therapies
participants and informed written consent was obtained from for stress management
those who agreed to be interviewed. Before considering their involvement in workplace stress
management initiatives, participants were asked to reflect on
Participants and setting their perceptions and experiences of CATs more generally.
Participants were registered nurses recruited from the local All participants stated that they had engaged with them for
emergency department and burns high-dependency unit of perceived stress reduction with massage being the most popular
a single site of an acute hospital trust, using a combination of form of therapy:
convenience and snowball sampling techniques.These settings
It just takes away the tension, really stops you
were selected as it has been consistently evidenced that working
feeling tense.
in these clinical areas is stressful (Helps, 1997; Negble et al, 2014;
P004
Adriaenssens et al, 2015). Ward managers and research group
leaders were asked to distribute a study information sheet to Using CATs as a mechanism for managing stress was seen
nurses in their teams.Those who wanted to participate returned to be beneficial by the majority of participants, and several
an expression of interest to the researcher.A total of 12 registered participants made references to the potential for CATs to reduce
nurses took part in the study.These included two prior users of sickness absence in hospital employees when delivered in the
the workplace therapies services who had accessed a wellness workplace setting:
unit (SenzOri Egg) and massage therapies within the workplace
I think it will reduce sickness, reduce people
setting, but infrequently accessed CATs outside of the workplace.
being irritable or upset on the wards.
The other ten participants were non-users of the workplace
P003
therapies service, and eight of them had accessed a diverse range
of CATs outside of the workplace setting, including massage However, some participants highlighted concerns about
therapies, acupuncture, aromatherapy, reflexology, and Reiki. using CATs that appeared to be twofold: a lack of a robust
Two participants had not previously accessed CATs. All of the evidence for the effectiveness of some therapies, coupled with
participants that had accessed CATs had accessed more than a conflict between the underpinning philosophy of health care
one type of CAT, whether inside or outside of the workplace. within the NHS (dominated by medicine) and the principles
All participants were female and aged 2453 years. They had of some CAT approaches:
worked at the hospital trust for between 3 and 35years.Three
It (CAT) has quite a stigma in this
of the nurses interviewed were band6 deputy sisters and nine
environment it does, of being quite wishy
were band5 registered nurses.
washy, its about trying to correlate the two,
The NHS organisation where the study was undertaken has
medicine and complementary therapy.
an established workplace wellness programme for employees,
P006
developed in 2005 and still active in 2016 at the time of
publication. This offers a wide range of services to promote For some, this conflict included a dissonance between their
and support health and wellbeing, including staff gym, exercise own cultural or spiritual beliefs and the philosophy perceived
classes and fitness challenges, staff physiotherapy service, to underlie some CATs:
and mental wellbeing (e.g. coping with stress and building
I dont do yoga because it has a bit of a
resilience). Services have evolved over time and periodically
spiritual attachment to it ... Id rather not do it
change according to staff need but are described in more
... because I dont want to compromise what I
detail elsewhere (Blake et al, 2013) and in terms of CATs, have
2016 MA Healthcare Ltd

believe.
included a wellness unit (SenzOriEgg), massage, aromatherapy
P003
and reflexology. The range of workplace CATs available at
the time of this study have been described in more detail In summary, the majority of participants had accessed
in other literature (Meade et al, 2009; Lee and Blake, 2009; CATs outside of the workplace, and perceived clear benefits
Blake et al, 2013). of using CATs in the workplace to manage stress. However,

