Using computerized ambulatory diaries for the assessment of job characteristics and work-related stress in nurses

Abstract

Much research into work-related stress is based on retrospective self-reports, whereas records made at the time could be more valuable. In this study the primary components of two models of work stress, Karasek's demand-control (DC) model and Siegrist's effort-reward imbalance (ERI), were assessed in trained nurses using ambulatory diaries and traditional questionnaire methods. The diaries were entered on small hand-held computers and the method used has been termed ecological momentary assessment (EMA), in which recordings are made in real time in the working environment. The participants were 36 nurses who completed standardized questionnaires evaluating ERI, strain (from DC model), and, over three shifts, computerized behavioural diaries that measured effort-demand, control, reward, and stress every 90 minutes on average, enabling determination of strain and ERI repeatedly in the work situation. A total of 674 observations were recorded. Using multilevel linear modelling, it was found that the questionnaire and computerized diary derived measures of strain (DC) and ERI were reliably correlated. In addition, the ambulatory measures of both strain (DC) and ERI correlated with ratings of stress taken at the same time. From this study it would appear that ambulatory diaries could be a powerful and flexible way of assessing work related stress and its putative determinants in a real life work setting.     

Impact of shift work and department type upon strain and attitudinal measures of hospital nurses

The effects of shift work (fixed versus rotating), type of hospital department (intensive care unit versus non-ICU), and job scope on stress and attitudes have been reported previously. The goal of the present study was to examine the interactive, as well as individual, impact of these variables on measures of perceived work stress, strain, work satisfaction and withdrawal intentions. Respondents in the study were nurses in a large general hospital in Israel. None of the two- or three-way interactions received empirical support. However, significant multivariate main effects for each of the three independent measures were found. The negative influence of rotating work shift compared to fixed work shift was supported. Nurses who thought that their job was more enriching were more satisfied and perceived their workload as being lower. Department type affected only burnout level; nurses in non-ICUs were lower in burnout. Several theoretical and practical possible interpretations and possible implications are presented.     

Effort-reward imbalance and work-home interference: a two-wave study among European male nurses

ABSTRACT

This one-year follow-up study among 1,421 male nurses from seven European countries tested the validity of the Effort-Reward Imbalance (ERI) model in predicting prospective vital exhaustion and work-home interference. We hypothesised that effort and lack of reward would have both main and interactive effects on future outcomes. Results of structural equation modelling (SEM) showed that effort was positively related to exhaustion and work-home interference, both simultaneously and over time. Lack of reward predicted increased exhaustion at follow-up, but effort-reward imbalance did not influence the outcomes. Additionally, Time 1 exhaustion predicted increased work-home interference and exhaustion at follow-up. These results do not support the ERI model, which postulates a primacy of effort-reward imbalance over main effects. Instead, the findings are in line with dual path models of job stress and work-home interference. Multi-group SEM showed partial cross-cultural metric invariance for the ERI measure of effort, but the ERI measure of rewards showed no metric measurement invariance, indicating its meaning is qualitatively different across cultures. Nevertheless, the main conclusions were markedly similar for each national sub-sample. We discuss the theoretical and practical implications of our study.     

Personality and the effort-reward imbalance model of stress: Individual differences in reward sensitivity

Abstract

The Effort-Reward Imbalance (ERI) model comprises both situational components (i.e. effort and reward) and a person-specific component (overcommitment). The aims of this study were to investigate the role of theoretically and historically linked personality variables (i.e. overcommitment and Type A personality) within the ERI model and to expand and extend the ERI model by investigating the contribution of individual reward components to both psychological (i.e. psychological distress) and attitudinal (i.e. affective commitment) employee strain indicators. A total of 897 police officers from a large Australian police agency participated in the study. The results provided no evidence of an interaction effect of effort or reward with overcommitment. The Type A variables did, however, make significant contributions and were involved in a number of interactions, suggesting that the person-specific component of the ERI model could be extended with the Type A personality profile. The findings also suggest that the esteem component of reward has the greatest relevance to employee outcomes, although tangible aspects of reward are more likely to act as a buffer of perceived work demand.     

