Approaches to workload in psychiatric and mental health nursing

integrative literature review using six databases, covering January 2005 to March 2019. Articles in full in English, Spanish and Portuguese were included.

Results:

the sample consisted of 23 original articles classified as quantitative or emotional. The quantitative dimension was addressed in 12 articles and included: assessing patient care needs, identifying activities performed by the team, measuring time spent and developing and validating a measurement instrument. The emotional dimension included 11 articles the focus of which was on identifying stressors in the workplace, psychosocial risks and coping strategies.

Conclusion:

strategies were found for measuring workload and assessing the impact of stressors on nursing teams.

Descriptors:
Workload; Nursing Staff; Psychiatric Nursing; Mental Health; Workplace

Author, Year, Country	Type of Study and Situation	Approach	Results and Conclusion	WL Dimension
Iglesias, Villa, 2005 Spain	Observational Psychiatric hospital	Application of the Resources Utilization Groups (RUG T18) instrument for categorizing psychiatric patient care.	61.3% of patients were classified in the serious behavioral problem category . The instrument needs refinement due to its low sensitivity in perceiving changes in psychopathological conditions.	Quantitative
Carvalho, Felli 2006 Brazil	Case study (focus groups) Psychiatric hospital	Identifying workloads and coping strategies for nursing workers.	The psychological load was considered to exacerbate the others (physical, physiological, biological, mechanical and chemical), generating a process of physical and mental exhaustion; Coping strategies: support from colleagues.	Emotional
Bee et al. 2006 United Kingdom	Descriptive 3 psychiatric inpatient units in general hospitals	Classification of activities performed by the mental health nursing team; Identification of time dedicated to direct and indirect care.	Most work by nurses in Professional Communication (35.5%) and assistants in direct activities with the patient (63.5%). Average reported time: 31.7 minute/hours (assistants) and 18.5 minutes/hours (nurses).	Quantitative
Ridley 2007 United Kingdom	Observational Psychiatric inpatient unit of a hospital for children and adolescents	Assessment of nursing care dependence and its relationship with the number of staff in the team and the quality of care.	Based on patients' level of dependence, it was found that 10 employees per day was insufficient, and 12 proved to be adequate to generate a score of "good" or "very good" in the care quality.	Quantitative
Cai, Li, Zhang 2008 China	Cross-sectional exploratory Psychiatric inpatient units of two teaching hospitals and a psychiatric hospital	Identification of stressors in the workplace of psychiatric nurses and their coping strategies.	WL and dealing with death scored highest. Forms of positive coping were used by most respondents.	Emotional
Martins, Arantes, Forcella, 2008 Brazil	Descriptive-exploratory Psychiatric hospital	Evaluation of the reliability, concordance and construct validity of an instrument to classify the care needs of patients with mental disorders.	The instrument was considered reliable, with satisfactory levels of concordance and validated construct.	Quantitative
Henderson et al. 2008 Australia	Action research (focus groups) Community mental health service	Identifying factors that contribute to the WL of nurses considering 4 aspects: Team, Client characteristics, Local organization and Health Care system.	Team: lack of personnel to meet demand. Client characteristics: greatest impact on WL. Local organization: access to the service. Health Care system: lack of integration of services, and time spent on bureaucracy.	Quantitative

