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

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.     

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 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.     

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.     

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.     

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.     

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.     

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 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.     

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.     

ENOP: Organizational issues in hospitals

Abstract

The major aim of this study was to examine how job stress in the offshore working environment may affect workers experience of strain. This study also analyses both the main and moderator effect of social support on the association between job stress and strain. The association between strain and absenteeism is also analysed. The analyses are based on a self-completion questionnaire survey among employees on offshore oil installations in the Norwegian part of the North Sea (n = 1137). The data collection was carried out in 1994. A similar study was conducted in 1990. Job stress was found to be associated with job dissatisfaction, as well as experience of strain. Social support from a supervisor had a main effect on strain. Some evidence of the moderating effects of social support were found. The employees who had been absent from work experienced most strain. It is concluded that job stress predicted job dissatisfaction and strain. In turn, strain and absenteeism were associated with each other. These results suggest that improving organizational and social factors should be the focal area in health promotion in the offshore oil industry.     

结构式团体在临床护士心理压力调解中的应用

目的探讨应用结构式团体在临床护士心理压力调解中的改善效果。方法选择临床护士60例,均为2020年06月~2020年12月间我院在册在岗内科病区护士,依据护士入科先后顺序采取分组,即前期入科护理人员30例采取自我调节方式应用心理压力,观察组为后期入科护理人员30例,采取结构式团体干预模式进行心理压力调节,对比护士不同调节方式下,情绪分值变化及对自我职业的倦怠评分、心理健康状态评分,并采取科室设计的满意度问卷展开评估。结果由自评量表结果所示,观察组护理人员在干预前焦虑、抑郁分值均无明显变化(P>0.05),干预后观察组护理人员焦虑、抑郁分值有所下降,与对照组呈鲜明对比(P<0.05)。职业倦怠量表测评结果所示,观察组护理人员情绪衰竭、工作态度、个人成就感三个维度的分值均低于对照组,差异显著(P<0.05)。由科室自我设计满意度问卷所示,观察组对自我工作满意度较高,与对照组比值差异明显(P<0.05)。两组在SCL-90量表测评下,观察组护理人员各项指标得分低于对照组(P<0.05)。结论结构式团体在临床护士心理压力的调解中的应用效果值得肯定,可改善职业倦怠感,提高工作效率。     

Work & stress: Information

The aim of this study was to investigate whether psychosocial factors at work are related to low-back pain among nursing personnel. It was conducted as a short-term follow-up study of 200 Danish female nursing personnel, providing care for the elderly. Self-reported measures of psychosocial factors such as time pressure, emotional demands of clients, control and social support were obtained by questionnaire at baseline, while stress, physical exertion and low-back pain were reported by diary records made in two, three-day periods in the subsequent 6 months. The study examines the possible influence of psychosocial factors preceding low-back pain as well as stress and physical exertion reported simultaneously with low-back pain. Only stress was associated with low-back pain (Odds Ratio (OR)=2.3; Confidence Interval (CI)=1.3-3.9) while neither physical exertion or any of the psychosocial factors were related to low-back pain. A possible pathway connecting emotional demands of clients to low-back pain through the mediation of stress was suggested.     

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.     

Specific relationships between psychosocial job conditions and job-related stress: A three-level analytic approach

This cross-sectional questionnaire study presents a multi-level analysis on 2565 workers in 188 departments in 36 organizations in the Netherlands. A three-level model is used in which individual workers are nested within departments, which in turn are nested within organizations. Research questions concern (1) the amount and distribution of variance in job-related stress explained for the three levels in the study (individuals, departments, organizations), and (2) the specificity of relationships between psychosocial job demands and job-related stress in the three-level model. Well-being showed slightly more raw variance to be explained at supra-individual levels than strain. The full regression model explained about 35% of the total variance in both work-related strain and well-being. Psychosocial job conditions did not exceed the expected amount of 10 to 15% contribution to this explained variance. These results do not differ from comparable studies that do not use multi-level analysis. The variance distribution in the full model, however, showed unexplained variance to be located at the individual level for both strain and well-being, and at the departmental level only for well-being. This last finding shows a direction for possible improvement of work stress models. Specificity of relationships was also shown: psychological job demands were more strongly related to strain, whereas job content variables (i.e. job variety, job control) were more strongly related to well-being. Results also suggested that social support was more strongly associated with well-being than with strain. Well-being appeared to have a more widely varying range of predictors than strain.     

