优质病区护士压力源及应对方式调查与分析

目的：探究优质病区护士压力的来源和应对方式.方法：对南京市3所三甲医院优质护理示范病区238名护士进行了问卷调查.结果：不同科室、学历和职称的优质病区护士压力差异有统计学意义,优质病区护士积极应对压力得分均大于消极应对得分,消极应对与压力存在正相关性.结论：建议采取增加人员的配备,合理排班,提高护士的工作热情,减少压力源.     

‘Management Standards’ work-related stress in the UK: practical development

Research commissioned for the UK's Health & Safety Executive (HSE) supports the view that a preventative, risk-assessment based approach would be more effective than case-based methods in achieving a nationwide reduction in work-related stress. The background to this approach is described and discussed in a companion paper in this issue (Mackay, Cousins, Kelly, Lee, & McCaig, ). The present paper describes the development of HSE's new stress Management Standards—which offer organizations continuous improvement through a three-phase stress preventative process—and the development of a supporting ‘Indicator Tool’ (a two-phase questionnaire to assess employee perceptions of working conditions). The Management Standards comprise a series of ‘states to be achieved’, which are statements of good practice in six key stressor areas: demands, control, support, relationships, role and organizational change. For each stressor area there is also a ‘platform statement’ that outlines the main aims to be achieved by the organization. This statement may include a target percentage of employees finding that the organization meets the standard: this matter will be settled after the standards have been assessed in a public consultation campaign. To use the new process, an organization's state can first be assessed using the Indicator Tool; liaising with workers in focus groups enables a further exploration of issues raised; finally, there may be formulation of interventions and subsequent review. It is not intended that the standards will be legally enforceable. HSE's aim is that they and the associated methodology will enable organizations to effectively tackle work-related stress, and subsequently reduce both its incidence and prevalence.     

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

Abstract

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.     

Measuring exposure to bullying at work: The validity and advantages of the latent class cluster approach

Abstract

This paper addresses the construct and predictive validity of two methods for classifying respondents as victims of workplace bullying. Although bullying is conceived as a complex phenomenon, the dominant method used in bullying surveys, the operational classification method, only distinguishes two groups: victims versus non-victims. Hence, the complex nature of workplace bullying may not be accounted for. Therefore a latent class cluster approach is suggested to model the data, which was obtained by using the Negative Acts Questionnaire (NAQ) administered to employees in Belgium (n=6,175). Latent class modelling is a method of analysis that does not appear to have been used in occupational health psychology before. In this study, six latent classes emerged: “not bullied,” “limited work criticism,” “limited negative encounters,” “sometimes bullied,” “work related bullied,” and “victims.” The results show that compared to the traditional operational classification method, the latent class cluster approach shows higher construct and higher predictive validity with respect to self-assessments and indicators of strain and well-being at work. The consequences of these results for theory, future research, and practice are discussed.     

Work-related stress,coping resources,and heavy drinking in the restaurant business

Abstract

This study aimed to test whether curvilinearity would add explanatory power to the long-term relationships between job characteristics and mental well-being. The study was based on cross-sectional and longitudinal data from phases 3 and 5 of the Whitehall II sample (N=4154 for job satisfaction and 6000 for context-free mental well-being, mean follow-up 5.8 years). The curvilinear components of the job characteristics were introduced after controlling for the baseline outcome measure, demographic factors, and the linear measures of the job characteristics. The cross-sectional analyses showed only a curvilinear association with the expected U-shape between job demands and context-free mental well-being. The longitudinal analyses showed no curvilinear relationships between the job characteristics and context-free mental well-being. While small non-linear relationships were found between social support and decision latitude and job-related mental well-being, the shape of these relationships was the reverse of that expected. Post hoc analyses revealed that only the positive segment of the relationship between decision latitude and job satisfaction was significant, while both segments of the relationship between social support and job satisfaction were significant. The findings from this study, based on a large sample with high variety in working conditions, provide little support for the assumption of curvilinearity in the long-term relationship between psychosocial working conditions and mental well-being. This has practical implications, as if associations are linear this would indicate that it would be reasonable to take a population (rather than individually targeted) approach to stress management interventions.     

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.     

Bricks without clay: On urban myths in occupational health psychology

Abstract

There is a lack of intricate research into the relationships between work performance and other variables. This study examined the causal relationship between work, non-work stressors, and work performance. Using longitudinal multi-group data from three groups—university staff, trainee nurses, and part-time employees (overall N=244)—structural equation modelling was employed to explore one-way and reverse competing models. The results produced a good fitting model with one-way causal paths from work-related and non-work stressors (time 1) to job performance (time 2). Nested model comparison analysis provided further evidence to support this best fitting model, emphasizing the strong influence that non-work factors have within the workplace. This study has important implications for theory, methodology and statistical analysis, and practice in the field of work-related stressors and performance.     

Evaluating organizational-level work stress interventions: Beyond traditional methods

Abstract

Since the early 1990s, there has been a growing literature on organizational-level interventions for work-related stress, and associated calls for such interventions to be evaluated. At the same time, doubts have been expressed about the adequacy of traditional scientific research methods in applied psychology (the natural science paradigm) in providing an effective framework for such evaluations. This paper considers some of the philosophical and methodological issues raised by evaluation research in relation to organizational-level interventions for work-related stress. Four key issues are discussed: the concept of a study being “fit for purpose” in relation to research designs and the nature of acceptable evidence; the issue of control of research conditions in real-world studies; the need to evaluate process as well as outcome, including the interrelated nature of process and outcome; and the interpretation of imperfect evidence sets. The starting point of this paper is the reality of organizational life, which is complex and continually changing. Its main objective is not to offer an alternative to a scientific approach but to argue for a more broadly conceived and eclectic framework for evaluation that acknowledges the limitations of the traditional approach. It espouses an approach that is reflective of the reality of organizational life and in which the methods used for evaluating an intervention are fit for purpose. The paper concludes by offering an outline framework for this broader approach to the evaluation of interventions.     

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.