Is there an optimum number of night shifts? Relationship between sleep, health and well-being

By concentrating on the impact of a specific shift-system feature on the well-being of those concerned, rather than on the impact of the shift system as a whole, one might be able to offer more meaningful suggestions as to what constitutes a better form of shift system. The present study focused on the impact of the number of consecutive night shifts worked on the health and well-being of two groups of nurses (permanent night and rotating shift). All nurses completed a copy of the Standard Shiftwork Index, which is a set of questionnaires designed for comparing the effects of different types of shift system on large groups of workers. It includes measurements of psychological ill-health, physical ill-health, chronic fatigue, social and domestic disruption, attitudes towards shiftwork, sleep quality and sleep habits. Results showed clearly the impact of the number of consecutive nights worked on health and well-being, not directly, but indirectly through the impact on sleep duration and sleep quality. Sleep duration was shown to increase with more consecutive nights worked. This in turn was found to predict sleep quality, which in turn was found to be the stronger direct predictor of psychological and physical ill-health: i.e. better health was associated with longer and better quality sleeps. Explanations in terms of circadian adaptation are discussed.     

Is there an optimum number of night shifts? Relationship between sleep,health and well-being

Abstract

By concentrating on the impact of a specific shift-system feature on the well-being of those concerned, rather than on the impact of the shift system as a whole, one might be able to offer more meaningful suggestions as to what constitutes a better form of shift system. The present study focused on the impact of the number of consecutive night shifts worked on the health and well-being of two groups of nurses (permanent night and rotating shift). All nurses completed a copy of the Standard Shiftwork Index, which is a set of questionnaires designed for comparing the effects of different types of shift system on large groups of workers. It includes measurements of psychological ill-health, physical ill-health, chronic fatigue, social and domestic disruption, attitudes towards shiftwork, sleep quality and sleep habits. Results showed clearly the impact of the number of consecutive nights worked on health and well-being, not directly, but indirectly through the impact on sleep duration and sleep quality. Sleep duration was shown to increase with more consecutive nights worked. This in turn was found to predict sleep quality, which in turn was found to be the stronger direct predictor of psychological and physical ill-health: i.e. better health was associated with longer and better quality sleeps. Explanations in terms of circadian adaptation are discussed.     

Subjective health and its relationship with working time variables and job stressors: Sequence or general factor model?

Abstract

This study compares two theoretical models that make different assumptions about the structure of subjective health constructs and about the effects of job stressors and working time variables on health. The first model, the sequence model, is based on sequential models of the development of ill-health and posits that chronic fatigue and sleep problems mediate the effects of job stressors and working time variables on depression and somatic complaints. The second model, the general strain factor model, posits that specific health constructs (e.g. fatigue, depression, and somatic complaints) are reflections of a common general strain factor (i.e. detrimental job conditions increase the individual's sensitization to strain). In this way the study expands traditional models of stress-related effects on health. The analyses were carried out in a sample of 365 individuals in Germany. Although both models fitted the data, the general strain factor model was found to be superior. Furthermore, the effects of job stressors and working time on the health constructs fatigue and sleep quality were mediated by the general strain factor. Also, a negative relationship emerged between working time duration and general strain. It is suggested that the general strain model could be useful in future health psychology research.     

Work and other factors influencing coronary health and sickness absence

Two major problems encountered in studies of the impact of work on health are the determination of which diseases and health states may be affected, and the separation of work from other factors affecting health. The greatest burden of ill-health may be due to the psychosocial work environment, rather than exposure to traditionally studied environmental agents. A common concern is with coronary heart disease (CHD). The author and his colleagues have been studying CHD, mental health and sickness absence, this last as a measure which combines social, psychological and physical functioning. Two longitudinal studies were conducted on civil servants, with the major aim of investigating the effect on health of occupational and other socioeconomic influences on white-collar workers. It was found that the lowest risk of CHD was in administrators, and the highest risk in the lower socioeconomic groups. Type A behaviour was higher in higher grades of worker. Lower-grade workers had less healthy lifestyle habits. It may not be possible to separate the effect of work from other influences on an individual, and it could be that the point of intervention should be not the individual but the environment.     

