The Effort‐reward Imbalance Model: Experience in Japanese Working Population

Effort-Reward Imbalance at Work and Drug Misuse: Evidence from a National Survey in the U.S

With the rise of drug misuse among workers in recent years, preliminary research on potential risk factors in the workplace of single-type of drug misuse has been reported. This is the first study to examine cross-sectional associations of work stress, in terms of effort-reward imbalance, with multiple drug misuse (including any drug misuse, opioid misuse, sedatives misuse, cannabis misuse, and other drug misuse) during the past 12 months in a national sample of U.S. workers. Data of 2211 workers were derived from the nationally representative and population-based Midlife in the United States (MIDUS) study. Internal consistency reliability and factorial validity of a 17-item effort-reward imbalance measure were robust and satisfactory. After adjustment for relevant covariates, logistic regression analyses showed that workers experiencing effort-reward imbalance at work had significantly higher odds of any drug misuse (OR and 95% CI = 1.18 (1.03, 1.37)), especially opioid misuse (OR and 95% CI = 1.35 (1.07, 1.69)) and other drug misuse (OR and 95% CI = 1.36 (1.01, 1.83)). The findings suggest that a stressful work environment may act as a determinant of drug misuse, and further prospective evidence is needed.

The experience of occupational psychosocial stress among librarians in three African countries

Purpose

The purpose of this paper is to focus on describing the experience of occupational psychosocial stress among librarians in Ghana, Nigeria and South Africa. It further seeks to identify the various psychosocial stress components and how they interact to determine the stress level of librarians.

Design/methodology/approach

Using the Effort-Reward Imbalance scale, this descriptive study employed a web-based data collection tool (Google Form) to design and solicit data from respondents. Convenient sampling technique was used to employ 153 librarians from Ghana, Nigeria and South Africa with at least a diploma in any library-related programme, who work in either academic, public or special libraries.

Findings

This study established the prevalence of occupational psychosocial stress among librarians from Ghana, Nigeria and South Africa. It was realised that gender, country of residence of respondents, age, work experience, workers with children under 13 years of age and work roles were the main factors that influenced the occupational stress among the respondents.

Research limitations/implications

The response rate for this study was low. As a result, undertaking any inferential statistics to explain relationships was not possible.

Originality/value

The value of this study lies in the depth of narrative data collected and the insight it affords with regards to contemporary work within libraries in Africa and beyond. The results presented may provide both a starting point for further discussion and may also promote an increased openness about issues of employee safety in the library environment.

Relationship between stress-related psychosocial work factors and suboptimal health among Chinese medical staff: a cross-sectional study

OBJECTIVES

The study aimed to develop and validate a model to measure psychosocial factors at work among medical staff in China based on confirmatory factor analysis (CFA). The second aim of the current study was to clarify the association between stress-related psychosocial work factors and suboptimal health status.

DESIGN

The cross-sectional study was conducted using clustered sampling method.

SETTING

Xuanwu Hospital, a 3A grade hospital in Beijing.

PARTICIPANTS

Nine hundred and fourteen medical staff aged over 40 years were sampled. Seven hundred and ninety-seven valid questionnaires were collected and used for further analyses. The sample included 94% of the Han population.

MAIN OUTCOME MEASURES

The Copenhagen Psychosocial Questionnaire (COPSOQ) and the Suboptimal Health Status Questionnaires-25 were used to assess the psychosocial factors at work and suboptimal health status, respectively. CFA was conducted to establish the evaluating method of COPSOQ. A multivariate logistic regression model was used to estimate the relationship between suboptimal health status and stress-related psychosocial work factors among Chinese medical staff.

RESULTS

There was a strong correlation among the five dimensions of COPSOQ based on the first-order factor model. Then, we established two second-order factors including negative and positive psychosocial work stress factors to evaluate psychosocial factors at work, and the second-order factor model fit well. The high score in negative (OR (95% CI)=1.47 (1.34 to 1.62), P<0.001) and positive (OR (95% CI)=0.96 (0.94 to 0.98), P<0.001) psychosocial work factors increased and decreased the risk of suboptimal health, respectively. This relationship remained statistically significant after adjusting for confounders and when using different cut-offs of suboptimal health status.

CONCLUSIONS

Among medical staff, the second-order factor model was a suitable method to evaluate the COPSOQ. The negative and positive psychosocial work stress factors might be the risk and protective factors of suboptimal health, respectively. Moreover, negative psychosocial work stress was the most associated factor to predict suboptimal health.