British Journal of Nursing, 2016, Vol 25, No 211209


the underpinning principles of some of the approaches was Although CATs services were designed to be accessible
thought to conflict with both the dominant philosophy and outside of shifts (e.g. on days off or at the end of the working
evidence-based nature of healthcare provision and even personal day), nurses had little motivation to attend outside of their
belief systems. For some, this was identified as problematic for working hours:
implementing CATs within the NHS workplace, and for their
It would have to probably be before or after a
personal engagement with them.
shift and then it would take some push to make
me go, because at the end of the shift all you
Theme 2: engagement with workplace wellbeing
want is to go home.
initiatives
P008
Although all 12 participants were aware of workplace health
initiatives within their local NHS organisation, only two had Participants suggested that therapies could be delivered
accessed them. One individual had accessed massages through the directly to them within their clinical setting to increase access
CATs service and the second had used the SenzOri Egg (Lee and and reduce time taken to engage in CATs:
Blake, 2009).The latter is a self-contained wellness unit designed
If they [the therapists] came on to the ward or
for taking 15-minute relaxation breaks. Both the participants
something ... and be there for us to just drop in
shared positive experiences of engaging in these activities:
when we have got a free minute.
Massages are brilliant, I love it ... really helps. P009
P007
Cost of attendance was perceived to be prohibitive, although
it was evident that participants were unaware that the cost of
On my night shifts sometimes on my break I
accessing workplace CATs was lower than average costs for
would go and sit in the (SenzOri) Egg, and it
therapies offered outside of the workplace:
just kind of sits you back and the lights go dim
and the door shuts around you, and it vibrates, They are quite expensive, they are about 30-
its really cool and relaxing. 40 arent they for half an hour if I went for
P010 a massage every time I was stressed I think Id
be spending thousands.
Those participants who had not used CATs in the workplace
P012
felt positively about their availability and recognised the potential
benefits of CATs for stress reduction: However, nurses generally felt that the benefits of CATs
would justify the cost:
It makes sense to use them at work where we
are most stressed. If I thought it would benefit me then I would
P009 pay it, definitely.
P013
Going off to have a neck, back and shoulder
Issues were raised relating to the culture of nursing as
massage would be lovely, definitely, it would
a profession, and for some, their non-engagement with
refresh you, take your mind off work.
workplace CATs was associated with logistical issues around
P011
attending and feeling unable to take a break at work. Many
Nurses expressed that provision of CATs at work was a sign of the nurses felt that it would be perceived negatively if they
that the organisation valued its employees and that active steps took breaks at lunchtime, especially to attend a workplace
were being taken to support their wellbeing: health appointment:
I think as a nurse you dont really expect to get
anything, so the fact that you can have things Staff didnt feel like they should go for breaks.
like that subsidised, massages and things, is a P006
really nice idea.
In summary, although participants were aware that CATs were
P009
offered within their workplace, knowledge about the provision
A number of logistical and practical barriers to access was limited and very few of the nurses had personally accessed
were raised, the most common being time, location and cost. them, although their existence was enough to make nurses
Most notably, nurses perceived that they would not have the feel more valued by their employer. Nurses that had accessed
time to get away from the clinical setting in order to attend the CATs perceived them to be highly beneficial. However,
appointments for CATs: there were numerous barriers to access identified, including
2016 MA Healthcare Ltd

having the time to attend during the working day, location of


My last ward, they didnt really have very good services away from the clinical area, the misperception of high
breaks, you didnt get the time ... only had an cost and a perception that their attendance for an appointment
hour and that wasnt really enough. at the service would be perceived negatively by colleagues
P006 and superiors.

