An Investigation of the Role of Non–Work-Time Behavior in Buffering the Effects of Work Strain

The insomnia, fatigue, and psychological well-being of hospital nurses 18 months after the COVID-19 pandemic began: A cross-sectional study

BACKGROUND

Research has shown sleep problems, elevated fatigue, and high cases of burnout, as well as signs of post-traumatic stress and psychological distress among nurses during the COVID-19 pandemic. Many US hospitals attempted to minimise its impact on staff by providing basic resources, mental health services, and wellness programs. Therefore, it is critical to re-evaluate these well-being indices and guide future administrative efforts.

PURPOSE

To determine the long-term impact of the COVID-19 pandemic after 18 months on hospital nurses' insomnia, fatigue, burnout, post-traumatic stress, and psychological distress.

DESIGN

Cross-sectional.

METHODS

Data were collected online mainly through state board and nursing association listservs between July-September 2021 (N = 2488). The survey had psychometrically tested instruments (Insomnia Severity Index, Occupational Fatigue Exhaustion Recovery Scale, Maslach Burnout Inventory, Short Post-Traumatic Stress Disorder, and Patient Health Questionnaire-4) and sections on demographics, health, and work. The STrengthening the Reporting of Observational studies in Epidemiology checklist was followed for reporting.

RESULTS

Nurses had subthreshold insomnia, moderate-to-high chronic fatigue, high acute fatigue, and low-to-moderate intershift recovery. Regarding burnout, they experienced increased emotional exhaustion and personal accomplishment, and some depersonalisation. Nurses had mild psychological distress but scored high on post-traumatic stress. Nurses who frequently cared for patients with COVID-19 in the past months scored significantly worse in all measures than their co-workers. Factors such as nursing experience, shift length, and frequency of rest breaks were significantly related to all well-being indices.

CONCLUSION

Nurses' experiences were similar to findings from the early pandemic but with minor improvements in psychological distress. Nurses who frequently provided COVID-19 patient care, worked ≥12 h per shift, and skipped rest breaks scored worse on almost all well-being indices.

RELEVANCE TO CLINICAL PRACTICE

Administration can help nurses' recovery by providing psychological support, mental health services, and treatment options for insomnia, as well as re-structure current work schedules and ensure that rest breaks are taken.

Perception of Whole Day Workload as a Mediator Between Activity Engagement and Stress in Workers with Type 1 Diabetes

Associations between various forms of activity engagement (e.g. work, leisure) and the experience of stress in workers have been widely documented. The mechanisms underlying these effects, however, are not fully understood. Our goal was to investigate if perceived whole day workload accounted for the relationships between daily frequencies of activities (i.e. work hours and leisure/rest) and daily stress. We analyzed data from 56 workers with type 1 diabetes (T1D) who completed approximately two weeks of intensive longitudinal assessments. Daily whole day workload was measured with an adapted version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). A variety of occupations were reported including lawyer, housekeeper, and teacher. In multilevel path analyses, day-to-day changes in whole day workload mediated 67% (p<.001), 61% (p<.001), 38% (p<.001), and 55% (p<.001) of the within-person relationships between stress and work hours, rest frequency, active leisure frequency, and day of week, respectively. Our results provided evidence that whole day workload perception may contribute to the processes linking daily activities with daily stress in workers with T1D. Perceived whole day workload may deserve greater attention as a possible stress intervention target, ones that perhaps ergonomists would be especially suited to address.

Linkages Between Transformational Leadership, Work Meaningfulness and Work Engagement: A Multilevel Cross-Sectional Study

Purpose

The issue of employee engagement has increasingly become a focus of concern in public management practice. Based on the theory of purposeful work behavior, integrative theory of employee engagement and Pratt and Ashforth’s typology of work meaningfulness, this study proposes and examines the mediating effects of two types of meaningfulness between transformational leadership and work engagement and the moderating effects of transformational leadership on the relationship between two types of meaningfulness and work engagement.

Patients and Methods

By adopting a multilevel cross-sectional design, this study examines assumed mediation and moderation effects. The data collection was conducted anonymously by means of an online survey. A total of 261 local police officers from 32 police stations were recruited in professional training programs as a sample.