Psychosocial safety climate as an antecedent of work characteristics and psychological strain: A multilevel model

Abstract

Psychosocial safety climate (PSC) refers to a specific organizational climate for the psychological health of workers. It is largely determined by management and at low levels is proposed as a latent pathogen for psychosocial risk factors and psychological strain. Using an extended Job Demands-Control-Support framework, we predicted the (24 month) cross-level effects of PSC on psychological strain via work conditions. We used a novel design whereby data from two unrelated samples of nurses working in remote areas were used across time (N=202, Time 1; N=163, Time 2), matched at the work unit level (N= 48). Using hierarchical linear modelling we found that unit PSC assessed by nurses predicted work conditions (workload, control, supervisor support) and psychological strain in different nurses in the same work unit 24 months later. There was evidence that the between-group relationship between unit PSC and psychological strain was mediated via Time 2 work conditions (workload, job control) as well as Time 1 emotional demands. The results support a multilevel work stress model with PSC as a plausible primary cause, or “cause of the causes”, of work-related strain. The study adds to the literature that identifies organizational contextual factors as origins of the work stress process.     

Long-term patterns of effort-reward imbalance and over-commitment: Investigating occupational well-being and recovery experiences as outcomes

The aim of this study was, first, to identify long-term patterns of effort-reward imbalance (ERI) and over-commitment (OVC), and, second, to examine how occupational well-being (burnout, work engagement) and recovery experiences (psychological detachment, relaxation, mastery and control) differ in these patterns. The study was based on follow-up data with three measurement points (2006, 2008, 2010) collected from Finnish managers (N=298). Latent Profile Analysis resulted in five long-term ERI-OVC patterns: a high-risk pattern (high ERI, high OVC), found in 20% of the participants; a low-risk pattern (low ERI, low OVC), found in 24% of participants; a relatively low-risk pattern (low ERI, moderate OVC), found in 47% of participants; a favourable change pattern (decreasing ERI and OVC), in 7%; and an unfavourable change pattern (high ERI with increasing linear trend, OVC with curvilinear trend) in 2%. The results showed, in line with the ERI model, that managers in the high-risk pattern showed higher burnout scores and poorer recovery experiences compared to those in the low-risk patterns. However, no differences were found in work engagement between the high and low-risk patterns. Thus, the ERI model seemed better to explain stress-related indicators of occupational well-being than motivational indicators.     

Health and well-being of older workers: comparing their associations with effort–reward imbalance and Pressure,Disorganisation and Regulatory Failure

Work organisation has well-established associations with health. This study compares the associations of Pressure, Disorganisation and Regulatory Failure (PDR) and effort–reward imbalance (ERI) with health and well-being among older workers. Participants were 714 Australian workers aged 45–65 (56.3% female), with a mean age of 54.6 years (SD = 5.0) and a mean of 34.7 working hours per week (SD = 13.9). Hierarchical regression analyses tested the strengths of the associations of both ERI and PDR with work–life conflict and mental health. Independent variables were entered in blocks: demographic characteristics (age and gender), working hours and then ERI or PDR (measured using the four subscales: financial pressure, reward pressure, disorganisation and regulatory failure). Compared to ERI, the PDR subscales collectively accounted for slightly less variance in work–life conflict and slightly more variance in mental health. The PDR subscales also accounted for extra variance in both dependent variables when ERI was included in the model. These findings indicate that PDR is a promising construct that includes elements of work organisation not addressed by ERI.     

The Japanese version of the Effort-Reward Imbalance Questionnaire: a study in dental technicians

To test the psychometric properties and criterion validity of the Japanese version of the EffortReward Imbalance (ERI) Questionnaire (Siegrist, 1996), a survey was conducted among 105 male dental technicians. The Japanese version of the questionnaire was developed through a backtranslation process. Internal consistency and factorial structure were tested and the criterion validity with respect to musculoskeletal symptoms was estimated with the help of a correlation matrix and logistic regression analysis. In psychometric terms, the factorial structure of the scales measuring the components of the theoretical concept was replicated satisfactorily, and internal consistencies of the scales measuring the extrinsic and intrinsic components of the model were appropriate. Significant associations between components of the ERI and musculoskeletal symptoms were found. Logistic regression analysis revealed a significantly elevated risk of musculoskeletal symptoms in participants scoring high on the scale measuring the model's intrinsic component, 'overcommitment'. This study indicates that, at least for the occupational group under study, the Japanese version of the ERI Questionnaire is a feasible and psychometrically well justified new measure for assessing psychosocial stress at work with relevance to health.     

