The Work Limitations Questionnaire

OBJECTIVE: The objective of this work was to develop a psychometrically sound questionnaire for measuring the on-the-job impact of chronic health problems and/or treatment ("work limitations"). RESEARCH DESIGN: Three pilot studies (focus groups, cognitive interviews, and an alternate forms test) generated candidate items, dimensions, and response scales. Two field trials tested the psychometric performance of the questionnaire (studies 1 and 2). To test recall error, study 1 subjects were randomly assigned to 2 different questionnaire groups, a questionnaire with a 4-week reporting period completed once or a 2-week version completed twice. Responses were compared with data from concurrent work limitation diaries (the gold standard). To test construct validity, we compared questionnaire scores of patients with those of healthy job-matched control subjects. Study 2 was a cross-sectional mail survey testing scale reliability and construct validity. SUBJECTS: The study subjects were employed individuals (18-64 years of age) from several chronic condition groups (study 1, n = 48; study 2, n = 121) and, in study 1, 17 healthy matched control subjects. MEASURES: Study 1 included the assigned questionnaires and weekly diaries. Study 2 included the new questionnaire, SF-36, and work productivity loss items. RESULTS: In study 1, questionnaire responses were consistent with diary data but were most highly correlated with the most recent week. Patients had significantly higher (worse) limitation scores than control subjects. In study 2, 4 scales from a 25-item questionnaire achieved Cronbach alphas of > or = 0.90 and correlated with health status and self-reported work productivity in the hypothesized manner (P < or = 0.05). CONCLUSIONS: With 25 items, 4 dimensions (limitations handling time, physical, mental-interpersonal, and output demands), and a 2-week reporting period, the Work Limitations Questionnaire demonstrated high reliability and validity.     

A national survey of health-related work limitations among employed persons in the United States

Purpose: To estimate the total prevalence of health-related work limitations among working people in the United States (US) as well as their condition-specific prevalence. Methods: A new questionnaire measuring limitations in ability to perform specific work demands was administered to 940 employed people in a national household survey. The prevalence of specific work limitations is reported as are conditionspecific risk estimates (odds ratios) based on logistic regression. Results: In the US, 19.3% of working people (CI=14.0, 24.6) were limited in their abilities to perform physical work demands; 24.1% (CI=18.9, 29.2) were limited in performing psychosocial work demands; and 13.8% (CI=8.3,19.3) were limited in their abilities to function without difficulty within the ambient work environment. With successive increments in the number of conditions, the odds of having a limitation increased significantly. Conclusions: This study contributes new information concerning the implications of chronic health problems for working people and the significant risks for workers with multiple chronic conditions.     

A national survey of health-related work limitations among employed persons in the United States

Purpose: To estimate the total prevalence of health-related work limitations among working people in the United States (US) as well as their condition-specific prevalence. Methods: A new questionnaire measuring limitations in ability to perform specific work demands was administered to 940 employed people in a national household survey. The prevalence of specific work limitations is reported as are conditionspecific risk estimates (odds ratios) based on logistic regression. Results: In the US, 19.3% of working people (CI=14.0, 24.6) were limited in their abilities to perform physical work demands; 24.1% (CI=18.9, 29.2) were limited in performing psychosocial work demands; and 13.8% (CI=8.3,19.3) were limited in their abilities to function without difficulty within the ambient work environment. With successive increments in the number of conditions, the odds of having a limitation increased significantly. Conclusions: This study contributes new information concerning the implications of chronic health problems for working people and the significant risks for workers with multiple chronic conditions.     

Exploring extensions to working life: job lock and predictors of decreasing work function in older workers

Purpose.?Job lock, one form of restricted job mobility that often prevents older workers from retiring, is linked to existing health and work place problems. This study explored (i) the rate of change in work limitation for job locked and non-job locked older workers and (ii) the factors associated with these changes over a 12-month period following a work injury.

Methods.?Prospective observational cohort study of adults aged ≥55 years. Data were collected using self-completed questionnaires. Individual growth modelling was used to examine the pre- and post- injury influences on work limitation.

Results.?Work limitation was greater in the job locked older workers pre-injury. Both job-locked and non-job locked respondents had initial post-injury decreases in work limitations, suggesting a positive impact of temporary post-injury accommodations. However, both groups had increases in work limitations over time, but the increases were greater in the non-job locked group. In those with job lock, return to work problems were associated with increases in work limitations; in those without job lock, greater increases were associated only with low education.

