کاهش استرس شغلی در پرستاران ثبت شده در استرالیا: رویکرد پژوهش مشارکتی Reducing occupational stress among registered nurses in very remote Australia: A participatory action research approach

1. Background Remote area practice is characterised by geographical, social and professional isolation – servicing a small, dispersed and highly mobile population with, high morbidity and mortality, climatic extremes, an extended practice role, a multidisciplinary approach and cross-cultural issues affecting everyday life (Wakerman 2004). Nurses who work in remote areas in Australia are called remote area nurses or ‘RANs’, and are defined as …specialist practitioners that provide and co-ordinate a diverse range of health care services for remote, disadvantaged or isolated populations within Australia and her Territories and undertake appropriate educational preparation for their practice (CRANA 2003). Nurses working in very remote areas, as defined by the Accessibility/Remoteness Index of Australia (ARIA+ )(AIHW, 2004), are the mainstay of health services in these regions (Lenthall, Wakerman, Dollard et al., 2011). They work in complex and isolated settings that are often cross cultural, and for which they are usually inadequately prepared (Lenthall, Wakerman, Opie, M. Dollard et al., 2011). Discussions between different health, professional and university groups in the Northern Territory identified occupational stress among RANs as a problem. In 2008, the, Northern Territory Department of Health and Families (NTDH&F), Council of Remote Area Nurses of Australia plus (CRANAplus), Commonwealth Health Department, Office of Aboriginal and Torres Strait Islander Health, Katherine West Health Board, Centre for Remote Health, Flinders University and University of Northern British Colombia, Canada, agreed to be partners on a successful Australian Research Council Linkage grant, ‘Back from the edge: reducing occupational stress among RANs in the Northern Territory’. The ensuing study aimed to describe stressors, measure levels of occupational stress in RANs, and develop, implement and evaluate interventions that reduce and prevent the impact of occupational stress in the remote area nursing workplace. The first part of the study, described stressors and measured levels of occupational stress in RANs via a survey to all registered nurses in very remote Australia (Opie, Dollard et al., 2010). Given the high demand and under resourced environment, an extended Job Demands-Resources (JD-R) model (Demerouti, Bakker, Nachreiner, & Schaufeli, 2001) was adopted to examine stress among RANs. The model proposes that worker well-being is affected by a number of variables that can be categorised as either job demands or job resources. Job demands become stressors when the employee is required to expend considerable effort in order to meet them, with possible outcomes such as psychological distress and emotional exhaustion.