Psychosocial stressors at work, psychological stress and musculoskeletal symptoms in the care for the elderly

The role of leisure crafting for emotional exhaustion in telework during the COVID-19 pandemic

BACKGROUND

After the worldwide outbreak of COVID-19 in 2020, many employees transitioned from in-office work to telework to slow down the spread of the virus. Building on the Job Demands-Resources model, we examined day-level relationships between job demands, home demands and emotional exhaustion during telework. Moreover, we tested if leisure crafting (i.e., the proactive pursuit and enactment of leisure activities targeted at goal setting, socializing, growth and development) is negatively related to emotional exhaustion. We expected that proactive personality would be positively related to leisure crafting. Finally, emotional exhaustion was predicted to relate negatively to job performance.

METHODS

We tested our assumptions using a daily diary study on seven consecutive days with 178 employees (964 observations in total).

RESULTS

Multilevel path analysis supports the assumptions that daily job demands as well as daily home demands during telework are positively related to emotional exhaustion. As predicted, we found leisure crafting to be negatively related to emotional exhaustion, and proactive personality to be positively related to leisure crafting. Finally, emotional exhaustion was negatively related to job performance.

CONCLUSIONS

Overall, our study supports a health-promoting role of leisure crafting above the unfavorable relationships between job demands and home demands with emotional exhaustion.

The turnover intentions and intentions to leave the country of foreign-born physicians in Finland: a cross-sectional questionnaire study

Background

A physician shortage is a worldwide problem and foreign-born physicians fill in the shortage of physicians in many developed countries. One problem that is associated with the physician shortage is increased physician turnover. Also, regarding foreign-born physicians, migration can be costly. The present study aimed to examine the turnover intentions and intentions to leave the country of foreign-born physicians. We examined how demographics, discrimination, language problems, perceived employment barriers, satisfaction with living in Finland, team climate, job satisfaction and patient-related stress were associated with these factors.

Methods

The present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland that were aged between 26 and 65 (65% women). Binary logistic regression analyses were conducted to examine the associations.

Results

Half of the respondents had turnover intentions and 14.5% had considered leaving the country. High satisfaction with living in Finland was associated with a lower likelihood of both turnover intentions and intentions to leave the country. High levels of discrimination and employment barriers were associated with a high likelihood of turnover intentions whereas good team climate was associated with a low likelihood of turnover intentions. High levels of language problems were associated with a high likelihood of intentions to leave the country.

Conclusions

The present study showed the importance of satisfaction with living in the host country, the prevention of discrimination and employment barriers, language skills and a good team climate for the retention of foreign-born physicians in their current job and in the host country. Thus, to keep their foreign-born physicians, health care organisations should implement measures to tackle these challenges. Organisations could arrange, for example, diversity training, self-assessment, team reflections, leadership coaching and culturally-specific networks. Moreover, internships associated with the qualification process could be utilised better in order to give a thorough introduction to the host country’s health care environment and the possibilities for learning the language.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4487-1) contains supplementary material, which is available to authorized users.

Foreign-born physicians' perceptions of discrimination and stress in Finland: a cross-sectional questionnaire study

Background

Foreign-born physicians fill in the shortage of physicians in many developed countries. Labour market theory and previous studies suggest that foreign-born physicians may be a disadvantaged group with a higher likelihood of discrimination and less prestigious jobs. The present study examines foreign-born physicians’ experiences of discrimination (coming from management, colleagues and patients separately) and patient-related stress and integration-related stress, and it examines how gender, age, employment sector, country of birth, years from getting a practicing license in Finland, language problems, cross-cultural training, cross-cultural empathy, team climate and skill discretion were associated with these factors.

Methods

The present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland, aged between 26 and 65 (65% women). Analyses of covariance and logistic regression analyses were conducted to examine the associations.

Results

A good team climate and high cross-cultural empathy were associated with lower likelihoods of discrimination from all sources, patient-related stress and integration-related stress. Skill discretion was associated with lower levels of integration-related stress and discrimination from management and colleagues. Language problems were associated with higher levels of integration-related stress. The biggest sources of discrimination were patients and their relatives.