The Risk of Developing Diabetes in Association With Long Working Hours Differs by Shift Work Schedules

Background

The impact of long working hours on diabetes is controversial; however, shift work is known to increase the risk of diabetes. This study aimed to investigate the association between long working hours and diabetes among civil servants in Japan separately by shift work schedules.

Methods

A prospective cohort study was conducted from April 2003 to March 2009. A total of 3195 men aged ≥35 years who underwent an annual health checkup at baseline were analyzed by shift work schedules (2371 non-shift workers and 824 shift workers). Self-reported working hours were categorized as 35–44 and ≥45 hours per week. The incidence of diabetes was confirmed by fasting plasma glucose concentration ≥126 mg/dL and/or self-reported medical diagnosis of diabetes at the annual checkup. A Cox proportional model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for developing diabetes associated with long working hours.

Results

The median follow-up period of non-shift and shift workers was 5.0 and 4.9 years, respectively. During this period, 138 non-shift workers and 46 shift workers developed diabetes. A decreased HR was found among non-shift workers working ≥45 hours per week (HR 0.84; 95% CI, 0.57–1.24); however, shift workers working ≥45 hours per week had a significantly increased risk of diabetes (HR 2.43; 95% CI, 1.21–5.10) compared with those working 35–44 hours per week. An analysis restricted to non-clerical workers also showed similar results.

Conclusions

The risk of diabetes associated with long working hours differed by shift work schedules.

Perceived Job Stress and Presence of Hypertension Among Administrative Officers in Sri Lanka

A cross-sectional survey was carried out among 275 and 760 randomly selected senior officers (SOs) and managerial assistants (MAs) aged between 30 and 60 years. Sum of scores of efforts, rewards, and overcommitment and effort-reward ratio assessed job stress. Blood pressure was measured and classified using JNC-7 guidelines. The response rates of SOs and MAs were 98.9% and 97.2%, respectively. The prevalence of job stress based on high effort-rewards imbalance among SOs and MAs was 74.6% and 80.5%, respectively. The prevalence of overcommitment among SOs and MAs was 35.3% and 29%, respectively. Statistically significant differences (P = .05) were observed between the prevalence of effort-reward imbalance and overcommitment among SOs and MAs. Multivariate analysis indicated effort-reward imbalance (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.1-7.4), high efforts (OR = 2.5; 95% CI = 1.2-5.3), and overcommitment (OR = 2.5; 95% CI = 1.1-5.6) were significantly associated with hypertension among SOs. Similarly, effort-reward imbalance and high efforts increased the risk of hypertension by 2-fold (OR = 2.2; 95% CI = 1.1-4.2) and 3-fold (OR = 3.02; 95% CI = 1.9-4.8), respectively, among the MAs. A significant number of administrators are afflicted by job stress, and job stress was significantly associated with hypertension.

Long working hours and sleep problems among public junior high school teachers in Japan

OBJECTIVES

Long working hours may impact human health. In Japan, teachers tend to work long hours. From 2002 to 2012, the number of leaves of absence due to diseases other than mental disorders, or mental disorders among public school teachers increased by 1.3 times (from 2,616 to 3,381), or 1.8 times (from 2,687 to 4,960), respectively. The present study aimed to investigate the association between long working hours and sleep problems among public school teachers.

METHODS

This cross-sectional study was conducted from mid-July to September 2013 in Hokkaido Prefecture, Japan. Questionnaires were distributed to 1,245 teachers in public junior high schools. Information about basic characteristics including working hours, and responses to the Pittsburgh Sleep Quality Index were collected anonymously. Multiple logistic regression analysis was used to calculate odds ratios (ORs) for the association between long working hours and sleep problems separately by sex.

RESULTS

The response rate was 44.8% (n=558). After excluding ineligible responses, the final sample comprised 515 teachers (335 males and 180 females). Sleep problems was identified in 41.5% of males and 44.4% of females. Our results showed a significantly increased risk of sleep problems in males working >60 hours per week (OR 2.05 [95% CI 1.01-4.30]) compared with those working ≤40 hours per week. No significant association was found in females.

CONCLUSIONS

There is a significant association between long working hours and sleep problems in male teachers. Reducing working hours may contribute to a reduction in sleep problems.

