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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 56

Relationship between job stress and fatigue based on job demand-control-support model in hospital nurses


1 Student Research Committee, Department of Occupational Health Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
2 Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran

Date of Submission13-Apr-2017
Date of Acceptance28-Oct-2017
Date of Web Publication06-May-2019

Correspondence Address:
Alireza Choobineh
Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpvm.IJPVM_178_17

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  Abstract 


Background: This study aimed to examine nurses' job stress based on Karasek's demand-control-support model and assess its relationship with different aspects of fatigue. Methods: This cross-sectional study was conducted on 522 nurses working in educational hospitals. Job stress dimensions and fatigue were measured by the Persian version of Job Content Questionnaire (JCQ) and Multidimensional Fatigue Inventory (MFI), respectively. Results: The results showed that psychological and physical job demands obtained high scores, but social support and decision latitude got low scores. MFI results indicated that the highest score was related to the general fatigue. Moreover, the results showed a significant positive relationship between psychological job demands and general fatigue, but a significant negative correlation to reduced activity. Conclusions: Considering the effects of job stress on nurses' fatigue, it is necessary to develop a suitable interventional program for nurses in healthcare centers, especially hospitals, to decrease job stress and improve working conditions.

Keywords: Cross-sectional studies, fatigue, job stress, nurses


How to cite this article:
Jalilian H, Shouroki FK, Azmoon H, Rostamabadi A, Choobineh A. Relationship between job stress and fatigue based on job demand-control-support model in hospital nurses. Int J Prev Med 2019;10:56

How to cite this URL:
Jalilian H, Shouroki FK, Azmoon H, Rostamabadi A, Choobineh A. Relationship between job stress and fatigue based on job demand-control-support model in hospital nurses. Int J Prev Med [serial online] 2019 [cited 2019 Sep 17];10:56. Available from: http://www.ijpvmjournal.net/text.asp?2019/10/1/56/257747




  Introduction Top


In the past decades, job complexities have increased fast in both public and private sectors[1] because workers need to learn many new and complicated things. This has resulted in increase in job demands and job strains in workers in different workplaces, especially healthcare settings, such as nurses, in hospitals.[2] This fast rise in job demands and job strains among workers, especially nurses, can lead to health problems,[3] low productivity,[4] increase in human errors (medical errors),[5] and increase in cost and job turnover.[6]

Studies have indicated that job stress is a critical issue in health and safety of workers in different workplaces.[7],[8] Research has also demonstrated various factors, such as social support, physical and psychological job demands, and decision control, as the risk factors of job stress.[9] These risk factors have been mentioned to be effective in job stress in Karasek's job demand-control-support model. Karasek's model hypothesized that job stress is resulted from the combination of high physical and psychological job demands accompanied by low social support and decision latitude.[10] Furthermore, job stress caused by high psychological job demands can lead to physical and mental problems in working populations in different societies.[7],[11] Researchers believe that this aspect of job strain may be created and increased by poor psychological conditions in workplaces. Thus, job stress can have adverse effects on different aspects of workers' health and life.[12],[13]

Individuals in various jobs suffer from different levels of job stress.[14] Nursing is one of the high-stress jobs and nurses suffer from job stress[15] and its destructive consequences, including fatigue.[16],[17]

Fatigue is defined as a type of physical and mental burnout[18] that is increased as a result of stress,[16] high workload,[19] and some psychosomatic disorders.[20] Fatigue can also occur due to the problems associated with high job demands and low job control.[21] Besides, a continuation of chronic fatigue decreases health status and performance[22] and increases the risk of accidents and job disability.[23],[24]

In the recent years, fatigue has attracted notable attention in occupational health studies. Today's safety and health costs are a small part of the negative consequences of fatigue.[25] Based on epidemiological studies conducted in European Union countries recently, the prevalence of fatigue has increased in workplaces. These studies conducted on 8833 subjects revealed that 22% of the participants suffered from fatigue.[26] Houtman also carried out a study on workers in the Netherlands and reported that 1 out of the 3 cases receiving compensation for job disability was related to psychological and mental disorders with fatigue being the contributing factor.[27]

