Psychological stress in nurses assisting Amyotrophic Lateral Sclerosis patients: a statistical analysis based on Non-Parametric Combination test

Angela Alibrandi, Massimiliano Giacalone, Agata Zirilli

Abstract


We aimed to evaluate the psychological, emotional and relational burden of nurses who provide assistance to patients affected by Amyotrophic Lateral Sclerosis (ALS). A survey was conducted by administering a questionnaire, the “Health Professions Stress and Coping Scale”, which proposes some potentially stressful work situations. The questionnaire was administered to 105 nurses working in hospitals where there is a ward for patients suffering from ALS. We used the "Non-Parametric Combination Test", a multivariate methodology based on permutation solution, widely applicable in various research contexts. Firstly, we investigated the areas of stress; then, the attention was focused on the different coping strategies adopted by respondent nurses within each stress area. The analyses were stratified according to different confounding factors, in order to control their potential effect. The results show the presence of an average level of stress, regardless of gender and educational status. Furthermore, there are significant differences in stress levels in subjects classified according to the ward in which they operate and a positive correlation between higher stress levels and the number of service years was found. In the future this study could also be of interest to nurses working in wards with potentially stressful situations.


Keywords


Psychological stress in Nurses; Amyotrophic Lateral Sclerosis; Health Professions Stress and Coping Scale; Non Parametric Combination procedure.

Full Text:

PDF

References


Abbate C., Micali E., Giorgianni C., Munaò F., Brecciaroli R., Salmaso L., Germanò D. (2004). Affective Correlates of Occupational Exposure to Whole-Body Vibration. Psychotherapy and Psychosomatics, 73(6), 375-379. https://doi.org/10.1159/000080391

Agovino, M., Aprile, M. C., Garofalo, A., Mariani, A. (2018). Cancer mortality rates and spillover effects among different areas: A case study in Campania (southern Italy). Social Science & Medicine, 204, 67-83. https://doi.org/10.1016/j.socscimed.2018.03.027

Alfieri, R., Bonnini, S., Brombin, C., Castoro, C., Salmaso, L. (2016). Iterated combination-based paired permutation tests to determine shape effects of chemotherapy in patients with esophageal cancer. Statistical methods in medical research, 25(2), 598-614. https://doi.org/10.1177/0962280212461981

Arboretti, R., Bathke, A. C., Carrozzo, E., Pesarin, F., Salmaso, L. (2020). Multivariate permutation tests for two sample testing in presence of nondetects with application to microarray data. Statistical Methods in Medical Research, 29(1), 258-271. https://doi.org/10.1177/2F0962280219832225

Arboretti, R., Bordignon, P., Corain, L., Palermo, G., Pesarin, F., Salmaso, L. (2015). Test statistici nella ricerca medica: metodi tradizionali vs test multivariati di permutazione NPC. Urologia, 82 (2), 130-136. http://dx.doi.org/10.5301/uro.5000117

Arboretti, R., Ceccato, R., Salmaso, L. (2020). Permutation testing for goodness-of-fit and stochastic ordering with multivariate mixed variables. Journal of Statistical Computation and Simulation, 1(21), 876-896. https://doi.org/10.1080/00949655.2020.1836182

Arboretti, R., Fontana, R., Pesarin, F., Salmaso, L. (2018). Nonparametric combination tests for comparing two survival curves with informative and non-informative censoring. Statistical methods in medical research, 27(12), 3739-3769. https://doi.org/10.1177/0962280217710836

Auteri, M., Guccio, C., Pammolli, F., Pignataro, G., Vidoli, F. (2019). Spatial heterogeneity in non-parametric efficiency: An application to Italian hospitals. Social Science & Medicine, 239(C).: https://doi.org/10.1016/j.socscimed.2019.112544

Basso, D., Chiarandini, M., Salmaso, L. (2007). Synchronized permutation tests in replicated I× J designs. Journal of Statistical Planning and Inference, 137(8), 2564-2578. http://dx.doi.org/10.1016/j.jspi.2006.04.016

Berger, R. L. (1982) Multiparameter hypothesis testing and acceptance sampling. Technometrics, 24(4), 295-300. https://doi.org/10.1080/00401706.1982.10487790

Boateng, G. O., Schuster, R. C., Boateng, M. O. (2019). Uncovering a health and wellbeing gap among professional nurses: situated experiences of direct care nurses in two Canadian cities. Social Science & Medicine, 242, 112568. https://doi.org/10.1016/j.socscimed.2019.112568

Bonnini, S., Corain, L., Marozzi, M., Salmaso, L. (2014). Nonparametric hypothesis testing: rank and permutation methods with applications in R. Chichester, West Sussex : John Wiley & Sons.