Relationship between occupational stress and burnout among Chinese teachers: a cross-sectional survey in Liaoning, China

OBJECTIVES

Teaching has been reported to be one of the most stressful occupations in the world. Few studies have been conducted to explore the effects of occupational stress on burnout among teachers in developing countries. This study aimed to explore the relationship between occupational stress and burnout among teachers in primary and secondary schools in the Liaoning Province of China.

METHODS

A questionnaire that assessed occupational stress comprised of Karasek's job content questionnaire (JCQ), Siegrist's effort-reward imbalance questionnaire (ERI), and burnout assessed by the Maslach Burnout Inventory-General Survey was distributed to 681 teachers in primary and secondary schools. A total of 559 effective respondents became our final study subjects. Hierarchical linear regression and logistic regression analyses were performed through the use of SPSS 17.0 to explore the association between occupational stress and burnout.

RESULTS

A high level of emotional exhaustion was significantly associated with high extrinsic effort, high overcommitment, low skill discretion, and high job demand. A high level of cynicism was associated with low reward, low skill discretion, high overcommitment, and low supervisor support. The low level of professional efficacy was associated with low coworker support, low reward, low skill discretion, and high job demand. Compared to the JCQ, the ERI was more likely to explain the burnout of teachers in our study.

CONCLUSIONS

Occupational stress proved to be associated with dimensions of burnout among Chinese teachers. It is important for administrators of primary and middle schools to note that strategies to decrease teachers' occupational stress seem to be crucial to enhance physical and mental health of teachers in China.

Job stress and temperaments in female nurses

BACKGROUND

According to previous studies, temperament predicts a large share of the variance in job stress. It may be necessary for mental health practitioners to offer intervention strategies in accordance with individual temperament.

AIMS

To investigate the relationship between job stress and temperament among nurses in a general hospital and to provide insight into personality traits influencing their mental or physical health.

METHODS

A questionnaire survey of nurses in a general hospital. Work stress was measured using the Japanese version of the Effort-Reward Imbalance (ERI) scale. Temperament was assessed by a Japanese version of Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A). Hierarchical multiple regression analysis was used to determine the independent contribution of temperament to effort-reward ratio and over-commitment.

RESULTS

Response rate was 48% (326/685). Temperament predicted part of the variance of the four ERI ratios (effort-reward ratio 26%; effort-esteem ratio 27%; effort-promotion ratio 26%; and effort-security ratio 18%) and also of over-commitment (38%). Depressive temperament influenced all four ERI ratios and over-commitment. Anxious temperament influenced only over-commitment.

CONCLUSIONS

Nurses with depressive or anxious temperaments should be identified, monitored for signs of job stress and offered interventions to prevent adverse physical and mental effects.

The relationship between sex life satisfaction and job stress of married nurses

BACKGROUND

The purpose of this study was to investigate the relationship among work stress, sex life satisfaction, and mental health of married nurses. Demographic information, work stress, sex life satisfaction, sexual desire and mental health measured using the Chinese Health Questionnaire, data were collected from 100 married nurses in Taiwan.

FINDINGS

Sex life satisfaction and age were negatively correlated, but sex life satisfaction and sexual desire were positively correlated. The mental health of over-committed nursing staff was not affected. Higher reward for effort was positively correlated with sex life satisfaction.

CONCLUSIONS

No matter whether job stress was high or low, receiving a higher reward for effort led to better sex life satisfaction, which had a satisfying positive effect on the nurses' lives. To improve nursing care quality at the hospital, nursing administrators should assist nurses in confronting work stress via positive adjustment, which is associated with the nurses' sexual harmony, and quality of life.

Gender differences in insomnia and the role of paid work and family responsibilities

PURPOSE

A higher prevalence of insomnia in females has been consistently demonstrated across countries and cultures. The aim of this study was to clarify whether gender differences in insomnia could be explained by gender differences in paid work and family responsibilities.

METHODS

Participants were employees at two local governments in Hokkaido, Japan, who underwent annual health checkups from April 2003 to March 2004. All data were obtained via self-administered questionnaires. Insomnia was evaluated by the Athens Insomnia Scale. For work and family characteristics, occupation, working hours, days off, shift work, visual display terminal (VDT) work, occupational stress, marital status, hours spent on household tasks, childcare, and caregiving were chosen. Data from 7,451 participants (5,951 men and 1,500 women) were analyzed. Logistic regression analysis examined how much paid work and family responsibilities explained gender differences in insomnia.

