Violence in the nursing profession: Occupational and lifestyle risk factors in Swedish nurses

Abstract

In a national study of the work environment, physical, and mental well-being of more than 2600 Swedish nurses, 30% reported having experienced violence at work. Possible association between violence and a range of occupational, demographic, and lifestyle characteristics were studied. Stepwise multiple linear and logistic regressions were used to further examine risk factors for violence. Occupational factors with significant correlations to workplace violence were nursing discipline (type of ward or facility), years of work experience, supervisory responsibilities, night work, work dissatisfaction, work-related musculoskeletal injury, and frequency of patient handling. Demographic/lifestyle factors related to violence were age, gender, smoking, coffee consumption at work, and use of alcohol to relax after work. The best fit linear regression model explained 17% of the variance in violence, 13%, of the variance in threat of violence. The logistic regression model confirmed an increased risk of violence and threats in psychiatric and geriatric settings. However, much remains unexplained about the aetiology of violencc in health carc settings. This report provides the basis for a pilot intervention study currently in progress.     

Job satisfaction and occupational stress in UK general hospital nursing staff

This study investigated factors associated with the perceptions of stress reported by nurses in a general hospital environment in the UK. The levels and sources of stress experienced by nursing staff were examined in relation to the type of ward or department, and nursing grade. The association between reported stress and job satisfaction was also examined. By means of a self-completion questionnaire survey, data were collected from 234 nurses from 24 wards in a single general hospital. The Brayfield and Rothe job satisfaction index was used to provide data for analysis. Factor analysis, analysis of variance, and Pearson product moment correlation procedures were performed on these data. The factor analysis identified two main factors concerned with sources of stress: interpersonal relations and resource problems, and dealing with death. Although there were no differences found across wards, the analyses of variance revealed that reported stress varied over different nursing grades. It was also found that job satisfaction was correlated with nursing experience and negatively related to stress.     

Editorial statement: Stress and work compensation

Shift work has been reported to predict health problems, and a possible explanation is that shift work may lead to poorer health habits, thereby increasing a person's vulnerability to illness. This study examined the association between shift work and health habits, as indicated by smoking, alcohol intake, physical activity and by being overweight. A questionnaire was sent to all 2795 female nurses working in the 10 hospitals of two Finnish health care districts. From the 2299 respondents, we selected those 506 shift workers who reported having always done shift work and those 183 day workers who had never done shift work. Shift workers were found to smoke more and to be overweight more often than day workers. These differences gradually increased in each successive age group, being 1.94 pack-years in smoking and 0.9 kg m^-2 in body mass index among nurses over 45 years of age. Shift work was not associated with alcohol intake or sedentary lifestyle. This evidence is compatible with the possibility that shift work in nurses increases smoking and being overweight to a degree that contributes to health problems, including coronary heart disease.     

Psychosocial work environment and psychosomatic health of nurses in Hungary

The main goal of this preliminary study was to detect the relative effects of sociodemographics, socio-economic factors and some variables of psychosocial work environment on an overall index of psychosomatic symptoms as an indicator of psychosomatic health in a sample of female Hungarian nurses. The participants were registered nurses and student nurses chosen at random from public hospitals ( n =420). Self-administered questionnaires contained various items on psychosomatic symptoms, sociodemographics, socio-economic variables, work schedule, the frequency of stressful situations and emotionally provoking problems at work, and social support from peers. Multiple regression models revealed that the frequency of stressful situations and emotionally provoking problems, and the lack of social support from peers, i.e. measures of psychosocial work environment, proved to be the only significant contributors to psychosomatic health complaints, after controlling for other variables in both registered and student nurses.     