Author, Year, Country	Type of Study and Situation	Approach	Results and Conclusion	WL Dimension
Furaker 2009 Sweden	Documentary General, medical, surgical, geriatric and psychiatric hospitalization units	Evaluating time spent on nurses' activities.	On average, 38% of the work in all units consisted of direct care. The psychiatric unit consumed more time than other units: 100 minutes/day in general nursing and 150 minutes/day in administrative activities.	Quantitative
Gerolamo 2009 United States	Documentary Psychiatric hospital	Analysis of the relationship between activities performed and nurses' perceptions of their workloads	The number of high scores was related to the total number of shifts that nurses reported WL as 4 (medium to heavy) or 5 (heavy).	Quantitative
Currid 2009 United Kingdom	Hermeneutic Phenomenology 4 psychiatric inpatient units in general hospitals	Evaluation of occupational stressors experienced by nurses.	We found: pressure (from managers, lack of beds, WL); aggressive patient behavior (hostility, intimidation, physical violence); inability to switch off from work.	Emotional
Oliveira, Laus, 2011. Brazil	Descriptive Psychiatric inpatient units at a general hospital.	Characterizing hospitalized patients according to the degree of dependence in relation to nursing care.	More than 60% of patients were classified as having mild dependence.	Quantitative
Leka, Hassard, Yanagida, 2012 Japan	Descriptive-exploratory6 psychiatric hospitals	Assessing demographic factors and psychosocial risks associated with two dimensions of general well-being: tension and emotional exhaustion in nurses.	Higher emotional exhaustion in young nurses; this was associated with high demands for psychological work and low social support at work. There was an association with high demands for psychological work, low psychological control and low social support at work.	Emotional
Hamaideh 2012 Jordan	Correlational Inpatient units at public, private and armed forces psychiatric hospitals	Assessing occupational stress, social support and quality of life among nurses.	Most common occupational stressors: "difficulties with patients", "lack of resources" and "WL". Predictive factors of occupational stress: low social support, low quality of life.	Emotional
Willis et al., 2012 Australia	Action research, (focus groups) Community mental health service	Development and preliminary assessment of a tool to equally adapt the WL of nurses working in community mental health and community health.	Tool was proven to be able to manage the intensity of work, adjust the WL and increase transparency regarding work practices.	Quantitative
Bogaert et al, 2013 Belgium	Quantitative 2 psychiatric hospitals	Evaluating the relationships between the practice environment, WL, burnout, responses to work and quality of care assessed by nurses.	Positive evaluations of the dimensions of the practice environment predicted results such as job satisfaction and low intention to leave the hospital/profession and high quality of care.	Emotional
Mukai, Jericó, Perroca 2013 Brazil	Descriptive Neuro-psychiatric hospital	Investigating nursing care needs, average hours of care provided and the WL of the nursing team.	The following was observed 73.3% of patients had mild dependence. Average hours of care: 0.57 to 0.88 (nurses) and 1.97 to 3.16 (nursing assistants). The average workload: 119.6 to 183 hours.	Quantitative

Author, Year, Country	Type of Study and Situation	Approach	Results and Conclusion	WL Dimension
Yada et al., 2014 Japan	Descriptive-exploratory 6 psychiatric hospitals	Investigating occupational stress in psychiatric nurses who care for elderly inpatients with dementia symptoms.	The most significant stressors were physical WL and the work environment. The most common reactions to stress were irritability and anxiety.	Emotional
McTiernan, McDonald, 2015 Ireland	Comparative Psychiatric Hospital and Community Mental Health Service	Assessment of stressors in psychiatric nurses. Comparison of occupational stress, coping strategies and burnout in psychiatric nurses working in a hospital environment with those working in community services.	Stressors: lack of resources, difficulties with the patient and WL, which was a predictive factor of emotional exhaustion. Both groups reported average levels of emotional exhaustion and used avoidant coping strategies. Hospital nurses: higher depersonalization scores; community service nurses: greater personal fulfillment.	Emotional
Fanneran et al., 2015 United Kingdom	Qualitative 6 psychiatric inpatient and learning disability units in general hospitals	Evaluation of the experience of nursing teams in the use of tools: Safer Nursing Care Tool (SNCT) and Mental Health and Learning Disability Workload Tool (MHLDWT).	SNCT: 79% considered it practical, easy to use and suitable for calculating personnel requirements; with limited ability to capture "all activities". MHLDWT: for 57%, it is practical, easy to use and suitable for calculating personnel requirements; for most it was time consuming and more difficult to use.	Quantitative
Alves et al., 2016 Brazil	Comparative 2 psychiatric hospitals	Assessment of work overload in nursing professionals working in public and private psychiatric hospitals.	There was no significant difference in the assessment of overload between groups, however the private sector service team showed higher averages of overload in all aspects in the individual assessment of each subscale.	Emotional
Heslop et al., 2016 Australia	Qualitative (focus groups) 4 community mental health services	Identifying nurses' activities and measuring time spent.	18 activities were identified. Highlights included: "internal coordination of care" (285 hours), "clinical documentation" (283.3 hours), "monitoring patients' psychopathology" (175 hours).	Quantitative
Konstantinoua et al., 2018 Greece	Quantitative Private psychiatric clinic	Investigating the relationship between conflict and ambiguity of roles, organizational commitment and job satisfaction with burnout.	The predictors of burnout were: conflict of roles, satisfaction with WL, satisfaction with training, ambiguity of role, satisfaction with remuneration and family problems.	Emotional
Yang et al., 2018 China	Descriptive-exploratory Psychiatric hospital	Investigating the incidence, type, related factors and effects of violence at work; level of burnout and coping strategies of nurses.	High incidence (94.6%) of violence (verbal and physical aggression, sexual harassment). Effects: feelings of injustice, depression and anger. Burnout levels increased with age, job title, years of work. Coping strategies: asking for help from colleagues and supervisors, physical restraint and avoiding patients.	Emotional

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[1] Corresponding author: Tássia Ghissoni Pedroso. E-mail: tassia.gp@gmail.com