Results

The analysis reveals that both meaningfulness in work and meaningfulness at work positively mediate the relationship between transformational leadership and work engagement. Transformational leadership moderates the relationship between meaningfulness at work and work engagement rather than the relationship between meaningfulness in work and work engagement. There are no other significant effects of sex, age or length of service.

Conclusion

Work meaningfulness transmits and combines the effect of transformational leadership to impact work engagement. These findings not only confirm the critical role of work meaningfulness proposed by the theoretical frameworks of the theory of purposeful work behavior, integrative theory of employee engagement and Pratt and Ashforth’s typology of work meaningfulness, but also further extend and clarify the role of and difference in two substructures of work meaningfulness (ie, work meaningfulness in work and at work) in the context of the linkage between transformational leadership and work engagement.

Participation in recreational activities varies with socioeconomic position and is associated with self-rated health and well-being

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This study shows social inequalitues in recreational activity participation (RAP).

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Regardless of educational level, RAP was associated with better self-rated health.

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RAP may modify social inequality in self-rated health and quality of life.

Recreational activities may promote and maintain health and well-being, but empirical evidence is limited. The aim of this study was to explore socioeconomic variations in participation in recreational activities in the local community and to examine associations with health and well-being in the general population.

Participants ≥ 16 years from the Danish Capital Region Health Survey, conducted in 2017 (N = 55,185, response rate 52.6%) were included. Participation in community-based recreational activities, self-rated health, quality of life, and health status was assessed by questionnaire. Socioeconomic variables (educational level, occupational and marital status) were obtained from national registers. Multiple logistic regression models were used to examine associations.

Less than half of the population participated in community-based recreational activities. Individuals with a higher educational level were 55% more likely to participate in recreational activities compared to those with a lower educational level (OR = 1.55, CI:1.45–1.66). Individuals with a low educational level who participated in recreational activities, were more likely to have an excellent/good quality of life (OR = 2.03 (95% CI:1.86–2.21)) and an excellent/very good self-rated health (OR = 1.61 (95% CI:1.51–1.71)), than those who did not participate in recreational activities.

Regardless of educational level, recreational activity participation was associated with better self-rated health and quality of life. Thus, to counter-balance social inequality in health, a focus on participation in recreational activities is important when planning community public health interventions.

Work-Related Predictors of Sleep Quality in Chinese Nurses: Testing a Path Analysis Model

BACKGROUND

Good sleep is essential to human health. Insufficient quality sleep may compromise the wellness of nurses and even jeopardize the safety of patients. Although the contributors of sleep quality in nurses have been previously studied, the direct and indirect effects of modifiable work-related predictors remain uncertain.

PURPOSE

The study was designed to explore the direct and indirect effects of modifiable work-related factors on sleep quality in Chinese nurses.

METHODS

A multistage sampling method was employed in this cross-sectional study to recruit 923 participants. An evidence-based predicting model was postulated and then subsequently tested and optimized using path analysis.

RESULTS

The final model fit the data well, with the involved predictors accounting for 34.1% of the variance in sleep quality of the participants. Shift work, job demands, exposure to hazards in work environments, chronic fatigue, and inter-shift recovery were identified as direct predictors, while whereas job satisfaction, job control, support at work, and acute fatigue were identified as indirect predictors.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Sleep quality in Chinese nurses is influenced directly and indirectly by various modifiable work-related factors. Interventions such as adjusting work shifts and reducing job burdens should be prioritized by administrative staff to ensure the sleep quality and clinical performance of Chinese nurses and to subsequently improve nursing care quality.

Modeling the Effects of Stress, Anxiety, and Depression on Rumination, Sleep, and Fatigue in a Nonclinical Sample

Stress and affective distress have previously been shown to predict sleep quality, and all the factors have been shown to predict fatigue severity. However, few prior studies have examined the likely indirect mediational relationships between stress, affective distress, and sleep quality in predicting fatigue severity, and the potential role played by ruminative thinking. A short questionnaire asked 229 participants about their recent experiences of stress, affective distress, rumination, sleep, and fatigue in a community sample. High stress, anxiety, and depression were related to more ruminative thinking, which in turn was related to poor sleep quality (composed of subjective sleep quality, daytime dysfunction, sleep latency, and sleep disturbance) and poor sleep quality predicted worse fatigue. The results suggest that rumination parsimoniously explains the tendency of stress and affective distress to contribute to poor sleep quality, and together with poor sleep, it may also contribute to worse fatigue in some individuals.