RESULTS

The prevalence of insomnia in female subjects (31.0%) was significantly larger than in males (23.2%), but the gender difference disappeared after adjustment for paid work and family responsibilities. The results of stratified analyses revealed that significant gender differences were found only among workers with comparatively favorable work and family conditions, such as non-shift work, less than 6 h/day of VDT work, exposure to low levels of occupational stress, household tasks for less than 1 h/day, and not living with persons who needed care and support.

CONCLUSIONS

These results suggest that gender differences in insomnia are explained, in the main, by gender differences in work and family characteristics.

Effort-reward imbalance and depression among private practice physicians

PURPOSE

Current private practice physicians provide medical services in a harsh economic situation. The effort-reward imbalance (ERI) model puts its emphasis on an imbalance between high efforts spent and low rewards received in occupational life. ERI model includes three different reward factors from task to organizational levels. We examined whether ERI in terms of low organizational reward (poor prospective and job insecurity) could be the most relevant and strongly associated with depression among private practice physicians.

METHODS

This is a cross-sectional questionnaire study of 1,103 private practice physicians who were currently working in clinical settings and completed the data of exposure and outcome. The study questionnaire was mailed to all the physicians listed as members of a local branch of the Japan Medical Association (n = 3,441) between November and December 2008. Outcomes were prevalence of depression as measured by the Center for Epidemiologic Studies Depression Scale and adjusted odds ratios (OR) of depression with respect to ERI.

RESULTS

Fifty-seven percent of physicians were exposed to ERI, and 18% of the physicians were depressed. Logistic regression analyses revealed that ERI was significantly associated with depression (OR and 95% confidence interval = 3.57; 2.43-5.26). ERI with regard to organizational reward was most prevalent (60%) and had the strongest association with depression (5.14; 3.36-7.92).

CONCLUSION

Predominant prevalence of ERI in terms of organizational level low reward and strong associations between the ERI component and depression suggests that countermeasures from social perspective are crucial.

Factors associated with the intention to leave among newly graduated nurses in advanced-treatment hospitals in Japan

AIM

The early resignation of newly graduated nurses (NGNs) will become a concern in Japan as the need for nurses increases. The aim of this study was to conduct an investigation using the Effort-Reward Imbalance (ERI) questionnaire to examine the effect of stressful experiences in the work environment and over-commitment on NGNs' intention to leave and to identify the factors that were associated with their intention to leave, clarifying the appropriate times at which to conduct interventions to prevent NGNs from leaving advanced-treatment hospitals.

METHODS

Anonymous self-administered questionnaires were distributed to all the NGNs (n = 1364) in 14 advanced-treatment university hospitals. Questionnaires with no missing data were returned by 737 NGNs (54%). For the development of the questionnaire, we designed a framework that consisted of the factors that occur during three stages of the NGNs' transition into the workplace. The questions addressed items for individual attributes, employment and organizational characteristics, the Role Model Scale, the ERI questionnaire, two scale items for health status, and the intention to leave. In order to determine the factors that related to the dependent variables, hierarchical multiple linear regression analyses were carried out.

RESULTS

We revealed that effort, subjective health status, role models, and effort were important factors that related to the NGNs' intention to leave, as well as their age and city size. Over-commitment and reward were not significant factors. We also found that three subscales of the Job Readiness Scale independently related to the NGNs' intention to leave.

CONCLUSION

These findings can help employers, supervisors, and senior staff of advanced-treatment university hospitals in Japan to improve their work environment in order to benefit NGNs and aid in their retention.

Effort-reward imbalance and depressive state in nurses

BACKGROUND

The mental health of nurses is an important issue.

AIMS

To examine relationships between effort-reward imbalance (ERI) and depression and anxiety in nurses of a Japanese general hospital.

METHODS

A self-report survey was conducted among 406 nurses. Work stress was measured using a Japanese version of the ERI scale. Depression and anxiety were assessed by an item of the QOL-26. Logistic regression analysis was used to determine the independent contribution of the effort-reward ratios or overcommitment to the depressive state.

RESULTS

Both higher effort-money ratio and higher overcommitment significantly correlated with the depressive state (OR: 2.75; 95% CI: 1.34-5.66 and OR: 1.27; 95% CI: 1.15-1.41, respectively).

CONCLUSIONS

These findings suggest that in addition to effort-money ratio, overcommitment at work is an especially important issue that may be able to be managed in health promotion services for nurses in general hospitals.

