Equity/inequity,stress and employee commitment in a health care setting

This article investigates the relationship between perceptions of equity, occupational stress and employee commitment in a health care setting. Significant relationships were found among these variables and implications for the health care field are discussed.     

Type A personality,work stress and psychological distress in Japanese adult employees

To explore work stress–strain relations and the effect of Type A/B personality among Japanese adult employees, a questionnaire survey was conducted in two branches of a large bank in Hokkaido, Japan. Data were obtained from 256 adult employees (158 males and 98 females). The questionnaire consisted of several scales concerning role stress, the 28-item General Health Questionnaire (GHQ-28), job dissatisfaction, the Jenkins Activity Survey, and others. While most of the variables differed across three subsamples (male clerks, males of chief clerk status or higher, and female clerks), both role overload and conflict were comparable. Role overload and conflict were highly associated with psychological distress, but role ambiguity showed a few significant correlations. Also, fewer significant correlations were found for Type A/B subscales. A moderated multiple regression analysis was carried out by subsample for each pair of role stress and Type A/B subscale for each psychological distress. A buffering effect of Type A/B was tested by considering the significance of its interaction term with role stress. As a whole global A tendency ie, high scores on the JAS-A/B subscale would play a role as ‘buffer’, but high hard-driving and competitive tendencies would play roles as both ‘buffer’ and ‘exaggerator’ according to the type of stress. Most of these results, however, were detected in the analyses of male clerks. Therefore, either buffering or exacerbating effects of Type A/B personality on stress–strain relations were recognized to vary between genders, across job positions, and/or across the types of stress at work and distress.     

Mental health problems and British workers: a survey of mental health problems in employees who receive counselling from Employee Assistance Programmes

This study assesses levels of psychological disturbance in employees who attend counselling schemes provided by their employer through Employee Assistance Programmes (EAPs). Over two‐thirds (33) of the organizations covered by a major United Kingdom EAP provider allowed their employees to be surveyed. A standardized and well‐respected screening test aimed at detecting psychiatric disorders in the community (General Health Questionnaire) was given to employees when they visited counsellors. Steps were taken to ensure confidentiality and anonymity. One hundred and eleven of 466 (24 per cent) employees receiving counselling returned questionnaires and the results show 86.6 per cent of these experienced significantly high levels of psychiatric problems. Findings suggest that a significant proportion of employees who experience stress in the workplace and consequently attend their employer's EAP may have serious mental health symptoms, and that employers are providing a service for those in genuine psychological need. The study also raises the possibility that when some employees complain of ‘stress’ in the workplace, they may in fact be experiencing significant mental health problems, particularly anxiety and depression, requiring professional assistance. Copyright © 2002 John Wiley & Sons, Ltd.     

A shooting incident in an elementary school: Effects of worker stress on public safety,mental health,and medical personnel

The effects of impact of event and five categories of worker stress were studied with 140 police, fire, medical, and mental health personnel who were involved in emergency service work following a shooting in an elementary school. A questionnaire distributed 6 months after the incident was utilized. Public safety personnel reported a recollection of significantly fewer intrusive thoughts than medical and mental health professionals immediately following the incident. Groups did not differ in intrusive or avoidance scores on the Impact of Event Scale 6 months after the event and all groups showed a significant decrease in both scores over time. Stepwise linear regression showed that a self-reported qualitatively heavy work load predicted intrusiveness and avoidance of thoughts both immediately after and at the 6-month anniversary of the incident. Additionally, time pressure and quantitatively heavy work load also predicted avoidance score at the time of the incident. Results are discussed in terms of control models of anxiety and as foci for debriefing with affected personnel.     

