Patient safety and nursing: interface with stress and Burnout Syndrome

This was an integrative literature review. Data collection was performed in February 2016 in the following databases: Medical Literature Analysis and Retrieval System Online - PubMed/MEDLINE, Latin American and Caribbean Literature in Health Sciences - LILACS.

Results:

Ten scientific productions were selected, which listed that factors contributing to stress and Burnout Syndrome of nursing professionals are the work environment as a source of stress, and excessive workload as a source of failures.

Conclusion:

The analysis found that the stress and Burnout Syndrome experienced by these professionals lead to greater vulnerability and development of unsafe care, and factors such as lack of organizational support can contribute to prevent these failures.

Descriptors:
Nursing; Patient Safety; Professional Stress; Burnout Syndrome; Professional Exhaustion

Objective	Method	Stress-patientsafety interface
To measure the relationships between work environment and professional exhaustion - exhaustion of nurses and physicians.	Cross-sectional	The chaotic work environment (poorly organized) was related to professionals' stress, physical and mental exhaustion and with their intention of leaving the position. In addition, emotional exhaustion, relationships of time pressure to perform a given task, and lower levels of autonomy.
To explore the influence of the characteristics of incidents andtheir seriousness, and the reception of emotional support related to nurses' work.	Longitudinal	Fatigue and stress at work can interact to produce a lower quality of patient care, thus increasing the frequency of clinical errors.
To identify the levels of factors in Irish hospitals that have impact on nurses and patient safety.	Cross-sectional	Patient safety can be improved by the level of professional knowledge and reduction of nurses' workload. In addition, increased qualification levels of nursing professionals in hospitals, and the hospitals adjustment to staff sizing are examples of how to improve patient safety.
To investigate the impact of environmental factors on nurses' practice and work, and the characteristics of Burnout at work by reporting outcomes and quality of care.	Cross-sectional	Health workers' feelings of exhaustion when dealing with unfavorable environments result in low quality of care.
To examine if conditions in which safety is organized affect the emotional exhaustion and amount of work in nursing units.	Cross-sectional	The high rate of adverse events in the unit was negatively related to the unit's organization and the emotional exhaustion of professionals involved.
To determine if a good organization of care can affect patient care in European countries.	Cross-sectional	Each additional patient per nurse increased the chances of reporting care of poor or reasonable quality. The outcomes of high rates of Burnout in nurses were related to intentions of leaving the position and to job dissatisfaction. The effect of working conditions/environment was generally stronger than the specific personal effect.
To give an overview of the wide range of risks for nurses, patients and employers whoare linked to shift work, long working hours, and poor sleep quality from other sources.	Cross-sectional	Declines in leadership and neurocognitive performance were related to higher rates of injuries, errors and fatigued workers.
To investigate the role of clinical Burnout, demography and organizational characteristics in predicting subjective and objective indicators of patient safety.	Cross-sectional	Patient safety evaluated by the physician was associated with exhaustion, waking state and professional role.
To examine the effects of stress-related work with regard to patient safety.	Cross-sectional	Increased job demands, lack of professional self-control, and social support were problems identified as influencing stress and patient safety.
To analyze the working conditions and well-being of health professionals and patient safety.	Integrative review	The working hours and excessive workload are two failures of the format that have proven to decrease patient safety and the well-being of healthcare professionals around the world.

Study title	Conclusion of the study
Emotional exhaustion and workarounds in acute care: cross sectional tests of a theoretical framework	Burnout Syndrome is not simply an individual problem, as it influences the work environment as a whole because of its relation with the attitudes of professionals.
Does clinical incident seriousness and receipt of work-based support influence mood experienced by nurses at work? A behavioral diary study	Fatigue and stress can result in complex effects in the workplace that reflect on poor quality patient care.
The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach	Burnout Syndrome provides evidence on the impact on nurses' work and the organization of their units in the hospital environment.
Nursing unit teams matter: impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events - a cross sectional survey	Importance of the relationship between workers' feelings of exhaustion,which are unfavorable to practice.
Safety organizing, emotional exhaustion, and turnover in Hospital Nursing Units	Adverse events were associated with higher levels of emotional exhaustion in the investigated units.
Patient safety, satisfaction and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States	Association between nursing and safety quality are similar, even though the levels of each of them vary.
Negative impacts of shiftwork and long work hours	The results indicate that professionals' health and patient safety should be managed simultaneously.
Emotional exhaustion and work load predict clinician-rated and objective patient safety	To assist patient safety despite the high workload.
Patient safety and job-related stress: A focus group study	The demanding work environment coupled with minimal control and social support from peers result in increased stress with effect on patient safety.
Healthcare provider working conditions and well-being: sharing international lessons to improve patient safety	Better working conditions influence patient safety.

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[1] CORRESPONDING AUTHOR: Cláudia Cristiane Filgueira Martins Rodrigues. E-mail: claudiacrisfm@yahoo.com.br