title: The impact of occupational stress on nurses' caring behaviors and their health related quality of life.
abstract: BACKGROUND
  Nursing is perceived as a strenuous job. Although past research has documented that stress influences nurses' health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health.
  
  
  METHODS
  A correlational study of nurses (N= 246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Contact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health.
  
  
  CONCLUSIONS
  Occupational stress affects nurses' health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.
authors.affiliation: Department of Nursing, Cyprus University of Technology, Limassol, Cyprus ; Hellenic Open University, Faculty of Social Sciences, Patra, 26335 Greece.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Sarafis
authors.affiliation: Hellenic Open University, Faculty of Social Sciences, Patra, 26335 Greece.
authors.forename: Eirini
authors.initials: E
authors.lastname: Rousaki
authors.affiliation: Hellenic Open University, Faculty of Social Sciences, Patra, 26335 Greece ; Centers for the Prevention of Addictions and Promoting Psychosocial Health of Municipality of Thessaloniki, Thessaloniki, 54634 Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Tsounis
authors.affiliation: Hellenic Open University, Faculty of Social Sciences, Patra, 26335 Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Malliarou
authors.affiliation: Hellenic Open University, Faculty of Social Sciences, Patra, 26335 Greece.
authors.forename: Liana
authors.initials: L
authors.lastname: Lahana
authors.affiliation: Hellenic Open University, Faculty of Social Sciences, Patra, 26335 Greece ; Aristotle University of Thessaloniki, Medical School, Thessaloniki, 54124 Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Bamidis
authors.affiliation: Hellenic Open University, Faculty of Social Sciences, Patra, 26335 Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Niakas
authors.affiliation: Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.
authors.forename: Evridiki
authors.initials: E
authors.lastname: Papastavrou
keywords: Caring behaviors; Health-related quality of life; Nurses; Occupational stress