Factors associated with treatment limitations in two Swedish intensive care units: Prevalence and patient involvement

The aim was to study the prevalence, documentation, and patient involvement in treatment limitations (TLs) in two Swedish intensive care units (ICUs). All patients admitted to the ICUs of two Swedish regional hospitals in 2019 were screened for inclusion. Exclusion criteria included postanesthesia care <24 h. Patients were identified using the Swedish Intensive Care Registry (SIR) and data were extracted from SIR and hospital charts. Uni- and multivariable logistic analysis was performed to investigate associations with the presence of TLs. A total of 3090 patients were admitted to the two ICUs in 2019. After exclusion, 1019 patients were included in the study. 45.5% were women and the mean age was 62.9 years. 26.5% of the patients had one or several TLs. Age (OR 1.04 per one year increase 95% confidence interval (CI) 1.02–1.05), SAPS3-score (OR 1.08 per one unit increase 95% CI 1.06–1.09) and ICU length of stay (OR 1.11 per one day increase 95% CI 1.05–1.17) were independently associated with an increased likelihood of receiving a TL. 17% of the patients were involved in the decision-making process and in >30% of cases neither the patient nor next-of-kin were informed. Women were to a larger extent involved in the decision process than men (24.5 vs. 12.5% p < .05). When the intensivist documented why a TL was established, patient autonomy was four times more commonly stated as the motivation for the TL among women compared to men (15.5% vs. 3.8% p < .05). TLs were common in two Swedish ICUs but a substantial number of patients and next-of-kin were not involved in the decision-making process or informed of the decision. Women were more often than men engaged in the decision to establish a TL.     

Inequalities in rural health care: differences in surgical intervention between metropolitan and rural Western Australia

BACKGROUND: To compare surgical procedure rates between metropolitan and rural/remote residents in Western Australia (WA). METHODS: The WA Data Linkage System was used to identify all patients who underwent a procedure for cataract, ureteric calculi or urinary outflow obstruction symptoms for the time periods 1981-2000, 1981-1997 and 1981-1995, respectively. Age-standardized procedure rates were calculated and Poisson regression modelling was used to estimate effects of locality of residence and demographic covariates. RESULTS: Overall, rural/remote patients underwent first-time procedures for cataract (IRR 0.92; 95% CI 0.90-0.94), ureteric calculi (0.76; 0.72-0.80), or urinary outflow obstruction (0.71; 0.69-0.74) less frequently than patients in the metropolitan area. They were also significantly less likely to undergo multiple procedures for cataracts (0.90; 0.88-0.91) and ureteric calculi (0.69; 0.67-0.73). CONCLUSION: A distinctly reduced level of surgical intervention was found in rural patients for three generally non-life threatening conditions. The reasons for this require further investigation.     

Management in non-traumatic arm,neck and shoulder complaints: differences between diagnostic groups

Arm, neck and/or shoulder complaints are common in western societies. In the Netherlands, general practice guidelines are issued on shoulder pain and epicondylitis only. Little is known about actual management of the total range of diagnoses. The objectives of the study are: to determine management in patients consulting the GP with a new episode of non-traumatic arm neck and shoulder complaints up to 6 months after the first consultation. To evaluate differences in management between patients with specific diagnoses versus non-specific diagnoses and between specific diagnostic groups. In a prospective cohort study in general practice. We recruited 682 eligible patients. Data on diagnosis, management, patient- and complaint-characteristics were collected. Co-occurrence of treatment options was presented in scaled rectangles. After 6 months, additional diagnostic tests had been performed in 18% of the patients, mainly radiographic examination (14%). Further, 49% had been referred for physiotherapy and 12% to the medical specialist. Patients with specific diagnoses were more frequently referred for specialist treatment, and patients with non-specific diagnoses for physiotherapy. Corticosteroid injections (17%) were mainly applied specific diagnoses (e.g. impingement syndrome, frozen shoulder, carpal tunnel and M. Quervain). Frequencies of prescribed medication (51%) did not differ between specific and non-specific diagnoses. In 19% of the patients no referral, prescribed analgesics or injection was applied. Braces (4%) were mainly prescribed in epicondylitis. Overall, management most frequently consisted of prescribed analgesics and referral for physiotherapy. Specific and non-specific diagnostic subgroups differed in the frequency corticosteroid injections were applied, and referrals to physiotherapy and to a medical specialist.     

