Abstract
Background: The healthcare work environment poses numerous stressors contributing to distress1, and poor health outcomes in nurses4,5. A critical nursing shortage exists, and it is crucial to explore the work environment, leading to distress symptoms. Coping strategies using health promotion behaviors are essential to restore nurses' health3, which has not been explored well.
Purpose: Examine the work environment - workload and the association with psychological distress, sleep disturbance, and health promotion behaviors in nurses, using a structural equation modeling (SEM) approach guided by the job demands-resources framework.
Methods: The Nurse Worklife and Wellness Study data collected between November to March using a cross-sectional survey from nine representative US states (n=1170) was used to test the direct and indirect associations between variables such as workload, health promotion, psychological distress, sleep, and health.
A confirmatory factor analysis was performed, and the factor loadings for the indicators in each variable were analyzed using Mplus. The variables demonstrated evidence of composite reliability and convergent / discriminant validity. Model building was performed using weighted least squares estimation (WLSMV). Model fit was assessed using the chi-square statistic, root mean square error of approximation (RMSEA), comparative fit index, Tucker-Lewis index, and the standardized root mean residual2.
Results: The structural model showed that the job demands from increased workload significantly increased psychological distress (β = 1.47, p< 0.001), increased sleep disturbance (β = 1.22, p< 0.01), and decreased overall health (β = -1.36, p< 0.01). Health promotion behaviors had restorative effects, significantly mediating the relationship between workload and psychological distress, reducing distress (β = -1.01) and sleep disturbance (β = -0.94), and increasing overall health (β = 0.67).
Conclusions: Our findings underscore the importance of improving nurses' work environment by reducing their workload and address nurses distress. It is crucial for nurses to advocate for policies that standardize the structure, distribution, and supervision of their work, and future research should focus on longitudinal studies of the work environment using comprehensive measurement tools. Implementing strategies to encourage health promotion behaviors could help alleviate nurses distress, enhance their well-being, and contribute to workforce stability.
Notes
References:
1.Atli Özbas, A., & Kovanci, M. (2022). The experience of moral distress by chief nurse officers during the covid19 pandemic: A descriptive phenomenological study. Journal of Nursing Management, 30(7), 2383–2393. https://doi.org/10.1111/jonm.13780
2. Kline, R. B. (2023). Principles and practice of structural equation modeling (5th ed.). The Guilford Press
3. Ross, A., Yang, L., Wehrlen, L., Perez, A., Farmer, N., & Bevans, M. (2018). Nurses and health promoting selfcare: Do we practice what we preach? Journal of Nursing Management, 27(3), 599–608. https://doi.org/10.1111/jonm.12718
4. Sönmez, B., Yildiz Keskin, A., Ispir Demir, Ö., Emiralioğlu, R., & Güngör, S. (2022). Decent work in nursing: Relationship between nursing work environment, job satisfaction, and physical and mental health. International Nursing Review, 1–11. https://doi.org/10.1111/inr.12771
5. Wang, K.-Y., Chien, C.-M., Lee, H.-F., & Yobelina, Y. (2023). The mediation of health-promoting lifestyle on self-perceived health status and quality of life among nurses: A cross-sectional study. BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01608-y
Sigma Membership
Pi at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Quantitative Research
Keywords:
Workforce, Stress and Coping, Policy and Advocacy, Global Health Issues and Ethics, Nursing Shortage
Recommended Citation
Edwin, Hephzibah Sophie, "Transform the Work Environment & Psychological Distress in Nurses: Sustain Health Promotion Behaviors" (2025). Biennial Convention (CONV). 83.
https://www.sigmarepository.org/convention/2025/presentations_2025/83
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-11-26
Funder(s)
National Council of State Boards of Nursing
Transform the Work Environment & Psychological Distress in Nurses: Sustain Health Promotion Behaviors
Indianapolis, Indiana, USA
Background: The healthcare work environment poses numerous stressors contributing to distress1, and poor health outcomes in nurses4,5. A critical nursing shortage exists, and it is crucial to explore the work environment, leading to distress symptoms. Coping strategies using health promotion behaviors are essential to restore nurses' health3, which has not been explored well.
Purpose: Examine the work environment - workload and the association with psychological distress, sleep disturbance, and health promotion behaviors in nurses, using a structural equation modeling (SEM) approach guided by the job demands-resources framework.
Methods: The Nurse Worklife and Wellness Study data collected between November to March using a cross-sectional survey from nine representative US states (n=1170) was used to test the direct and indirect associations between variables such as workload, health promotion, psychological distress, sleep, and health.
A confirmatory factor analysis was performed, and the factor loadings for the indicators in each variable were analyzed using Mplus. The variables demonstrated evidence of composite reliability and convergent / discriminant validity. Model building was performed using weighted least squares estimation (WLSMV). Model fit was assessed using the chi-square statistic, root mean square error of approximation (RMSEA), comparative fit index, Tucker-Lewis index, and the standardized root mean residual2.
Results: The structural model showed that the job demands from increased workload significantly increased psychological distress (β = 1.47, p< 0.001), increased sleep disturbance (β = 1.22, p< 0.01), and decreased overall health (β = -1.36, p< 0.01). Health promotion behaviors had restorative effects, significantly mediating the relationship between workload and psychological distress, reducing distress (β = -1.01) and sleep disturbance (β = -0.94), and increasing overall health (β = 0.67).
Conclusions: Our findings underscore the importance of improving nurses' work environment by reducing their workload and address nurses distress. It is crucial for nurses to advocate for policies that standardize the structure, distribution, and supervision of their work, and future research should focus on longitudinal studies of the work environment using comprehensive measurement tools. Implementing strategies to encourage health promotion behaviors could help alleviate nurses distress, enhance their well-being, and contribute to workforce stability.
Description
The work environment with an increasing workload is associated with distress symptoms impacting nurses' health and wellbeing. Behavioral attributes such as health promotion behaviors can mitigate the negative impacts of a high workload on nurses' distress and health. Healthcare leaders must prioritize the work environment, address workload, promote wellness, and create a supportive practice environment for nurses. Failure to protect nurses could impact the workforce, exacerbating the shortage.