1210 British Journal of Nursing, 2016, Vol 25, No 21


RESEARCH

Discussion should discuss alternative delivery times with nurses, and perhaps
In the UK, improving the health and wellbeing of NHS employees offer brief CATs that may be perceived to be more accessible.
remains high on public health agenda.An announcement by NHS Nurses perceived a cultural barrier to taking work breaks and felt
Englands chief executive, Simon Stevens, indicated a clear need that accessing workplace wellness services within breaks would
to reduce stress in the public health workforce (NHS England, not be supported within their work environment. Managers and
2015). The emergency department and burns units present individual nurses need to be fully informed about the risks and
particular challenges in this regard. The combination of acute costs associated with high stress within the nursing profession,
(e.g. life-or-death decision-making, violence and aggression) and the potential benefits of workplace-delivered initiatives
and chronic (e.g. high physical demands and time pressures) to prevent and manage stress. This may require a cultural shift
stressors with an unpredictability of working conditions can within hospital workplace environments to ensure that efforts
lead to nurses experiencing high levels of emotional distress to promote positive health and wellbeing for nurses are fully
and burnout (Adriaenssens et al, 2015).The consequences may recognised by all so that, where possible, break times for nurses
have an impact on both the individual concerned, and the are protected.
profession, as it has been identified that nurses experiencing When considering the implications of the study it is important
these very intense reactions may change career, or use alcohol to do so within the context of its limitations. Data collection
to cope with the stress (see, for example, Duffy et al (2015)). took place in 2011/2012 and so may be considered dated.
Given the current shortage of nurses within the healthcare However, the findings continue to have currency, given the
workforce (NHS Improvement, 2016) there is clearly a need to ongoing and increasing attention on the health and wellbeing
maintain a focus on supporting wellbeing and mangaging stress of NHS staff in contemporary literature, current policies and
in this occupational group. In this study, the authors investigated in the media. For example, the Boorman review of NHS
nurses views towards the use and implementation of CATs for health and wellbeing in 2009 recommended that trusts should
managing stress at work and found their attitudes to be very design and implement strategies for improving the physical and
positive towards inclusion of such services within workplace mental health of their staff (Boorman, 2009; Burnham, 2009).
wellness programmes, irrespective of whether they had accessed Following this, the NHS Future Forum recommended that
the services themselves. trusts should be held accountable for improving the health and
At an organisational level, the provision of CATs within wellbeing of their workforce (Ford, 2012). Nurses health and
the workplace demonstrates that employers are concerned wellbeing continue to be at the forefront of NHS employee
about staff welfare (Mackereth et al, 2005; Phillipp and Thorne, health concerns (Blake, 2014), especially given the high levels
2008) and this resonates with the views expressed by the nurses of sickness absenteeism, stress and burnout among frontline
participating in this study. Indeed, earlier evaluations have shown care staff (Wilkinson, 2015). The environments in which this
that staff opinions towards the NHS as an employer may be data was collected continue to generate high levels of stress and
improved following implementation of workplace wellness emotional burden (e.g. emergency departmentsMaddineshat
programmes incorporating CATs (Blake et al, 2014). et al (2016); burns unitsKellogg et al (2014)).
Although participants identified the positive impact from The self-selecting nature of the sampling strategy and the
treatments traditionally associated with CATs, it appeared that small number of participants mean that care needs to be taken
being able to access a quiet place if only for a few minutes was when transferring the findings to other settings.All participants
perceived to be very helpful in managing stress. This might were women and this means that the findings may not reflect
simply be a quiet room in which nurses could take a break, the experiences of male nurses. Given these limitations there is a
or self-contained wellness units offering time-out for nurses need for further research into the experience of stress for nurses
and potentially reducing perceived stress (Lee and Blake, 2009). working in different settings, the potential support mechanisms
Having a quiet place to go during breaks is not only perceived for preventing and managing workplace stress effectively and
positively by individual nurses but may have an impact on patient the barriers and facilitators to accessing these.
care and outcomes. For example, Gardner et al (2009) found
that where quiet time was implemented in clinical settings, Conclusion
patients and nurses felt more satisfied and relaxed, with patients The nurses in this small study were broadly positive about using
reporting improved sleep patterns. CATs for their own health and wellbeing, and the provision of
Nurses from high-stress clinical environments, such as the wellbeing schemes within the workplace that include CATs
emergency department and burns units, valued workplace- is seen as a positive development. Of particular importance is
delivered CATs and perceived CATs to be beneficial for the recognition this provides to nurses that they are valued by
wellbeing, although some identified uncertainty and/or stigma their employer. Some logistical and practical issues need to be
associated with their use by health professionals, which has been addressed to ensure that CATs are perceived to be accessible.
recognised previously (Peters; 2000; Furnham, 2001; Adams, Workplace culture around taking breaks needs to be further
2016 MA Healthcare Ltd

2006) and is often associated with a lack of robust evidence investigated to ensure that nurses feel able to take breaks and able
base (Adams, 2006). to access services, and that this is supported by their colleagues
Where relevant, workplace health and wellbeing services and managers. Healthcare employers should consider provision
need to increase awareness of the reduced cost of in-house CATs of wellbeing services within clinical settings and providing quiet
compared with external therapy services. Service providers spaces for relaxation and time out during breaks. BJN