Furthermore, evidence has indicated the multifactorial etiology of fatigue, with psychological factor playing an important role. For example, the results of a study performed by England National Health Service on workers in 131 different jobs revealed that psychological factors, such as high job demands and role ambiguity, were important in the occurrence of fatigue among workers.[28]

In reviewing the literature, very few studies were found on the association between job stress and fatigue among Iranian nurses. Previous published studies were carried out among healthcare stuff from other countries. This study was therefore conducted to investigate the relationship between job stress dimensions and different aspects of fatigue among Iranian nurses based on Karasek's demand-control-support model.


  Methods Top


Study population and sample selection

The participants were recruited from the nurses working in educational hospitals affiliated to Shiraz University of Medical Science (SUMS), Shiraz, Iran. Totally, 570 questioners were distributed between the nurses, but 522 questioners were completed or returned to researchers (response rate: 92%). Simple random sampling was used to select hospitals, wards, and nurses. First, we listed all educational hospitals affiliated to SUMS. The researchers randomly selected hospitals. The hospitals and wards included Namazi, Faghihi, Hafez, Mother and Child, and Ali-Asghar, and coronary care unit, Intensive Care Unit, emergency, surgery, internal, babies and infants, childbirth, and dialysis, respectively. Then, the researchers distributed the questioners among nurses with BS or above university degree and at least 1 year of job experience. The researchers explained the questioners to subjects, and at the end of shift time, they collected all questioners from different wards.

Data collection tools

In this study, the data were collected through self-report using a demographic questionnaire. It had included some demographic features such as age, sex, marital status, and education level.

Fatigue was assessed by multidimensional fatigue inventory (MFI-20). MFI-20 consists of 20 items in five dimensions. These dimensions include general fatigue (GF), physical fatigue (PF), mental fatigue (MF), reduced motivation (RM), and reduced activity (RA). The items of MFI-20 were scored based on a five-point scale ranging from Yes (true) to No (not true). The reliability and validity of the Persian version of this inventory (P-MFI-20) were assessed and approved by Hafezi et al.,[2] and they reported α = 0.85 and r > 0.7, respectively, for the MFI-20.

Job content questionnaire (JCQ) was used to measure job stress by 27 items in four different dimensions selected from the full version of JCQ. The selected dimensions for this study included psychological job demands (5 items), decision latitude or control (9 items), social support (8 items), and physical job demands (5 items). The items of JCQ were scored using a four-point scale ranging from 1 (strongly disagree or never) to 4 (strongly agree or often). The score of this questionnaire was calculated in accordance with the “JCQ User's Guide.”[29] The Persian version of JCQ (P-JCQ) was previously validated by Choobineh et al.[30] In addition, reliability was calculated using Cronbach's alpha that for decision latitude and psychological job demands scales were 0.54 and 0.58, respectively, and ranged from 0.64 to 0.85 for other scales.[30]

Data analysis

The data were entered into the SPSS statistical software, version 16 and were analyzed using descriptive statistics (mean, standard deviation (SD), maximum and minimum scores, and frequency). Pearson's correlation coefficients among MFI and JCQ scales were calculated. P ≤ 0.05 was considered statistically significant.

Ethical consideration

The vice chancellery for research affairs of SUMS approved the study. Managers and nursing administrators of each hospital gave their permission for the study, and the participants were informed about the protocol and of the study before they gave their consent. The participants were able to withdraw from the study at any time. All participants answered the questionnaires anonymously, and they completed informed consent of SUMS for participation in the current study.