Bio-mathematical fatigue models predict sickness absence in hospital nurses: An 18 months retrospective cohort study

This study examined the associations between bio-mathematical fatigue-risk scores and sickness absence (SA) in hospital nurses over 18 months. Work schedules and SA data were extracted from the hospital's attendance system. Fatigue-risk scores were generated for work days using the Fatigue Audit InterDyne (FAID) and Fatigue Risk Index (FRI). Over the study period, 5.4% of the shifts were absence shifts. FAID-fatigue ranged from 7 to 154; scores for a standard 9-5 work schedule can range from 7 to 40. Nurses with high FAID-scores were more likely to be absent from work when compared to standard FAID-scores (41-79, OR = 1.38, 95%CI = 1.21-1.58; 80-99, OR = 1.63, 95%CI = 1.37-1.94 and ≥ 100, OR = 1.73, 95%CI = 1.40-2.13). FRI-fatigue ranged from 0.9 to 76.8. When FRI-scores were >60, nurses were at 1.58 times (95%CI = 1.05-2.37) at increased odds for SA compared to scores in the 0.9-20 category. Nurse leaders can use these decision-support models to adjust high-risk schedules or the number of staff needed to cover anticipated absences from work.

Cross-sectional Internet-based survey of Japanese permanent daytime workers' sleep and daily rest periods

Objectives:

This study aimed to describe the sleep quantity, sleep quality, and daily rest periods (DRPs) of Japanese permanent daytime workers.

Methods:

Information about the usual DRP, sleep quantity, and sleep quality (Japanese version of the Pittsburgh Sleep Quality Index: PSQI-J) of 3,867 permanent daytime workers in Japan was gathered through an Internet-based survey. This information was analyzed and divided into the following eight DRP groups: <10, 10, 11, 12, 13, 14, 15, and ≥16 h.

Results:

The sleep durations for workers in the <10, 10, 11, 12, 13, 14, 15, and ≥16 h DRP groups were found to be 5.3, 5.9, 6.1, 6.3, 6.5, 6.7, 6.7, and 6.9 h, respectively. The trend analysis revealed a significant linear trend as the shorter the DRP, the shorter was the sleep duration. The PSQI-J scores for the <10, 10, 11, 12, 13, 14, 15, and ≥16 h DRP groups were 7.1, 6.7, 6.7, 6.3, 6.0 (5.999), 5.6, 5.2, and 5.2, respectively. The trend analysis revealed a significant linear trend as the shorter the DRP, the lower was the sleep quality.

Conclusions:

This study described sleep quantity, sleep quality, and DRP in Japanese daytime workers. It was found that a shorter DRP was associated with poorer sleep quantity as well as quality.

Total workload and recovery in relation to worktime reduction: a randomised controlled intervention study with time-use data

Objectives

A 25% reduction of weekly work hours for full-time employees has been shown to improve sleep and alertness and reduce stress during both workdays and days off. The aim of the present study was to investigate how employees use their time during such an intervention: does total workload (paid and non-paid work) decrease, and recovery time increase, when work hours are reduced?

Methods

Full-time employees within the public sector (n=636; 75% women) were randomised into intervention group and control group. The intervention group (n=370) reduced worktime to 75% with preserved salary during 18 months. Data were collected at baseline, after 9 months and 18 months. Time-use was reported every half-hour daily between 06:00 and 01:00 during 1 week at each data collection. Data were analysed with multilevel mixed modelling.

Results

Compared with the control group, the intervention group increased the time spent on domestic work and relaxing hobby activities during workdays when worktime was reduced (P≤0.001). On days off, more time was spent in free-time activities (P=0.003). Total workload decreased (−65 min) and time spent in recovery activities increased on workdays (+53 min). The pattern of findings was similar in subgroups defined by gender, family status and job situation.

Conclusions

A worktime reduction of 25% for full-time workers resulted in decreased total workload and an increase of time spent in recovery activities, which is in line with the suggestion that worktime reduction may be beneficial for long-term health and stress.

