Investigating the role of organizational stress in nurses' psychosomatic complaints: Evidence from a study in northeastern Italy.

Background: Nursing is pivotal to healthcare delivery but is often associated with high levels of organizational stress. In this cross-sectional study, we aimed to investigate the associations between exposure to organizational stressors, measured using the Health and Safety Executive Management Standards Indicator Tool, and psychosomatic complaints among nurses in a medium-sized city hospital in northeastern Italy. Methods: A total of 215 nurses participated in the study, completing self-report questionnaires assessing organizational stressors and the prevalence of psychosomatic complaints experienced over the preceding six months. Results: Significant associations were observed between various organizational stressors and psychosomatic complaints among nurses. Specifically, the Relationships factor emerged as a significant predictor of palpitations, irritability, anxiety, physical and mental tiredness, and headache. Additionally, Demands and Managers' support were identified as significant predictors of specific psychosomatic complaints. Conclusion: This study highlights the critical role of addressing organizational stressors, particularly those related to interpersonal relationships, in promoting nurse well-being and optimizing patient care delivery. Despite its strengths, including the use of a well-established measurement tool and a comprehensive assessment of psychosomatic complaints, limitations such as the cross-sectional design and self-report measures warrant consideration. By prioritizing supportive work environments and implementing targeted interventions, healthcare organizations can cultivate a culture of well-being among nurses, ultimately enhancing the quality and safety of healthcare delivery.

Mental wellbeing and psychosocial working conditions of autistic veterinary surgeons in the UK.

BACKGROUND: Certain autistic characteristics (such as hyper-focus and attention to detail) are valued by veterinary surgeons and autistic adults may disproportionately self-select into the profession. Links between mental wellbeing and retention in the veterinary profession highlight an imperative to profile autistic veterinary surgeons' mental wellbeing and identify protective factors. The psychosocial work environment may represent one such protective factor. We aimed to assess autistic veterinary surgeons' mental wellbeing, the extent to which their psychosocial working conditions achieved UK government management standards and links between these. METHODS: Eighty-five autistic veterinary surgeons completed the Warwick-Edinburgh Mental Wellbeing Scale and the Health and Safety Executive's Management Standards Indicator Tool. Descriptive comparisons were drawn with normative data; correlation and linear regression analyses examined relations between mental wellbeing and psychosocial working conditions. RESULTS: Mental wellbeing and psychosocial work environment quality were markedly below veterinary surgeon and general workforce norms. Psychosocial working conditions accounted for 44% of the unique variance in mental wellbeing, with 'control' and 'role' making a significant contribution. LIMITATION: This exploratory study involved a small self-selecting sample, raising the possibility of response bias. CONCLUSION: Work design centred on the enhancement of control and role clarity would likely support mental wellbeing in this population.

Worker Protection Scenarios for General Analytical Testing Facility under Several Infection Propagation Risks: Scoping Review, Epidemiological Model and ISO 31000.

Infectious disease is a risk threating industrial operations and worker health. In gastrointestinal disease cases, outbreak is sporadic, and propagation is often terminated within certain populations, although cases in industrial sites are continuously reported. The ISO 31000 international standard for risk management, an epidemiological triad model, and a scoping review were the methods used to establish response procedures (scenarios) to protect workers from the risk of the propagation of a gastrointestinal disease. First, human reservoirs and transmission routes were identified as controllable risk sources based on a scoping review and the use of a triad model. Second, the possibility of fomite- or surface-mediated transmission appeared to be higher based on environmental characterization. Thus, the propagation could be suppressed using epidemiological measures categorized by reservoirs (workers) or transmission routes during a primary case occurrence. Next, using results of a matrix, a strengths-weaknesses-opportunities-threats analysis and a scoping review, the risk treatment option was determined as risk taking and sharing. According to epidemiology of gastrointestinal infections, systematic scenarios may ensure the efficacy of propagation control. Standardized procedures with practicality and applicability were established for categorized scenarios. This study converged ISO 31000 standards, an epidemiological model, and scoping review methods to construct a risk management scenario (non-pharmaceutical intervention) optimized for the unique characteristics of a specific occupational cluster.

A multi-method quality improvement approach to systematically improve and promote the quality of national health and social care information.