British Journal of Nursing, 2016, Vol 25, No 211211


Health and Safety Executive (2014) Work related stress, anxiety and
KEY POINTS depression statistics in Great Britain 2015. http://tinyurl.com/cmlzp5
(accessed 14 November 2016)
Work-related stress is a challenge to public health Helps S (1997) Experiences of stress in accident and emergency nurses. Accid
Emerg Nurs 5(1): 48-53
Among health professionals, nursing is among those with the highest levels Kellogg MB, Barker M, McCune N (2014) The lived experience of pediatric
of work-related stress burn nurses following patient death. Pediatr Nurs 40(6): 297-301
Lee S, Blake H (2009) Tackling NHS staff stress levels in an eggstraordinary
Complementary and alternative therapies are a popular mechanism for way. Health Psychology Update 18(2): 8-13
stress relief Lee S, Blake H, Lloyd S (2010) The Price is right: making
workplace wellness financially sustainable. International Journal
Healthcare employers should consider provision of wellbeing services of Workplace Health Management 3(1): 58-69. http://dx.doi.
org/10.1108/17538351011031948
within clinical settings Mackereth P, White K Cawthorn A, Lynch B (2005) Improving stressful
working lives: Complementary therapies, counselling and clinical
supervision for staff. Eur J Oncol Nurs 9(2) 147-54
McVicar A (2003) Workplace stress in nursing: A literature review. J Adv Nurs
Declaration of interest: none 44(6): 633-42
Maddineshat M, Rosenstein AH, Akaberi A, Tabatabaeichehr M (2016)
Disruptive behaviors in an emergency department: the perspective
Adams J (2006) An exploratory study of complementary and alternative of physicians and nurses. J Caring Sci 5(3): 241-9. doi: 10.15171/
medicine in hospital midwifery: models of care and professional struggle. jcs.2016.026
Complement Ther Clin Pract 12(1): 407. http://dx.doi.org/10.1016/j. Meade O, Maclennan SJ, Blake H, Coulson N (2009) Workplace
ctcp.2005.09.003 complementary and alternative therapies for hospital-site staff.
Adriaenssens J, De Gucht V, Maes S (2015) Causes and consequences of International Journal of Workplace Health Management 2(3): 258-71. http://
occupational stress in emergency nurses, a longitudinal study. J Nurs dx.doi.org/10.1108/17538350910993449
Manag 23(3): 34658. http://dx.doi.org/10.1111/jonm.12138 National Centre of Complementary and Alternative Therapies (2011) Terms
Bgat I, Ellefsen B, Severinsson E (2005) Nurses satisfaction with their work related to complementary and integrative health. http://tinyurl.com/
environment and the outcomes of clinical nursing supervision on nurses zldfo2u (accessed 14 November 2016)
experiences of well-beinga Norwegian study. J Nurs Manag 13(3): Negble M, Agbenorku P, Hoyle-Williams PE (2014) Nursing severe burn
22130. http://dx.doi.org10.1111/j.1365-2834.2004.00527.x injury patients: emotional impact on nurses. International Journal of
Blake H, Batt ME (2015) Employee perceptions of a pedometer walking Medicine and Medical Sciences 47(1): 1430-3. http://tinyurl.com/hag9n88
intervention in a hospital workplace. International Journal of Health (accessed 14 November 2016)
Promotion and Education 53(5): 25770. http://dx.doi.org/10.1080/14635 NHS England (2015) Simon Stevens announces major drive to improve
240.2015.1016621 health in NHS workplace. 2 September. http://tinyurl.com/h89q33p
Blake H, Bennett E, Batt ME (2014) Evaluation of occupational health (accessed 14 November 2016)
checks for hospital employees. Intl J of Workplace Health Mgt 7(4): 24766. NHS Improvement (2016) Evidence from NHS Improvement on Clinical Staff