Conclusions.?These results suggest that job accommodations may be important in moderating increasing work limitation in job-locked older workers. Results support prior findings that job-locked older workers have unique characteristics, perhaps requiring more tailored interventions to maintain them in the workforce.     

The faculty work plan and appraisal: its potential for faculty role development

This exploratory study was designed to begin analysis on the "Faculty Work Plan" and its potential for faculty role development in a university setting. The specific goals were: (1) to identify the degree of congruence between faculty work plans and the school goals; and (2) to determine the relationship between faculty work plan/school goal congruence, faculty productivity, potency, and job satisfaction. The sample was composed of 26 respondents, 26 to 50 years old, from a pool of 48 full-time faculty members affiliated with a school of nursing in a university setting. Likert-type rating scores were used to measure Faculty Work Plan-School Goal Congruence (FWP-SG), job satisfaction, productivity, and potency. Data analyses were focused on frequency distribution, group means, and Pearson Correlation Coefficients on selected pairs of variables. Interesting findings were revealed. A strong relationship was found between FWP-SG congruence and faculty productivity (r = .85; p = .000) and potency (r = .84; p = .000). Several recommendations were suggested.     

Premenstrual dysphoric disorder: is there an economic burden of illness?

OBJECTIVE: To quantify the economic burden associated with premenstrual dysphoric disorder (PMDD) by assessing health care service use and related expenditures, work loss, role limitation, and productivity. METHODS: Women ages 21 to 45, randomly selected from membership of a northern California HMO (n = 1,194), provided prospective daily symptom ratings and survey data on health care use and productivity for two menstrual cycles. Summary measures of 12-month utilization and expenditures based on HMO encounter data also were constructed. Based on daily symptom ratings, we classified women as having minimal (n = 186), moderate (n = 801), and severe (n = 151) premenstrual symptoms, or PMDD (n = 56) and compared health care use and expenditures, predicted values of productivity and work loss, and marginal effects of symptom severity on outcome measures. RESULTS: Women with PMDD had higher degrees of luteal phase (premenstrual) productivity impairment than those with minimal symptoms. Compared with the minimal and moderate symptom groups, women with PMDD continued to report lower productivity (P <0.01) in the 5 to 10 days after onset of menses (follicular phase). We found little evidence that women spent more time in bed, reduced time at work, or decreased activities at home or school as a result of premenstrual symptoms. As symptom severity increased, the likelihood of health care service use increased only for an emergency department, obstetrician/gynecologist, or alternative medicine provider visit. There were no significant differences in health care expenditures across the symptom groups. CONCLUSION: The economic burden associated with PMDD manifests itself primarily in reported productivity decrements rather than health care utilization or costs associated with time away from work.     

Evaluating work ability and quality of life for clinical nurses in Taiwan

This study investigated the work ability and its relationship with quality of life for the clinical nurses in Taiwan. The survey was of 1534 nursing professionals from 8 different hospitals. Work ability of nursing professionals varied by age, work experience, working departments and hospital types. Work ability of nurses increased with age until after the age of 45. Personal health condition and physical workload were the main factors contributing to the decline of the perceived work ability for senior nurses. For young nurses, the mental demands of work were a critical influence on their work ability. Moreover, work ability of nurses varied among hospital type and department. The work ability of nurses was strongly associated with the quality and safety of the work environment and leisure time management. For improving and maintaining the work ability of nurses, countermeasures such as enhancing the ability to cope with the job's mental demands for young nurses, and improving the job design to reduce physical workload for senior nurses are recommended.     

Nurses' work demands and work-family conflict: a questionnaire survey

BACKGROUND: Work-family conflict is a type of interrole conflict that occurs as a result of incompatible role pressures from the work and family domains. Work role characteristics that are associated with work demands refer to pressures arising from excessive workload and time pressures. Literature suggests that work demands such as number of hours worked, workload, shift work are positively associated with work-family conflict, which, in turn is related to poor mental health and negative organizational attitudes. The role of social support has been an issue of debate in the literature. This study examined social support both as a moderator and a main effect in the relationship among work demands, work-to-family conflict, and satisfaction with job and life. OBJECTIVES: This study examined the extent to which work demands (i.e., work overload, irregular work schedules, long hours of work, and overtime work) were related to work-to-family conflict as well as life and job satisfaction of nurses in Turkey. The role of supervisory support in the relationship among work demands, work-to-family conflict, and satisfaction with job and life was also investigated. DESIGN AND METHODS: The sample was comprised of 243 participants: 106 academic nurses (43.6%) and 137 clinical nurses (56.4%). All of the respondents were female. The research instrument was a questionnaire comprising nine parts. The variables were measured under four categories: work demands, work support (i.e., supervisory support), work-to-family conflict and its outcomes (i.e., life and job satisfaction). RESULTS: The structural equation modeling results showed that work overload and irregular work schedules were the significant predictors of work-to-family conflict and that work-to-family conflict was associated with lower job and life satisfaction. Moderated multiple regression analyses showed that social support from the supervisor did not moderate the relationships among work demands, work-to-family conflict, and satisfaction with job and life. Exploratory analyses suggested that social support could be best conceptualized as the main effect directly influencing work-to-family conflict and job satisfaction. CONCLUSION: Nurses' psychological well-being and organizational attitudes could be enhanced by rearranging work conditions to reduce excessive workload and irregular work schedule. Also, leadership development programs should be implemented to increase the instrumental and emotional support of the supervisors.     