Associations of fatigue to work-related stress, mental and physical health in an employed community sample

BACKGROUND

While work-related fatigue has become an issue of concern among European employees, the relationship between fatigue, depression and work-related stressors is far from clear. The purposes of this study were (1) to determine the associations of fatigue with work-related stressors, severe medical disease, health behavior and depression in the working population and (2) to determine the unique impact of work-related stressors on fatigue.

METHODS

We used cross-sectional data of N = 7,930 working participants enrolled in the Gutenberg Health Study (GHS) from 2007 to 2012 filled out the Personal Burnout Scale (PBS) of the Copenhagen Psychosocial Questionnaire (COPSOQ), the PHQ-9, and a list of work-related stressors.

RESULTS

A total of 27.5% reported increased fatigue, esp. women, younger persons with a lower social status and income, smokers, severely medically ill, previously and currently depressed participants. Fatigue was consistently associated with severe medical disease, health behavior and depression, which need to be taken into account as potential confounders when analyzing its relationship to work-related strains. Depression was consistently associated with work-related stressors. However, after statistically partialling out depression, fatigue was still significantly associated with work-related stress.

CONCLUSIONS

Fatigue as an indicator of allostatic load is consistently associated with work-related stressors such as work overload after controlling for depression. The brief Personal Burn-out Scale is suitable for assessing work-related fatigue in the general population.

Burnout among public servants after the Great East Japan Earthquake: decomposing the construct aftermath of disaster

OBJECTIVES

To examine whether disaster-related variables, in addition to known work-related risk factors, influence burnout and its subscales (exhaustion, cynicism, and lack of professional efficacy) among public servants who experienced a major disaster.

METHODS

Cross-sectional studies were conducted among public servants of Miyagi prefecture at 2 and 16 months after the Great East Japan Earthquake (n=3,533, response rate 66.8%); burnout was assessed at 16 months using the Japanese version of the Maslach Burnout Inventory-General Survey. We examined the relationships between burnout and its subscales with disaster-related variables at 2 months after the disaster, while controlling for age, gender, and work-related variables at 16 months after the disaster.

RESULTS

After controlling for age, gender, and work-related variables, a significant risk factor of burnout was having severe house damage. For the each subscale of burnout, living someplace other than their own house increased the risk of both exhaustion and cynicism, while handling residents' complaints did so only for exhaustion. Notably, workers from health and welfare departments showed an increased risk of burnout, exhaustion, and cynicism, but not lack of professional efficacy.

CONCLUSIONS

The findings suggest that special attention is needed for workers with severe house damage to prevent burnout, as well as those who lived someplace other than their own house to prevent exhaustion and cynicism after a major disaster. Interventions directed at workers of the health and welfare department should focus more on limiting exhaustion and cynicism, rather than promoting professional efficacy.

Fatigue, Work Schedules, and Perceived Performance in Bedside Care Nurses

Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses’ practice that should be monitored by nursing management.

A Qualitative Study on the Types and Purposes of Social Activities in Late Life

This qualitative study examines older adults' subjective views on the types and purposes of social activities. In-depth interviews were conducted with a purposive sample of 20 older adults, with low (n = 10) and high (n = 10) memory performance. We used grounded theory methods to analyze the narrative data. Four types of social activities-Altruism, Creativity, Game, and Motion-were identified. The purpose of social activities included enjoyment, relaxation, stimulation, and belongingness. Those in the low memory group seemed to face more barriers to participation. Different types of social activities may be important for cognitive health and well-being.

A practical measure of workplace resilience: developing the resilience at work scale

OBJECTIVE

To develop an effective measure of resilience at work for use in individual work-related performance and emotional distress contexts.

METHODS

Two separate cross-sectional studies investigated: (1) exploratory factor analysis of 45 items putatively underpinning workplace resilience among 397 participants and (2) confirmatory factor analysis of resilience measure derived from Study 1 demonstrating a credible model of interaction, with performance outcome variables among 194 participants.

RESULTS

A 20-item scale explaining 67% of variance, measuring seven aspects of workplace resilience, which are teachable and capable of conscious development, was achieved. A credible model of relationships with work engagement, sleep, stress recovery, and physical health was demonstrated in the expected directions.

