Hostname: page-component-7c8c6479df-5xszh Total loading time: 0 Render date: 2024-03-28T14:30:54.830Z Has data issue: false hasContentIssue false

Psychological Distress Among Nurses Caring for Victims of War in Sri Lanka

Published online by Cambridge University Press:  15 August 2013

Wasantha Jayawardene*
Affiliation:
Department of Applied Health Science, School of Health, Physical Education, and Recreation, Indiana University
Ahmed YoussefAgha
Affiliation:
Department of Applied Health Science, School of Health, Physical Education, and Recreation, Indiana University
Scott LaJoie
Affiliation:
Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville
Mohammad Torabi
Affiliation:
Department of Applied Health Science, School of Health, Physical Education, and Recreation, Indiana University
*
Address correspondence and reprint requests to Dr Wasantha Jayawardene, Department of Applied Health Science, School of Health, Physical Education, and Recreation, Indiana University Bloomington, 1025 East 7th St, Room 116, Bloomington, IN 47405 (e-mail wajayawa@indiana.edu).

Abstract

Objective

To determine prevalence and factors associated with psychological distress among nurses caring for war victims in Sri Lanka.

Methods

Descriptive, cross-sectional study design was used to collect data from 241 nurses from 2 hospitals with stratified random sampling according to workstation. Self-administered 30-item General Health Questionnaire was used to detect psychological distress.

Results

The prevalence of psychological distress was 21%. Female sex was found to be the most significant predictor of psychological distress among nurses. Factors, such as being married, having children, or both, were found to be protective. High exposure to war victims, measured by the frequency with which a nurse tended to those patients, also resulted in less psychological distress.

Conclusions

The prevalence of psychological distress is higheramong nurses in this study compared with that among the general population. Brief screening instruments, such as the General Health Questionnaire, can be used to identify individuals at risk for psychological distress. Results suggest that the presence of a social support network helped to psychologically buffer these nurses. Findings also imply the importance of promoting positive attitudes and beneficial stress (eustress) to complement a well-developed focus on distress prevention. (Disaster Med Public Health Preparedness. 2013;7:278-286)