Leading for change: line managers’ influence on the outcomes of an occupational health intervention

Line managers may play a central role in the success of occupational health interventions. However, few studies have focussed on the relationship between line managers’ behaviours and the outcomes of occupational health interventions. We examined the influence of both line managers’ attitudes and actions towards an intervention as well as their transformational leadership on the expected outcomes of the intervention (i.e. employee self-rated health and work ability). The intervention consisted of the implementation and use of a web-based system for occupational health management. A sample of 180 employees provided data for the analysis. Self-rated health and work ability were measured at the baseline (Time 1) and follow-up (Time 3), while employee ratings of line managers’ attitudes and actions, and transformational leadership were measured during the intervention process (Time 2). The results revealed that line managers’ attitudes and actions positively predicted changes in both self-rated health and work ability. The influence of transformational leadership was indirect and mediated through line managers’ attitudes and actions towards the intervention. Based on the results, we suggest using process measures that include aspects of both line managers’ attitudes and actions as well as their transformational leadership in future process evaluation.     

Changing work environments: Innovative coping responses to occupational stress

To what degree do individuals adapt their work environments in response to occupational stress? The research reported below addresses this question through a qualitative questionnaire survey that assesses the extent to which innovation is used as a stress coping strategy amongst health care professionals (community and hospital nurses, administration workers and paramedics; N = 333). Overall, 32% of these workers reported a coping response subsequently coded as innovative, and significant between-occupational group differences in the frequency of usage were found. Overwork, procedural difficulties and dealing with others were the stressors eliciting the greatest number of innovative coping responses. The study indicated that such responses were perceived as an effective and important way of dealing with occupational stress. It is concluded that stress management programmes that encourage individuals to change workplace factors through innovation, would be a worthwhile addition to interventions that emphasize individual adaptation to stressful work environments.     

Lay representations of workplace stress: What do people really mean when they say they are stressed?

An individual's beliefs in relation to stress are likely to affect their perceptions, and hence their work-related actions (such as absenteeism). In this paper, lay representations of work stress were investigated utilising semi-structured interviews with 45 individuals from a range of occupations. The meaning of occupational stress, its antecedents and outcomes, and ways by which it may be managed were examined. Dominant factors were established through the use of thematic content analysis. Similarities and differences were found between lay and professional discourses on work stress. Results indicate that lay representations of occupational stress are multi-faceted. Little consensus was found in how participants interpreted the concept: a diverse range of personal, environmental, and societal factors was highlighted. A different (and arguably more complex) range of definitions of job stress and the manner in which it impacts on individuals was revealed than has been reported in previous studies. The causes of stress at work were perceived as being predominantly organisational, but the impact of stress on the employee was more salient than organisational outcomes. Paradoxically, secondary and tertiary stress management techniques were thought to be more effective than interventions designed to prevent stress at work. Interviewees with line management responsibility were more likely to emphasise individual responsibility for managing stress, most others maintained that the individual and the organisation are equally responsible. The potential value of examining lay representations of job stress to the discipline of Occupational Health Psychology is discussed and suggestions for future research are made.     

Occupational health psychology

Abstract

An individual's beliefs in relation to stress are likely to affect their perceptions, and hence their work-related actions (such as absenteeism). In this paper, lay representations of work stress were investigated utilising semi-structured interviews with 45 individuals from a range of occupations. The meaning of occupational stress, its antecedents and outcomes, and ways by which it may be managed were examined. Dominant factors were established through the use of thematic content analysis. Similarities and differences were found between lay and professional discourses on work stress. Results indicate that lay representations of occupational stress are multi-faceted. Little consensus was found in how participants interpreted the concept: a diverse range of personal, environmental, and societal factors was highlighted. A different (and arguably more complex) range of definitions of job stress and the manner in which it impacts on individuals was revealed than has been reported in previous studies. The causes of stress at work were perceived as being predominantly organisational, but the impact of stress on the employee was more salient than organisational outcomes. Paradoxically, secondary and tertiary stress management techniques were thought to be more effective than interventions designed to prevent stress at work. Interviewees with line management responsibility were more likely to emphasise individual responsibility for managing stress, most others maintained that the individual and the organisation are equally responsible. The potential value of examining lay representations of job stress to the discipline of Occupational Health Psychology is discussed and suggestions for future research are made.     