Bowers, J., Fredrickson, M. M., Panagopoulos, C. (2013). Reasoning about interference between units: A general framework. Political Analysis, 21(1), 97-124. https://doi.org/10.7910/DVN/3EGVBB

Brombin, C, Di Serio, M. (2016). Evaluating treatment e effect within a multivariate stochastic ordering framework: NPC methodology applied to a study on Multiple Sclerosis. Statistical Methods in Medical Research, 25(1), 366-384. https://doi.org/10.1177/0962280212454203

Brombin, C., Midena, E., Salmaso, L. (2013). Robust non-parametric tests for complex-repeated measures problems in ophthalmology. Statistical methods in medical research, 22(6), 643-660. https://10.1177/0962280211403659

Brombin, C., Salmaso, L. (2009). Multi-aspect permutation tests in shape analysis with small sample size. Computational Statistics & Data Analysis, 53(12), 3921-3931. https://doi.org/10.1016/j.csda.2009.05.010

Caughey, D., Dafoe, A., Seawright, J. (2017). Nonparametric combination (NPC): A framework for testing elaborate theories. The Journal of Politics, 79(2), 688-701. https://doi.org/10.1086/689287

Cîrstoveanu, C., Oprea, B., Burtăverde, V., Dimitriu, M., Stoian, A. P., Ionescu, A. C., . & Chiper, B. (2020). Emotional intelligence and the perception of stressors at work among healthcare employees in neonatology and paediatrics. Mediterranean journal of Clinical Psychology, 8(3). https://doi.org/10.6092/2282-1619/mjcp-2678

Corain, L., Salmaso, L. (2004). Multivariate and multistrata nonparametric tests: the nonparametric combination method. Journal of Modern Applied Statistical Methods, 3(2), 443-461. http://dx.doi.org/10.22237/jmasm/1099268160

Corain, L., Salmaso, L. (2015). Improving power of multivariate combination-based permutation tests. Statistics and Computing, 25(2), 203-214. https://doi.org/10.1007/s11222-013-9426-0

Corder G. W., Foreman D. I., (2009). Nonparametric statistics for non‐statisticians, International Statistical Review, John Wiley & Sons Inc., 99-105. https://doi.org/10.1002/9781118165881

Di Giacomo, D. (2020). Public Health emergencies and quarantine: virtual patient engagement as challenge and opportunity for Mental Health strategy. Mediterranean Journal of Clinical Psychology, 8(2). https://doi.org/10.6092/2282-1619/mjcp-2533

Di Nuovo, S. F., & Narzisi, V. (2021). Telepsychology: Acceptability of online assessment and treatment in users and professional psychologists. Mediterranean Journal of Clinical Psychology, 9(3). https://doi.org/10.13129/2282-1619/mjcp-3261

Dunning, T. (2012). Natural experiments in the social sciences: a design-based approach. Cambridge University Press. https://doi.org/10.1017/CBO9781139084444

Finos, L., Salmaso, L. (2006). Weighted methods controlling the multiplicity when the number of variables is much higher than the number of observations. Nonparametric Statistics, 18(2), 245-261. https://doi.org/10.1080/10485250600720803

Fisher, R.A. (1935). Design of Experiments. Oliver and Boyd, Edinburgh: Tweeddale Court.

Frisone, F., Sicari, F., Settineri, S., & Merlo, E. M. (2021). Clinical psychological assessment of stress: a narrative review of the last 5 years. Clinical Neuropsychiatry, 18(2), 91. https://doi.org/10.36131/cnfioritieditore20210203

Folks, J. (1984) 6 Combination of independent tests. Handbook of statistics, 4, 113-121. https://doi.org/10.1016/S0169-7161(84)04008-6

Friedrich, S., Brunner, E., Pauly, M. (2017). Permuting longitudinal data in spite of the dependencies. Journal of Multivariate Analysis, 153(C), 255-265. https://doi.org/10.1016/j.jmva.2016.10.004

Giacalone, M., Zirilli, A., Cozzucoli, P. C., Alibrandi, A. (2018a). Bonferroni-Holm and permutation tests to compare health data: methodological and applicative issues. BMC medical research methodology, 18(1), 81. https://doi.org/10.1186/s12874-018-0540-8