Conclusions

The present study showed the importance of a good team climate, cross-cultural empathy and patience, skill discretion and language skills in regard to the proper integration of foreign-born health care employees into the workplace. Good job resources, such as a good team climate and the possibility to use one’s skills, may help foreign-born employees, for instance by giving them support when needed and offering flexibility. Health care organizations should invest in continuous language training for foreign-born employees and also offer support when there are language problems. Moreover, it seems that training increasing cross-cultural empathy and patience might be beneficial.

Finnish physicians' stress related to information systems keeps increasing: a longitudinal three-wave survey study

Background

Poorly functioning, time-consuming, and inadequate information systems are among the most important work-related psychosocial factors causing stress in physicians. The present study examined the trend in the perceived stress that was related to information systems (SRIS) among Finnish physicians during a nine-year follow-up. In addition, we examined the associations of gender, age, employment sector, specialization status, leadership position, on-call burden, and time pressure with SRIS change and levels.

Methods

A longitudinal design with three survey data collection waves (2006, 2010 and 2015) based on a random sample of Finnish physicians in 2006 was used. The study sample included 1095 physicians (62.3% women, mean age 54.4 years) who provided data on SRIS in every wave. GLM repeated measures analyses were used to examine the associations between independent variables and the SRIS trend during the years 2006, 2010, and 2015.

Results

SRIS increased during the study period. The estimated marginal mean of SRIS in 2006 was 2.80 (95% CI = 2.68–2.92) and the mean increase was 0.46 (95% CI = 0.30–0.61) points from 2006 to 2010 and 0.25 (95% CI = 0.11–0.39) points from 2010 to 2015. Moreover, our results show that the increase was most pronounced in primary care, whereas in hospitals SRIS did not increase between 2010 and 2015. SRIS increased more among those in a leadership position. On-call duties and high time-pressures were associated with higher SRIS levels during all waves.

Conclusions

Changing, difficult, and poorly functioning information systems (IS) are a prominent source of stress among Finnish physicians and this perceived stress continues to increase. Organizations should implement arrangements to ease stress stemming from IS especially for those with a high workload and on-call or leadership duties. To decrease IS-related stress, it would be important to study in more detail the main IS factors that contribute to SRIS. Earlier studies indicate that the usability and stability of information systems as well as end-user involvement in system development and work-procedure planning may be significant factors.

On-call work and physicians' turnover intention: the moderating effect of job strain

Physician shortage and turnover are major problems worldwide. On-call duties may be among the risk factors of high turnover rates among physicians. We investigated whether having on-call duties is associated with physicians' turnover intention and whether job strain variables moderate this association. The present study was a cross-sectional questionnaire study among 3324 (61.6% women) Finnish physicians. The analyses were conducted using analyses of covariance adjusted for age, gender, response format, specialization status and employment sector. The results showed that job strain moderated the association between being on-call and turnover intention. The highest levels of turnover intention were among those who had on-call duties and high level of job strain characterized by high demands and low control opportunities. The lowest levels of turnover intention were among those who were not on-call and who had low strain involving low demands and high control. Also, job demands moderated the association between being on-call and turnover intention; turnover intention levels were higher among those with on-call duties and high demands than those being on-call and low demands. To conclude, working on-call was related to physicians' turnover intention particularly in those with high job strain. Health care organizations should focus more attention on working arrangements and scheduling of on-call work, provide a suitable working pace and implement means to increase physicians' participation and control over their job.

Are there high-risk groups among physicians that are more vulnerable to on-call work?

BACKGROUND

Work done in the emergency departments is one stressful aspect of physicians' work. Numerous previous studies have highlighted the stressfulness of on-call work and especially of night on call. In addition, previous studies suggest that there may be individual differences in adjusting to changes in circadian rhythms and on-call work.

OBJECTIVE

The objective of this study was to examine whether physicians' on-call work is associated with perceived work-related stress factors and job resources and whether there are groups that are more vulnerable to on-call work according to sex, age, and specialization status.

