Problem statement and or hypothesis
The purpose of the study was to examine how job-related stress manifests itself among Certified Registered Nurse Anesthetists (CRNAs) regarding their ability to relate to their peers. The title of the article – The Certified registered Nurse Anesthetist: Occupational Responsibilities, Perceived Stressors, Coping Strategies, and Work Relationships – is very broad. It does not concisely represent the content of the study. The study presented four research questions which are found in the title itself and which are discussed in the article. The research questions are the following: (1) What are the roles and responsibilities of the CRNAs as they see them? (2) What are the CRNAs’ perceived stressors encountered on the job? (3) What are their coping strategies related to the perceived stressors? (4) What is the relationship between CRNA job stress and interpersonal work connections?
Literature review
There has been increased concern in recent years about occupational stress as a major cause of work-related illness, notably in the service professions, including the nursing profession. The nursing profession faces a significant problem with turnover, absenteeism, and work-related injuries which are commonly attributed to the stressful nature of the job. Occupational stress is at least partially responsible for much of the health claims, absenteeism and turnover in the workplace and has also been established as a precipitating factor in injury occurrence at work .
Stress is a contributing factor to organizational inefficiency, high staff turnover, absenteeism because of sickness, decreased quality and quantity of care, increased costs of health care, and decreased job satisfaction. Studies of occupational stress in nurses have uncovered a number of common stressors in this population. In the particular field of CRNAs, the common stressors as found out in the study are patient-related stressors (e.g. death of a patient), administrative stressors (e.g. work schedule and staffing issues), interpersonal relationships, and the operating room (OR) environment (the environment is depressing).
To assist organizations with assessing and managing workplace stress, researchers have devised a number of general stress scales and occupational stress scales. In recent years researchers have argued that occupation-specific and industry-specific stress scales are more reliable and valid predictors of stress and effects of stress than general occupational stress scales. As a result of this argument, a great deal of recent stress research on various occupational groups (e.g. teachers, nurses, and police officers) has used occupational stress scales specifically designed for these groups. For example, in this particular study regarding CRNAs, an occupation-specific stress scale – the Nursing Stress Scale – was used specifically as a guide for the author in constructing the interview tools used.
Though stressors in the workplace cause stress which, in turn, leads to strains (negative effects on health and quality of work), researchers have identified a number of moderating variables which can reduce the experience of stress or reduce the negative effects of stress. Some examples of these variables are coping strategies, social support, and hardiness. This particular study tackled coping strategies as a variable in reducing occupational stress. The participants identified several coping strategies designed to counteract the job-related stressors.
The study deals only with the CRNAs and not all the nurses in general so it is understandable that the occupational responsibility is already narrowed down. The article presented an abstract that represents a rather vague summary of the purpose, method, results and the conclusions of the study. Take for example the perceived stressors – in the abstract it mentioned six different stressors. In the results of the study, it only presented 4 major stressors of which the others are a part of.
Theoretical and conceptual framework
Existing literature are rich with studies on occupational-related stress in the nursing profession, nonetheless there is a scarcity of research on the particular issue of occupation-related CRNA stress. For this reason most of the CRNAs are unaware of the perceived stressors and the best way to handle stress in their environment, leading to a shortage of registered nurses and anesthetists. To address this gap in the literature, this particular study was conducted which specifically explored the roles and responsibilities of the CRNAs, the perceived stressors associated with the job, the coping strategies related to the perceived stressors, and the relationship between CRNA job stress and interpersonal work connections.
Research Design
For this particular study, the author employed a qualitative research design utilizing interviews, observations and artifact data to answer the research questions. The chief method for data collection that was used was a semi-structured interview of the participants. Two types of nonprobability, purposive sampling was used. The study participants are 20 CRNAs composed of 16 women and 14 men. The area where these CRNAs work was chosen for its traveling convenience.
The interview tools were created by the author after researching the literature and using the Nursing Stress Scale as a guide in constructing interview questions that are tailored for CRNAs.
Data collection procedures
There was no mention of obtaining an approval from an ethics committee before the study was conducted. However, an informed consent was acquired from the participants before any data were gathered. This includes informing the participants of the purpose of the study, the methods that will be used, the significance of doing such a study and confidentiality of their participation. Permission was also sought from the investigator’s university and the hospital where the observations were conducted. The name of the hospital was changed to protect the privacy of the hospital and the participants involved in the study.
Each CRNA was interviewed once personally, either at their personal residences or at work. All the interviews, except one, were recorded on tape with the participants’ permission and then transcribed. The participants were then offered the opportunity to read the transcription and make amendments to any of their statements.
Five of the twenty participants who were interviewed were also observed for an accumulated 65 hours of clinical observation at the hospital. They were observed at the OR, staff lounge, recovery room, magnetic resonance imaging room, and when the nurses make their preoperative rounds.
Qualitative analysis
A constant comparative method of analysis was used. The analysis was conducted as the data was obtained. The information gathered was coded and the data constructed into categories or themes by analyzing information in relation to the research questions. Profiles and brief essays of the participants’ experiences were also created from the results obtained in the study.
Interpretation of results
The study presented three major roles of the CRNAs: (1) typical anesthesia duties – e.g. making preoperative and postoperative rounds & difficulties encountered with patient care; (2) offering assistance or being a reliable coworker – anesthetists believe that it is part of their job to help others especially their peers; and (3) collaborator – collaboration is so ingrained in the work life of the nurse anesthetists. Three major responsibilities are also revealed: patient care and safety, continuing education and administrative duties.
Perceived stressors are patient-related stressors, administrative stressors, interpersonal relationships, and the OR environment. Production pressure and workload are the major stressors the participants identified. The coping strategies used by the CRNAs include remaining calm, internalization, spiritual beliefs and prayers, internal reflection, making jokes or funny comments, and participating in hobbies outside the scope of their work. The study also found out that relationships and alliances that the participants form with other staff persons can be stressful.
Data Quality / Importance of the topic to nursing practice and/or research
The data is of high quality since it can be used by fellow nurses and future nurses in the field of anesthesiology. This can ultimately improve the effectiveness of care and health outcomes in patients requiring the aid of a nurse anesthetist. The CRNA can be better prepared for his/her role by knowing the findings of this article. This way, he/she can be ready for the stress it brings and also be aware of how to cope with them.
Although personally I think that the research is very broad, it is still quite relevant to the nursing staff especially to the CRNAs. The answers to the findings/conclusions to the research questions can be very helpful to the nurse anesthetist. The findings can help the CRNA in many ways such as knowing what to do when faced with occupational-related stress and to be able to carry out their specific duties. Coping strategies are very helpful and knowing what strategies the CRNAs used can be helpful to other nurse in the field.
The study is also useful in that the findings can help solve the increasing number of nurse shortage as a result of occupational stress. By knowing the roles and responsibilities, the perceived stressors, and the coping strategies that can be used, the nurse anesthetist can be better prepared for his/her role.
By letting nurses participate in the design and carrying out of multidisciplinary scientific research projects such as this particular study regarding occupational stress in CRNAs, aspects regarding job performance as well as satisfaction could be increased, the nursing shortage could be decreased, and ultimately there would be an improvement in client care.
Credit:ivythesis.typepad.com
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