  Results Top


The demographic characteristics of the nurses who participated in the study are presented in [Table 1].
Table 1: The demographic characteristics of the participants (n=522)

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The mean ± SD scores of the scales of the Persian version of JCQ have been presented in [Table 2]. For better comparison of different P-JCQ scales, minimum and maximum attainable scores have been shown, as well.
Table 2: The mean scores of the scales of the Persian version of job content questionnaire (27 items)

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Based on the results presented in [Table 2], higher mean scores of psychological and physical job demands and lower mean scores of decision latitude (control) and social support showed the participants' high levels of job stress.

The mean scores of different scales of MFI-20 are displayed in [Table 3]. The minimum and maximum attainable scores have also been shown for better comparison of the results.
Table 3: The mean scores of the scales of the Persian version of multidimensional fatigue inventory (20 items)

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Based on the results, GF, PF, and MF obtained higher scores in comparison to RM and RA. This indicated a high level of fatigue among the nurses under study.

The correlation between job stress dimensions and different dimensions of fatigue is presented in [Table 4].
Table 4: Pearson's correlation between the scales of job content questionnaire and multidimensional fatigue inventory

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The results of Pearson's correlation revealed a significant positive relationship between psychological and physical job demands and GF. However, a significant negative correlation was found between psychological job demand and RM. A stronger negative correlation was also observed between psychological job demand and RA. Moreover, the results showed a significant negative association between decision latitude and physical job demand and RA.


  Discussion Top


Based on the results presented in [Table 2] and demand-control-support model, high score of psychological job demand and low scores of social support and decision latitude (control) indicated that most of the nurses under study were in the isometric situation that, from macro ergonomic perspective, was the worst situation.[31],[32],[33] This implied that the study nurses experienced high levels of job stress. High job stress among hospital healthcare workers, especially Iranian nurses, can be attributed to various reasons, including responsibility for patient safety, high workload, low payment, working environment, and low experience in young nurses.[34]

It is to be noted that the pattern of scores obtained in the present study was similar to that of Barzideh et al. study which was conducted on Shiraz city hospital nurses, Iran, in 2014.[31] For instance, the mean score of psychological job demands in the current study (37.4 ± 5.8) was close to that of Barzideh et al.(38.19 ± 5.14).[31] The same holds true for social support mean score (23 ± 4.8) for the present study versus 22.67 ± 3.67 for Barzideh et al. Moreover, finally, the mean score of decision latitude in the present study (65.3 ± 7.61) was relatively close to that of Barzideh et al. (58.18 ± 6.5).[31]

The findings of the present study showed that the mean scores of GF, MF, and PF were higher compared to the two other dimensions of fatigue. Thus, it could be concluded that the nurses suffered from high levels of fatigue.[5] This problem can have negative effects on different aspects of nurses' life, such as social and working life. In other words, fatigue in nurses can be an important problem with distractive consequences, such as medical errors and physical and psychological diseases. Researchers have also demonstrated that fatigue and its different subscales are influenced by some parameters including job stress,[17] shift work,[35] and adverse work conditions in patient care.[5] In addition, job stress and fatigue can have undesirable impacts on nurses' physical and psychological health, eventually influencing important issues, such as efficiency and patient safety (medical errors caused by human errors).[5]

These results are in agreement with Hafezi's et al.[2] findings which showed the mean score PF, MF, and RM for the graduate students were close to those of our study (10.84 ± 2.92 vs. 10.5 ± 3.3, 9.83 ± 3.23 vs. 10.9 ± 2.2, and 9.9 ± 3.02 vs. 9.6 ± 2.4, respectively).

Based on other studies conducted on job stress and fatigue, we hypothesized that job stress was one of the important contributing factors in the prevalence of physical and psychological disorders and problems, such as physical, mental, and GF.[36] Therefore, the main aim of this study was evaluation of the relationship between job stress dimensions based on Karasek's model and different aspects of fatigue (GF, PF, MF, RA, and RM). According to [Table 4] results and kind of correlation founded between job stress and fatigue dimensions, we can conclude these results are reasonable because high physical job demands increase activity and can finally lead to PF. Moreover, the combination of physical and psychological job demands can result in high GF.[37]

Based on the results presented in [Table 4], negative relationships were found between decision latitude (control) and all dimensions of fatigue. Yet, decision latitude showed a stronger negative association with RA followed by RM and PF. These findings were in accordance with those of a previous study.[38] This implies that if nurses have more decision control on the task, they will have more motivation for doing their responsibilities. This, in fact, increases the nurses' physical activities for doing the job and improves their morale for doing their duties.