METHODS

This was a cross-sectional questionnaire study among 3230 Finnish physicians (61.5% women). The analyses were conducted using analyses of covariance adjusted for sex, age, specialization status, and employment sector.

RESULTS

Physicians with on-call duties had more time pressure and stress related to team work and patient information systems compared with those who did not have on-call duties. In addition, they had less job control opportunities and experienced organization as less fair and team climate as worse. Older physicians and specialists seemed to be especially vulnerable to on-call work regarding stress factors, whereas younger and specialist trainees seemed vulnerable to on-call work regarding job resources.

CONCLUSIONS

Focusing on team issues and resources is important for younger physicians and trainees having on-call duties, whereas for older and specialists, attention should be focused on actual work load and time pressure.

The importance of leadership style and psychosocial work environment to staff-assessed quality of care: implications for home help services

Work in home help services is typically conducted by an assistant nurse or nursing aide in the home of an elderly person, and working conditions have been described as solitary with a high workload, little influence and lack of peer and leader support. Relations between leadership styles, psychosocial work environment and a number of positive and negative employee outcomes have been established in research, but the outcome in terms of quality of care has been addressed to a lesser extent. In the present study, we aimed to focus on working conditions in terms of leadership and the employee psychosocial work environment, and how these conditions are related to the quality of care. The hypothesis was that the relation between a transformational leadership style and quality of care is mediated through organisational and peer support, job control and workload. A cross-sectional survey design was used and a total of 469 questionnaires were distributed (March-April 2012) to assistant nurses in nine Swedish home help organisations, including six municipalities and one private organisation, representing both rural and urban areas (302 questionnaires were returned, yielding a 65% response rate). The results showed that our hypothesis was supported and, when indirect effects were also taken into consideration, there was no direct effect of leadership style on quality of care. The mediated model explained 51% of the variance in quality of care. These results indicate that leadership style is important not only to employee outcomes in home help services but is also indirectly related to quality of care as assessed by staff members.

Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care

BACKGROUND

Although international migration of physicians is increasing, research information on their adjustment to working in a new country is scarce. This study examined the differences in employment, perceptions of psychosocial work environment and well-being between migrant and native physicians in Finland.

METHODS

A cross-sectional survey was sent to a random sample of physicians in Finland (N = 7000) and additionally to all foreign-born physicians licensed to practice in Finland (N = 1292). The final response rates were 56% (n = 3646) among native Finns and 43% (n = 553) among foreign-born physicians.

RESULTS

Migrant physicians worked more often in primary care and on-call services and less often in leadership positions than native Finns. They more often experienced lack of professional support and lower work-related well-being compared with native Finns. Those migrant physicians who had lived for a shorter time in Finland perceived less stress related to electronic patient records systems and higher organizational justice compared with native physicians or those foreign physicians who had migrated earlier.

CONCLUSIONS

Foreign-born physicians are more often employed in the primary care sector, where there are most difficulties in recruiting from the native workforce in Finland. Attention should be paid to enhancing equitable career opportunities and well-being among foreign-born physicians working in Finnish health care. Although migrant physicians are relatively well adjusted to Finnish health care in terms of perceptions of psychosocial work environment, their lower well-being calls for attention.

Musculoskeletal pain and reported workplace assault: a prospective study of clinical staff in nursing homes

OBJECTIVE

This study examined prospectively the effect of workplace violence on musculoskeletal symptoms among nursing home workers.

BACKGROUND

Previously we reported a cross-sectional relationship between physical assaults at work and musculoskeletal pain. This follow-up provides stronger evidence of the effect of workplace violence on musculoskeletal outcomes within the same workforce over two years.

METHOD

Nursing home workers who responded to three consecutive annual surveys formed the study cohort (n = 344). The outcomes were any musculoskeletal pain, widespread pain, pain intensity, pain interference with work and sleep, and co-occurring pain with depression. The main predictor was self-reported physical assault at work during the 3 months preceding each survey. Prevalence ratios (PRs) were assessed with log-binomial regression, adjusting for other workplace and individual factors.

