The Development And Effectiveness Of Occupational Stress Intervention Program For Newly Graduated Nurses During Transition

Objectives : This study was mainly aimed at developing occupational stress intervention program for newly graduated nurses during transition and examine its effectiveness.The specific objectives were as follows :1 longitudinally monitor Chinese newly graduated nurses' occupational stress,explore the trajectory of change and its predictors;2 explore stressors experienced by newly graduated nurses and collect and develop clinical stressful scenarios through qualitative approach;3 develop occupational stress intervention program for newly graduated nurses on the basis of theories,previous research results and the framework of Stress Inoculation Training;4 test the effectiveness of developed intervention program within two tertiary hospitals,and provide solid evidence for intervention improvement and further application;5 explore newly graduated nurses' occupational stress change trajectory during the first three years of practice and to identify potential subgroups of longitudinal trajtoeory.Methods : Mixed method has been used in this study to explore the longitudinal trajectory of occupational stress among newly graduated nurses,to develop occupational stress intervention program,and to test the effectiveness of the program.1 theoretical framework was developed based on literature review,related stress theories;2 longitudinal study was used form August,2014 to August,2015,343 newly graduated nurses from 4 tertiary hospitals selected within 4 districts in Shanghai have been asked to take quarterly paper surveys to explore the longitudinal trajectory and predictors of occupational stress;3 10 newly graduated nurses who experienced high level of occupational stress at some or all time points were selected to participate into semi-structured interview,and inductive content analysis was conducted to explore their stressors during transition;4 Behavioral Event Interview was conducted to collect real clinical stressful situations among 11 newly graduated nurses,and these situations were transferred to stressful scenarios through narrativization;5 occupational stress intervention program was developed on the basis of theories,previous research results and the framework of Stress Inoculation Training and was modified by expert panel;6 Randomized Controlled Trail was conducted within 2 tertiary hospitals in Shanghai,and the effectiveness of the intervention program was tested by both quantitative and qualitative approaches;7 A 3-year longitudinal study was condeucted based on the previous longitudinal study,group-based trajectory modeling was performed to identify potential subgrups of occupational stress trajectory.Results:1 Newly graduated nurses experienced above-average level of occupational stress during the transition generally,perceived differently at different time point,and perceived the highest level of occupational stress at 4months post-graduation(65.89±16.32).The sources of stress were found to be different at different time periods through analyzing the four domains of occupational stress scale,and academic degree,employment type,professional identity,coping strategy were predictors of occupational stress during transition(p<0.05);2 5 main categories were identified through inductive content analysis including clinical competency,work environment,work characteristics,interpersonal relationship and leadership and management;3 54 scenarios were developed through narrativization on the basis of 54 clinical stressful situations;4 quantitative results showed that the developed intervention program was effective on reducing occupational stress,improving positive coping,increase professional identity,easing transition shock,reducing intention to leave;qualitative results turned out that the newly graduated nurses in intervention group were more likely to pay attention to occupational stress,to positively cope with stress,to be supported by peers,and they felt they were concerned by their hospitals;5 newly graduated nurses perceived the highest occupational stress at baseline(66.04±17.84)and the lowest after 2-year's work(52.5±15.55),and the scores of occupational stress had a slightly increase from the second to the third year(54.73±17.48);the following analysis among three subgroups identified by GBTM turned out that newly graduated nurses who came from areas outside of Shanghai,who were employed as ‘bianzhi' nurses and who were assigned their preceptors by their shifts were more likely to perceive higher occupational stress than other nurses(p?0.001).Conclusion : More attention is badly needed on occupational stress management among newly graduated nurses during their transition,especially the first 4 months.The development of tailored occupational stress intervention program should pay attention to its significant predictors and real stressors of newly graduated nurses.The intervention program developed in this study was tested to be effective.At the meanwhile,the longitudinal change of occupational stress during the first three years pf practice also need more attention,the early identification of newly graduated nurses with specific characteristics can contribute to the development and implementation of targeted stress management programs.