Giacalone, M., Zirilli, A., Moleti, M., Alibrandi, A. (2018b). Does the iodized salt therapy of pregnant mothers increase the children IQ? Empirical evidence of a statistical study based on permutation tests. Quality & Quantity, 52(2), 1423-1435. https://link.springer.com/article/10.1007/s11135-017-0529-0

Giancristofaro, R.A., Brombin, C. (2014). Overview of Non-Parametric Combination-based permutation tests for Multivariate multi-sample problems. Statistica, 74(3), 233-246. https://doi.org/10.6092/issn.1973-2201/5303

Glynn, A. N., Ichino, N. (2014). Using qualitative information to improve causal inference. American Journal of Political Science, 59(4), 1055-1071. https://doi.org/10.1111/ajps.12154

Gordon, P. H. (2013). Amyotrophic lateral sclerosis: an update for 2013 clinical features, pathophysiology, management and therapeutic trials. Aging and disease, 4(5), 295-310. https://doi.org/10.14336/ad.2013.0400295

Hardiman, O., van den Berg, L., Kiernan, M.C. (2011). Clinical diagnosis and management of amyotrophic lateral sclerosis. Nature Reviews Neurology, 7(11), 639–649. https://doi.org/10.1038/nrneurol.2011.153

Heinemann, L. V., Heinemann, T. (2017). Burnout research: Emergence and scientific investigation of a contested diagnosis. Sage Open, 7(1). https://doi.org/10.1177/2F2158244017697154.

Ho, D. E., Imai, K. (2006). Randomization inference with natural experiments: An analysis of ballot effects in the 2003 California recall election. Journal of the American statistical association, 101(475), 888-900. https://doi.org/10.1198/016214505000001258

Janssen, A. (1977). Studentized permutation tests for non-iid hypotheses and the generalized Behrens-Fisher problem. Statistics & probability letters, 36(1), 9-21. https://doi.org/10.1016/S0167-7152(97)00043-6

Keele, L., McConnaughy, C., White, I. (2012). Strengthening the experimenter’s toolbox: Statistical estimation of internal validity. American Journal of Political Science, 56(2), 484-499. https://doi.org/10.1111/j.1540-5907.2011.00576.x

Kiernan, M. C., Vucic, S., Cheah, B. C., Turner, M. R., Eisen, A., Hardiman, O., Burrell, J.R., Zoing, M. C. (2011). Amyotrophic lateral sclerosis. The Lancet, 377(9769), 942-955. https://doi.org/10.1016/S0140-6736(10)61156-7

Klingenberg, B., Solari, A., Salmaso, L., Pesarin, F. (2009). Testing marginal homogeneity against stochastic order in multivariate ordinal data. Biometrics, 65(2), pp. 452-462. https://doi.org/10.1111/j.1541-0420.2008.01067.x

Lehmann, E. L., Romano, J. P. (2006). Testing statistical hypotheses. Springer Science & Business Media, United States of America.

Ludbrook, J., Dudley, H. (1998). Why permutation tests are superior to t and F tests in biomedical research. The American Statistician, 52(2), 127-132. https://doi.org/10.1080/00031305.1998.10480551

McKnight, J., Nzinga, J., Jepkosgei, J., English, M. (2020). Collective strategies to cope with work related stress among nurses in resource-constrained settings: an ethnography of neonatal nursing in Kenya. Social Science & Medicine, 245, 112698. https://doi.org/10.1016/j.socscimed.2019.112698

Merlo, E. M., Stoian, A. P., Motofei, I. G., & Settineri, S. (2020). Clinical psychological figures in healthcare professionals: Resilience and maladjustment as the “cost of care”. Frontiers in Psychology, 11, 3166. https://doi.org/10.3389/fpsyg.2020.607783

Merlo, E.M., Sicari, F., Frisone, F., Alibrandi, A., Settineri, S. (2021a). Burden and professional quality of life of caregivers: The clinical role of suppression and resilience. Life Span and Disability, 24(1).