Recurrent changes in the work environment, job resources and distress among nurses: a comparative cross-sectional survey

BACKGROUND AND OBJECTIVES: Occupational stress in nursing has frequently been considered in nursing literature. The operationalization of job demands in different work settings and its relation to distress have been discussed to identify significant interactions with job resources. In this study, job demands were defined as recurrent changes in the work environment of nurses (i.e. changing colleagues, supervisors, workplaces, working hours and tasks). In particular, we focused on the 'negative appraisal' (i.e. 'threat') of these changes. The interaction between 'threat' and job resources (i.e. timing control, method control and supervisor support) and its relation to distress among Registered Nurses was examined. METHODS: The study was part of a larger cross-sectional survey among 7863 (response rate 51%) employees belonging to 10 general hospitals in Belgium. The results are based on self-administered questionnaires of 1094 Registered Nurses employed in intensive care units (ICU) (n = 416) and surgery/medical wards (non-ICU) (n = 678). General Linear Modelling was used to test the moderating effects. RESULTS: In both study samples, 'threat' was positively associated with distress (P < 0.001). However, in contrast with non-ICU nurses, ICU nurses only considered 'supervisor support' as a significant moderator in the positive relationship between 'threat' and distress (P = 0.023). 'Timing and method control', instead of supervisor support, moderated this relation among non-ICU nurses (P = < 0.001 and 0.018, respectively). CONCLUSION: These findings provide additional evidence to consider negative appraisal of recurrent changes as occupational specific stressor in nursing. Moreover, the buffering effects which were found between 'threat' and the measured job resources in relation to distress, and the difference of these interactions in ICU and non-ICU health care settings, confirmed the suggestion to consider particular job characteristics in job stress research. Finally, the findings of our study may be of importance for nursing administrators who are dealing with distress among nurses.     

Job strain,work characteristics and back pain: A study in a University hospital

Objectives: The demand‐control‐support “job strain” model is frequently used in occupational health research. We sought to explore the relationship between job strain and back pain. Method: One thousand two hundred and ninety‐eight collaborators of a Swiss teaching hospital responded to a cross‐sectional questionnaire survey that measured job strain, the occurrence of back pain as well as the characteristics and consequences of this pain. Results: Job strain computed with both psychological and physical demands was strongly and significantly associated with various measures of back pain. These associations displayed a dose—response pattern, and remained strong even after adjustment for job characteristics and professional categories. In contrast, separate dimensions of job strain (except physical demands) and job strain computed with only psychological demands did not remain significantly associated with back pain after adjustment for other variables. Conclusion: Our results support the findings linking back pain to job strain. Moreover, the relationship between back pain and job strain is much stronger if job strain includes both psychological and physical demands. Results of this study suggest that workplace interventions that aim to reduce job strain may help prevent back pain and may alleviate the personal, social, and economic burden attributable to back pain.     

Employee empowerment, innovative behavior and job productivity of public health nurses: a cross-sectional questionnaire survey

Background

Employee empowerment is an important organizational issue. Empowered employees with new ideas and innovative attributes may increase their ability to respond more effectively to face extensive changes in current public health care work environments.

Objectives

The objective of this study was to investigate the relationships between employee empowerment, innovative behaviors and job productivity of public health nurses (PHNs).

Design

This study conducted a cross-sectional research design.

Settings and participants

Purposive sampling was conducted from six health bureaus in northern Taiwan. 670 PHNs were approached and 576 valid questionnaires were collected, with a response rate of 85.9%.

Methods

Structured questionnaires were used to collect data by post.