Stress, coping, and mental health-seeking behaviors: gender differences in OEF/OIF health care providers

Health care providers (HCPs) are often placed in positions of heightened stress when serving in military operations. As military HCPs have a large number of female providers, there is a concern that gender may influence both risk and resiliency within the health care provider subgroup. The purpose of this secondary analysis of the 2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel (data collected April through August 2005) is to describe stress, coping, and health-seeking behaviors of Operation Enduring Freedom and Operation Iraqi Freedom deployed military health care providers and the role gender may have for both health care officers and specialists. Female HCP responses indicate the lives of these women are significantly impacted by their family responsibilities. Reluctance of females to seek mental health care is concerning with perhaps more concern over career than personal well-being. Findings included (a) concern about performance, odds ratio (OR) = 1.86, 95% confidence interval (CI) [0.43, 8.12] for enlisted females, OR = 2.83, 95% CI [0.31, 25.66] for female officers; (b) problems with money, OR = 1.6 CI [0.69, 3.7] for enlisted females; (c) having a drink to cope, OR = 3.26, 95% CI [0.22, 48.68] for enlisted females; and (d) damage military career to seek mental health care, OR = 1.78, 95% CI [0.59, 5.39] for female officers. Results indicate needed provider awareness concerning mental health-seeking behavior and sensitivity toward gender differences that contribute to unique manifestations of operational stress outcomes.     

Behavioural,cognitive and emotional responses to SARS: differences between college students in Beijing and Suzhou

This research was designed to explore the differences in behaviour, cognition and emotion between college students in Beijing and Suzhou, who were under different external stresses during the severe acute respiratory syndrome (SARS) prevalence time in China from 22 April to 23 June, 2003. A ‘Psychological responses questionnaire on SARS’ designed by the authors was filled out by subjects. A total of 268 valid cases were collected in Beijing through e‐mails or websites, and 397 valid copies were collected in Suzhou through pencil‐and‐paper tests. The two groups differed in their behaviours, cognitions and emotions. Cognitive and behavioural responses of the Beijing sample changed along with the time and the epidemic situation, and so did the negative emotions of the Suzhou sample. Path analysis of the Beijing sample found support for the mediating effects of the cognition on the relationships of stress and the emotional and behavioural responses, while the results of the Suzhou sample did not. Differences between the two samples are discussed. Copyright © 2005 John Wiley & Sons, Ltd.     

Racism,stress and health in Asian Americans: A structural equation analysis of mediation and social support group differences

The buffering effect of social support on the negative effects of racism exposure on health outcomes has been mixed in prior studies regarding Asian Americans. Based on the stress-coping framework and using structural equation modelling (SEM) methods, we tested a theoretical model portraying simultaneous mediational paths from racism exposure to general physical and mental health through racism-related stress. Bootstrap analysis was used to test the indirect effects present in the model. Additionally, multi-group SEM analysis was conducted to investigate the moderation effect of social support from family and friends on the paths in the model. The sample consisted of 310 Asian American adults who completed an online survey. The results from the two-step SEM analysis and bootstrap analysis supported the theoretical model—racism exposure can simultaneously have a negative indirect effect on Asian Americans' physical and mental health via racism-related stress. Multi-group SEM analysis showed that there were no differences in model path coefficients based on having varying levels of social support from friends or family.     

Outcome from intensive care after cardiac arrest: comparison between two patient samples treated in 1986-87 and 1999-2001 in Finnish ICUs

BACKGROUND: The aim of the study was to find out whether the characteristics of patients and the outcome from intensive care after cardiac arrest have changed over time. METHODS: Two nationwide databases were compared: (i) The Finnish National Intensive Care Study data in 1986-87 and (ii) data on 28,640 admissions to Finnish ICUs in 1999-2001. Patients whose reason for ICU admission was cardiac arrest were included. The former study included 604 patients treated in 18 medical and surgical ICUs in and the latter 1036 patients in 25 medical and surgical ICUs. Data on the components of Acute Physiology and Chronic Health Evaluation (APACHE II) were prospectively collected in both study periods. Logistic regression analysis was used to test the independent contribution of the study period on hospital mortality. RESULTS: In 1986-87, patients were younger and the proportion of males was lower than in 1999-2001. The hospital mortality in 1986-87 was 61.3% and in 1999-2001 59.1% (P= 0.396). Among patients aged < 57 years, the hospital mortality in 1986-87 was 62.1% and in 1999-2001 48.8% (P < 0.01). In multivariate analysis, controlling for age, gender, Glasgow coma score (GCS), chronic health evaluation points and source of admission, treatment during 1986-87 was an independent predictor for hospital death among all patients (OR 1.273; 95% CI 1.015-1.594), those aged < 57 years (OR 1.959; 95% CI 1.270-3.021) and among males (OR 1.384; 95% CI 1.050-1.825). CONCLUSION: Since the late 1980s, the outcome from intensive care after cardiac arrest may have improved especially among younger patients and males.     