CONCLUSION

The new scale shows considerable promise as a reliable instrument for use in the area of employee support and development.

Association of sleep and fatigue with decision regret among critical care nurses

BACKGROUND

The effects of inadequate sleep on clinical decisions may be important for patients in critical care units, who are often more vulnerable than patients in other units. Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome.

OBJECTIVES

To examine the association between selected sleep variables, impairment due to fatigue, and clinical-decision self-efficacy and regret among critical care nurses. Decision regret was the primary outcome variable. Methods A nonexperimental, descriptive design and extant measures were used to obtain data from a random sample of full-time nurses. Binary logistic regression models were used to examine the association between sleep variables, fatigue, and clinical-decision self-efficacy and regret. The discrimination of the models was compared with the C statistic, the area under the receiver operating characteristic curve.

RESULTS

A total of 605 nurses returned the questionnaires (17% response rate). Among these, decision regret was reported by 157 of 546 (29%). Nurses with decision regret reported more fatigue, more daytime sleepiness, less intershift recovery, and worse sleep quality than did nurses without decision regret. Being male, working a 12-hour shift, and clinical-decision satisfaction were significantly associated with decision regret (C statistic, 0.719; SE, 0.024).

CONCLUSION

Nurses who experience impairments due to fatigue, loss of sleep, and inability to recover between shifts are more likely than unimpaired nurses to report decision regret.

[How are leisure activity and shiftwork schedule associated with recovery from fatigue in shiftwork nurses?]

OBJECTIVES

The period of leisure is an appropriate time to recover from work-induced fatigue, though some recovery takes place during rest breaks at work. Recently, much attention has been paid to the critical role of leisure activity in recovery. However, the findings relevant to shiftwork nurses who cannot take a day-off regularly are limited. This study explored how leisure activity during days off and shift work schedule are associated with recovery from fatigue in nurses working rotating shifts.

METHODS

A total of 426 nurses working rotating shifts at a university hospital returned a questionnaire regarding leisure activity and fatigue (response rate: 81.5%). Nurses were eligible for this study if they were female, worked 2 or 3 shifts, and had no missing data. A total of 390 respondents satisfied the inclusion criteria. A factor analysis classified their responses on how to spend an assumed period of two consecutive days off into three activity types: outdoor-, sleep-, and indoor-oriented. Fatigue (recovery from fatigue, accumulated fatigue, burnout), work conditions (working time, overtime, nightshift napping), sleep (sleep duration before day shift or day off, sleepiness) were measured. These data were analyzed using a two-way mixed model analysis of covariance (type [outdoor, sleep, indoor], shift schedule [two or three-shift system]). Covariates included age, length of career, partner, children, and hospital ward. Multiple regression analyses were performed to examine the factors determining the level of fatigue.

RESULTS

Outdoor-oriented nurses showed significantly faster fatigue recovery, lower accumulated fatigue and less burnout symptoms than others, regardless of the shiftwork schedule. In contrast, sleep-oriented nurses showed significantly slower recovery from fatigue. Besides, their level of fatigue deteriorated more when they worked under a 3-shift system (counter-clockwise) compared with under 2-shift system (with mainly 16-hour nightshift). Multiple regression analysis indicated that sleep-oriented type of leisure activity, workload perception of working time, work-induced insomnia and length of nightshift naps were significantly related to fatigue-related outcomes.

CONCLUSIONS

The primary finding of this study suggests that the level of fatigue is associated with the type of leisure activity, especially sleep-oriented activity, during shiftwork nurses' days off. Also, ensuring sufficient nightshift nap time may be one of the most important nightshift-related factors for recovery from fatigue. The present findings may have implications for appropriate activities during days off as factors facilitating recovery from work, though further investigations are needed to examine the causal links.

Parental burnout in relation to sociodemographic, psychosocial and personality factors as well as disease duration and glycaemic control in children with Type 1 diabetes mellitus

AIM

 To examine associations between burnout and sociodemographic, psychosocial, personality and medical factors in parents of children with Type 1 Diabetes Mellitus (T1DM).

METHODS

 A total of 252 parents of children with T1DM participated in a population-based study. We used self-report questionnaires to assess symptoms of burnout and background factors.