The current study findings also showed a negative correlation between social support and GF, PF, and MF. Nevertheless, only the relationship between social support and GF was statistically significant. This indicates that different dimensions of fatigue are related to individuals rather than other workplace conditions, such as coworker support and supervisor support. Therefore, social support and its subscales do not have an important effect on fatigue decrement.[17]

The results of Pearson's correlation test revealed that as physical job demand increased, RA and RM decreased, but the relationship was only significant regarding RA. In addition, a significant reverse relationship was observed between RA and RM and psychological job demand. These results were similar to those obtained in a previous study.[17] Based on these findings, it is highly necessary to find an answer to the following question: “Why does physical and psychological job demands increment lead to RM and RA decrement.”

Most of the previous studies showed that decision latitude (control) in jobs led to an increase in motivation and activity. However, Hackman and Oldham reported that autonomy resulted in a decrease in intrinsic motivation and concluded that autonomy had a destructive effect on motivation.[39] Yet, this issue is more complicated because activity and motivation are under the influence of different aspects of job stress based on Karasek's model. Therefore, in jobs with critical situations where job demands (physical and psychological) and decision latitude are both high, job strain increases because individuals who are allowed to make decisions in critical and high-risk jobs have great concerns related to making certain and safe decisions and planning correctly for doing their jobs.[17] In such situations, individuals have to increase their activity and motivation for doing the job with high quality and low errors rate. Van Yperen and Hagedoorn also concluded in their study that high job demands led to fatigue.[17] In this respect, nurses are not exceptions because they are highly responsible for their patients' lives.[38],[39]

In high-stress jobs with high physical and psychological job demands and low decision latitude, such as nursing, due to lack of time for recovery, the signs of fatigue may be more apparent compared to jobs with high job demands, and high decision latitude. Furthermore, if social support is low, the effects of job stress on fatigue will be more obvious.[17]

Van Yperen and Hagedoorn stated that in cases of low decision latitude, high job demands were associated with higher levels of fatigue. However, they found no significant relationship between high job demands and motivation.[17] Given the cross-sectional nature of the study and self-report method for data collection, the findings should be interpreted cautiously. This type of methodology for data collection has weak points such as recall bias, deception, and denial. However, in the present study by taking large sample size, we tried to modify these types of shortcomings.


  Conclusions Top


Considering the effects of job stress on nurses' fatigue, it is necessary to develop a suitable interventional program for nurses in healthcare centers, especially hospitals, to decrease job stress and improve working conditions.

Acknowledgments

This study was financially supported by SUMS (grant No. 93-01-42-7692). Hereby, the authors wish to thank all the managers and nursing staff of SUMS for their cooperation in this study. They are also grateful for Ms. A. Keivanshekouh at the Research Improvement Center of SUMS for preparing the use of English version of manuscript.

Financial support and sponsorship

This study was financially supported by SUMS (grant No. 93-01-42-7692).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Karasek R, Theorell T. Healthy Work: Stress, Productivity, and the Reconstruction of Working Life. New York: Basic Books; 1992.  Back to cited text no. 1
    
2.
Hafezi S, Zare H, Mehri SN, Mahmoodi H, editors. The Multidimensional Fatigue Inventory Validation and Fatigue Assessment in Iranian Distance Education Students. 4th ed. International Conference on Distance Learning and Education; 2010.  Back to cited text no. 2
    