Annual Burden of Occupationally‐Acquired Influenza Infections in Hospitals and Emergency Departments in the United States

Infections among health‐care personnel (HCP) occur as a result of providing care to patients with infectious diseases, but surveillance is limited to a few diseases. The objective of this study is to determine the annual number of influenza infections acquired by HCP as a result of occupational exposures to influenza patients in hospitals and emergency departments (EDs) in the United States. A risk analysis approach was taken. A compartmental model was used to estimate the influenza dose received in a single exposure, and a dose–response function applied to calculate the probability of infection. A three‐step algorithm tabulated the total number of influenza infections based on: the total number of occupational exposures (tabulated in previous work), the total number of HCP with occupational exposures, and the probability of infection in an occupational exposure. Estimated influenza infections were highly dependent upon the dose–response function. Given current compliance with infection control precautions, we estimated 151,300 and 34,150 influenza infections annually with two dose–response functions (annual incidence proportions of 9.3% and 2.1%, respectively). Greater reductions in infectious were achieved by full compliance with vaccination and IC precautions than with patient isolation. The burden of occupationally‐acquired influenza among HCP in hospitals and EDs in the United States is not trivial, and can be reduced through improved compliance with vaccination and preventive measures, including engineering and administrative controls.     

Is there an optimum number of night shifts? Relationship between sleep, health and well-being

By concentrating on the impact of a specific shift-system feature on the well-being of those concerned, rather than on the impact of the shift system as a whole, one might be able to offer more meaningful suggestions as to what constitutes a better form of shift system. The present study focused on the impact of the number of consecutive night shifts worked on the health and well-being of two groups of nurses (permanent night and rotating shift). All nurses completed a copy of the Standard Shiftwork Index, which is a set of questionnaires designed for comparing the effects of different types of shift system on large groups of workers. It includes measurements of psychological ill-health, physical ill-health, chronic fatigue, social and domestic disruption, attitudes towards shiftwork, sleep quality and sleep habits. Results showed clearly the impact of the number of consecutive nights worked on health and well-being, not directly, but indirectly through the impact on sleep duration and sleep quality. Sleep duration was shown to increase with more consecutive nights worked. This in turn was found to predict sleep quality, which in turn was found to be the stronger direct predictor of psychological and physical ill-health i.e. better health was associated with longer and better quality sleeps. Explanations in terms of circadian adaptation are discussed.     

Computerized Estimates of Potential Occupational Health Risk Due to Chemical Exposure

Estimating the potential health risk encountered by workers due to their exposure to various chemicals is enormously complex, since many chemicals be involved and each may have multiple toxic effects. As an aid to this estimation process, a computer program, or model, which computes index numbers expressing the relative health risk of occupational groups due to their potential chemical exposures was developed at the National Institute for Occupational Safety and Health (NIOSH). This model considers an inventory of the chemicals to which specific occupational groups are potentially exposed, the published information regarding the toxic effects of each chemical, and the conditions of occupational exposure. The system then develops indices of potential occupational group health risk by considering weighted combinations of eight distinct health effects. No direct comparison with external occupational risk indices is currently possible, but internal testing of the model reveals no obvious inconsistencies.     

