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A Daily Diary Approach to the Examination of Chronic Stress, Daily Hassles and Safety Perceptions in Hospital Nursing

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Abstract

Purpose

Stress is a significant concern for individuals and organisations. Few studies have explored stress, burnout and patient safety in hospital nursing on a daily basis at the individual level. This study aimed to examine the effects of chronic stress and daily hassles on safety perceptions, the effect of chronic stress on daily hassles experienced and chronic stress as a potential moderator.

Method

Utilising a daily diary design, 83 UK hospital nurses completed three end-of-shift diaries, yielding 324 person days. Hassles, safety perceptions and workplace cognitive failure were measured daily, and a baseline questionnaire included a measure of chronic stress. Hierarchical multivariate linear modelling was used to analyse the data.

Results

Higher chronic stress was associated with more daily hassles, poorer perceptions of safety and being less able to practise safely, but not more workplace cognitive failure. Reporting more daily hassles was associated with poorer perceptions of safety, being less able to practise safely and more workplace cognitive failure. Chronic stress did not moderate daily associations. The hassles reported illustrate the wide-ranging hassles nurses experienced.

Conclusion

The findings demonstrate, in addition to chronic stress, the importance of daily hassles for nurses’ perceptions of safety and the hassles experienced by hospital nurses on a daily basis. Nurses perceive chronic stress and daily hassles to contribute to their perceptions of safety. Measuring the number of daily hassles experienced could proactively highlight when patient safety threats may arise, and as a result, interventions could usefully focus on the management of daily hassles.

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Notes

  1. 39.8% of participants completed five diaries, 18.1% completed four diaries, 34.9% completed three diaries, and 7.2% completed two diaries; 83.6% of the diaries were completed on a weekday.

  2. Cronbach’s alphas (α) we report are from our analyses.

  3. Hassle categories were not mutually exclusive.

  4. Intra-class correlation coefficients (ICC) for outcome variables: perceptions of patient safety .42, safe practitioner measure .23 and workplace cognitive failure .66

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Acknowledgements

We would like to thank the nurses who completed the questionnaires and made this study possible. The study was funded by the University of Leeds and Bradford Institute for Health Research (PhD Studentship).

Author information

Authors and Affiliations

  1. Bradford Royal Infirmary, Bradford Institute for Health Research, Duckworth Lane, Bradford, BD9 6RJ, UK

    Gemma Louch & Jane O’Hara

  2. Leeds Institute of Medical Education, University of Leeds, Leeds, LS2 9JT, UK

    Jane O’Hara

  3. School of Psychology, University of Leeds, Leeds, LS2 9JT, UK

    Peter Gardner & Daryl B. O’Connor

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  1. Gemma Louch
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  2. Jane O’Hara
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  3. Peter Gardner
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  4. Daryl B. O’Connor
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Corresponding author

Correspondence to Gemma Louch.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the University of Leeds School of Psychology Ethics Committee in February 2013. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Appendices

Appendix 1 General Form of Models and Equations for Research Questions

Are higher ratings of chronic stress related to nurses’ daily safety perceptions?

The general form of the model is expressed by the following equation:

$$ \begin{array}{l}\begin{array}{l}\mathrm{Outcome}\ \mathrm{variable}\left(\mathrm{e}.\mathrm{g}.\mathrm{safety}\ \mathrm{perception}\right)={\upbeta}_{00}+{\upbeta}_{01}\left(\mathrm{gender}\right)+{\upbeta}_{02}\left(\mathrm{age}\right)+{\upbeta}_{03}\left(\mathrm{length}\ \mathrm{of}\ \mathrm{time}\ \mathrm{qualified}\right)+{\upbeta}_{04}\left(\mathrm{chronic}\ \mathrm{stress}\right)+\upvarepsilon \\ {}{\upbeta}_{00}=\mathrm{Mean}\ \mathrm{level}\ \mathrm{of}\ \mathrm{outcome}\ \mathrm{variable}\left(\mathrm{e}.\mathrm{g}.\mathrm{safety}\ \mathrm{perception}\right)\end{array}\hfill \\ {}{\upbeta}_{01}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{gender}\hfill \\ {}{\upbeta}_{02}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{age}\hfill \\ {}{\upbeta}_{03}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{length}\ \mathrm{of}\ \mathrm{time}\ \mathrm{qualified}\hfill \\ {}{\upbeta}_{04}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{level}\ \mathrm{of}\ \mathrm{chronic}\ \mathrm{stress}\hfill \\ {}\upvarepsilon =\mathrm{Error}\ \mathrm{term}\hfill \end{array} $$

Are more daily hassle experiences related to nurses’ daily safety perceptions?