http://dx.doi.org/10.1108/IJWHM-07-2013-0027 Shortages: A Workforce Analysis. http://tinyurl.com/h7l55ty (accessed 14
Blake H (2014) Nurses recognise their own health can affect care quality. November 2016)
Nurs Times 110(38): 7 NHS Staff Council Health Safety and Wellbeing Partnership Group (2014)
Blake H, Zhou D, Batt ME (2013) Five-year workplace wellness intervention Guidance on the Prevention and Management of Stress at Work. NHS
in the NHS. Perspect Public Health 133(5): 262-71 Employers, London. http://tinyurl.com/jrwdtdm (accessed 14 November
Blake H, Lloyd S (2008) Influencing organisational change in the NHS: 2016)
lessons learned from workplace wellness initiatives in practice. Qual Prim Peters D (2000) From holism to integration, is there a future for
Care 16(6): 449-55 complementary therapies within the NHS? Complement Ther Nurs
Boorman S (2009) NHS Health and Well-being Review: Final Report. http:// Midwifery 6(2): 59-60
tinyurl.com/oh9txy6 (accessed 16 November 2016) Philipp R, Thorne P (2008) Would complementary and alternative medicine
Burnham A (2009) Department of Health response to NHS Health and Well- be welcomed in the workplace? Public Health 122(10): 11247. https://
being Review. 23 November. http://tinyurl.com/j4waeok (accessed 11 dx.doi.org/10.1016/j.puhe.2008.01.012
November 2016) Phillips S (1996) Labouring the emotions: expanding the remit of nursing
Duffy E, Avalos G, Dowling M (2015) Secondary traumatic stress among work? J Adv Nurs 24(1): 139-43
emergency nurses: a cross-sectional study. Int Emerg Nurs 23(2): 53-58. Ritchie J, Spencer L (1994) Qualitative data analysis for applied policy
Ford S (2012) Nurse health and wellbeing should be core principle for research. In: Bryman A, Burgess RG, eds, Analyzing Qualitative Data.
NHS trusts. Nurs Times 10 January. http://tinyurl.com/zebvvms (accessed Routledge, London: 173-94
11 November 2016) Tiran D, Chummun H (2004) Complementary therapies to reduce
Furnham AF (2001) Alternative and complementary healing practices. In: physiological stress in pregnancy. Complement Ther Nurs Midwifery 10(3):
Smelser NJ, Wright J, Baltes PB, eds, International Encyclopedia of the Social 162-7
and Behavioural Sciences. Pergamon, Oxford: 404-7 Wilkinson E (2015) UK NHS staff: stressed, exhausted, burnt out. Lancet
Gardner G, Collins C, Osborne S, Henderson A, Eastwood M (2009) 385(9971): 8412. https://dx.doi.org/10.1016/S0140-6736(15)60470-6
Creating a therapeutic environment: A non-randomised controlled trial Wu H, Chi H, Chen L, Wang L, Jin Y-P (2010) Occupational stress among
of a quiet time intervention for patients in acute care. Int J Nurs Stud hospital nurses: A cross-sectional survey. J Adv Nurs 66(3): 627-34. doi:
46(6): 778-86. doi: 10.1016/j.ijnurstu.2008.12.009 10.1111/j.1365-2648.2009.05203.x

BJN CALL FOR CLINICAL PAPERS ( 020 7738 5454 8 bjn@markallengroup.com @BJNursing

The British Journal of Nursing welcomes unsolicited articles on a range of clinical subjects
The journal publishes literature reviews, case studies, review articles and original research
2016 MA Healthcare Ltd

All articles submitted to BJN are subject to double-blind peer review


The journal is indexed on the International Nursing Index, PubMed and CINAHL
Author guidelines can be found on the journals website (http://tinyurl.com/bjnguide16). If you have any queries relating to potential articles please
email the editor: julie.smith@markallengroup.com, or call 020 7501 6702

1212 British Journal of Nursing, 2016, Vol 25, No 21


Copyright of British Journal of Nursing is the property of Mark Allen Publishing Ltd and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.

Вам также может понравиться