RESULTS

Every fourth nursing home worker, and 34% of nursing aides, reported persistent workplace assault over the 2 years. Among respondents assaulted frequently, two thirds experienced moderate to extreme musculoskeletal pain, and more than 50% had pain interfering with work and/or sleep. Baseline exposure to assault predicted pain outcomes 1 year later. Repeated exposure was associated with a linear increase over 2 years in the risks of pain intensity, interference with work, and interference with sleep; co-occurring pain and depression had an adjusted PR of 3.6 (95% CI = 1.7-7.9).

CONCLUSION

Workplace assault, especially when repeated over time, increases the risk of pain that may jeopardize workers' ability to remain employed.

APPLICATION

More effective assault prevention would protect and support the workforce needed to care for our increasing elderly and disabled population.

Psychosocial factors in GP work: the effects of taking a GP position or leaving GP work

BACKGROUND

We examined the effects of leaving public sector general practitioner (GP) work and of taking a GP position on changes in work-related psychosocial factors, such as time pressure, patient-related stress, distress and work interference with family. In addition, we examined whether changes in time pressure and patient-related stress mediated the association of employment change with changes of distress and work interference with family.

METHODS

Participants were 1705 Finnish physicians (60% women) who responded to surveys in 2006 and 2010. Analyses of covariance were conducted to examine the effect of employment change to outcome changes adjusted for gender, age and response format. Mediational effects were tested following the procedures outlined by Baron and Kenny.

RESULTS

Employment change was significantly associated with all the outcomes. Leaving public sector GP work was associated with substantially decreased time pressure, patient-related stress, distress and work interference with family. In contrast, taking a position as a public sector GP was associated with an increase in these factors. Mediation tests suggested that the associations of employment change with distress change and work interference with family change were partially explained by the changes in time pressure and patient-related stress.

CONCLUSIONS

Our results showed that leaving public sector GP work is associated with favourable outcomes, whereas taking a GP position in the public sector is associated with adverse effects. Primary health-care organizations should pay more attention to the working conditions of their GPs, in particular, to time pressure and patient-related stress.

Understanding the link between psychosocial work stressors and work-related musculoskeletal complaints

It is well established that psychosocial work stressors relate to employees' work-related musculoskeletal disorder (WRMSD) symptoms. Using a model investigating psychological strain as a mediator between work stressors and WRMSD complaints, this study demonstrated that high levels role conflict, low job control, and low safety-specific leadership are associated with increased employee strain. Strain, in turn, was related to higher levels of WRMSD symptoms of the wrist/hand, shoulders, and lower back. Partial mediation of some relationships was also found, suggesting that additional meditational mechanisms for the relationships between stressors and musculoskeletal symptoms are plausible. This work supports the notion that psychosocial stressors in the work environment have important links to employee health, especially WRMSDs.

Prevention of low back pain in female eldercare workers: randomized controlled work site trial

STUDY DESIGN

Randomized controlled trial.

OBJECTIVE

To evaluate the effectiveness of an ergonomic and psychosocial intervention in reducing low back pain (LBP) among health care workers.

SUMMARY OF BACKGROUND DATA

LBP and injuries are reported frequently among health care workers worldwide. Improvement of person-transfer techniques is the preferred tool in the prevention of both. Although popular, to our knowledge, any effect has not been documented in controlled trials.

METHODS

Study participants were eldercare workers from 19 eldercare groups randomly assigned to the transfer technique, stress management, or reference arm. A total of 163 individuals (79% of the source population) participated in both baseline and follow-up after 2 years. Outcome was intra-individual change in rating of LBP during the past 3 and 12 months.

RESULTS

We found no difference in LBP in any of the intervention arms over the study period.

CONCLUSION

The study showed no effect of a transfer technique or stress management program targeting LBP. Thus, there is a need for discussing other priorities in the prevention of LBP among health care workers.