Computerized Estimates of Potential Occupational Health Risk Due to Chemical Exposure

Estimating the potential health risk encountered by workers due to their exposure to various chemicals is enormously complex, since many chemicals may be involved and each may have multiple toxic effects. As an aid to this estimation process, a computer program, or model, which computes index numbers expressing the relative health risk of occupational groups due to their potential chemical exposures was developed at the National Institute for Occupational Safety and Health (NIOSH). This model considers an inventory of the chemicals to which specific occupational groups are potentially exposed, the published information regarding the toxic effects of each chemical, and the conditions of occupational exposure. The system then develops indices of potential occupational group health risk by considering weighted combinations of eight distinct health effects. No direct comparison with external occupational risk indices is currently possible, but internal testing of the model reveals no obvious inconsistencies.     

Workers’ Risk Tolerance and Occupational Injuries

This study explores the relationship between individuals’ risk tolerance and occupational injuries. We analyze data from a national representative survey of U.S. workers that includes information about injuries, risk tolerance, cognitive and noncognitive attributes, and risky behaviors. We measure risk tolerance through questions regarding individuals’ willingness to gamble on their lifetime income. We estimate zero‐inflated count models to assess the role played by such measures on workers’ recurrent injuries. We discuss some implications of our results for future research and occupational safety policies. Our results highlight the concurrent and changing role played by individual, work, and environmental factors in explaining recurrent incidents. They show that risk tolerance affects recurrent injuries, although not in the direction that proponents of the concept of proneness would expect. Our measure of risk aversion shows that individuals who are somewhat more risk tolerant have fewer recurrent injuries than those who are risk averse. But the estimated relationship is U‐shaped, not monotonic and, therefore, not easy to predict. At the same time, we find that individuals’ “revealed risk preferences”—specific risky behaviors—are related to higher injury probabilities. Demanding working conditions, measures of socioeconomic status, health, and safety problems experienced by workers during their youth remain among the most important factors explaining the phenomena of recurrent injuries. So our results contribute also to the important debate about the relationship between health and socioeconomic status.     

The perception of occupational stress and its relation to research and teaching among academic staff

A sample of full-time teaching staff from a former polytechnic participated in a study to examine the relationships between their perception of occupational stress and their involvement in research. Information was obtained from 60% of staff approached. The mean scores on the Occupational Stress Indicator (OSI) for job satisfaction and stress-related measures of mental health and physical health did not differ significantly from data obtained in previous studies on university academic personnel. Scores on these variables were not significantly related to research activity. The degree of satisfaction and degree of stress emanating from participation in research, in teaching and in administration were separately assessed in structured interviews.     

A review of the non-auditory effects of noise on health

This paper reviews epidemiological studies, human experimental studies, and animal research on the non-auditory effects of noise on health. The following topics are covered: vegetative responses (e.g., blood pressure, digestion), biochemical effects, excretion of catecholamines, sleep, physical illness, subjective annoyance, and mental health. Combined effects of noise and other occupational health hazards on physiological functioning and health are also reviewed. Overall, the results suggest that there are non-auditory health effects. However, these require confirmation in prospective, longitudinal studies with interventions reducing noise levels.     

Job characteristics as predictors of ill-health and sickness absenteeism in different occupational types--a multigroup structural equation modelling approach

The objective of the present study was to test for multigroup invariance in measurement models and structural models between job characteristics, psychosocial intervening variables, health outcomes and sickness absenteeism. Four types of occupation were represented in the study: blue-collar workers ( n = 241), white-collar workers ( n = 209), elderly-care workers ( n = 338) and child-care workers ( n = 336). A first-order, six-factor multigroup confirmatory factor analysis model (i.e. measurement model) composed of two perceived job characteristics ( job autonomy and skill discretion), appraised workload, job satisfaction, stress-related ill-health and sickness absenteeism provided a good model fit. Invariance tests showed that the six-factor model fits well for all occupations. A partially recursive mediated multigroup structural model showed both similarities and differences across occupations as regards the relationships between independent latent variables ( job autonomy, skill discretion), intervening latent variables (appraised workload, job satisfaction) and dependent latent variables (stressrelated ill-health, sickness absenteeism). By comparing a generic model with occupation-specific models across occupations, this study showed that occupation-specific models were more plausible. The results indicate that it is important to examine different occupational contexts in detail to better understand how certain psychosocial factors at work influence strain in different occupations. Since job characteristics can potentially be amended, the findings have important implications for the differentiation of prevention and intervention in different occupations.     