3.
Carugno M, Pesatori AC, Ferrario MM, Ferrari AL, Silva FJ, Martins AC, et al. Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses. Cad Saude Publica 2012;28:1632-42.  Back to cited text no. 3
    
4.
Thirumakkal M. A study on role of occupational stress on employees productivity. Int J Manage 2015;6:560-72.  Back to cited text no. 4
    
5.
Saremi M, Fallah MR. Subjective fatigue and medical errors among nurses in an educational hospital. Iran Occup Health 2013;10:1-8.  Back to cited text no. 5
    
6.
Hayes LJ, O'Brien-Pallas L, Duffield C, Shamian J, Buchan J, Hughes F, et al. Nurse turnover: A literature review - An update. Int J Nurs Stud 2012;49:887-905.  Back to cited text no. 6
    
7.
Moustaka A, Constantinidis TC. Sources and effects of work-related stress in nursing. Health Sci J 2010;4:210-16.  Back to cited text no. 7
    
8.
Peltzer K, Shisana O, Zuma K, Van Wyk B, Zungu-Dirwayi N. Job stress, job satisfaction and stress-related illnesses among South African educators. Stress Health 2009;25:247-57.  Back to cited text no. 8
    
9.
Nieuwenhuijsen K, Bruinvels D, Frings-Dresen M. Psychosocial work environment and stress-related disorders, a systematic review. Occup Med (Lond) 2010;60:277-86.  Back to cited text no. 9
    
10.
Häusser JA, Mojzisch A, Niesel M, Schulz-Hardt S. Ten years on: A review of recent research on the job demand – control (-Support) model and psychological well-being. Work Stress 2010;24:1-35.  Back to cited text no. 10
    
11.
Palmer S, Cooper C. How to Deal with Stress. Croydon: Kogan Page; 2013.  Back to cited text no. 11
    
12.
Arsalani N, Fallahi-Khoshknab M, Josephson M, Lagerström M. Musculoskeletal disorders and working conditions among Iranian nursing personnel. Int J Occup Saf Ergon 2014;20:671-80.  Back to cited text no. 12
    
13.
Menzel NN. Psychosocial factors in musculoskeletal disorders. Crit Care Nurs Clin North Am 2007;19:145-53.  Back to cited text no. 13
    
14.
Johnson S, Cooper C, Cartwright S, Donald I, Taylor P, Millet C. The experience of work-related stress across occupations. J Manage Psychol 2005;20:178-87.  Back to cited text no. 14
    
15.
Jones CB. Revisiting nurse turnover costs: Adjusting for inflation. J Nurs Adm 2008;38:11-8.  Back to cited text no. 15
    
16.
Barker LM, Nussbaum MA. Fatigue, performance and the work environment: A survey of registered nurses. J Adv Nurs 2011;67:1370-82.  Back to cited text no. 16
    
17.
Van Yperen NW, Hagedoorn M. Do high job demands increase intrinsic motivation or fatigue or both? The role of job control and job social support. Acad ManageJ 2003;46:339-48.  Back to cited text no. 17
    
18.
Sliter M. Hurting those who help: Development and validation of a victim conflict scale. J Behav Health 2015;4:22-7.  Back to cited text no. 18
    
19.
Arellano JL, Martínez JA, Perez JN, Alcaraz JL. Relationship between workload and fatigue among mexican assembly operators. Int J Phys Med Rehabil 2015;3:1-6.  Back to cited text no. 19
    
20.
Harvey SB, Wessely S, Kuh D, Hotopf M. The relationship between fatigue and psychiatric disorders: Evidence for the concept of neurasthenia. J Psychosom Res 2009;66:445-54.  Back to cited text no. 20
    
21.
Tang FC, Li RH, Huang SL. The association between job-related psychosocial factors and prolonged fatigue among industrial employees in Taiwan. PLoS One 2016;11:e0150429.  Back to cited text no. 21
    
22.
Phillips RO. A review of definitions of fatigue – And a step towards a whole definition. Transp Res Part F Traffic Psychol Behav 2015;29:48-56.  Back to cited text no. 22
    