Anxiety, burnout and coping styles in general hospital staff exposed to workplace aggression: a cyclical model of burnout and vulnerability to aggression

Although an increasing problem, the aggression ( physical assault, threatening behaviour and verbal aggression) directed toward general hospital staff rather than staff in psychiatric institutions has not been widely investigated. The present study first compared anxiety, coping styles and burnout according to the frequency of aggressive experiences. Second, a sub-sample was examined to determine any immediate after-effects from aggressive encounters. Healthcare staff ( n = 375) across professions completed the State-Trait Anxiety Inventory, the Maslach Burnout Inventory and the Coping Responses Inventory, which were analysed according to the type and frequency of aggression experienced within the preceding year. There were no significant differences in levels of anxiety or in coping styles. However, significant differences were determined in levels of burnout. Emotional exhaustion and depersonalization were significantly higher in those staff more frequently victimized suggesting that aggressive encounters might lead to an increase in burnout. Equally, the converse might be true. Therefore, a cyclical model is put forward in which we propose that elevated levels of burnout from all sources might increase vulnerability to victimization. Increases in emotional exhaustion lead directly to an increase in depersonalization as a coping mechanism, which subsequently manifests as a negative behavioural change toward patients, thus rendering staff more vulnerable to further aggression.     

Psychosocial work environment and psychosomatic health of nurses in Hungary

The main goal of this preliminary study was to detect the relative effects of sociodemographics, socio-economic factors and some variables of psychosocial work environment on an overall index of psychosomatic symptoms as an indicator of psychosomatic health in a sample of female Hungarian nurses. The participants were registered nurses and student nurses chosen at random from public hospitals ( n =420). Self-administered questionnaires contained various items on psychosomatic symptoms, sociodemographics, socio-economic variables, work schedule, the frequency of stressful situations and emotionally provoking problems at work, and social support from peers. Multiple regression models revealed that the frequency of stressful situations and emotionally provoking problems, and the lack of social support from peers, i.e. measures of psychosocial work environment, proved to be the only significant contributors to psychosomatic health complaints, after controlling for other variables in both registered and student nurses.     

Anxiety,burnout and coping styles in general hospital staff exposed to workplace aggression: A cyclical model of burnout and vulnerability to aggression

Although an increasing problem, the aggression ( physical assault, threatening behaviour and verbal aggression) directed toward general hospital staff rather than staff in psychiatric institutions has not been widely investigated. The present study first compared anxiety, coping styles and burnout according to the frequency of aggressive experiences. Second, a sub-sample was examined to determine any immediate after-effects from aggressive encounters. Healthcare staff ( n = 375) across professions completed the State-Trait Anxiety Inventory, the Maslach Burnout Inventory and the Coping Responses Inventory, which were analysed according to the type and frequency of aggression experienced within the preceding year. There were no significant differences in levels of anxiety or in coping styles. However, significant differences were determined in levels of burnout. Emotional exhaustion and depersonalization were significantly higher in those staff more frequently victimized suggesting that aggressive encounters might lead to an increase in burnout. Equally, the converse might be true. Therefore, a cyclical model is put forward in which we propose that elevated levels of burnout from all sources might increase vulnerability to victimization. Increases in emotional exhaustion lead directly to an increase in depersonalization as a coping mechanism, which subsequently manifests as a negative behavioural change toward patients, thus rendering staff more vulnerable to further aggression.     

Violence towards psychiatric staff: a comparison of gender, job and environmental characteristics in England and Sweden

Workplace violence is receiving increasing attention world-wide, and studies suggest that, for example, nurses and women may be more abused at work than psychiatrists and men. However, there is a lack of cross-cultural data on the topic. Further, relatively few studies have addressed the influence of environmental factors in the occurrence of violence and within a cross-cultural context. The present study compares among other things the nature of violence encountered by female/male staff (nurses and psychiatrists) in Sweden and England. Psychiatric personnel from England (301 nurses; 74 psychiatrists) and Sweden (745 nurses; 306 psychiatrists) were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. nature of violence). The univariate analyses showed an association between being abused and male gender, young age, being British and a nurse, physical and psychological strain. The multivariate logistic regression confirmed that British nurses and male nurses were the main risk group for exposure to violence. Further, the multivariate analysis indicated that the odds of being abused increased with increasing age, physical strain and dissatisfaction with quality of care. Interventions thus need to be sensitive to gender differences, societal context, professional roles and interactions between them. Further, clinical supervision and team functioning, organizational and environmentally friendly settings may help to reduce violence in mental health care.     

