CONCEPTUAL FRAMEWORK FOR THE STUDY OF MORAL DISTRESS IN NURSES
The Conceptual Model of Associations between Work Intensification Stress and Nurses Job Satisfaction in Ontario
How To Encourage Team Building Amongst Nurses
There are numerous studies in which the focus has been a single occupation. Depression has been the focus of interest in recent studies of secretaries (Garrison and Eaton 1992), professionals and managers (Phelan et al. 1991; Bromet et al. 1990), computer workers (Mino et al. 1993), fire-fighters (Guidotti 1992), teachers (Schonfeld 1992), and maquiladoras (Guendelman and Silberg 1993). Alcoholism and drug abuse and dependence have been recently related to mortality among bus drivers (Michaels and Zoloth 1991) and to managerial and professional occupations (Bromet et al. 1990). Symptoms of anxiety and depression which are indicative of psychiatric disorder have been found among garment workers, nurses, teachers, social workers, offshore oil industry workers and young physicians (Brisson, Vezina and Vinet 1992; Fith-Cozens 1987; Fletcher 1988; McGrath, Reid and Boore 1989; Parkes 1992). The lack of a comparison group makes it difficult to determine the significance of this type of study.
Several studies of the relationships between stress and absenteeism provide evidence that supports the conclusion that they may be occupationally determined (Baba and Harris 1989). To illustrate, work-related stress among managers tends to be associated with the incidence of absenteeism but not with days lost attributed to illness, while this is not so with shop-floor employees (Cooper and Bramwell 1992). Occupational specificity of the stresses predisposing employees to be absent has been regarded as a major explanation of the meagre amount of absence variance explained by work-related stress across many studies (Baba and Harris 1989). Several studies have found that among blue-collar employees who work on jobs considered stressful - that is those that possess a combination of the characteristics of assembly-line type of jobs (namely, a very short cycle of operations and a piece-rate wage system) - job stress is a strong predictor of unexcused absence. (For a recent review of these studies, see McKee, Markham and Scott 1992; note that Baba and Harris 1989 do not support their conclusion that job stress is a strong predictor of unexcused absence).
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The immediate work area extends from the core of an employees desk or workstation to the physical enclosure or imaginary boundary surrounding his or her work space. Several features of the immediate work area have been found to influence employee well-being. The degree of physical enclosure surrounding ones desk or workstation, for example, has been shown in several studies to be positively related to the employees perception of privacy, satisfaction with the work environment and overall job satisfaction (Brill, Margulis and Konar 1984; Hedge 1986; Marans and Yan 1989; Oldham 1988; Sundstrom 1986; Wineman 1986). Moreover, open-plan (low enclosure) work areas have been linked to more negative social climates in work groups (Moos 1986) and more frequent reports of headaches among employees (Hedge 1986).
Knowledge about human needs, abilities and constraints provides guidelines for shaping psychosocial work conditions so as to reduce stress and improve occupational health (Frankenhaeuser 1989). Brain research and behavioural research have identified the conditions under which people perform well and the conditions under which performance deteriorates. When the total inflow of impressions from the outside world falls below a critical level and work demands are too low, people tend to become inattentive and bored and to lose their initiative. Under conditions of excessive stimulus flow and too high demands, people lose their ability to integrate messages, thought processes become fragmented and judgement is impaired. This inverted U-relationship between workload and brain function is a fundamental biological principle with wide applications in working life. Stated in terms of efficiency at different workloads, it means that the optimal level of mental functioning is located at the midpoint of a scale ranging from very low to very high work demands. Within this middle zone the degree of challenge is just right, and the human brain functions efficiently. The location of the optimal zone varies among different people, but the crucial point is that large groups spend their lives outside the optimal zone that would provide opportunities for them to develop their full potential. Their abilities are constantly either underutilized or overtaxed.
Types and Levels of Conflicts Experienced by Nurses in …
In a separate analysis of the data on nurses reported in their earlier study (Mossholder, Bedeian and Armenakis 1981), these authors (1982) found that peer group interaction had a significantly more negative relationship to self-reported tension among low SEs than among high SEs. Likewise, low SEs reporting high peer-group interaction were less likely to wish to leave the organization than were high SEs reporting high peer-group interaction.
