Work-Related Stress and Stress Management Practice Among Chinese Hospital Staff Working Night Shifts: A Mixed-Methods Study

Health care workers (HCWs) are susceptible to cumulative stressors and their detrimental effects. Hence, it is important to identify the factors in HCWs' stress management behaviors to help them better cope with daily stress. Inspired by the health belief model (HBM), we decided to focus on examining the psychosocial pathway between stressors and stress outcomes among HCWs. A sequential explanatory mixed-methods study was conducted in two general hospitals in Wuhan, China. A constructive questionnaire was applied to assess the psychological measures of stress, and the Holter devices were used to evaluate the physical effects of stress. Subsequently, a multiple case study was conducted to better understand factors related to stress management attitudes and behaviors among HCWs. A total of 292 HCWs were included in this study. The results showed that 67.1% of participants were overstressed, with 57.5%, 69.2%, and 78.4% of participants suffering from depression, anxiety, and stress symptoms, respectively. Only half of the participants adopted stress management behaviors, and stress management attitudes and behaviors played a mediating role between stressors and stress outcomes for both physical indicators (beta = 0.014, p = .006) and psychological measures (beta = -.001, p = .052). Analyses of the results of this qualitative study consistently found that knowledge, skills, and positive feedback were critical elements for stress management behaviors. Promoting positive health beliefs around stress management, and emphasizing, in particular, the positive role of stress management in HCWs' personal lives, was critical to help HCWs build stress management behaviors.