23.
Marcus JH, Rosekind MR. Fatigue in transportation: NTSB investigations and safety recommendations. Inj Prev 2017;23:232-8.  Back to cited text no. 23
    
24.
Ehsani SR, Cheraghi MA, Nejati A, Salari A, Esmaeilpoor AH, Nejad EM, et al. Medication errors of nurses in the emergency department. J Med Ethics Hist Med 2013;6:11.  Back to cited text no. 24
    
25.
Ricci JA, Chee E, Lorandeau AL, Berger J. Fatigue in the U.S. workforce: Prevalence and implications for lost productive work time. J Occup Environ Med 2007;49:1-10.  Back to cited text no. 25
    
26.
Bültmann U, Kant IJ, Van den Brandt PA, Kasl SV. Psychosocial work characteristics as risk factors for the onset of fatigue and psychological distress: Prospective results from the maastricht cohort study. Psychol Med 2002;32:333-45.  Back to cited text no. 26
    
27.
Houtman I. Feiten en fabels op een rij. Werkdruk in cijfers (Work pace in numbers). Arbeidsomstandigheden 1999;75:2-5.  Back to cited text no. 27
    
28.
Hardy GE, Shapiro DA, Borrill CS. Fatigue in the workforce of national health service trusts: Levels of symptomatology and links with minor psychiatric disorder, demographic, occupational and work role factors. J Psychosom Res 1997;43:83-92.  Back to cited text no. 28
    
29.
Karasek RA. Job Content Questionnaire and User's Guide. Lowell, Massachusetts: Department of Work Environment, University of Massachusetts; 1985.  Back to cited text no. 29
    
30.
Choobineh A, Ghaem H, Ahmedinejad P. Validity and reliability of the persian (Farsi) version of the job content questionnaire: A study among hospital nurses. East Mediterr Health J 2011;17:335-41.  Back to cited text no. 30
    
31.
Barzideh M, Choobineh AR, Tabatabaee HR. Job stress dimensions and their relationship to musculoskeletal disorders in Iranian nurses. Work 2014;47:423-9.  Back to cited text no. 31
    
32.
Engels JA, van der Gulden JW, Senden TF, van't Hof B. Work related risk factors for musculoskeletal complaints in the nursing profession: Results of a questionnaire survey. Occup Environ Med 1996;53:636-41.  Back to cited text no. 32
    
33.
Ando S, Ono Y, Shimaoka M, Hiruta S, Hattori Y, Hori F, et al. Associations of self estimated workloads with musculoskeletal symptoms among hospital nurses. Occup Environ Med 2000;57:211-6.  Back to cited text no. 33
    
34.
Lotfizadeh M, Moazen B, Habibi E, Hassim N. Occupational stress among male employees of esfahan steel company, Iran: Prevalence and associated factors. Int J Prev Med 2013;4:803-8.  Back to cited text no. 34
    
35.
Yumang-Ross DJ, Burns C. Shift work and employee fatigue: Implications for occupational health nursing. Workplace Health Saf 2014;62:256-61.  Back to cited text no. 35
    
36.
Akerstedt T, Knutsson A, Westerholm P, Theorell T, Alfredsson L, Kecklund G, et al. Mental fatigue, work and sleep. J Psychosom Res 2004;57:427-33.  Back to cited text no. 36
    
37.
Karasek Jr RA. Job demands, job decision latitude, and mental strain: Implications for job redesign. Adm Sci Q 1979:285-308.  Back to cited text no. 37
    
38.
Richer SF, Vallerand RJ. Supervisors' interactional styles and subordinates' intrinsic and extrinsic motivation. J Soc Psychol 1995;135:707-22.  Back to cited text no. 38
    
39.
Hackman JR, Oldham GR. Work redesign. Reading, MA: Addison-Wesley; 1980.  Back to cited text no. 39
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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