Type
Original Research
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV-TR. Washington, DC: American Psychiatric Association; 2000.Google Scholar
2.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV. Washington, DC: American Psychiatric Association; 1994.Google Scholar
3.Morrison, J. DSM-IV Made Easy: The Clinician's Guide to Diagnosis. New York: Guilford Press; 2000.Google Scholar
4.Princeton University. WordNet Dictionary—a lexical database for English. http://wordnet.princeton.edu. Accessed May 9, 2011.Google Scholar
5.Recognition and Alleviation of Pain and Distress in Laboratory Animals. Institute of Laboratory Animal Resources. Washington, DC: Commission on Life Sciences, National Research Council; 1992.Google Scholar
6.Selye, H. The Physiology and Pathology of Exposure to Stress: A Treatise Based on the Concepts of the General Adaptation Syndrome and the Diseases of Adaptation. Montreal, Canada: Acta Inc Medical Publishers; 1950.Google Scholar
7.Huppert, FA, Walters, DE, Day, NE, Elliott, BJ. The factor structure of the General Health Questionnaire (GHQ-30). A reliability study on 6317 community residents. Br J Psychiatry. 1989;155:178-185.CrossRefGoogle Scholar
8.O'Brien, LS. Traumatic Events and Mental Health. Cambridge, UK: Cambridge University Press; 1998.CrossRefGoogle Scholar
9.Arnold, JL, Ortenwall, P, Birnbaum, ML, etal. A proposed universal medical and public health definition of terrorism. Prehosp Disaster Med. 2003;18(2):47-52.CrossRefGoogle Scholar
10.Eisenman, DP, Wold, C, Fielding, J, etal. Differences in individual-level terrorism preparedness in Los Angeles County. Am J Prev Med. 2006;30(1):1-6.CrossRefGoogle ScholarPubMed
11.Torabi, MR, Seo, DC. National study of behavioral and life changes since September 11. Health Educ Behav. 2004;31(2):179-192.CrossRefGoogle ScholarPubMed
12.Kawana, N, Ishimatsu, SI, Matsui, Y, Tamaki, S, Kanda, K. Chronic post-traumatic stress symptoms in victims of Tokyo subway sarin gas attack. Traumatology. 2005;11:87-102.CrossRefGoogle Scholar
13.Chang, EM, Hancock, KM, Johnson, A, Daly, J, Jackson, D. Role stress in nurses: review of related factors and strategies for moving forward. Nurs Health Sci. 2005;7(1):57-65.CrossRefGoogle ScholarPubMed
14.Jones, MC, Johnston, DW. Distress, stress and coping in first-year student nurses. J Adv Nurs. 1997;26(3):475-482.CrossRefGoogle ScholarPubMed
15.Jones, MC, Johnston, DW. The derivation of a brief Student Nurse Stress Index. Work Stress. 1999;13:162-181.CrossRefGoogle Scholar
16.Jones, MC, Johnston, DW. Reducing distress in first level and student nurses: a review of the applied stress management literature. J Adv Nurs. 2000;32(1):66-74.CrossRefGoogle ScholarPubMed
17.Hogston, R. Nurses’ perceptions of the impact of continuing professional education on the quality of nursing care. J Adv Nurs. 1995;22(3):586-593.CrossRefGoogle ScholarPubMed
18.Mann, S, Cowburn, J. Emotional labour and stress within mental health nursing. J Psychiatr Ment Health Nurs. 2005;12(2):154-162.CrossRefGoogle ScholarPubMed
19.Deary, IJ, Blenkin, H, Agius, RM, Endler, NS, Zealley, H, Wood, R. Models of job-related stress and personal achievement among consultant doctors. Br J Psychol. 1996;87(Pt 1):3-29.CrossRefGoogle ScholarPubMed
20.LeSergent, CM, Haney, CJ. Rural hospital nurse's stressors and coping strategies: a survey. Int J Nurs Stud. 2005;42(3):315-324.CrossRefGoogle ScholarPubMed
21.Alexander, MF, Fawcett, JN, Runciman, PJ. Nursing Practice: Hospital and Home, 2nd ed. Edinburgh: Churchill Livingstone; 1994.Google Scholar
22.Maslach, C, Jackson, SE. Maslach Burnout Inventory Manual, 2nd ed. Palo Alto, CA: Consulting Psychologists Press; 1986.Google Scholar
23.Shiri, S, Wexler, ID, Alkalay, Y, Meiner, Z, Kreitler, S. Positive psychological impact of treating victims of politically motivated violence among hospital-based health care providers. Psychother Psychosom. 2008;77(5):315-318.CrossRefGoogle ScholarPubMed
24.Shiri, S, Wexler, ID, Alkalay, Y, Meiner, Z, Kreitler, S. Positive and negative psychological impact after secondary exposure to politically motivated violence among body handlers and rehabilitation workers. J Nerv Ment Dis. 2008;196(12):906-911.CrossRefGoogle ScholarPubMed
25.Heir, T, Weisaeth, L. Acute disaster exposure and mental health complaints of Norwegian tsunami survivors six months post disaster. Psychiatry. 2008;71(3):266-276.CrossRefGoogle ScholarPubMed
26.Beck, SL. An ethnographic study of factors influencing cancer pain management in South Africa. Cancer Nurs. 2000;23(2):91-99, quiz 99-100.CrossRefGoogle ScholarPubMed
27.Williams, JE, Chandler, A, Ranwala, R, DeSilva, BSS, Amarasinghe, I. Establishing a cancer pain clinic in a developing country: effect of a collaborative link project with a UK cancer pain center. J Pain Symptom Manage. 2001;22(4):872-878.CrossRefGoogle Scholar