Relationship between quality of life and occupational stress among teachers

OBJECTIVES

With major changes in the education system and limited resources supplied by the Government, Chinese teachers have been suffering from greater occupational stress in recent years, which is believed to affect their physical and mental health. The aim of this study was to explore the relationship between quality of life and occupational stress in primary and middle school teachers.

STUDY DESIGN

Originals.

METHODS

A cross-sectional study was conducted using cluster sampling. The study population was composed of 3570 school teachers working in 64 primary and middle schools in Heping District in Shenyang, China. A demographic questionnaire, the 36-item Short-Form Health Survey (SF-36) and the Occupational Stress Inventory Revised Edition were employed to collect demographic variables and assess quality of life and occupational stress. Multivariate stepwise linear regression analyses were performed to study the relationship between quality of life and occupational stress.

RESULTS

The mean scores for both male and female teachers in this study were significantly lower than those for the Chinese general population for all dimensions of quality of life, except mental health and vitality (P<0.05). Male teachers scored significantly higher than female teachers for physical functioning, bodily pain, vitality and physical health (P<0.05). Age, role overload, role insufficiency, vocational strain, psychological strain, physical strain, recreation and rational coping were significantly associated with both the physical and mental component summaries of the SF-36 (P<0.05). Gender, physical environment and self-care appeared to be robust indicators of physical health (P<0.05), while role insufficiency, interpersonal strain and social support were strong indicators of mental health (P<0.05).

CONCLUSIONS

In China, teachers have a lower health status than the general population. The quality of life of female teachers is worse than that of male teachers, and deteriorates with age. Occupational stress and strain induce worsening physical and mental conditions for teachers, while coping resources could promote their health. This study suggests that having adequate coping resources, especially social support, in workplaces may be an important factor for improving teachers' quality of life. Moreover, psychological interventions should be set up for teachers, and psychological counselling should be provided to relieve stress and enhance quality of life.

The relationship between temperament, job stress and overcommitment: a cross-sectional study using the TEMPS-A and a scale of ERI

This cross-sectional study examined the relationship between temperament, job stress, and overcommitment using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire version (TEMPS-A) and a scale of the effort-reward imbalance (ERI) model. In July 2004, self-administered questionnaires were distributed to all employees in a Japanese IT service company through the company postal system. Total response rate was 63% (N=874), with 730 completed questionnaires. Information collected included individual attributes, employment and organizational characteristics. The TEMPS-A and the Japanese version of the ERI questionnaire were self-administered. The completed data of 637 personal computer technical support staff (87%) were used in a hierarchical regression analysis. Our results showed that depressive and anxious temperaments attenuate the influence of working hours and influence effort and rewards independently. While actual working hours had more impact on perceived high effort, our findings regarding rewards suggest that understanding anxious and depressive temperaments has a significant role in stress self-management. Temperaments explained 36% of the variance of overcommitment, and the variance was more than that of mean working hours. Our research has provided meaningful insights into occupational health, which could assist employees in self-management of job stress and contribute to better adaptation at the workplace.

Three job stress models/concepts and oxidative DNA damage in a sample of workers in Japan

OBJECTIVE

Three job stress models/concepts (the job demands-control [DC] model, the effort-reward imbalance [ERI] model, and organizational justice) have been linked to coronary heart disease (CHD) at work. In recent years, oxidative DNA damage has been identified as a new risk factor for CHD. However, evidence for the association between these job stressors and oxidative DNA damage is limited. The present cross-sectional study investigated the association between these job stress models/concepts and oxidative DNA damage as a possible mediator of the adverse health effects of job stress.

METHODS

A total of 166 male and 51 female workers of a manufacturing factory in Japan were surveyed using a mailed questionnaire regarding job stressors and demographic, occupational, and lifestyle variables. Urinary concentrations of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a biomarker of oxidative DNA damage, were also measured.

RESULTS

In male subjects, the urinary concentrations of 8-OHdG were significantly higher among the group with lower interactional justice, one of the two components of organizational justice; however, no association was observed with the DC model or the ERI model. In female subjects, high job demands/control ratio was significantly and positively associated with the urinary concentrations of 8-OHdG.

CONCLUSION

Interactional justice among male workers and the DC model-based strain among female workers may be associated with increased urinary concentrations of 8-OHdG which possibly reflects oxidative DNA damage.