The association between stress,sense of coherence and subjective health complaints in adolescents: sense of coherence as a potential moderator

The present study investigated the association between domain‐specific stress, sense of coherence (SOC) and subjective health complaints (SHC), as well as the possible moderation effect of SOC on the relationship between stress and SHC. The study is based on responses from 1183 adolescents 13–18 years old. The initial results showed that girls scored higher than boys on all stress domains and on SHC. Conversely, boys reported stronger SOC. Results from the hierarchical multiple regression analysis showed a significant association between increasing stress related to each of the stress domains of peer pressure, home life, school attendance, as well as to a higher level of SHC. SOC was inversely related to SHC. However, no moderation effect of SOC was found. The findings in the present study thus show that stress and SOC are separately associated with SHC. The results support the importance of improving coping efficacy with stress during adolescence. The results also give some preliminary support for the view that promoting salutogenic factors has positive implications in relation to subjective health in adolescents. Copyright © 2010 John Wiley & Sons, Ltd.     

Patient education materials on pressure injury prevention in hospitals and health services in Victoria,Australia: Availability and content analysis

Pressure injuries (PIs) are a common quality indicator for hospital care, and preventing PIs often requires patient engagement; as such, Australian consensus research has recommended that high‐quality education materials be made to patients for PIs via hospital networks. The purpose of the present study was to assess the availability and accuracy of patient education materials on PIs in publicly available hospital websites in Victoria, Australia. Two independent coders assessed 212 websites for content on PI prevention and management, analysing availability and accuracy of PI definitions, risk factors, preventive strategies, referral, visual tools, consumer endorsement, information for family/carers, and translation on community languages. A greater proportion of hospitals did not have any patient education materials on PI prevention publicly available, with private hospitals (compared with public) and metropolitan hospitals (compared to rural) more likely to have materials available on their sites. The available materials contained accurate messages on PI defining characteristics and risk factors for PIs, although there was considerable variability on the availability of other information. Our findings suggest a significant deficit in the availability of educational materials for acute care patients and their families. There is a need for evidence‐based, consumer‐endorsed, uniform materials on all hospital websites to prevent PIs in acute care.     

Stress prevention training: sex differences in types of stressors,coping, and training effects

The present study was aimed at examining the effectiveness of preventive group training and sex differences in types of work stressors, coping strategies, and training effects. Sixty‐eight trainees of stress prevention courses of Regional Institutions for Ambulatory Mental Health Care (RIAGGs) in the Netherlands took part in the study before training (T1), 36 of them after the training (T2), and 3 months later 24 of them (T3). For controlling time effects, a non‐training group was used as the control which had not sought help at a RIAGG nor suffered from stress complaints. Questionnaires were administered at all three time intervals, reflecting health, stress, coping, personality, and perceived job (context) characteristics. After training (T2), the trainees reported significantly less psychological and somatic complaints, less stress, a lower need for recovery after work, the use of more active coping and social support seeking, and a higher capability for managing new situations. The positive effects were maintained at T3. The control group showed no differences between T1 and T2. Women compared with men reported to have less executive tasks and possibilities in their jobs, and less participation and autonomy. Training effects were not affected by being male or female. However, before, as well as after training, women suffered from more health and stress complaints. Future training programmes might be improved by paying attention to sex differences in antecedents as well as consequences of work‐related stress. Copyright © 2001 John Wiley & Sons, Ltd.     