Safe and reliable healthcare depends on access to health information that is accurate, valid, reliable, timely, relevant, legible and complete. National data collections are repositories of health and social care data and play a crucial role in healthcare planning and clinical decision-making. We describe the development of an evidence-informed multi-method quality improvement program aimed to improve the quality of health and social care data in Ireland. Specific components involved: development of guidance to support implementation of health information standards; review program to assess compliance with standards; and educating health information stakeholders about health data and information quality. Observations from implementation of the program indicate enhanced health information stakeholder awareness of, and increased adoption of information management standards. The methodology used in the review program has proved to be a robust approach to identify areas of good practice and opportunities for improvement in information management practices. There has been positive adoption of the program among organisations reviewed and acceptance of the proposed recommendations. Early indications are that this multi-method approach will drive improvements in information management practices, leading to an improvement in health and social care data quality in Ireland. Aspects of this approach may be adapted to meet the needs of other countries.

[Beyond the assessment of work-related stress risk: the management standards approach for organizational wellbeing.] / Oltre la valutazione del rischio stress lavoro-correlato: l'approccio dei Management Standards per il benessere organizzativo.

SUMMARY: La valutazione approfondita del rischio stress lavoro-correlato (SLC), oltre a soddisfare un obbligo normativo, rappresenta un momento per riflettere sulle condizioni di salute di un'organizzazione e sugli elementi su cui intervenire per migliorarle. Nel presente contributo vengono riportati i risultati ottenuti dalla valutazione approfondita dello SLC condotta in un'azienda di facility management tramite la somministrazione dell'HSE Management Standards Indicator Tool (HSE-MS IT) e ulteriori misure atte a valutare lo stress percepito, la soddisfazione lavorativa e la motivazione al lavoro. Hanno partecipato allo studio 196 operai di un'azienda che si occupa di pulizie ospedaliere, industriali e civili. Dalla valutazione approfondita è emersa la presenza di rischio nelle dimensioni Domanda, Relazioni, e Supporto dei Colleghi e di rischio grave nella dimensione Controllo. L'analisi delle correlazioni e delle regressioni multiple hanno permesso di identificare le aree organizzative significativamente associate allo stress percepito, alla soddisfazione lavorativa e alla motivazione. Tramite modelli di path analysis si è inoltre valutato l'effetto diretto e indiretto dei Management Standards su queste tre misure di output. Domanda, Controllo e Relazioni hanno un effetto diretto sullo stress percepito, mentre il Supporto dei Colleghi e il Supporto dei Superiori influiscono rispettivamente sulla soddisfazione e sulla motivazione al lavoro. Lo stress percepito ha inoltre un effetto diretto sulla soddisfazione lavorativa, che a sua volta influenza la motivazione al lavoro. In conclusione, una valutazione approfondita del rischio SLC che integri il tradizionale approccio basato sui Management Standards considerando ulteriori misure di benessere organizzativo costituisce un'occasione utile per identificare non solo i fattori che possono produrre SLC, ma anche le aree di gestione che possono incidere su dimensioni, quali ad esempio la motivazione e la soddisfazione lavorativa, che contribuiscono criticamente al benessere complessivo di un'azienda.

Home Blood Pressure Monitoring in Cases of Clinical Uncertainty to Differentiate Appropriate Inaction From Therapeutic Inertia.

PURPOSE: Conventional clinic blood pressure (BP) measurements are routinely used for hypertension management and physician performance measures. We aimed to check home BP measurements after elevated conventional clinic BP measurements for which physicians did not intensify treatment, to differentiate therapeutic inertia from appropriate inaction. METHODS: We conducted a pre and post study of home BP monitoring for patients with uncontrolled hypertension as determined by conventional clinic BP measurements for which physicians did not intensify hypertension management. Physicians were notified of average home BP 2-4 weeks after the initial clinic visit. Outcome measures were the proportion of patients with controlled hypertension using average home BP measurements, changes in hypertension management by physicians, changes in physicians' hypertension metrics, and factors associated with home-clinic BP differences. RESULTS: Of 90 recruited patients who had elevated conventional clinic BP recordings, 65.6% had average home BP measurements that were <140/90 mm Hg. Physicians changed treatment plans for 61% of patients with average home BP readings of ≥140/90 mm Hg, whereas decisions to not change treatment for the remaining patients were based on contextual factors. Substituting average home BP for conventional clinic BP for 4% of patients from 2 physicians' hypertension registries improved the physicians' hypertension control rates by 3% to 5%. Greater body mass index and increased number of BP medications were associated with home BP measurement ≥140/90 mm Hg. Clinic BP levels did not estimate normal home BP levels. CONCLUSIONS: Documented home BP in cases of clinical uncertainty helped differentiate therapeutic inertia from appropriate inaction and improved physicians' hypertension metrics.