28.Abeykoon, P. The Implications of Technology Change for Health Care Delivery in Sri Lanka. Colombo, Sri Lanka: World Health Organization; 2003.Google Scholar
29.Fernando, JNO. Collaboration between open universities in the Commonwealth: successful production of the first ever Sri Lankan nursing graduates at the Open University of Sri Lanka by distance education. Brunei Darussalam: Pan Commonwealth Forum on Open Learning. Bandar Seri Begawan; 1999:1-5.Google Scholar
30.Jayasekara, RS, Schultz, T. Health status, trends, and issues in Sri Lanka. Nurs Health Sci. 2007;9(3):228-233.CrossRefGoogle ScholarPubMed
31.Annual Health Bulletin. Colombo, Sri Lanka: Department of Health Services; 2003.Google Scholar
32.Jayasekara, RS. Issues, challenges and vision for the future of the nursing profession in Sri Lanka: a review. Int Nurs Rev. 2009;56(1):21-27.CrossRefGoogle ScholarPubMed
33.De Silva, BS, Rolls, C. Health-care system and nursing in Sri Lanka: an ethnography study. Nurs Health Sci. 2010;12(1):33-38.CrossRefGoogle ScholarPubMed
34. South ATP. Institute for Conflict Management. Fatalities in terrorist violence in Sri Lanka since March 2000. http://satp.org/satporgtp/countries/shrilanka/database/annual_casualties.htm. Accessed May 9, 2011.Google Scholar
35.National Health Bulletin. Colombo, Sri Lanka: Department of Health Services; 2007.Google Scholar
36.Lwanga, SK, Lemeshow, S. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization; 1991.Google Scholar
37.Flynn, B. Thoughts and reflections following the bombing. J Am Psychiatr Nurses Assoc. 1995;1:166-170.CrossRefGoogle Scholar
38. Mental Health Guidelines of Ministry of Health Colombo, Sri Lanka; 2007.Google Scholar
39.Goldberg, D, Williams, P. A User's Guide to the General Health Questionnaire. Windsor, Canada: HFER-Nelson; 1988.Google Scholar
40.Gelder, MG, Lopez-Ibor, JJ, Andreason, NC. New Oxford Text Book of Psychiatry. New York: Oxford University Press; 2001.Google Scholar
41.Wancata, J, Alexandrowicz, R, Benda, N. 30-item General Health Questionnaire in general hospitals: selecting items using a stepwise hierarchical procedure. Eur J Epidemiol. 2001;17(11):1001-1004.CrossRefGoogle ScholarPubMed
42.de Santiago, A, Vázquez, JL, Díez, JF. The feminine role as a determinant of mental health among the women of the general population of Cantabria. Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1993;21(5):168-180.Google ScholarPubMed
43.Rasul, F, Stansfeld, SA, Davey-Smith, G, Hart, CL, Gillis, C. Sociodemo-graphic factors, smoking and common mental disorder in the Renfrew and Paisley (MIDSPAN) study. J Health Psychol. 2001;6:149-158.CrossRefGoogle Scholar
44.Livingston, HM, Livingston, MG, Fell, S. The Lockerbie disaster—a 3-year follow-up of elderly victims. Int J Geriatr Psychiatry. 1994;9:989-994.CrossRefGoogle Scholar
45.Chung, MC, Easthope, Y, Chung, C, Clark-Carter, D. Traumatic stress and coping strategies of sesternary victims following an aircraft disaster in Coventry. Stress Health. 2001;17:67-75.CrossRefGoogle Scholar
46.Montazeri, A, Baradaran, H, Omidvari, S, etal. Psychological distress among Bam earthquake survivors in Iran: a population-based study. BMC Public Health. 2005;5:4.CrossRefGoogle ScholarPubMed
47.Sumathipala, A, Murray, J. New approach to translating instruments for cross-cultural research: a combined qualitative and quantitative approach for translation and consensus generation. Int J Methods Psychiatr Res. 2000;9:87.CrossRefGoogle Scholar
48.Kasthuriarachchi, K. A Study on Selected Socio-Demographic Factors and Psychological Status of Permanently Disabled Servicemen [Dissertation] Colombo, Sri Lanka: Post-Graduate Institute of Medicine University of Colombo; 2001.Google Scholar
49.Gunawardena, N, Senevirathne Rde, A, Athauda, T. Mental health outcome of unilateral lower limb amputee soldiers in two districts of Sri Lanka. Int J Soc Psychiatry. 2007;53(2):135-147.CrossRefGoogle ScholarPubMed
50.Frehywot, S, Mullan, F, Payne, PW, Ross, H. Compulsory service programmes for recruiting health workers in remote and rural areas: do they work? Bull World Health Organ. 2010;88(5):364-370.CrossRefGoogle ScholarPubMed
51.National Institute of Mental Health. Statistics. http://www.nimh.nih.gov/health/topics/statistics/index.shtml. Accessed May 9, 2011.Google Scholar
52.World Health Organization. Mental Health Update. June 2008. wwwwhosrilanka.org/LinkFiles/WHO_Sri_Lanka_Home_Page_Mental_Health_Factsheet.pdf. Accessed May 9, 2011.Google Scholar
53.Butler, AS, Panzer, AM, Goldfrank, L. Preparing for the Psychological Consequences of Terrorism: A Public Health Strategy. Washington, DC: Institute of Medicine; 2003.Google Scholar