Violence towards psychiatric staff: a comparison of gender,job and environmental characteristics in England and Sweden

Workplace violence is receiving increasing attention world-wide, and studies suggest that, for example, nurses and women may be more abused at work than psychiatrists and men. However, there is a lack of cross-cultural data on the topic. Further, relatively few studies have addressed the influence of environmental factors in the occurrence of violence and within a cross-cultural context. The present study compares among other things the nature of violence encountered by female/male staff (nurses and psychiatrists) in Sweden and England. Psychiatric personnel from England (301 nurses; 74 psychiatrists) and Sweden (745 nurses; 306 psychiatrists) were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. nature of violence). The univariate analyses showed an association between being abused and male gender, young age, being British and a nurse, physical and psychological strain. The multivariate logistic regression confirmed that British nurses and male nurses were the main risk group for exposure to violence. Further, the multivariate analysis indicated that the odds of being abused increased with increasing age, physical strain and dissatisfaction with quality of care. Interventions thus need to be sensitive to gender differences, societal context, professional roles and interactions between them. Further, clinical supervision and team functioning, organizational and environmentally friendly settings may help to reduce violence in mental health care.     

Risk factors for neck and back pain in a working population in Sweden

The relationship between lifestyle, ergonomie and psychosocial workplace factors and musculo-skeletal pain was examined in this cross-sectional study. A total of 22180 employees undergoing screening examinations at their occupational health-care service filled in a series of questionnaires concerning their health, lifestyle and working situation. Of these 31% reported having had neck pain and 18% had seen a health professional for such pain during the previous year. Similarly, 39% reported having had back pain and 16% had seen a professional during the year. Odds ratios were calculated to estimate the relative risk of the various exposure factors. Although not eating regularly and smoking increased the risk for both neck and back pain somewhat, not exercising and consuming alcohol did not increase the risk for these musculoskeletal pains. Lifting, monotonous work tasks, vibration and uncomfortable work postures were the most important ergonomie factors (odds ratios from 1.01 to 2.95). Sitting, however, did not increase the risk for either neck or back pain. A 'poor' psychosocial work environment, as compared to a 'good' one, increased the risk for both neck and back pain (odds ratios from 1.62 to 3.01). Work content and social support were of particular relevance. Finally, a combination of a 'poor' psychosocial work environment and exposure to one of the ergonomic variables produced the highest risk factors (odds ratios from 2.42 to 3.61). Although the conclusions that may be drawn are limited by the cross-sectional nature of this study, the results seem to underscore the complex aetiology of musculoskeletal pain and especially the importance of psychosocial variables. Prevention programmes should therefore be broad-based and include psychosocial as well as ergonomic measures.     

The role of social support and coping behaviour in nursing work: Main or buffering effect?

In the field of stress research it is often assumed that social support as well as coping behaviour contributes to feelings of health and well-being. However, until now it has not been altogether clear whether a main-effect model or a buffer model was the more appropriate for explaining the role of these factors in response to stressful situations. In this paper, a research project is described in which both the direct and indirect effects of social support and coping were studied in the work situation of nurses. The results offer more support for a main-effect model than for a buffer or moderating-effect model, especially with regard to the coping strategies 'active problem-solving' and 'palliative behaviour'. However, some moderating effects on nurses' reactions to their work situation were found for social support and for 'comforting cognitions' as a coping strategy.     