Assessing the Risk of Stress in Organizations: Getting the Measure of Organizational-Level Stressors.

Great Britain's Health and Safety Executive (HSE) developed the Management Standards Indicator Tool to help organizations to assess and monitor organizational risks of work-related stress through surveying employees about the psychosocial risks for stress in their jobs. The use of employee-level data for deriving an organizational-level measure of psychosocial risks assumes that the constructs have equivalent meanings at different levels. However, this isomorphic condition has never been tested and this study fills this gap. Using data collected by the Italian Workers' Compensation Authority (INAIL) from 66,188 employees nested in 775 organizations, we demonstrate that the organizational-level measure representing the seven dimensions of the Management Standards Indicator Tool is equivalent, though not identical, to the individual-level measure. This implies that the organizational level is not a mirror of the aggregation of the individual level, and that the risk of work-related stress in an organization may derive not simply from bottom-up processes, but may be generated by top-down influences (e.g., organizational policies). Interventions may then be meaningfully targeted at the organizational level in the expectation that they will reduce the risk of work-related stress among the entire workforce, the valid measurement of which can be performed through the HSE's Management Standards Indicator Tool.

Implementation of Standards for Managing Pharmaceutical, Medical Devices and Disposable Medical Materials in Community Pharmacy in Medan City.

BACKGROUND: The implementation of pharmacy service standards is a way to implement the practice philosophy, which in essence aims to protect the public from unprofessional pharmaceutical services. The Indonesians standard of pharmacy services has been updated several times according to the development of legal requirements in the community pharmacy setting. AIM: This study aimed to evaluate the implementation of pharmacy service standards for managing pharmaceuticals, medical devices and disposable medical materials at pharmacies. METHODS: The study was conducted with a descriptive method using a cross sectional survey research design, with a checklist as an instrument for retrieving variable data on pharmaceutical services at pharmacies in the city of Medan, Indonesia. The study was conducted from July to November 2018. RESULTS: The overall standard implementation from 99 pharmacies showed that 72 pharmacies were at a good level (72.72%), fair level as many as 26 pharmacies (26.26%) and 1 pharmacy in bad level (1.02%). CONCLUSION: The study result revealed that even though the level of implementation was good but there were some elements that have high level of "done but not documented" (especially in planning and destruction/withdrawal standards). There were many aspects that must be improved especially the documentation aspect and require cooperation from all relevant parties.

Management protocols for chronic heart failure in India.

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient's quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

[Diagnostic and treatment standards for cerebral sinus venous thrombosis : Results of an online survey of German stroke units]. / Diagnose- und Behandlungsstandards der zerebralen Sinus­/Venenthrombose : Ergebnisse einer Onlineumfrage an deutschen Stroke-Units.

BACKGROUND AND PURPOSE: The aim of this survey was to characterize the current diagnostic and therapeutic strategies for thrombosis of the cerebral sinus and veins (CVT) performed in German stroke units (SU). METHODS: Between September 2015 and January 2016 all clinical heads of certified SUs in Germany were invited to participate in a standardized online survey. The survey concentrated on the basic characteristics of SUs, diagnostic and therapeutic procedures and was made anonymous if so desired. Frequencies were expressed as percentages and differences between regional stroke units (RSU) and supraregional (i. e. comprehensive) SUs (SRSU) were compared with the χ2-test or Fisher's test RESULTS: A total of 107 SU heads participated (response rate 42.8%) and 55.1% of these were RSUs. In 77.2% the diagnosis is made by magnetic resonance imaging angiography (MR-A, RSU 81.1% vs. SRSU 72.3%; p = 0.29). Of the SUs 79.1% determined d­dimer if CVT is suspected (79.3% vs. 78.7%; p = 0.94) and 88.5% carried out screening for thrombophilia (89.5% vs. 87.2%; p = 0.72). Intravenous unfractionated heparin (67.2% vs. 70.2%; p = 0.74) or subcutaneous low molecular weight heparin (32.8% vs. 29.8%; p = 0.74) are first line therapy in all SUs. Invasive procedures, such as hypothermia (3.7% vs. 10.6%; p = 0.25), hemicraniectomy (26% vs. 63.9%; p = 0.0001), endovascular techniques (11.1% vs. 40.4%; p = 0.0007) and systemic thrombolysis (5.5% vs. 10.6%; p = 0.47) are performed more frequently in SRSUs. Of the SUs 18.5% already use new oral anticoagulants (10.7% vs. 27.7%; p = 0.027). Most of the SUs organize a follow-up visit (70.9% vs. 76.6%; p = 0.52) with a MRI (94.2% vs. 91.1%; p = 0.7) within the first 6 months. CONCLUSION: The survey revealed substantial homogeneity between RSUs and SRSUs and standards are mostly in line with the guidelines. Non-established procedures, such as invasive therapeutic procedures and the administration of new oral anticoagulants were used significantly more often in SRSUs.

