title: Dementia care worker stress associations with unit type, resident, and work environment characteristics: a cross-sectional secondary data analysis of the Swiss Nursing Homes Human Resources Project (SHURP).
abstract: Although caring for residents with dementia in nursing homes is associated with various stressors for care workers, the role of the unit type, and particularly the proportion of residents with dementia, remains unclear. This study aimed to explore associations between unit type and care worker stress, taking into account additional potential stressors.
  
  
  
  This cross-sectional study was a secondary data analysis in the Swiss Nursing Homes Human Resources Project, which included data from 3,922 care workers from 156 Swiss nursing homes. Care workers' stress was measured with a shortened version of the Health Professions Stress Inventory. Generalized estimating equation models were used to assess care worker stress and its relationships with three unit types (special care units and others with high or low proportions of residents with dementia), work environment factors, and aggressive resident behavior.
  
  
  
  After including all potential stressors in the models, no significant differences between the three unit types regarding care worker stress were found. However, increased care worker stress levels were significantly related to lower ratings of staffing and resources adequacy, the experience of verbal aggression, and the observation of verbal or physical aggression among residents.
  
  
  
  Although the unit type plays only a minor role regarding care worker stress, this study confirms that work environment and aggressive behavior of residents are important factors associated with work-related stress. To prevent increases of care worker stress, interventions to improve the work environment and strengthen care workers' ability to cope with aggressive behavior are suggested.
authors.affiliation: Pflegewissenschaft - Nursing Science (INS),University of Basel,Basel,Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Vogel
authors.affiliation: Pflegewissenschaft - Nursing Science (INS),University of Basel,Basel,Switzerland.
authors.forename: Sabina
authors.identifier: 0000-0001-6596-7237
authors.initials: S
authors.lastname: De Geest
authors.affiliation: Pflegewissenschaft - Nursing Science (INS),University of Basel,Basel,Switzerland.
authors.forename: Katharina
authors.identifier: 0000-0003-1709-4560
authors.initials: K
authors.lastname: Fierz
authors.affiliation: Pflegewissenschaft - Nursing Science (INS),University of Basel,Basel,Switzerland.
authors.forename: Sonja
authors.initials: S
authors.lastname: Beckmann
authors.affiliation: Pflegewissenschaft - Nursing Science (INS),University of Basel,Basel,Switzerland.
authors.forename: Franziska
authors.identifier: 0000-0002-8844-4903
authors.initials: F
authors.lastname: Zúñiga
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology; D003430:Cross-Sectional Studies; D003704:Dementia / Q000451:nursing / Q000523:psychology*; D005260:Female; D006707:Homes for the Aged / Q000145:classification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000145:classification*; D009740:Nursing Staff / Q000523:psychology*; D000073397:Occupational Stress / Q000517:prevention & control; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013557:Switzerland; D000078329:Workforce; D017132:Workplace / Q000523:psychology*
keywords: burden; cross-sectional; dementia; long-term care; nursing homes; nursing staff; psychological stress; strain