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

描述(由申请人提供)：有证据表明，家庭保健护士的工作压力随机构工作环境属性的不同而不同。虽然医院护士的工作环境已经得到了广泛的研究，但家庭护理护士的环境却截然不同，因为它延伸到病人的家中，组织资源和支持都是偏远的。关于家庭护理护士的工作环境对工作压力的影响，人们知之甚少。本研究旨在探讨家庭护理工作环境对护士工作压力的影响，以期找出有效干预的机会。具体目标是： 1.确定家庭保健护士所描述的特定于其执业和工作环境的压力源 2.确定工作环境的特点，以适度降低与工作有关的水平 家庭护理护士感受到的压力 3.阐述护士在工作环境中的自主性和适应能力与工作压力的关系 4.寻求理解为什么全职工作的家庭保健护士有更多的工作年限 终身教职报告工作相关压力水平较高 这项拟议的研究将使用嵌入式多案例研究设计，以对比来自新英格兰一个州的两家家庭医疗机构的工作环境。这项研究将以一个整合了工作压力理论的理论模型--尼尔家庭健康护理实践理论为指导，并建议在支持专业护理实践环境的机构工作的护士经历较少的压力。数据将通过半结构化访谈、直接观察和焦点小组访谈来收集。数据将使用模式匹配和扎根理论方法进行分析。这项研究与公共健康相关，因为与工作相关的压力会对患者护理的质量、护士对工作的感受以及他们是否会继续工作产生不利影响。这对获取和护理质量有影响。相信这项研究的发现将有助于确定工作环境干预措施，以减轻家庭保健护士所经历的压力水平。

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.