The Japanese version of the Effort-Reward Imbalance Questionnaire: A study in dental technicians

To test the psychometric properties and criterion validity of the Japanese version of the EffortReward Imbalance (ERI) Questionnaire (Siegrist, 1996), a survey was conducted among 105 male dental technicians. The Japanese version of the questionnaire was developed through a backtranslation process. Internal consistency and factorial structure were tested and the criterion validity with respect to musculoskeletal symptoms was estimated with the help of a correlation matrix and logistic regression analysis. In psychometric terms, the factorial structure of the scales measuring the components of the theoretical concept was replicated satisfactorily, and internal consistencies of the scales measuring the extrinsic and intrinsic components of the model were appropriate. Significant associations between components of the ERI and musculoskeletal symptoms were found. Logistic regression analysis revealed a significantly elevated risk of musculoskeletal symptoms in participants scoring high on the scale measuring the model's intrinsic component, 'overcommitment'. This study indicates that, at least for the occupational group under study, the Japanese version of the ERI Questionnaire is a feasible and psychometrically well justified new measure for assessing psychosocial stress at work with relevance to health.     

The Effort-Reward Imbalance model of psychosocial stress at the workplace—a comparison of ERI exposure assessment using two estimation methods

It is not unusual for old data to be used in epidemiological studies. Recently developed instruments for measuring work-related stress did not exist when the data collection was carried out. Therefore, approximate questions are sometimes used. An apparent problem is the lack of validation of proxy questions. The aim of this study was to compare the original questions for measuring Effort-Reward Imbalance (ERI) with approximate questions. The study population corresponded with a subgroup in the WOLF-n (WOrk, Lipids, Fibrinogen-north) cohort study of cardiovascular risk in a working population in the north of Sweden: 655 men and 178 women. The agreement in exposure between the original and the approximate ERI single questions was relatively low throughout, whereas the correlation between the ERI subscales and the ERI ratios was reasonable. The latter agreement between the original and the approximate ERI ratio indicates that the approximate measures might have been useful in the past. Yet, whenever possible the implementation of the original questionnaire in study protocols is recommended since a complete measurement of ERI might help to further improve the internal consistency and the predictive validity of this exposure to effort-reward imbalance.     

Cardiac measures of stress in British prison officers

This paper considers the experience of stress in British prison officers and in particular the physiological effect of work activity on those individuals. It reviews the evidence provided by some international studies as well as the recent occupational mortality statistics produced by the OPCS (1986). In particular, the paper concentrates on the benefits of using ambulatory measures of heart rate as a measure of stress and illustrates this with the initial data of a study carried out at HM Prison, Gartree. Results are described in terms of mean heart rate by time and by work activity.     

Trajectories of effort-reward imbalance in Swedish workers: Differences in demographic and work-related factors and associations with health

ABSTRACT

The aim of the study was to identify trajectories of effort-reward imbalance (ERI), to examine these with respect to demographic (age, gender, socio-economic position) and work-related (employment contract, work hours, shift work, sector) factors, and to investigate associations with different health indicators (self-rated health, depressive symptoms, migraine, sickness absence). The study used four waves of data (N?=?6702), collected biennially within the Swedish Longitudinal Occupational Survey of Health (SLOSH). Using latent class growth modelling, we identified four trajectories: a stable low imbalance trajectory, which comprised 90% of all participants, and three change trajectories including a decreasing trajectory (4% of the participants), an inverted U-shaped trajectory and an increasing imbalance trajectory, both in 3% of the participants. Results indicate that a sizeable proportion of Swedish employees’ experience imbalance between efforts and rewards at work. The most favourable trajectory comprised relatively more men and was characterised by better work-related characteristics than the less favourable ERI trajectories. All change trajectories were dominated by women and employees in the public sector. Health developments followed ERI trajectories, such that less favourable trajectories associated with impaired health and more favourable trajectories associated with better health. Sickness absence increased among all ERI trajectories, most so for the decreasing and increasing ERI trajectory.     