The next stage in the health care economy: aligning the interests of patients,providers, and third-party payers through consumer-driven health care plans

This article reviews employers' attempts over the past 25 years to address the cost and accessibility of health care services for their employees and the effect these efforts have had on U.S. health care delivery. The difficulties in aligning the interests of all parties in a third-party health beneficiary contract are examined. Many employers are considering consumer-driven health care plans as an alternative to managed care plans to both control health care costs and improve employee satisfaction. Such plans differ from fee-for-service and managed care models in terms of the economic alignment of the parties. Consumer-driven plans align the employer's economic interest with the employee/patient, and reduce health benefit costs by providing information, tools, and direct economic incentives to employees for self-management of health care dollars. Because these incentives are designed to reduce the consumption of services, providers are the party left out of economic alignment under the consumer-driven model.     

Gender differences in experiencing occupational stress: the role of age,education and marital status

Studies investigating gender differences over the past two decades have produced contradictory results, with some to indicate no differences, and some suggesting that either men or women experience more psychological stress. In this study, we examine gender differences in occupational stress, taking into consideration the role of marital status, age and education. Results from a sample of 2775 professionals suggest that women experience higher levels of occupational stress than men. Nevertheless, when marital status, age and education were introduced in the equation, no significant gender differences were identified. Implications and future research directions are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

肿瘤科护士工作压力、A型人格、控制源与心理健康的关系研究

目的探讨肿瘤科护士工作压力、A型人格、控制源与心理健康的关系,为肿瘤科护士的压力管理提供依据。方法采用护士工作压力源量表、A型行为问卷(TABP)、工作控制源量表(WLCS)和症状自评量表(SCL-90)对494名肿瘤科护士进行测量。结果不同年龄、科室、工作班次组间部分工作压力比较,差异有统计学意义(P0.05,P0.01);工作压力与心理健康呈显著正相关(P0.05,P0.01);A型人格护士工作压力感最大(64.08±19.42),心理健康水平最低(190.58±70.85);B型人格护士工作压力感最小(45.49±23.22),心理健康水平最高(125.75±35.13);控制源对工作压力和心理健康的影响无统计学意义(均P0.05);A型人格与控制源对护士工作压力及心理健康的影响未呈现交互作用(均P0.05)。结论 A型人格对肿瘤科护士的工作压力及心理健康水平有预测作用,工作压力影响心理健康水平。护理管理者应了解、重视肿瘤科护士的人格特征,制定压力管理措施,增进肿瘤科护士的心理健康,从而提高护士工作效率和护理服务质量。     

Women in midlife: stress, health and life satisfaction

Midlife is filled with challenges and unique stressors for women, which necessitate a greater understanding of the factors that influence their life satisfaction. This study examined the relationship of family strains/changes and weight to life satisfaction, as mediated by family coping, physical activity, sleep and health stress. The findings indicated that women in midlife, who experienced more stressful life changes and had higher body mass index scores, slept fewer hours and had greater health stress, which resulted in lower life satisfaction. These results have implications for family health professionals and programmes that deal with family and health problems, including sleep, weight and stress.     

Breast self-examination: knowledge,attitudes, and practices among female health care workers in Tehran,Iran

A cross-sectional study was conducted to examine the knowledge of breast cancer, attitudes toward breast self-examination (BSE), and practice of BSE among a sample of female health care workers in Tehran, Iran. Using a purposed questionnaire, a total of 410 women from seven health centers completed the questionnaire. The mean age of the respondents was 32.9 years (SD = 9.5), most (58%) were married, and family history of breast cancer was reported by 11%. Seventy-five percent of the women knew about breast cancer prevalence, but only 27% knew that breast pain is not a symptom of breast cancer. Although 73% of women did know that contact with a relative with breast cancer could not lead to development of breast cancer, the respondents' knowledge of risk factors of breast cancer was not satisfactory. With regard to women's attitudes toward BSE, the majority believed that it is not difficult and time consuming or troublesome (63% and 72%, respectively). Sixty-three percent of the respondents claimed that they know how to examine their breasts, but only 6% performed BSE monthly. The practice of BSE was significantly associated with age ( p = 0.01), the level of education ( p < 0.0001), personal history of breast problems ( p < 0.0001), and knowledge of how to examine the breasts ( p < 0.0001). The study findings suggest that the knowledge and behaviors of female health care workers concerning breast cancer is relatively poor and it needs to be improved. Considering the role that health care workers may play in communicating health behaviors to the general public, planning health education interventions for this group of females is essential.