Work satisfaction,health, and stress: A study of Dutch nurses

Abstract

A study was conducted to compare nurses' work satisfaction and feelings of health and stress in five different nursing departments: a cardiac care unit and a general surgical ward in a general hospital; and an admissions department, a short-stay department, and a long-stay department in a psychiatric hospital. One hundred nurses took part in the study: the instruments used were questionnaires and structured interviews. The main results showed that:

(1) nurses in the cardiac care unit had the most positive satisfaction scores

(2) nurses in the general surgical ward had the most positive scores on the health and stress variables

(3) feelings of dissatisfaction and stress were most prominent in the short-stay department and, to a lesser extent, in the long-stay department.

The findings are interpreted in terms of the different work situations and die implications for hospital management are discussed.

Dr J. A. Landeweerd graduated in industrial and organizational psychology in 1968 (PhD in 1978). He has worked at Eindhoven University of Technology (Department of Industrial Engineering) and now holds a position as senior lecturer at Limburg University (Department of Health Sciences), where he is project-leader for a number of research projects on the relationships between work and health.

Nicolle Boumans, MA, graduated in health sciences in 1985 (specialization: nursing science) and is now a research assistant. She is working on a PhD thesis concerned with the relationship between task characteristics of nurses and their reaction in terms of job satisfaction, health and stress.     

The Danish psychosocial work environment and symptoms of stress: The main,mediating and moderating role of sense of coherence

The aim of this cross-sectional study was to explore the main, mediating and moderating role of sense of coherence (SOC) on stress symptoms and on the association between perceived psychosocial work environment and stress symptoms. The sample includes 2053 Danish employees from 52 workplaces. Hierarchical regression models were applied for each measure of stress. The results strongly supported the presence of a main effect for SOC. People with high levels of SOC experienced fewer stress symptoms. A mediating effect of SOC was also supported. Thus, SOC in part explained the association between work environment and stress symptoms. In addition, some support for a moderating effect of SOC was found, suggesting that people with higher SOC coped more efficiently with work environmental strain that people with lower SOC. Taken together the regression models explained 11–32% of the variance in stress symptoms. The results suggest that measures of individual factors such as SOC should be included in analyses of the effects of work environmental factors on stress and well-being.     

Effects of neuroticism,extraversion, circadian type and age on reported driver stress

Studies have examined effects of various personality variables, including extraversion and neuroticism, as well as age, on driver stress. However, the effect of the morningness-eveningness dimension (circadian type) on reported driver stress among commuters has not been investigated. This study aimed to assess the influence of circadian type as well as extraversion, neuroticism and age on driver stress. Participants were 101 Australian university administrative staff who completed the Eysenck Personality Questionnaire-Revised, the Morningness-Eveningness Questionnaire, and also morning and evening driving diaries as a state measure of driver stress each weekday for one week. Two standard multiple regressions assessed whether neuroticism, extraversion, circadian type and age predicted reported driver stress for morning and evening drives. Neuroticism, circadian type, and age predicted reported driver stress in the mornings but age mainly predicted driver stress in the evenings. A repeated measures ANOVA isolated differences between circadian types for weekday mornings and evenings. Reported driver stress differed for day of week and time of day according to circadian type. The three-way interaction suggested that driver stress is influenced by circadian type and that factors influence driver stress differentially between mornings and evenings. Circadian type appears to influence when driver stress affects individuals.