Results

Meaning and competence subscales of psychological empowerment, information and opportunity subscales of organizational empowerment, and innovative behaviors were the predictors of job productivity, only accounting for 16.4% of the variance. The competence subscale of psychological empowerment made the most contribution to job productivity (β = 0.31). Meaning subscale of psychological empowerment has a negative impact on job productivity.

Conclusions

Employee empowerment and innovative behavior of PHNs have little influence on job productivity. Employees with greater competence for delivering public health showed higher self-evaluated job productivity. The negative influences on job productivity possibly caused by conflict meaning on public health among PHNs in current public health policy. It should be an issue in further researches. Public health department should strengthen continuing educations to foster competence of psychological sense of empowerment and innovative behavior to increase job productivity.     

Work stress and work ability: cross-sectional findings from the German sociomedical panel of employees

Purpose. Maintenance of work ability and restoration of reduced work ability by prevention and rehabilitation are major aims of disability management. To achieve these aims, decision-makers and health care providers need evidence of the determinants of restricted work ability. The aim of this article was to analyse the cross-sectional association between work stress and work ability in a population drawn from a random sample of employees.

Methods. A total of 1463 working men and women aged 30–59 years from the baseline survey of the German SPE were included in the analyses. Work stress was defined in terms of the demand-control model and the effort-reward (ER) imbalance model. Work ability was assessed by the Work Ability Index (WAI). We used multiple imputations to account for missing data and calculated logistic regression models to estimate associations between the two work stress models and restrictions of work ability.

Results. Approximately one third (32.0%) of the respondents reported restrictions of work ability (WAI <37) indicating a need of interventions to improve and to restore work ability. High job strain was experienced by about one third (34.2%) of the participants and 12.7% of the respondents reported an ER ratio > 1 indicating an ER imbalance. Restrictions of work ability were explained independently by high job strain due to high demand and low control (OR = 4.66; 95% CI = [2.93, 7.42]) and by effort-reward imbalance (OR = 2.88; 95% CI = [1.95, 4.25]).

Conclusion. Work stress is associated with restrictions of work ability, but longitudinal analyses are required to confirm a causal relation.     

Counterbalancing work-related stress? Work engagement among intensive care professionals

Background and objectives

Working in an Intensive Care Unit (ICU) is increasingly complex and is also physically, cognitively and emotionally demanding. Although the negative emotions of work-related stress have been well studied, the opposite perspective of work engagement might also provide valuable insight into how these emotional demands may be countered. This study focused on the work engagement of ICU professionals and explored the complex relationship between work engagement, job demands and advantageous personal resources.

Nurses' satisfaction with shiftwork and associations with work,home and health characteristics: a survey in the Netherlands

Title. Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands. Aim. This paper is a report of a study conducted to determine if satisfaction with irregular working hours that are a form of shiftwork operates as a mediator between work and home characteristics and health problems. Background. Shiftwork contributes to health problems, decreased well‐being and poorer health habits. It also affects employees’ decisions to leave the healthcare sector. Although many nurses voluntarily work shifts, there have been few studies of their satisfaction with irregular working hours when these are a form of shiftwork. Methods. A survey was carried out with 144 nurses working in three nursing homes and one care home in the Netherlands. Questionnaires were distributed in 2003 to 233 nurses who worked shifts (response rate 60%). The questionnaire contained items on work and home characteristics, satisfaction with irregular working hours that are a form of shiftwork and health. A new scale to measure satisfaction with irregular working hours was constructed. Results. All work characteristics, but no home characteristics, were associated with satisfaction with irregular working hours. The work characteristics ‘job demands’ and the home characteristics ‘autonomy at home’ and ‘home demands’ were associated with health. Satisfaction with irregular working hours did not mediate between work/home characteristics and health. Those reporting more social support, lower job demands and more job autonomy were more satisfied with their irregular working times that were a form of shiftwork. Conclusions. Satisfaction with irregular working hours is a useful construct that requires further longitudinal study. The results also underline the importance of considering home characteristics when predicting health outcomes.     

社区护士职业生命质量和工作绩效相关性研究

目的护士职业生命质量是影响护理工作绩效的关键。通过调查社区护士职业生命质量和工作绩效现状,研究两者的相关性,提出加强社区护士职业生命质量的建议和对策,以提高社区护理质量。方法采用Brooks职业生命质量量表和工作绩效量表对193名社区护士进行问卷调查,对调查数据进行统计分析。结果社区护士职业生命质量总体均分（3.93±0.53）,其中工作环境维度得分最高（4.14±0.59）,社会环境维度得分最低（3.55±0.71）。年龄、聘用方式、职称、学历、月收入及健康自评状况对总体均分差异有显著意义（P〈0.05）;工作绩效得分（3.60±0.50）,经person相关分析,得出职业生命质量均分与工作绩效均分呈正相关（r=0.451,P〈0.01）。其中,工作环境维度与工作绩效正相关最为明显（r=0.415）,工作与家庭平衡维度和工作绩效相关性最低（r=0.294）。结论护理管理者应健全社会支持系统,改善社区护士工作环境,了解护士家庭状况均衡工作量,协调其工作与家庭的平衡,重视个人发展规划,提高社区护士职业生命质量,提升工作绩效水平。     

