STUDENT SCHOLARSHIP

Promoting Situational Support for Nurses in Practice Evelyn Brooks, Judith M. Wilkinson, Sue Popkess-Vawter

Situational support entails promoting autonomy, control over practice, group cohesion, manager consideration, and substantive exchange. Support can reinforce nurses’ coping mechanisms, preserve their integrity, and thereby promote quality patient care. Using concept clarification and case examples the authors identify support mechanisms and coping styles for nurses at work and discuss how situational support can be used to cope with stress.

[Keywords: coping; retention in nursing service; stress management]

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urses endure tremendous stress in their work that can affect their well-being, reduce the quality of care, and increase turnover. If added to the work environment, situational support can help nurses cope with stress (Brooks, Wilkinson, Bott, &

Taunton, 1993). Situational support is defined as individuals and groups who can be depended on to be advocates and to assist in solving problems. The mechanisms to achieve situational support include those related to autonomy, control over practice, group cohesion, manager consideration, and substantive exchange.

A nurse’s sense of well-being can directly affect patient care (Mitchell, 1982). Nurses’ caregiving is less effective when the organizational climate and environment surrounding patients are unhealthy (Kramer, 1974). Nurses, being part of that environment, are instrumental in promoting patients’ health and adaptation. Nurses who are unhappy or coping unsuccessfully may experience difficulty in creating a climate that maximizes patients’ well-being (Kramer, 1974).

Antecedent Conditions to Perceived Situational Support

Situational support was first discussed in the 1960s by Aguilera and Messick (1982) in their crisis intervention theory. However, their definition of situational support did not address specific situational supports in nurses’ work environments. Moreover, there is no consensus in the literature about the antecedents to perceived situational support. According to Walker and Avant (1988), antecedents are the events or incidents that precede a phenomenon. For situational support, it can be inferred the antecedents are perceived stress, ineffective individual coping, and need for situational support.

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People make general and specific responses when attempting to maintain equilibrium in the presence of stressors. Specific individual responses are not so much a function of the type of stressor, but of a person’s perception of the experiences and the situational support available. Cook and Mandrill0 (1982) reported that when nurses cannot cope with the stressors they perceive in their work, then situational support mechanisms are needed to reduce stress. When nurses begin to find it difficult to cope, they may perceive situational support when at least one support mechanism exists. Once they perceive situational support, their coping can be bolstered and a feeling of personal and professional integxity can be promoted. It is human nature for people to socialize and depend on others to supply them with supportive appraisals of their values (Aguilera & Messick, 1982). Thus, all situational support mechanisms involve human interchange.

In a secondary analysis of data from a larger study of nurse managers, nurse retention, and patient outcomes (Taunton, 1989), five research-based variables were chosen to represent situational support mechanisms: autonomy, control over practice, group cohesion, manager consideration, and substantive (work-related, social, and personal) exchange. These variables were shown to not only function as situational support mechanisms but they were also inversely correlated with job stress (Brooks, et al., 1993).

Autonomy is a situational support mechanism that allows or encourages the nurse to share in making decisions about daily operations (Hinshaw, Smeltzer, & Atwood, 1987). Control over

Evelyn Brooks, RN, MN, Delta, is a doctoral candidate and research assistant; Judith M. Wilkinson, RN, MA, MS, Lambda Phi, i s a doctoral candidate; Sue Popkess-Vawter, RN, PhD, Delta, is Professor, all at the University of Kansas School of Nursing. Correspondence to Ms. Brooks, 1020 W. Edwards, Maryville, MO 64468.

Accepted for publication February 10, 1994.

Volume 26, Number 4, Winter 1994 305

Promoting Situational Support for Nurses in Practice

practice is the degree of centralization and decision making assigned to individual nurses that occurs by participation in formal, influential committees (Hinshaw et al., 1987). Group cohesion is the degree to which nurses feel integrated into work groups and the organization (Good & Nelson, 1973; Hinshaw et al., 1987). Manager consideration is the degree to which managers contribute to the comfort, well-being, status, and contribution of the nursing staff (Kruse & Stogdill, 1973). Substantive exchange is engagement in give-and-take in important and work-related decisions (Hansen, 1991).

Sole Defining Attribute To identify whether a concept exists, defining attributes are

specified (Walker & Avant, 1988). When nurses perceive one or more of the situational support mechanisms to be helping them cope, the defining attribute of situational support is present. However, the mere presence of any of the five support mechanisms does not necessarily assure situational support. Because of the subjective nature of this defining attribute, it is the nurses’ perception of autonomy, control over practice, group cohesion, manager consideration, and substantive exchange that is the essential defining attribute, not their actual presence. Therefore, a person’s expression of feeling supported at a time of need stands as the only reliable defining attribute.

Consequences The broad consequences of perceived situational support are

effective individual coping and perceived personal and professional integrity. Aguilera and Messick (1982) have theorized that by altering a person’s perception of stress, it can be ameliorated. Their theory has been supported in studies by Cook and Mandrill0 (1982), Lindop (1989), and Camevale, Annibale, Grenier, Guy, and Ottoni (1987).

Group cohesion and substantive exchange functioning as situational supports have been positively correlated with decreased stress (Dwyer, Schwartz, & Fox, 1992; Hansen, 1991; Langemo, 1988; McCloskey, 1990; Price & Mueller, 1981) and with modification of the effects of job stress (Hinshaw et al., 1987; Price & Mueller, 1981). Reduction of nurses’ stress is important not only for increasing retention and improving patient care, but also for helping to preserve the integrity of the caregiver (Haw, 1982; Kobasa, 1979; Selye, 1974). Other consequences of perceived situational support for nurses may include increased sense of personal and professional growth and improved ability to recognize stressors and to prevent their negative outcomes. Awareness by nurse managers’ and their activation of the situational support mechanisms at work may ultimately increase retention and improve patient care.