The Effort-Reward Imbalance model of psychosocial stress at the workplace—a comparison of ERI exposure assessment using two estimation methods

It is not unusual for old data to be used in epidemiological studies. Recently developed instruments for measuring work-related stress did not exist when the data collection was carried out. Therefore, approximate questions are sometimes used. An apparent problem is the lack of validation of proxy questions. The aim of this study was to compare the original questions for measuring Effort-Reward Imbalance (ERI) with approximate questions. The study population corresponded with a subgroup in the WOLF-n (WOrk, Lipids, Fibrinogen–north) cohort study of cardiovascular risk in a working population in the north of Sweden: 655 men and 178 women. The agreement in exposure between the original and the approximate ERI single questions was relatively low throughout, whereas the correlation between the ERI subscales and the ERI ratios was reasonable. The latter agreement between the original and the approximate ERI ratio indicates that the approximate measures might have been useful in the past. Yet, whenever possible the implementation of the original questionnaire in study protocols is recommended since a complete measurement of ERI might help to further improve the internal consistency and the predictive validity of this exposure to effort-reward imbalance.     

The stressor–strain relationship in diary studies: A meta-analysis of the within and between levels

Daily diary studies use the same set of measures repeatedly for several days. Within the work stress domain, these studies are able to isolate the effects of daily exposure to stressors within people from the general level of stressors between people. This meta-analysis investigated both content-related and methodological aspects of workplace stressor–strain relationships in diary studies. Results from 55 unique samples (a combined sample size of 5409) indicated that the magnitude of the stressor–strain relationship was stronger at the between-person level than the within-person level. Further, when the stressor was measured prior to the strain (within the same day), the relationship was somewhat stronger than when stressor and strain were measured concurrently. This suggests that stressor–strain effects might take some time to fully manifest. Differences were also detected among types of strains: affective strains had stronger relationship with stressors than behavioural strains. There were also differences in the stressor–strain relationship depending on both the type of strain and the timing of their respective measurement (concurrent versus predictive), suggesting that certain strain responses require more time to manifest. Overall, this meta-analysis elucidates important considerations in the design and interpretation of diary studies on occupational stress.     

Job tenure as a moderator of stressor–strain relations: A comparison of experienced and new-start teachers

Abstract

Few studies have investigated the extent to which the effects of work stressors on strain change over the duration of employees’ job incumbencies. Drawing on Karasek's (1979) job demands-control-support model, the current study examined the moderating influence of job tenure (experienced versus novice worker status) on stressor-strain relations. Using a sample of 422 experienced and 248 beginning schoolteachers in Australia, job factors and job strain were assessed on two occasions, 8 months apart. Analyses revealed that the three job factors were each correlated with strain as predicted, although the (elusive) demands×control interaction effect was evidenced amongst “new-start” teachers only. The findings provide mixed support for Karasek's model, and draw attention to the need to consider the role of job tenure and career stage in studies of work stress, as work stressor-strain effects may be routinely underestimated in research that ignores these factors.     

Job tenure as a moderator of stressor-strain relations: A comparison of experienced and new-start teachers

Few studies have investigated the extent to which the effects of work stressors on strain change over the duration of employees' job incumbencies. Drawing on Karasek's (1979) job demands-control-support model, the current study examined the moderating influence of job tenure (experienced versus novice worker status) on stressor-strain relations. Using a sample of 422 experienced and 248 beginning schoolteachers in Australia, job factors and job strain were assessed on two occasions, 8 months apart. Analyses revealed that the three job factors were each correlated with strain as predicted, although the (elusive) demands×control interaction effect was evidenced amongst “new-start” teachers only. The findings provide mixed support for Karasek's model, and draw attention to the need to consider the role of job tenure and career stage in studies of work stress, as work stressor-strain effects may be routinely underestimated in research that ignores these factors.     

