A critical review of the relationship between perception of the work environment, coping and mental health in trained nurses, and patient outcomes

The socio-ecological model of work stress (Schaefer & Moos 1993b) specifies the direct and indirect impact of the work environment on both staff and patient outcomes. Adopting this perspective, a critical review of the impact of the health-care setting on trained nurse and patient outcomes was carried out systematically using 94 studies identified for inclusion.

Evidence was found of the validity of elements of the socio-ecological model of work stress to detail the direct and indirect influences on work-related distress in trained nurses. However, several direct and reciprocal relationships contained within the model were not supported, and complex interactional effects were apparent which were not predicted by Schaefer and Moos (1993b). In addition, key elements of the model await systematic research, i.e. the impact of the health-care system on patient outcomes.

A nurse-specific extension of the socio-ecological model is presented in response. This amended model of work stress will enable the planning of evidence-based organizational strategies to alter problematic work climates faced by nurses, and provides a framework for the design of future research to maximize the quality of patient care provided by practitioners working in demanding health-care environments.