The general form of the model is expressed by the following equation:

$$ \begin{array}{l}\begin{array}{l}\mathrm{Outcome}\ \mathrm{variable}\left(\mathrm{e}.\mathrm{g}.\mathrm{safety}\ \mathrm{perception}\right)={\upbeta}_{00}+{\upbeta}_{01}\left(\mathrm{gender}\right)+{\upbeta}_{02}\left(\mathrm{age}\right)+{\upbeta}_{03}\left(\mathrm{length}\ \mathrm{of}\ \mathrm{time}\ \mathrm{qualified}\right)+{\upbeta}_{10}\left(\mathrm{total}\ \mathrm{hassle}\ \mathrm{experience}\right)+\upvarepsilon \\ {}{\upbeta}_{00}=\mathrm{Mean}\ \mathrm{level}\ \mathrm{of}\ \mathrm{outcome}\ \mathrm{variable}\left(\mathrm{e}.\mathrm{g}.\mathrm{safety}\ \mathrm{perception}\right)\end{array}\hfill \\ {}{\upbeta}_{01}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{gender}\hfill \\ {}{\upbeta}_{02}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{age}\hfill \\ {}{\upbeta}_{03}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{length}\ \mathrm{of}\ \mathrm{time}\ \mathrm{qualified}\hfill \\ {}{\upbeta}_{10}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{level}\ \mathrm{of}\ \mathrm{to}\mathrm{tal}\ \mathrm{hassle}\ \mathrm{experience}\hfill \\ {}\upvarepsilon =\mathrm{Error}\ \mathrm{term}\hfill \end{array} $$

Do nurses who report higher ratings of chronic stress also report more daily hassle experiences?

The general form of the model is expressed by the following equation:

$$ \begin{array}{l}\begin{array}{l}\mathrm{Outcome}\ \mathrm{variable}\left(\mathrm{e}.\mathrm{g}.\mathrm{safety}\ \mathrm{perception}\right)={\upbeta}_{00}+{\upbeta}_{01}\left(\mathrm{gender}\right)+{\upbeta}_{02}\left(\mathrm{age}\right)+{\upbeta}_{03}\left(\mathrm{length}\ \mathrm{of}\ \mathrm{time}\ \mathrm{qualified}\right)+{\upbeta}_{10}\left(\mathrm{total}\ \mathrm{hassle}\ \mathrm{experience}\right)+\upvarepsilon \\ {}{\upbeta}_{00}=\mathrm{Mean}\ \mathrm{level}\ \mathrm{of}\ \mathrm{outcome}\ \mathrm{variable}\ \left(\mathrm{total}\ \mathrm{hassle}\ \mathrm{experience}\right)\end{array}\hfill \\ {}{\upbeta}_{01}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{gender}\hfill \\ {}{\upbeta}_{02}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{age}\hfill \\ {}{\upbeta}_{03}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{length}\ \mathrm{of}\ \mathrm{time}\ \mathrm{qualified}\hfill \\ {}{\upbeta}_{04}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{level}\ \mathrm{of}\ \mathrm{chronic}\ \mathrm{stress}\hfill \\ {}\upvarepsilon =\mathrm{Error}\ \mathrm{term}\hfill \end{array} $$

Does chronic stress moderate the relationships between nurses’ daily hassle experiences and daily safety perceptions?

The general form of the model is expressed by the following equation:

$$ \begin{array}{l}\mathrm{Outcome}\ \mathrm{variable}\left(\mathrm{e}.\mathrm{g}.\mathrm{safety}\ \mathrm{perception}\right)={\upbeta}_{00}+{\upbeta}_{01}\left(\mathrm{gender}\right)+{\upbeta}_{02}\left(\mathrm{age}\right)+{\upbeta}_{03}\left(\mathrm{length}\ \mathrm{of}\ \mathrm{time}\ \mathrm{qualified}\right)+{\upbeta}_{04}\left(\mathrm{chronic}\ \mathrm{stress}\right)+{\upbeta}_{10}\left(\mathrm{total}\ \mathrm{hassle}\ \mathrm{experience}\right)+{\upbeta}_{11}\left(\mathrm{chronic}\ \mathrm{stress}\ \mathrm{X}\ \mathrm{to}\mathrm{tal}\ \mathrm{hassle}\ \mathrm{experience}\right)+\upvarepsilon \hfill \\ {}{\upbeta}_{00}=\mathrm{Mean}\ \mathrm{level}\ \mathrm{of}\ \mathrm{outcome}\ \mathrm{variable}\left(\mathrm{e}.\mathrm{g}.\mathrm{safety}\ \mathrm{perception}\right)\hfill \\ {}{\upbeta}_{01}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{gender}\hfill \\ {}{\upbeta}_{02}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{age}\hfill \\ {}{\upbeta}_{03}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{length}\ \mathrm{of}\ \mathrm{time}\ \mathrm{qualified}\hfill \\ {}{\upbeta}_{04}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{level}\ \mathrm{of}\ \mathrm{chronic}\ \mathrm{stress}\hfill \\ {}\begin{array}{l}{\upbeta}_{10}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{influenced}\ \mathrm{by}\ \mathrm{level}\ \mathrm{of}\ \mathrm{to}\mathrm{tal}\ \mathrm{hassle}\ \mathrm{experience}\\ {}{\upbeta}_{11}=\mathrm{Indicates}\ \mathrm{the}\ \mathrm{extent}\ \mathrm{to}\ \mathrm{which}\ \mathrm{this}\ \mathrm{average}\ \mathrm{is}\ \mathrm{conditional}\ \mathrm{on}\ \mathrm{the}\ \mathrm{level}\ \mathrm{of}\ \mathrm{chronic}\ \mathrm{stress}\\ {}\upvarepsilon =\mathrm{Error}\ \mathrm{term}\end{array}\hfill \end{array} $$

Appendix 2

Table 6 Hassle categories, frequencies and descriptions
Full size table

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Louch, G., O’Hara, J., Gardner, P. et al. A Daily Diary Approach to the Examination of Chronic Stress, Daily Hassles and Safety Perceptions in Hospital Nursing. Int.J. Behav. Med. 24, 946–956 (2017). https://doi.org/10.1007/s12529-017-9655-2

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