Changes in spine loading patterns throughout the workday as a function of experience, lift frequency, and personality

BACKGROUND CONTEXT

Psychosocial stressors have been associated with low back pain reporting. However, response to psychosocial risk factors may be dependent on the individual's personality type that, in turn, can affect muscle recruitment and spine loading. This study explores how personality might be associated with spine loading during repetitive lifting performed throughout an entire work shift.

PURPOSE

Assess spine loading as a function of an individual's personality type during repetitive, long-term exposure to a materials handling tasks.

STUDY DESIGN

Laboratory experiment where experienced and inexperienced participants performed repetitive, asymmetric lifts at various load and lift frequency levels throughout a series of 8-hour exposure periods. Spine loads were monitored throughout the work period.

PATIENT SAMPLE

Twelve novice and 12 experienced materials handlers who were asymptomatic for back pain.

OUTCOME MEASURES

Spine compression, anterior-posterior (A/P) shear, and lateral shear at the L5-S1 level.

METHODS

Participants were categorized into personality types based upon the Myers-Briggs personality type indicator. An electromyography-assisted biomechanical model was used to assess spine compression, A/P shear, and lateral shear throughout the exposure period.

RESULTS

The results indicate that intuitors had higher shear spinal loading regardless of moment exposure, lift frequency, and time through the work period, compared with the sensor personality type. In addition, higher spine compressive and shear forces occurred in the perceiver personality compared with the judgers' personality trait, regardless of moment and, often, lift frequency. Novice lifters typically experienced greater spine loading.

CONCLUSIONS

The results suggest that when there exists a personality-job environment mismatch, spinal loading increases via an increase in antagonistic co-contraction. The trends suggest that inherent personality characteristics may play a role in one's motor control strategies when performing a repetitive lifting task.

The moderating effect of employee hostility on the association of long-term elderly care unit's negative resident characteristics to employee stress and well-being

This study examined the moderating effect of employee hostility on the association of unit-level resident characteristics (depression and behavioral problems) to individual-level employee's resident-related stress and psychological well-being during 1-year follow-up study among 501 employees in elderly care. Our results showed that employee hostility was associated with decreased psychological well-being. In addition, hostility moderated the association between unit-level proportion of depressive residents and resident-related stress experienced by the individual employees. Hostile employees reported increased resident-related stress irrespective of the proportion of depressed residents in the unit. Instead, nonhostile employees were sensitive to the depression in the unit. They reported low levels of stress when depression levels in the unit were low and increased stress when depression levels were high.

Work Stressors and the Quality of Life in Long-Term Care Units

PURPOSE

The purpose of this work was to examine how structural factors, residents' needs for physical and psychosocial assistance, and the work stressors experienced by employees are related to the quality of life of elderly residents in long-term care.

DESIGN AND METHODS

Cross-sectional survey data were collected from 1,194 employees and 1,079 relatives of residents in 107 residential-home units and health-center bed wards. Data were analyzed using multilevel modeling.

RESULTS

The majority of differences in both employees' and relatives' perceptions of residents' quality of life across units could be explained by work stressors such as time pressure. Large unit size was related to both increased time pressure among employees and reduced quality of life of residents.

IMPLICATIONS

Long-term care units are encouraged to review their practices so that employee well-being is supported. Attention also should be focused on unit size, as small units appear better able to help employees cope with work stress, resulting in better quality of life for residents.

Gendered work conditions, health, and work outcomes

This cross-sectional study of nonfaculty university employees examined associations among gendered work conditions (e.g., sexism and discrimination), job demands, and employee job satisfaction and health. Organizational responsiveness and social support were examined as effect modifiers. Comparisons were made by gender and by the male-female ratio in each job category. The relationship of gendered conditions of work to outcomes differed on the basis of respondents' sex and the job sex ratio. Although the same predictors were hypothesized for job satisfaction, physical health, and psychological distress, there were some differing results. The strongest correlate of job satisfaction was social support; perceived sexism in the workplace also contributed for both men and women. Organizational factors associated with psychological distress differed between female- and male-dominated jobs.