Reciprocal relations between effort-reward imbalance at work and adverse health: a three-wave panel survey

Siegrist's [1996. Adverse health effects of high-effort/low-reward conditions. Journal of Occupational Health Psychology, 1, 27-41.] Effort-Reward Imbalance (ERI) Model assumes that ERI at one point in time influences health at a later point in time. Empirical cross-sectional and longitudinal findings have supported the influence of ERI on adverse health. However, the ERI model does not explicitly take into account that the relation between ERI and adverse health may be also explained by reversed causal relations, or even reciprocal (bi-directional) relations in which ERI and health mutually influence each other. The present 3-wave panel study among 211 Japanese male blue-collar workers in one construction machinery company examined reciprocal relations between ERI and adverse health (i.e., psychological distress and physical complaints) with a 1-year time-lag per wave. Hypotheses were tested using structural equation modeling (Amos 7.0J). Results showed cross-lagged and causally dominant effects of ERI on both psychological distress and physical complaints after 1 year for both Time 1-Time 2 and Time 2-Time 3. In addition, cross-lagged effects of psychological distress on ERI were found after 1 year for both Time 1-Time 2 and Time 2-Time 3. These findings suggest that (perceived) ERI and employee health influence each other reciprocally rather than uni-directionally, and underline the importance of studying reversed causal effects in the relation between ERI and employee health.

Relations of occupational stress to occupational class in Japanese civil servants--analysis by two occupational stress models

The aim of the present study was to identify relations between occupational stress and occupational class in Japanese civil servants, using two occupational stress models-the Effort-Reward Imbalance (ERI) Model and the Job Demand-Control (JDC) Model. The subjects were employees of three local public organizations. We distributed self-administered questionnaires and assessed occupational stress by ERI and JDC. We used seven occupational categories based on the Standard Occupational Classification for Japan. The data of 6,423 male and 1,606 female subjects were analyzed by logistic regression analysis to obtain odds ratios (OR) for relations between occupational stress and occupational class. In JDC, male clerical workers, transport/communication workers and protective service workers showed a significantly higher OR of being in the high occupational stress group, compared to managers. In ERI, male professionals/technicians, transport/communication workers, clerical workers and protective service workers showed a significantly higher prevalence OR, compared to managers, the two models giving different results. In ERI, female production workers/laborers and clerical workers had a significantly lower prevalence OR, compared to managers. The results of this study showed that occupational stress differed by occupational class and the two occupational stress models gave different results for occupational classes with high occupational stress.

A narrative approach to understanding the nursing work environment in Canada

Narrative interviews were conducted with hospital nurses participating in a research study designed to provide support and assistance to hospitals as they addressed work life issues for nurses in an attempt to create quality work environments. The eight interviews were conducted in a sample of Canadian hospitals and generated themes relating to an imbalance between the effort that nurses put into their work and rewards attained from it. Seigrist's ((1996) Journal of Occupational Health Psychology, 1, 27-41, (2002) In: P.L. Perrewe & D.G. Ganster (Eds.), Historical perspectives on stress and health. Research in Occupational Stress and Well Being (vol. 2). Boston, MA: Jai Press) effort-reward imbalance model was used to frame this study. The nurses' narratives suggest that multiple factors constitute the nurses' work environment and their experiences and perceptions of it. Issues which surfaced repeatedly in the interviews related to changing needs of hospitalized patients in today's health care system and the associated workload, the widespread shortage of nurses, and the imbalance this creates for nursing work. A crucial finding is the extent to which the nurse is impacted by the adequacy of care they are able to provide. These narratives outline the tremendous burden of guilt and the overcommitment that nurses bear when factors in the work environment prevent them from providing complete, quality care. Nurses are experiencing frustration and stress that is impacting their worklife, family and home life, personal health, and possibly patient outcomes.

Psychosocial factors and health: community and workplace study

The effects of psychosocial factors on health have drawn growing attention. An important prerequisite for epidemiologic studies is that instruments to measure psychosocial factors be reliable and valid based on psychometric properties. The introduction of occupational stress models has made breakthroughs in conceptualizing real-life complex phenomena in the workplace. This article describes some trials that explore the associations between psychosocial factors and health in the community and workplace. Scales for measuring social support and psychosocial job characteristics were developed, and their validation was pursued. Findings suggest that adverse social relationships and job characteristics measured by these instruments are associated with ill health. To strengthen the validities of the measurements and to provide strong causal evidence between psychosocial factors and health, more prospective studies and interventional approaches are needed.