Exploring the links between neuropsychological health and stress biomarkers among nurses: a rapid review

Abstract

Background The consequences of workplace stress on the global nursing workforce are staggering. Nurses report poor mental health, including depressive symptoms, suicidality, and anxiety, along with less-than-optimal working conditions. The psychological nature of stress is a functional response to changing circumstances (e.g., workload, patient-nurse ratios, and shift work). Short-term (acute) or long-term (chronic) responses can manifest emotionally, behaviorally, perceptually, or physiologically. Yet the relationships among the different manifestations of stress, whether neuropsychologically, perceptually, or physiologically, are unclear in the nursing workforce populations. Objective To conduct a rapid review investigating the use of subjective and objective measures of stress among nurses. Methods The protocol followed the 2024 Cochrane Rapid Reviews Methods Guidance. The protocol was registered with Prospero. Screening and extraction were conducted in Covidence. Risk of bias assessment was conducted using appropriate measures from the Joanna Briggs Institute. Results Our analysis identified a total of 46 studies from North and South America (n=16), Europe (n=16), Asia (n=12), and Africa (n=2). Stress studies examined acute, historical, or persistent high chronic stress levels. These studies focused primarily on biomarkers from the autonomic nervous system and the hypothalamus-pituitary-adrenal axis (e.g., cortisol, salivary alpha-amylase, heart rate variability, and C-reactive protein). Eighty-seven psychological instruments were used across 46 studies to measure stress and its neuropsychological symptoms (e.g., Perceived Stress Scale or Visual Analog Scale). Furthermore, 80 instruments were validated, and seven were researcher-generated. Heterogeneous methodologies were used, including biomarker analysis, evaluations of neuropsychological functioning, and assessments of perceived stress, which contributed to variability in conceptualizing stress as an inherent attribute, a symptomatic expression, or a manifestation of external stressors. Limitations Many of the studies had small sample sizes, were underpowered, lacked statistical rigor, and/or used voluntary/convenience recruitment. Adapted instruments were not always validated. Conclusion Measuring neuropsychological health using biomarkers and validated psychometric instruments will allow researchers to better assess the complex responses nurses have to workplace stressors and provide unique insights into the workplace stress nurses face daily.