The Work Environment and Job-related Stress among Home Healthcare Nurses

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DESCRIPTION (provided by the applicant): There is evidence that job-related stress among home healthcare nurses is variable based on agency work environment attributes. Although the work environment of nurses in hospital settings has been studied extensively, the environment of home healthcare nurses is quite different as it extends into patients' homes and organizational resources and support are remote. Little is known about the effect of the home healthcare nurses' work environment on job-related stress. The purpose of this proposed study is to describe the effect of the home healthcare work environment on job-related stress experienced by nurses in an effort to identify opportunities for effective intervention. The specific aims are to: 1. identify stressors that home healthcare nurses describe as specific to their practice and work environments 2. identify the characteristics of the work environment that moderate the levels of job-related stress experienced by home healthcare nurses 3. explicate the ways nurse autonomy and adaptation in the work environment relate to job stress 4. seek to understand why home healthcare nurses who work full time and have more years of tenure report higher levels of job-related stress An embedded multiple case study design will be used in the proposed study to contrast the work environments of two home healthcare agencies from one New England state. The study will be guided by a theoretical model derived from an integration of job stress theory, the Neal Theory of home health nursing practice, and proposes that nurses working in agencies that support a professional nursing practice environment experience less stress. Data will be collected by semi-structured interviews, direct observation and focus group interviews. Data will be analyzed using pattern matching and grounded theory methodology. This study is relevant to public health in that job-related stress adversely affects the quality of patient care, how nurses feel about their jobs, and whether they will remain in their jobs. This has implications for access and quality of care. It is believed that the findings from this study will help to identify work environment interventions that moderate levels of stress experienced by home healthcare nurses.