Occupational stress and cardiovascular reactivity in blue-collar workers

This study analyses the influence of chronic occupational stress on cardiovascular reactivity (heart rate [HR] and blood pressure [BP] elevation from baseline to maximal challenge) during a standard mental stress test (modified version of the STROOP colour word interference test). The test was applied to a sample of 190 healthy male blue-collar workers at the end of a regular working day. Our research hypothesis was based on the assumption that sustained autonomic activation due to chronic occupational stress may reduce cardiovascular responsiveness to challenge: workers defined by high level of chronic occupational stress exhibited lower maximal HR and BP elevations under challenge as compared to workers with low levels of stress. Three distinct indicators of occupational stress were derived from structured interviews: 'cumulative workload', 'worsening of job conditions', and 'high demand and low job security'. Statistical analysis, using ANOVA, showed that all main effects of chronic stress were in the expected direction (6 of 9 effects were statistically significant at the 0'05 level). These effects remained stable after adjusting for age, hypertensive status, physiological baseline level, cigarette smoking, test performance, and individual style of coping. In summary, cardiovascular reactivity under experimental challenge is modulated by an individual's experience of chronic occupational stress.     

Occupational overuse syndrome and the effects of psychosocial stressors on keyboard users in the newspaper industry

There is continuing concern about the incidence of occupational overuse syndrome (OOS) among workers using keyboards. Following results from research showing positive correlations between psychosocial factors in the workplace and the incidence of OOS symptoms, it was hypothesizcd that differences in rates of pain reporting by keyboard workers are related to job stress caused by different levels in thc quality of the psychosocial work environment. An interaction between autonomy and the impact of work pressure on pain reporting was also predicted. Data were used from a sample of 550 keyboard users in several different types of job, working in eight different newspaper offices of the same newspaper company. The results confirmed the hypotheses. Post hoc analysis showed that there were important differences between the types of stressors that predicted the reporting of pain between offices, and those that predicted pain reporting between types of job. These results confirm the importance of considering psychosocial factors in work and workplace design in connection with the prevention of OOS. Conclusions are also drawn about the situation specificity of such empirical research, and the need for more theoretical work in the search for the aetiology of OOS.     

The SAM Framework: Modeling the Effects of Management Factors on Human Behavior in Risk Analysis

Complex engineered systems, such as nuclear reactors and chemical plants, have the potential for catastrophic failure with disastrous consequences. In recent years, human and management factors have been recognized as frequent root causes of major failures in such systems. However, classical probabilistic risk analysis (PRA) techniques do not account for the underlying causes of these errors because they focus on the physical system and do not explicitly address the link between components' performance and organizational factors. This paper describes a general approach for addressing the human and management causes of system failure, called the SAM (System-Action-Management) framework. Beginning with a quantitative risk model of the physical system, SAM expands the scope of analysis to incorporate first the decisions and actions of individuals that affect the physical system. SAM then links management factors (incentives, training, policies and procedures, selection criteria, etc.) to those decisions and actions. The focus of this paper is on four quantitative models of action that describe this last relationship. These models address the formation of intentions for action and their execution as a function of the organizational environment. Intention formation is described by three alternative models: a rational model, a bounded rationality model, and a rule-based model. The execution of intentions is then modeled separately. These four models are designed to assess the probabilities of individual actions from the perspective of management, thus reflecting the uncertainties inherent to human behavior. The SAM framework is illustrated for a hypothetical case of hazardous materials transportation. This framework can be used as a tool to increase the safety and reliability of complex technical systems by modifying the organization, rather than, or in addition to, re-designing the physical system.     

Regional integration and the regional risk paradox

How does regional economic integration affect the risk exposure of multinational enterprises (MNEs)? Investigating firm regionalization patterns, I uncover evidence of the regional risk paradox: as MNEs regionalize to exploit the lower risk environment offered by regional economic integration initiatives, they ultimately increase their regional risk exposure by deepening their commitment and embeddedness in regional business networks. Informed by the Theory of the Regional Multinationals and by theories of regional integration, I employ a social network lens to investigate the evolving structure of business relationships in regions governed by different regional integration frameworks. I then explore the implications of these evolving relationship network structures on the transformation of regional business risk. I find that moderately integrated regions lower transaction costs to moderately low levels, thus encouraging moderate MNE regionalization. This leads to moderate MNE embeddedness in loosely coupled regional business networks and a moderate increase in regional risk. By contrast, deeply integrated regions lower regional administrative distance to very low levels and encourage intense MNE regionalization. This leads to deep MNE embeddedness in tightly coupled regional business networks and a significant increase in regional risk.     