Relationship between work–family conflict and a sense of coherence among Japanese registered nurses

Aim: Work–family conflict (WFC) refers to the conflict that arises between a person's work and family life. Previous studies have reported workload, job demands, and irregular working shifts as related to the WFC among nurses and have clarified that WFC is a predictor of job satisfaction, morale, and turnover intention. Very few studies have investigated WFC among Japanese nurses and no study has taken into consideration the sense of coherence (SOC) that helps nurses to cope with stress. The present study aimed to determine the relationship between WFC and SOC and to clarify how WFC and a SOC influence the mental and physical health of nurses in order to suggest ways of establishing work environments that enable nurses to achieve a balance between their work and family life. Methods: A self‐report questionnaire survey of 388 Japanese female nurses was conducted. The data from 138 nurses who were a mother and/or wife were analyzed. Results: Work–family conflict was significantly related to the SOC. It had a larger impact on the physical and mental health of nurses than their work and family characteristics. The SOC also had a major influence on the physical and mental health of nurses, while having a buffering effect on WFC with respect to depression. Conclusions: Our findings underscore the importance of taking organizational steps to create work environments that contribute to an enhanced SOC in order to reduce the WFC among nurses.     

Nursing working conditions in relation to restraint practices in long-term care units

OBJECTIVES: This study examined the effects of nursing working conditions on the use of physical restraints and antipsychotics as restraints in long-term care units for elderly residents. DESIGN: Cross-sectional data were obtained in Finland in 2002 from long-term care units that used the Resident Assessment Instrument (RAI) system and participated in a survey on working conditions. SETTING: A sample of 91 inpatient units in 31 facilities (23 residential homes and 8 health centers). PARTICIPANTS: Data included 2430 resident assessments and 977 nursing staff survey responses. MEASUREMENTS: We measured unit-level mean scores of physical restraint and antipsychotics use as restraints and resident characteristics (activities of daily living, cognitive impairment, and daily behavioral problems) based on the RAI system as measured by the Minimum Data Set 2.0. Head nurses reported the structural factors (nurse staffing levels and unit size). Nursing working conditions were measured by the Job-Demands and Job-Control Scales in the staff survey questionnaire. RESULTS: Controlling for resident characteristics, nurses' job demands and control had a combined effect on restraint practices. Job demands strongly increased the risk of physical restraint use in units where nurses reported low job control (odds ratio [OR] = 13.31, 95% confidence interval [CI] 1.55-114.30, P = 0.019), but not among high-control units (OR = 0.23, 95% CI 0.04-1.29, P = 0.090). Although the use of antipsychotics was not related to job demands in units with low control (OR = 1.11, 95% CI 0.26-4.99, P = 0.891), the antipsychotics use in particular decreased when high job demands were coupled with high job control (OR = 0.17, 95% CI 0.03-0.91, P = 0.038). CONCLUSION: The results suggest that restraint use can be reduced by enhancing working conditions so that the nursing staff has possibilities for skill usage and decision-making.     

Dimensions of nurse work time: Progress in instrumentation

Because the work of health care is embedded in time, understanding nursing time‐allocation practices is essential for identifying nurse staffing and workflow patterns that optimize healthcare cost and quality outcomes. The interdependent nature of nursing care requires that nurses share time with other members of their work group. Shared time, also known as social or organizational time, requires careful negotiation of workflows within healthcare teams. Evaluation of negotiated workflows is contingent upon valid and reliable measures of sociological nursing time. In this study, we evaluated the psychometric properties of a newly adapted instrument for measuring sociological nursing time and describe the experience of sociological time among hospital‐employed nurses. Using a cross‐sectional survey design with a convenience sample of nurses (n = 359), we identified nine reliable components of sociological nursing time: insufficient time allocation; strict adherence to schedules; increased time awareness; value of quality over speed; fast and unpredictable pace changes; predictable job duties punctuated with unpredictable job demands; expectations for a fast work pace; inconsistent work‐hour expectations across departments; and high expectations for punctuality.