Case Examples The following accounts of a shared clinical situation illustrate

nurses’ perceptions of situational support and the defining attributes. Linda is a new graduate nurse. During orientation, she was asked by her charge nurse to observe an arteriogram. The patient had a cardiac arrest during the procedure and died after unsuccessful attempts at resuscitation. Returning to her work unit, Linda said she felt preoccupied and stressed. The charge

nurse asked Linda (manager consideration) to join in a debriefing session. The nurses asked Linda about what she thought about the decisions that were made during the resuscitation (autonomy) as well as about formal changes she thought should be initiated regarding emergency supplies (control over practice). Members of her work group encouraged her to verbalize (group cohesion), and to suggest nursing interventions (substantive exchange) for the family. Linda reported feeling a part of the group. “The nurses discussed the good and the bad; they all became so human to me. I felt so much better after the debriefing ... all the nurses were in tears but it was O.K.!” Later that week, Linda again mentioned that the traumatic experience had become a positive one because of the support she felt from the other nurses.

Nancy also was present when the patient having the arteriogram suffered a cardiac arrest and died. In the previous year, Nancy’s 22-year-old son had been killed in an automobile accident and her father had died. Last month Nancy learned she would have to retake the state board examination for licensure as a registered nurse. Her husband is her main support in dealing with life events. No debriefing session for the incident was done on Nancy’s unit. A few days later, Nancy felt uneasy and sad. She explained that she kept thinking of her father’s death and how she would feel if the patient were her husband. “I just got so wrapped up in it, 1 didn’t feel like 1 learned anything. I just felt pain and sadness. I held it in for a long time and it has affected me ever since”. Nancy’s need for situational support was not assessed, nor were there supportive interventions. She perceived that the nurses saw the arrest as a mere technicality and did not view the patient as a dying human being. She did not perceive any situational support, and, therefore, none of the positive consequences.

Clarification of situational support underscores the need for reducing perceived job stress and supporting nurses as they attempt to cope. Administrators’ and practitioners’ awareness of the need for bringing situational support mechanisms to bear on work situations can improve nurses’ work environments.

References

American Heritage Dictionary. (1983). (2nd College ed.). Boston: Houghton Mifflin.

Aguilera, D., & Messick, J. (1982). Crisis intervention: Theory and methodology (4th ed.). St. Louis: Mosby.

Aguilera, D.C. (1990). Crisis intervention: Theory and methodology (6th ed.). St. Louis: C.V. Mosby.

Bowen, H.R., & Schuster, J.H. (1986). American professors: A national resource imperiled. New York Oxford University.

Brooks, E.L., Wilkinson, J.M., Bott, M., & Taunton, R.L. (1993). Situational supports and job stress: A correlational study. Nursing Connections, 6(1), 39-45.

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Promoting Situational Support for Nurses in Practice

Kruse, L.C., & Stogdill, RM. (1973). The leadership role of the nurse (RF Project 3204). Columbus: Ohio State University.

Langemo, D.K. (1988). Work related stress in baccalaureate nurse educators. Western Journal of Nursing Research, 10,327-334.

Lindop, E. (1989). Individual stress and its relationship to termination of nurse training. Nurse Education Today, 9, 172-179.

McCloskey, J.C. (1990). l b o requirements for job contentment: Autonomy and social integration. Image: Journal of Nursing Scholarship, 22, 140-143.

Mitchell, C. (1982). Integrity in interprofessional relationships. In G. Agich (Ed.), Responsibility in health care (163-184). Boston: Reidel.

Masby's Medical, Nursing, and Allied Health Dictionary. (1990). (3rd ed.). St. Louis: C.V. Mosby.

Price, J.L., & Mueller, C.W. (1981). Professional turnover: The case of nurses. Jamaica, N Y Spectrum.

Selye, H. (1974). Stress without distress. Philadelphia: Lippincott. Taunton, R.L. (1989-1993). Nurse managers, nurse retention, patient

outcomes. Unpublished grant application, NIHNCNR Grant NR02092-02, funded to the University of Kansas Medical Center, School of Nursing.

Walker, L.O., & Avant, K.C. (1988). Strategies for theory construction in nursing (2nd ed.). Norwalk Appleton & Lange.

Carnevale, F.A., Annibale, F., Grenier, A., Guy, E., & Ottoni, L. (1987). Nursing in the 1.C.U.: Stress without distress? Canadian Critical Care Nursing Journal, 4(1), 16-18.

Cook, C.B., & MandriUo, M. (1982). Perceived stress and situational supports. Nursing Management, 13(9), 31-33.

Dwyer, DJ., Schwartz, R.H., & Fox, M.L. (1992). Decision-making autonomy in nursing. The Journal of Nursing Administration, 22(2), 17-23.

Hansen, H.E. (1991) Collegiality among stafT registered nurses in acute care: Test of a conceptual model. Unpublished doctoral dissertation, University of Kansas, KS.

Haw, M.A. (1982). Women, work, stress: A review and agenda for the future. Journal of Health and Social Behavior, 23(2), 132-144.

Hinshaw, A.S., Smeltzer, C.H., & Atwood, J.R. (1987). Innovative retention strategies for nursing staff. Journal of Nursing Administration, 17(6), 8- 16.

Kobasa, S.C. (1979). Stressful life events, personality, health: An inquiry into hardiness. Journal of Personality and Social Psychology, 37(1), 1-1 1.

Kramer, M. (1974). Reality shock: Why nurses leave nursing. St. Louis: Mosby.

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