The role of risk preferences and flexibility for risk management: lessons from a custom manufacturing environment

In this paper, we study the management of financial risks of a custom manufacturer in the specialty chemicals industry arising from increased volatility of profits caused by market uncertainty and growing competitive pressure due to globalization. We argue that such risk management can be established either by creating and utilizing flexibility or by adjusting the risk preferences. Using a model-based approach, we operationalize flexibility and risk preferences to show their effects on the profit/risk and the decision making of a firm through a stylized example motivated by the specialty chemicals business.

Beyond demand and control: The contribution of organizational risk factors in assessing the psychological well-being of health care employees

Abstract

The job demand–control(–support) model is frequently used as a theoretical framework in studies on determinants of psychological well-being. Consequently, these studies are confined to the impact of job characteristics on worker outcomes. In the present study the relation between work conditions and outcomes (job satisfaction, emotional exhaustion, psychological distress, and somatic complaints) is examined from a broader organizational perspective. This paper reports on an analysis that examines both the unique and the additional contribution of organizational characteristics to well-being indicators, beyond those attributed to job characteristics. A total of 706 care staff from three public residential institutions for people with mental or physical disabilities in the Netherlands took part in this research. To assess organizational risk factors a measurement instrument was developed, the organizational Risk Factors Questionnaire (ORFQ), based on the safety-critical factors of the Tripod accident causation model. Factor analyses and reliability testing resulted in a 52-item scale consisting of six reliable sub-scales: staffing resources, communication, social hindrance, training opportunities, job skills, and material resources. These organizational risk factors explained important parts of the variance in each of the outcome measures, beyond that accounted for by demographic variables and job demand–control–support (JDCS) measures. Communication and training opportunities were of central importance to carers’ job satisfaction. Social hindrance, job skills, and material resources explained a substantial amount of unique variance on the negative outcomes investigated.     

Pre-employment antecedents of health resources, job factors and health risk behaviour in men and women

The role of individual factors in youth as predictors of adult health resources, job factors and health risk behaviour was studied in men and women. The studied health risk behaviours were smoking, use of alcohol and sedentary behaviour. Sense of coherence (SOC) was the used measure of adult health resources. The pre-employment data had been collected from a sample of 1084 subjects representative of Finnish youth at the mean age of 12 years. For this follow-up study, 345 women and 361 men, working in Finland, responded to a questionnaire at the mean age of 36 years. In the analyses of structural relationships, individual factors in youth were related to adult variables for both sexes, although only two consistent relationships were found for women: outgoing, social activities in youth predicted adult smoking and use of alcohol. Of the job factors, low job demands were related to smoking and lack of support at work was related to sedentary behaviour in women. The strong relationships of SOC with perceptions of social support and influence at work for both sexes characterized its role in health-promoting experiences at work, and supported its importance as a general health resource.     

Pre-employment antecedents of health resources,job factors and health risk behaviour in men and women

Abstract

The role of individual factors in youth as predictors of adult health resources, job factors and health risk behaviour was studied in men and women. The studied health risk behaviours were smoking, use of alcohol and sedentary behaviour. Sense of coherence (SOC) was the used measure of adult health resources. The pre-employment data had been collected from a sample of 1084 subjects representative of Finnish youth at the mean age of 12 years. For this follow-up study, 345 women and 361 men, working in Finland, responded to a questionnaire at the mean age of 36 years. In the analyses of structural relationships, individual factors in youth were related to adult variables for both sexes, although only two consistent relationships were found for women: outgoing, social activities in youth predicted adult smoking and use of alcohol. Of the job factors, low job demands were related to smoking and lack of support at work was related to sedentary behaviour in women. The strong relationships of SOC with perceptions of social support and influence at work for both sexes characterized its role in health-promoting experiences at work, and supported its importance as a general health resource.