Role stress among Canadian white-collar workers

The incidence of various stressors at work and outside work was examined in a group of public service workers with a large Canadian federal government department. Workers were either in clerical, technical and supervisory ('officers'), or management positions. Measures of work stress included role stressors (load, insufficiency, conflict ambiguity and responsibility), as well as stress due to the physical environment. Both life events and daily hassles were included as measures of non-work stress. The consequences of stress were considered in terms of vocational, psychological, interpersonal, and physical strain, as well as in terms of job satisfaction and organizational commitment. Potential moderators of stress included social support and self-esteem. Among work stressors conflict, ambiguity and insufficiency were the more closely associated with vocational outcomes. MANCOVA followed by discriminant function analysis showed that clerical workers were distinguished by higher levels of insufficiency, officers by higher levels of conflict and the lowest levels of job satisfaction and organizational commitment, and managers by higher levels of perceived responsibility for others. The results are discussed in terms of social role theory.     

A longitudinal investigation of the role of violence prevention climate in exposure to workplace physical violence and verbal abuse

The temporal direction of the relationships between violence prevention climate and both physical violence and verbal abuse was investigated in a longitudinal study of newly graduated registered nurses. A sample of 126 nurses, recruited into the study while students, completed similar surveys at approximately 6 and 12 months after graduation that assessed violence prevention climate, physical violence, verbal abuse exposure, and strains of anger, anxiety, depression, and physical symptoms. Results showed that high values of Time 1 climate were associated with less likelihood of violence and abuse at Time 2 when prior exposure to violence and abuse was controlled. Furthermore, repeated measures multivariate analyses of variance (MANOVA) results suggested that being exposed to violence or abuse did not affect perceptions of climate. Both climate and violence exposure were correlated with some strains both cross-sectionally and longitudinally, but repeated measures MANOVAs failed to find evidence that exposure to violence or abuse would result in an increase in strain over time. It is concluded that the direction of effects is from climate to violence/abuse but not the reverse, and that climate should be a target for interventions designed to keep employees safe from both forms of mistreatment.     

Stress at work and psychological and immunological parameters in a group of Norwegian female bank employees

This study concerned the immunological correlates of stress and work. Self reported stress, emotional state, ego-strength, and defensiveness were examined in relation to measures of cellular immunity (T-cell response to Con A and number of T4 and T8 cells) and humoral immunity (concentrations of immunoglobulins and complement components in plasma) in a group of 96 Norwegian female bank employees. The analyses showed that workload, the stress factor with the highest group mean, was associated with number of T-cells, while strain due to body posture during work was related to concentrations of IgM and C3. Further, depression was significantly correlated with IgM concentration and T-cell number, and anxiety with C3 concentration. T-cell activity was the immunological parameter most consistently associated with psychological well-being, showing positive correlations with defensiveness and ego-strength and negative correlations with anxiety and depression. In conclusion, T-cell number and concentrations of IgM and C3 were sensitive to both work-related stress experience and emotional distress. Coping abilities, indicated by the MMPI Ego-strength scale and emotional distress, were reflected in T-cell activity; insufficient coping was associated with low T-cell activity.     

Organizational change in the public sector: Augmenting the demand control model to predict employee outcomes under New Public Management

This study identifies the environmental and personal characteristics that predict employee outcomes within an Australian public sector organization that had, under New Public Management (NPM), implemented a variety of practices traditionally found in the private sector. These are more results-oriented, and their adoption can be accompanied by increased strain for employees. The current investigation was guided by two complementary theories, the Demand Control Support (DCS) model and Conservation of Resources (COR) theory, and sought to examine the benefits of building on the DCS to include both situation-specific stressors and internal coping resources. Survey responses from 1,155 employees were analysed. The hierarchical regression analyses indicated that both external and employee-centred variables made significant contributions to variations in psychological health, job satisfaction, and organizational commitment. The external resources, work based support and, to a lesser extent, job control, predicted relatively large proportions of the variance in the target variables. The situation-specific stressors, particularly those involving harmful management practices (e.g., insufficient time to do job as well as you would like, lack of recognition for good work), made significant contributions to the outcome measures and generally supported the process of augmenting the generic components of the DCS with more situation-specific variables. In terms of internal resources, problem and emotion-based coping improved the capacity of the model to predict psychological health. The results suggest that the impact of NPM can be ameliorated by incorporating the dimensions of the augmented DCS and coping resources into the change programme.