Psychometric properties of the Irish Management Standards Indicator Tool.

BACKGROUND: Work Positive is Ireland's national policy initiative to control work-related stress. Since the introduction of the UK Health and Safety Executive's Management Standards (MS) in 2004, a number of studies have been undertaken to assess the potential adaptation of the MS framework within Ireland. AIMS: To investigate the dimensionality, reliability and validity of the Irish version of the MS Indicator Tool (ROI-MSIT). METHODS: Between February 2011 and June 2014, we collected data from a wide range of public and private sector organizations that used the ROI-MSIT. In addition to the ROI-MSIT, respondents completed the WHO-Five Well-being Index (WHO-5). Exploratory factor analysis (EFA) was used to determine whether the ROI-MSIT maintained the structure of the UK instrument. The internal consistency of the ROI-MSIT was also assessed to determine its reliability, while its criterion-related validity was explored through correlation analysis with the WHO-5. RESULTS: Data were collected from 7377 participants. The factor structure of the ROI-MSIT consisted of six factors; the Demands, Control, Peer Support, Relationships and Role factors were equivalent to the original UK factors. Like the Italian version, a principal factor emerged that combined the Manager Support and Change domains. Cronbach's alpha scores ranged from 0.75 to 0.91. Finally, the ROI-MSIT's subscales and WHO-5 were positively correlated (r = 0.42-0.59, P < 0.001). CONCLUSIONS: The ROI-MSIT is reliable and valid, with a factor structure similar to the original UK instrument and the Italian MSIT. Further psychometric evaluation of the ROI-MSIT is recommended.

Psychometric Properties of a 36-Item Version of the "Stress Management Competency Indicator Tool".

The development of supervisors' behaviours has been proposed as an innovative approach for the reduction of employees' work stress. The UK Health and Safety Executive (HSE) developed the "Stress Management Competency Indicator Tool" (SMCIT), designed to be used within a learning and development intervention. However, its psychometric properties have never been evaluated, and the length of the questionnaire (66 items) limits its practical applicability. We developed a brief 36-item version of the questionnaire, assessed its psychometric properties and studied the relationship with the employees' psychosocial work environment. 353 employees filled in the brief SMCIT and the "Stress Management Indicator Tool". The latter is a self-report questionnaire developed by the UK HSE, measuring workers' perceptions of seven dimensions of the psychosocial work environment that if not properly managed can lead to harm. Data were analysed with structural equation modelling and multiple regressions. The results confirmed the factorial structure of the brief SMCIT questionnaire and mainly supported the convergent validity and internal consistency of the scales. Furthermore, with few exceptions, the relations hypothesized between supervisors' competencies and the psychosocial work environment were confirmed, supporting the criterion validity of the revised questionnaire and the UK HSE framework. We conclude that the brief 36-item version of the SMCIT represents an important step toward the development of interventions directed at supervisors and we discuss the practical implications for work stress prevention.

Age-related effects of job characteristics on burnout and work engagement.

