Six RCTs (449 nurses) and one PCS (84 care assistants) were included in the main results. One RCT (57 student nurses) and two PCSs (192 nurses) that measured symptoms were also included as auxiliary studies. The total number of participants over all included studies was 782.
Personnel approach interventions.
Cognitive: one RCT (n=57) found that a cognitive intervention (assertiveness training) significantly reduced stress compared with a control computer training programme (Perceived Stress Scale, MD 8.0 versus 2.0).
Exercise or music: one RCT (n=102) found that either exercise or a music programme significantly reduced stress compared with a no intervention waiting-list control, but there was no significant differences between the exercise and music programmes (Perceived Stress Scale, MD 4.1 with exercise versus 1.5 with music versus +1.2 with control). However, the clinical significance of the reduction in stress was not clear.
Education or relaxation: one RCT (n=134) showed that a relaxation programme significantly reduced stress compared with a control lecture programme (Nurses Stress Checklist, MD 0.7 with relaxation versus 0.2 with control).
Social support educational: one RCT (n=53) found that the control intervention, which was a booklet on stress-management, significantly reduced stress compared with a social support educational programme (DeVilliers Carson Leary Stress Scale, -11.5 with control versus 3.0 with intervention). Scores on two other scales that dealt with stress-related concepts also supported this result.
Humour, relaxation or control: one RCT (n=31) found no significant differences between humour, relaxation and 'no intervention' control interventions (Psychiatric Nurses Occupation Stress Scale, 137.9 with relaxation versus 128.9 with humour versus 125 with control).
Education plus role playing: one RCT (n=72) found no significant differences between an educational programme and a 'no intervention' control; no further data were reported in the RCT.
Environmental programmes: one PCS (n=84) found no significant differences between the introduction of a changed nursing method (structured training plus regular support programme) and a 'no intervention' control. Stress increased in both groups during the study according to all subscales tested.
Auxiliary studies.
Cognitive education plus role playing: one RCT (n=84) found no significant differences in any of the subscales tested between a cognitive, behavioural and physiological programme and a control intervention (self-awareness programme).
Environmental: one PCS (n=31) found that individualised nursing care reduced stress on an intervention ward, compared with a no intervention on a control ward, but the differences were not statistically significant.
Nursing method change: one PCS (n=161) found no significant changes on stress subscales from baseline to follow-up for either primary nursing on an intervention ward, or a no intervention control ward.