Nurses' perceptions of environmental pressures in relation to their occupational stress.

Aim: The aim of this paper was to explore nurses' stress experiences of working under the current health care system in Taiwan (the context) using a qualitative approach.

Background: Although most global health care institutions have been changing in response to the economic contraction, there is a deficit of information in understanding the changes of the ecology of the health care system in Taiwan from nurses' perspectives.

Design: Grounded theory.

Methods: A grounded theory approach was used to collect the data from a sample of 28 critical care nurses from seven hospitals in Taiwan. Data were analysed using a multi-step analytic procedure, based on the approaches of Glaser, Chesler and Strauss and Corbin.

Findings: The health care system changes were found to increase critical care nurses' occupational stress and work dilemmas. For the purpose of this study, the two categories that emerged in the 'context' component of the paradigm model are investigated. They were: hospital reorganisation and cultural burden of the nurse's role.

Conclusions: The findings indicated that hospital organisational changes and people's own belief of the nurse's role were recognised as the environmental pressures which increase critical care nurses' occupational stress. Cultural background may play an important role in influencing nurses' work atmosphere and their ways of being seen.

Relevance To Clinical Practice: Critical care nurses perceived that their hospitals were under huge demands due to the changes in health care policies; these had subsequently caused them a high level of occupational stress. Beliefs in the embedded culture were also identified as significant factors in causing nurses' role stress. These findings could enhance the knowledge of critical care nurses' occupational stress and identify the most appropriate stress management skills available to them. Findings will add to the understanding of Chinese nurses who may work globally.