Registered Nurses' Perceptions of Workplace Stress in Paediatric Intensive Care Units in Saudi Arabia: a Mixed-Method Research Study

Abstract

Background: Workplace stress among nurses in Intensive Care Units (ICU) has been shown to variously affect their health, the quality of nursing care, healthcare delivery and national healthcare costs (Mokhtar et al., 2016). Although this is equally true for Paediatric Intensive Care Units (PICUs), research into this environment has remained scarce and no previous studies have focused on workplace stress in PICUs within a Saudi Arabian (SA) context. The current research study addressed this omission. Aims: This research study used a mixed-method approach to explore and understand workplace stress and its sources among nurses working in public hospital PICUs in Riyadh and Dammam, SA. Methods: In this mixed-method research study, 172 Registered Nurses from six PICUs in large public hospitals completed questionnaires in Phase 1 (quantitative data collection). These questionnaires comprised of the Expanded Nursing Stress Scale (ENSS) and personal characteristic questions. In the subsequent Phase 2 (qualitative data collection), 24 of the original 172 participants from Phase 1 took part in face-to-face semi-structured interviews. Results: The majority of the nurses suffered from a medium level of workplace stress; this was associated with tangible personal characteristics, such as gender, nationality and academic nursing qualifications. Sources of workplace stress related to ‘workload’, ‘caring for critically ill children’, ‘cultural challenges’ and ‘nursing management and nursing colleagues’. However, nurses in PICUs (both SA and expatriates) practiced effective coping strategies that were both individual to each person as well as work related – these helped them to deal with workplace stress and remain working in a PICU environment for several years. The results of this research study led to the development of the dynamic model of workplace stress; this illustrates the complexity of workplace stress within a PICU context and highlights the interactions between both the sources and consequences of it. Conclusion and Implications: This research study found that nurses in public hospital PICUs in the cities of Riyadh and Dammam in SA, reported a medium level of workplace stress. However, interestingly, and importantly, the nurses perceived the PICU environment to be a most rewarding place to work. The results have implications for policy and practice for SA stakeholders in terms of how to enhance the working environment for nurses, raise healthcare professionals’ cultural awareness, provide insight into coping strategies and promote respect for the nursing profession in SA. These measures would potentially facilitate a reduction in PICU workplace stress and thus improve both the nurses’ health as well as the quality of the nursing care.