RESULTS

Psychosocial background factors were significantly associated with burnout in parents, whereas there were no associations between sociodemographic or medical factors and burnout. For both genders, parental burnout was associated with low social support, lack of leisure time, financial concerns and a perception that the child's disease affects everyday life. Low self-esteem and high need for control were risk factors for maternal burnout.

CONCLUSION

In the screening of risk factors for long-term stress in parents of children with T1DM, we should recognize parents' attitudes as well as situational psychosocial issues. In clinics, we need to pay attention to the day-to-day life circumstances in the support of these parents. Certain factors were associated with the risk for burnout only for mothers, which warrant further investigation of gender aspects. Continued research about the causal relationship between the parental responsibility, psychosocial factors and burnout is warranted.

Demographic and lifestyle factors associated with perceived stress in the primary care setting: a MetroNet study

BACKGROUND

Stress and stress-related disorders are common in primary care. The stress-related needs for patients are often unmet partially due to the time and resource constraints inherent to many primary care settings. We examined the relative significance of key demographic and lifestyle factors related to stress among primary care patients. This information is unknown and needed to strategize these increasingly limited resources.

METHODS

We distributed surveys to 100 consecutive adult patients in each of four family medicine centres in metropolitan Detroit between 2006 and 2007. Hierarchical multivariable regression analyses were used to assess the relative significance of the demographic and lifestyle factors related to stress.

RESULTS

Of the 400 distributed surveys, 315 (78.7%) answered a minimum of 70% of the questions and were included in the analysis. The lifestyle factors [exercise, body mass index (BMI), sleep, social support, recovery or self-care skills (such as the ability to rest, relax and recuperate)] explained 39% (P < 0.001) of the variance in stress compared to 10% (P < 0.001) by the demographic factors (age, gender, race, employment, education and marital status). Stress was inversely related to sleep (P < 0.001), recovery (P < 0.001) and social support (P = 0.02) and positively to education (P < 0.001).

CONCLUSIONS

The modifiable lifestyle factors explained significantly more of perceived stress among primary care patients than the demographic factors. Sleep and recovery had the biggest inverse relationship with stress, which suggests that they should be the primary target for assessment and intervention in patients who report stress or stress-related disorders.

Worktime control-dependent reductions in fatigue, sleep problems, and depression

We investigated the association between worktime control and fatigue, sleep problems, and depressive symptoms in a sample of daytime and shift workers. A total of 3681 permanent daytime workers and 599 shift workers completed a questionnaire designed to assess the above variables. Worktime control was evaluated in terms of both "control over daily working hours" and "control over days off". Worktime control × work schedule × gender analysis of covariance, adjusted for age and employment status, showed overall reductions in incomplete recovery, insomnia symptoms, daytime sleepiness, and depressive symptoms with increasing levels of worktime control. However, no associations between control over daily working hours and insomnia symptoms were observed in women. The reductions appeared to be more evident for control over days off. These results remained consistent after adjustments for other potential covariates. The present findings indicate that increased worktime control and enhanced control over days off in particular, may be associated with favorable health outcomes.

Design of the DIRECT-project: interventions to increase job resources and recovery opportunities to improve job-related health, well-being, and performance outcomes in nursing homes

Background

Because of high demands at work, nurses are at high risk for occupational burnout and physical complaints. The presence of job resources (such as job autonomy or social support) and recovery opportunities could counteract the adverse effect of high job demands. However, it is still unclear how job resources and recovery opportunities can be translated into effective workplace interventions aiming to improve employee health, well-being, and performance-related outcomes. The aim of the current research project is developing and implementing interventions to optimize job resources and recovery opportunities, which may lead to improved health, well-being and performance of nurses.

Methods/design

The DIRECT-project (DIsc Risk Evaluating Controlled Trial) is a longitudinal, quasi-experimental field study. Nursing home staff of 4 intervention wards and 4 comparison wards will be involved. Based on the results of a base-line survey, interventions will be implemented to optimize job resources and recovery opportunities. After 12 and 24 month the effect of the interventions will be investigated with follow-up surveys. Additionally, a process evaluation will be conducted to map factors that either stimulated or hindered successful implementation as well as the effectiveness of the interventions.

