It can be clearly seen from the survey results that the overall pressure of pediatric nurses is relatively high higher than internal nurses. It is mainly reflected in nursing specialty, working environment and resources, patient care, management and interpersonal relationship. Working experience, marriage condition and educational background are all factors influencing the stress levels of pediatric nurses. Lupien et al. have shown that nurses experience high levels of test anxiety, state anxiety, and stress, which can be improved after intervention. Sonia et al. point out that the effects of stress on the brain and behavior in adulthood are reversible and usually disappear when the stressor stops. Thus, analysis of possible stressors is important to deal with the pressure of pediatric nurse.
One of the critical reasons is the particularity of the pediatric nurses. Children have weak immune capacity and insufficient regulatory adaptability because of immature development and imperfect system function. The disease has the characteristics of rapid onset and rapid development of the disease process and the prognosis is not optimistic, which cause pediatric nurses to have heavy work content, significant responsibility, and greater pressure than internal medicine. Secondly, the second child policy in China in recent years generate a fertility boom, but the number of pediatric staff and the overall scale of pediatrics have not been expanded enough, which has increased the workload of pediatric medical staff. The increasing number of pediatric patients lead to the insufficiency of hospital capacity. Long waiting time for medical consultation and impatience among parents can easily spur conflicts between nurses and patients, or even escalates to the workplace violence. Studies have shown that emergency and pediatrics are the two most vulnerable departments for nurses to meet violence at work. Thirdly, in aspects of working environment, pediatric nurses have a low status, low rewards, more onerous work and more complex doctor-patient relationship compared with other departments, which aggravates the loss of personnel of pediatric nurses and makes it more difficult for pediatrics to recruit medical staff. Many hospitals have experienced pediatric "employment shortage". The lack of nursing staff, the heavy workload of nurses and the harsh working environment increase the subjective anxiety and pressure of nurses, leading to the stress among pediatric nurses generally higher than that among internal medicine nurses. A lot more reasons are worthy to consider, and our experiment looks at the problem from a novel perspective.
By comparing stool samples from pediatric nurses and internal medicine nurses, we found significant differences in the structure and abundance of intestinal bacteria (Fig. 1). Pediatric nurses had lower abundance of H.ammodendron but higher Bacteroides than medical nurses. Meanwhile, the abundances of γ-Proteobacteria and β-Proteobacteria were also varied in the bunch (Fig. 2, Fig. 3). Consistent with this, the analysis of the stress scores did show that the total stress factor scores and four dimensions of pediatric nurses were considerably higher than that of internal medicine nurses, and the differences were statistically significant.
This interesting consistency suggests a role for the brain's gut axis. The stress of pediatric nurses is closely related to the psychological effects of work stress. The external stimulation generated by working pressure influences intestinal activities through direct and indirect ways, causing changes in the release of duodenal bicarbonate, hormonal changes, and decreased mucosal immune function, and even intestinal diseases such as intestinal stress syndrome may occur. Enteropathy affects the central nervous system through changes in brain-gut peptide secretion. Anxiety, depression and other emotions of pediatric nurses continue to intensify, forming a vicious circle, and eventually lead to differences in the composition of intestinal bacteria between pediatric nurses and medical staff.
Existing studies have shown that biofeedback therapy and behavioral relaxation therapy can improve these symptoms. Bravo et al. found that probiotics can regulate GABA receptor expression in the cerebral cortex through the vagus nerve, thereby reducing anxiety and depressive behaviors. Sharon et al. demonstrated that serum 4-ethylphenyl sulfate (4EPS) concentrations were increased in autistic mice, and after treatment with B. fragilis, 4EPS concentrations were decreased and anxiety behaviors were alleviated in mice. These studies suggest that due to the characteristics of bidirectional communication of the brain-gut axis, it can also act on the central nervous system through the regulation of intestinal bacteria, providing a new therapeutic idea for clinical practice. At the same time, the latest research shows that non-probiotic interventions such as resistant dextrin supplementation can achieve better results, so the effect of dietary restructuring is better than probiotic supplements.
Numerous studies have shown that psycho-psychological factors are closely linked to intestinal motility disorders and visceral sensitivity mechanisms. Behavior and cognition can affect intestinal activity through indirect complex pathways. After feeling external stimuli, the action pathways of the brain-gut axis on the intestine include indirect pathways and direct pathways. The indirect pathway is through changes in gastrointestinal motility and secretion or changes in intestinal permeability. Direct pathways include the release of signaling molecules into the luminal lamina propria of intestinal cells (cells of enterochromaffin cells, neural cells, immune cells). Changes in intestinal activity, on the other hand, can affect changes in intestinal bacteria. For example, de Magistris's et al. found that autistic patients had increased intestinal mucosal permeability and increased blood concentrations of bacterial lipopolysaccharide (LPS), indicating that brain-gut axis dysfunction can disrupt the intestinal mucosal barrier causing bacterial translocation. In addition, the brain-gut axis causes irritable bowel syndrome (IBS) under stress conditions. IBS is a common functional bowel disorder which is closely related to the function of brain-gut axis. Since the bidirectional pathway of brain-gut axis also acts on the central nervous system, the generation of IBS will also have adverse effects on the patient's mood. Brilliant et al., after acupuncture and oral treatment of trimebutine maleate tablets in IBS patients, found that while IBS symptoms were relieved, brain-gut peptide secretion such as 5-HT, NPY, and CCRP was reduced, and mental stress was significantly reduced.
As a result, appropriate use of psychological biological agents, antibiotics and other drugs to regulate intestinal flora, through the intestinal and brain axis action to alleviate relatively serious psychological stress (such as anxiety, depression, etc.)[9, 29, 30]. Probiotics and prebiotics can be considered taken in daily work for pediatric nurses so as to moderately supply for reduced intestinal flora. From the perspective of traditional Chinese medicine, proper diet therapy can also improve the type and quantity of intestinal flora.
True, merely finding for a curable treatment to reduce psychological stress is a limited approach, which could only treat the symptoms but not the root causes. In view of this situation, pediatric nurses requires an appropriate policy and a better working environment to relieve potential stress. Hospitals should appropriately expand the scale of pediatrics to adapt to the “second-child policy” to ensure the workload of pediatric nurses within acceptable limits. Adopt more diversified management strategies, such as “double night shifts”. Under this policy, both physical need for rest and work effectiveness can be accommodated among the pediatric nurses. Managers could care about nurses such as organizing mindful exchange meetings to eliminate the impact of work stress. For the nurses themselves, improving their professionalism, correctly balancing the relationship between family and work and finding suitable channels for stress relief are also effective ways to relieve stress.