The perception of occupational stress and its relation to research and teaching among academic staff

Abstract

A sample of full-time teaching staff from a former polytechnic participated in a study to examine the relationships between their perception of occupational stress and their involvement in research. Information was obtained from 60% of staff approached. The mean scores on the Occupational Stress Indicator (OSI) for job satisfaction and stress-related measures of mental health and physical health did not differ significantly from data obtained in previous studies on university academic personnel. Scores on these variables were not significantly related to research activity. The degree of satisfaction and degree of stress emanating from participation in research, in teaching and in administration were separately assessed in structured interviews.     

The functions and dysfunctions of hierarchy

Functionalist accounts of hierarchy, longstanding in the social sciences, have gained recent prominence in studies of leadership, power, and status. This chapter takes a critical look at a core implication of the functionalist perspective – namely, that steeper hierarchies help groups and organizations perform better than do flatter structures. We review previous research relevant to this question, ranging from studies of communication structures in small groups to studies of compensation systems in large corporations. This review finds that in contrast to strong functionalist assertions, the effects of steeper hierarchies are highly mixed. Sometimes steeper hierarchies benefit groups and sometimes they harm groups. We thus propose five conditions that moderate the effects of hierarchy steepness: (1) the kinds of tasks on which the group is working; (2) whether the right individuals have been selected as leaders; (3) how the possession of power modifies leaders’ psychology; (4) whether the hierarchy facilitates or hampers intra-group coordination; and (5) whether the hierarchy affects group members’ motivation in positive or deleterious ways.     

Job characteristics as predictors of ill-health and sickness absenteeism in different occupational types--a multigroup structural equation modelling approach

The objective of the present study was to test for multigroup invariance in measurement models and structural models between job characteristics, psychosocial intervening variables, health outcomes and sickness absenteeism. Four types of occupation were represented in the study: blue-collar workers ( n = 241), white-collar workers ( n = 209), elderly-care workers ( n = 338) and child-care workers ( n = 336). A first-order, six-factor multigroup confirmatory factor analysis model (i.e. measurement model) composed of two perceived job characteristics ( job autonomy and skill discretion), appraised workload, job satisfaction, stress-related ill-health and sickness absenteeism provided a good model fit. Invariance tests showed that the six-factor model fits well for all occupations. A partially recursive mediated multigroup structural model showed both similarities and differences across occupations as regards the relationships between independent latent variables ( job autonomy, skill discretion), intervening latent variables (appraised workload, job satisfaction) and dependent latent variables (stressrelated ill-health, sickness absenteeism). By comparing a generic model with occupation-specific models across occupations, this study showed that occupation-specific models were more plausible. The results indicate that it is important to examine different occupational contexts in detail to better understand how certain psychosocial factors at work influence strain in different occupations. Since job characteristics can potentially be amended, the findings have important implications for the differentiation of prevention and intervention in different occupations.     

Evaluation of an intervention programme based on empowerment for eldercare nursing staff

This study evaluated the impact of an intervention programme at individual, worksite, and organizational level, for eldercare nursing staff at 12 eldercare units. The project aimed at empowering auxiliary nurses and nursing assistants, thus promoting good working conditions, health and well-being of eldercare staff, and improving their evaluation of the quality of nursing care. Questionnaire responses from the nursing staff (n=200) before and after an 18-month intervention programme evaluated the effects using ANOVA, repeated measures for the statistical analyses. Although the improvements were limited, the intervention seemed to impact on work conditions and on the perceived quality of nursing rather than on the health and well-being of staff. Work at nursing homes or at home-care was shown to modify the outcome due to different needs and priorities for work unit improvements. Staff turnover and multiple reorganizations are discussed as inhibiting factors for performance as well as for the evaluation of workplace interventions. The sharing of power between occupational groups or organizational levels must be carefully considered. The study emphasizes the importance of involving the middle management in early project planning and decisions.