Discussion

The DIRECT-project fulfils a strong need for intervention research in the field of work, stress, performance, and health. The results could reveal (1) how interventions can be tailored to optimize job resources and recovery opportunities, in order to counteract job demands, and (2) what the effects of these interventions will be on health, well-being, and performance of nursing staff.

Identification and measurement of work-related psychological injury: piloting the psychological injury risk indicator among frontline police

OBJECTIVE

To develop a self-report measure of work-related psychological injury, the Psychological Injury Risk Indicator (PIRI), with a comparable level of accuracy and reliability to individual clinical assessment by a skilled clinical psychologist.

METHOD

Two pilot studies investigated the responses of a) 34 frontline police officers completing the PIRI measure who were also examined by a highly experienced clinical psychologist and b) 217 officers who completed the PIRI measure and also the General Health Questionnaire 12 measure.

RESULTS

The PIRI scale identified both the presence and the level of psychological injury in the clinical group with a remarkably high level of correspondence to concurrent clinical assessment (r = 0.80).

SIGNIFICANCE

The PIRI scale can be used both for the individual assessment of psychological injury and as a potential online screening tool. Its latter use is that it could enable the early identification of evolving psychological injury among workers, facilitating timely and career-preserving intervention.

Relationships between leisure-time energy expenditure and individual coping strategies for shift-work

A total of 13 to 14% of European and North American workers are involved in shift work. The present aim is to explore the relationships between coping strategies adopted by shift workers and their leisure-time energy expenditure. Twenty-four female and 71 male shift workers (mean +/- SD age: 37 +/- 9 years) completed an adapted version of the Standard Shift-work Index (SSI), together with a leisure-time physical activity questionnaire. Predictors of age, time spent in shift work, gender, marital status and the various shift-work coping indices were explored with step-wise multiple regression. Leisure-time energy expenditure over a 14-d period was entered as the outcome variable. Gender (beta = 7168.9 kJ/week, p = 0.023) and time spent in shift work (beta = 26.36 kJ/week, p = 0.051) were found to be predictors of energy expenditure, with the most experienced, male shift workers expending the most energy during leisure-time. Overall 'disengagement' coping scores from the SSI were positively related to leisure-time energy expenditure (beta = 956.27 kJ/week, p = 0.054). In males, disengagement of sleep problems (beta = -1078.1 kJ/week, p = 0.086) was found to be negatively correlated to energy expenditure, whereas disengagement of domestic-related problems was found to be positively related to energy expenditure (beta = 1961.92 kJ/week, p = 0.001). These relations were not found in female shift workers (p = 0.762). These data suggest that experienced male shift workers participate in the most leisure-time physical activity. These people 'disengage' more from their domestic-related problems, but less from their sleep-related problems. It is recommended that physical activity interventions for shift workers should be designed with careful consideration of individual domestic responsibilities and perceived disruption to sleep.

Mediators and moderators of the stressor-fatigue relationship in nonclinical samples

OBJECTIVE

Two cross-sectional studies examined statistical mediators and moderators of the stressful life event (SLE)-fatigue relationship. If such factors can be delineated, they might suggest possible avenues for improving current psychological treatments for fatigue.

METHODS

In Study 1, 281 (63 males and 218 females) participants, 18 to 70 years, completed a questionnaire asking about stressors, social support, demographics, and fatigue. In Study 2, 609 (225 males and 384 females) participants, 18 to 80 years, answered questions about the abovementioned variables, and sleep quality and use of sleep medications.

RESULTS

Younger age, more SLEs, and low social support satisfaction were found to be related to fatigue levels in Study 1. These results were replicated in Study 2, and, additionally, sleep disturbance (i.e., low sleep quality, use of sleep medications) was related to fatigue levels, while age was related to fatigue via the use of sleep medications. The SLE-fatigue relationship was found to be mediated through different mechanisms in males and females: social support dissatisfaction and sleep quality mediated the relationship in females, while sleep quality mediated the relationship in males.

CONCLUSION

These results suggest that gender tailoring of psychological treatments may improve their effectiveness in treating fatigue, in particular, by targeting social support satisfaction in females and sleep hygiene in both sexes.