In the studies reviewed above, self-esteem was viewed as a proxy (or alternative measure) for self-appraisals of competence on the job. Ganster and Schaubroeck (1991a) speculated that the moderating role of self-esteem on role stressors effects was instead caused by low SEs lack of confidence in influencing their social environment, the result being weaker attempts at coping with these stressors. In a study of 157 US fire-fighters, they found that role conflict was positively related to somatic health complaints only among low SEs. There was no such interaction with role ambiguity.
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Types and Levels of Conflicts Experienced by Nurses in the Hospital Settings, Manal Zeinhom Ahmed Higazee
Chapter 34 - Psychosocial and Organizational Factors
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Census categories for occupations constitute a readily available source of information that allows one to explore associations between occupations and mental illness (Eaton et al. 1990). Epidemiological Catchment Area (ECA) study analyses of comprehensive occupational categories have yielded findings of a high prevalence of depression for professional, administrative support and household services occupations (Roberts and Lee 1993). In another major epidemiological study, the Alameda county study, high rates of depression were found among workers in blue-collar occupations (Kaplan et al. 1991). High 12-month prevalence rates of alcohol dependence among workers in the Unites States have been found in craft occupations (15.6%) and labourers (15.2%) among men, and in farming, forestry and fishing occupations (7.5%) and unskilled service occupations (7.2%) among women (Harford et al. 1992). ECA rates of alcohol abuse and dependence yielded high prevalence among transportation, craft and labourer occupations (Roberts and Lee 1993). Workers in the service sector, drivers and unskilled workers showed high rates of alcoholism in a study of the Swedish population (Agren and Romelsjo 1992). Twelve-month prevalence of drug abuse or dependence in the ECA study was higher among farming (6%), craft (4.7%), and operator, transportation and labourer (3.3%) occupations (Roberts and Lee 1993). The ECA analysis of combined prevalence for all psychoactive substance abuse or dependence syndromes (Anthony et al. 1992) yielded higher prevalence rates for construction labourers, carpenters, construction trades as a whole, waiters, waitresses and transportation and moving occupations. In another ECA analysis (Muntaner et al. 1991), as compared to managerial occupations, greater risk of schizophrenia was found among private household workers, while artists and construction trades were found at higher risk of schizophrenia (delusions and hallucinations), according to criterion A of the Diagnostic and Statistics Manual of Mental Disorders (DSM-III) (APA 1980).
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Most studies of work stress and mental illness have been conducted with scales from Karaseks Demand/Control model (Karasek and Theorell 1990) or with measures derived from the Dictionary of Occupational Titles (DOT) (Cain and Treiman 1981). In spite of the methodological and theoretical differences underlying these systems, they measure similar psychosocial dimensions (control, substantive complexity and job demands) (Muntaner et al. 1993). Job demands have been associated with major depressive disorder among male power-plant workers (Bromet 1988). Occupations involving lack of direction, control or planning have been shown to mediate the relation between socioeconomic status and depression (Link et al. 1993). However, in one study the relationship between low control and depression was not found (Guendelman and Silberg 1993). The number of negative work-related effects, lack of intrinsic job rewards and organizational stressors such as role conflict and ambiguity have also been associated with major depression (Phelan et al. 1991). Heavy alcohol drinking and alcohol-related problems have been linked to working overtime and to lack of intrinsic job rewards among men and to job insecurity among women in Japan (Kawakami et al. 1993), and to high demands and low control among males in the United States (Bromet 1988). Also among US males, high psychological or physical demands and low control were predictive of alcohol abuse or dependence (Crum et al. 1995). In another ECA analysis, high physical demands and low skill discretion were predictive of drug dependence (Muntaner et al. 1995). Physical demands and job hazards were predictors of schizophrenia or delusions or hallucinations in three US studies (Muntaner et al. 1991; Link et al. 1986; Muntaner et al. 1993). Physical demands have also been associated with psychiatric disease in the Swedish population (Lundberg 1991). These investigations have the potential for prevention because specific, potentially malleable risk factors are the focus of study.
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