Merlo, E. M., Stoian, A. P., Motofei, I. G., & Settineri, S. (2021b). The Role of Suppression and the Maintenance of Euthymia in Clinical Settings. Frontiers in psychology, 12, 1534. https://doi.org/10.3389/fpsyg.2021.677811

Mitchell, J. D., Borasio, G. D. (2007). Amyotrophic lateral sclerosis. The lancet, 369(9578), 2031-2041. https://doi.org/10.1016/s0140-6736(07)60944-1

Pesarin F. (2001). Multivariate Permutation Tests, with Applications in Biostatistics. West Sussex, England, UK: Wiley.

Pesarin, F. (1992). A resampling procedure for nonparametric combination of several dependent tests. Journal of the Italian Statistical Society, 1(1), 87-101.

Pesarin, F. (2020). Extending permutation conditional inference to unconditional ones. Statistical Methods and Applications, 11(2), 161-173. https://link.springer.com/article/10.1007/BF02511484

Pesarin, F. (1990). On a nonparametric combination method for dependent permutation tests with applications. Psychotherapy and Psychosomatics, 54(2-3), 172-179. https://doi.org/10.1159/000100210

Pesarin, F. (1997). Permutation testing of multidimensional Hypotheses, Cleup Editrice, Padova.

Pesarin, F., Salmaso, L. (2010). Permutation tests for complex data: theory, applications and software. John Wiley & Sons,

Pitman, E. J. (1937). Significance tests which may be applied to samples from any populations. Supplement to the Journal of the Royal Statistical Society, 4(1), pp. 119-130. http://dx.doi.org/10.2307/2983647

Ramlan, H., Shafri, N. I., Wahab, S., Kamarudin, M. A., Rajikan, R., Wahab, N. A. A., & Damanhuri, H. A. (2020). Depression, Anxiety and Stress in Medical Students: An Early Observation Analysis. Mediterranean Journal of Clinical Psychology, 8(2). https://doi.org/10.6092/2282-1619/mjcp-2516

Rania, N., Coppola, I., Pratesi, A., & Cavanna, D. (2021). Organizational well-being and motivation to work among employees and freelancers: the case of physiotherapists in Italy. Mediterranean Journal of Clinical Psychology, 9(3). https://doi.org/10.13129/2282-1619/mjcp-3065

Ripamonti, C. I., Bandieri, E. (2007). Il secondo gradino nella terapia del dolore da cancro: dalla ricerca alla pratica clinica. Clinical Drug Investigation, 27, 75-83.

Ripamonti, C., Prunas, A., Steca, P. (2006). Health Professions Stress and Coping Scale: studio preliminare di un nuovo strumento di valutazione dello stress e del coping in ambito sanitario. Psicologia della Salute, 2, 71-87. http://dx.doi.org/10.1400/91156

Rosenbaum, P. R. (2005). Sensitivity Analysis in Observational Studies. Encyclopedia of Statistics in Behavioral Science, 4, 1809–1814.

Roy, S.N. (1953). On a heuristic method of test construction and its use in multivariate analysis. The Annals of Mathematical Statistics, 24(2), 220-238. https://doi.org/10.1214/aoms/1177729029

Scheffe, H. (1943). Statistical inference in the non-parametric case. The Annals of Mathematical Statistics, 14(4), 305-332. https://www.jstor.org/stable/2235922

Sprent, P., Smeeton, N. C. (2016). Applied nonparametric statistical methods. CRC press.

Tippett, L. H. C. (1931). The methods of statistics; an introduction mainly for workers in the biological sciences, London, Williams & Norgate.

Winkler, A. M., Webster, M. A., Brooks, J. C., Tracey, I., Smith, S. M., Nichols, T. E. (2016) Non‐parametric combination and related permutation tests for neuroimaging. Human brain mapping, 37(4), 1486-1511. https://10.1002/hbm.23115

Wolski, A., Grafféo, N., Giorgi, R., (2020). CENSUR working survival group. A permutation test based on the restricted mean survival time for comparison of net survival distributions in non-proportional excess hazard settings. Statistical methods in medical research, 29(6), 1612-1623. https://doi.org/10.1177/0962280219870217

Zirilli A., Alibrandi, A. (2011). A permutation solution to compare two hepatocellular carcinoma markers. JP Journal of Biostatistics, 5(2), pp. 109-119.

Zirilli A., Alibrandi, A. (2012). The alteration of t,t-muconic acid and s-phenilmercapturic acid levels due to benzene exposure: an application of NPC test. JP Journal of Biostatistics, 7(2), 91-104.




DOI: https://doi.org/10.13129/2282-1619/mjcp-3411

Refbacks

  • There are currently no refbacks.