The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine

STUDY DESIGN

The effects of psychosocial stress on muscle activity and spinal loading were evaluated in a laboratory setting.

OBJECTIVE

To evaluate the influence of psychosocial stress, gender, and personality traits on the functioning of the biomechanical system and subsequent spine loading.

SUMMARY OF BACKGROUND DATA

Physical, psychosocial, and individual factors all have been identified as potential causal factors of low back disorders. How these factors interact to alter the loading of the spine has not been investigated.

METHODS

Twenty-five subjects performed sagittally symmetric lifts under stressful and nonstressful conditions. Trunk muscle activity, kinematics, and kinetics were used to evaluate three-dimensional spine loading using an electromyographic-assisted biomechanical model. A personality inventory characterized the subject's personality traits. Anxiety inventories and blood pressure confirmed reactions to stress.

RESULTS

Psychosocial stress increased spine compression and lateral shear, but not in all subjects. Differences in muscle coactivation accounted for these stress reactions. Gender also influenced spine loading; Women's anterior-posterior shear forces increased in response to stress, whereas men's decreased. Certain personality traits were associated with increased spine loading compared with those with an opposing personality trait and explained loading differences between subjects.

CONCLUSIONS

A potential pathway between psychosocial stress and spine loading has been identified that may explain how psychosocial stress increases risk of low back disorders. Psychosocially stressful environments solicited more of a coactivity response in people with certain personality traits, making them more susceptible to spine loading increases and suspected low back disorder risk.

The relationship between psychosocial work characteristics and low back pain: underlying methodological issues

OBJECTIVE

To evaluate the current epidemiological evidence linking psychosocial work characteristics with low back pain.

BACKGROUND

Psychosocial work characteristics have been widely evaluated as potential risk factors for low back injury. However, studies with different study populations and using various types of measures have had conflicting results.

METHODS

This review is the most extensive to date, reviewing 66 articles that have provided empirical evidence about the relationship between psychosocial work characteristics and initial reporting of lower back pain. The studies are reviewed with an emphasis on certain methodological issues: controlling for potential confounding; timing of the data collection; and measurement of the exposures and outcomes.

RESULTS

The results of this review suggest that controlling for potential confounding from occupational biomechanical demands had a large influence on the associations found between psychosocial work characteristics and lower back pain. In addition, the use of accurate and reliable measures for the occupational exposures (biomechanical and psychosocial) and the lower back pain outcomes appears to influence the strength of the associations found between psychosocial work characteristics and lower back pain.

CONCLUSION

Given the methodological concerns discussed in this review, it is difficult to draw strong causal inferences from this literature. However, it does appear that psychosocial characteristics are related to some lower back pain outcomes, and that employees' reactions to psychosocial work characteristics (e.g., job dissatisfaction and job stress) are more consistently related to lower back pain than are the psychosocial work characteristics themselves (e.g., work overload, lack of influence over work, quality of relationships with coworkers).

RELEVANCE

This review attempts to identify and address methodological issues in the literature evaluating the relationship between psychosocial work characteristics and lower back pain. Implications for future research are presented.

A comparison of approaches to modeling the relationship between ergonomic exposures and upper extremity disorders

BACKGROUND

For a study of upper extremity musculoskeletal disorders among automobile manufacturing workers, an ergonomic exposure index was constructed by summing ten psychophysical (interview) items. Here we explore the sensitivity of the exposure-response relationship to the formulation of that index.

METHODS

Five alternative exposure indices were constructed: three a priori weighting schemes and two sets of weights derived from multivariate regression coefficients. In addition, structural equation modeling was performed with LISREL.

RESULTS

The original index and a priori weighting schemes had similar associations with upper extremity disorders, adjusted for nonoccupational covariates. A reasonable model fit was achieved in LISREL after two modifications; the standardized solution showed that nonneutral postures were significantly related to upper extremity signs and symptoms.

CONCLUSIONS

In this large population, with adequate range of exposures, the exposure-response relationship appeared generally robust to the mathematical formulation of the exposure index. Among the available exposure variables, postural strain had the strongest association.