BACKGROUND: In light of an ageing and age-diverse workforce, it is imperative to understand how psychosocial aspects of work might influence health throughout working life. Recently, there has been an implicit call to differentiate job characteristics beyond the two factors of job demands and job resources. As needs, abilities and motivation fluctuate with age, different job characteristics might yield differential benefits. Additionally, markers beyond chronological age should be considered. AIMS: To explore systematically interactions between different job characteristics, age and age covariates (i.e. job tenure and position type) and their relationship with work-related health outcomes. METHODS: An online survey of workers in Switzerland, Austria and Germany, recruited through a panel data service provider. We excluded participants working fewer than 30 hours a week, trainees, self-employed people and senior managers. We assessed seven areas of psychosocial risks at work, burnout, work engagement and demographics. RESULTS: Of the 6000 workers contacted, 1916 responded (31%). After applying exclusion criteria, we analysed data from 1417 respondents. We found that age barely had a moderating effect between psychosocial factors and health outcomes, but its three-way interaction with age covariates had more explanatory potential. Young workers with high job tenure showed particular vulnerability to job demands and the lack of certain job resources. Older workers with managerial positions were more resilient. CONCLUSIONS: Age and its covariates, such as job tenure and position type, should be considered in developing age-sensitive occupational health models.

Management standards for stable coronary artery disease in India.

Coronary artery disease (CAD) is one of the important causes of cardiovascular morbidity and mortality globally, giving rise to more than 7 million deaths annually. An increasing burden of CAD in India is a major cause of concern with angina being the leading manifestation. Stable coronary artery disease (SCAD) is characterised by episodes of transient central chest pain (angina pectoris), often triggered by exercise, emotion or other forms of stress, generally triggered by a reversible mismatch between myocardial oxygen demand and supply resulting in myocardial ischemia or hypoxia. A stabilised, frequently asymptomatic phase following an acute coronary syndrome (ACS) is also classified as SCAD. This definition of SCAD also encompasses vasospastic and microvascular angina under the common umbrella.

Employee engagement and management standards: a concurrent evaluation.

BACKGROUND: The UK Health & Safety Executive's Management Standards Indicator Tool (MSIT) has been used to assess areas of work design, which may act as psychosocial hazards leading to burnout. These have not been assessed as predictors of employee engagement. AIMS: To determine the utility of the MSIT in evaluating employee engagement as measured by the Utrecht Work Engagement Scale (UWES). METHODS: A cross-sectional survey of employees from two sales organizations in London was performed using the MSIT and UWES. MSIT scores were analysed stratifying medium-high versus low engagement. Multivariate linear regression evaluated the association of all MSIT scores with UWES factors. RESULTS: Control, managerial support, peer support and employee role differed by engagement level. Demands, peer support and role exceeded MSIT benchmark guidance that would warrant urgent improvement. Role ambiguity was the only factor significantly associated with all subdomains of engagement. CONCLUSIONS: Role appears to play a major part in determining employee engagement. Assessment of the relationship between factors measured by the MSIT and UWES requires further investigation in wider organizational settings, particularly the influence of employee role on positive psychological outcomes.

Primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction in a patient taking dabigatran for chronic anticoagulation.

Interventional cardiologists have few data on which to base clinical decisions regarding optimal care for ST-segment-elevation myocardial infarction patients who are taking therapeutic chronic oral anticoagulation. We present what we believe to be the first reported case of emergency coronary angiography and primary percutaneous coronary intervention in an ST-segment-elevation myocardial infarction patient who was on a dabigatran regimen for atrial fibrillation. The patient tolerated the procedures well and had no observable bleeding sequelae. In addition to the patient's case, we discuss the current evidence regarding the periprocedural management of oral anticoagulation in patients who need coronary angiography and percutaneous coronary intervention.

Psychosocial work environment and leisure-time physical activity: the Stormont study.

BACKGROUND: Research findings on the relationship between the psychosocial work environment and leisure-time physical activity (LTPA) are equivocal. This might partly be due to studies having focused on a restricted set of psychosocial dimensions, thereby failing to capture all relevant domains. AIMS: To examine cross-sectional associations between seven psychosocial work environment domains and LTPA in a large sample of UK civil servants and to profile LTPA and consider this in relation to UK government recommendations on physical activity. METHODS: In 2012 Northern Ireland Civil Service employees completed a questionnaire including measures of psychosocial working conditions (Management Standards Indicator Tool) and LTPA. We applied bivariate correlations and linear regression analyses to examine relations between psychosocial working conditions and LTPA. RESULTS: Of 26000 civil servants contacted, 5235 (20%) completed the questionnaire. 24% of men and 17% of women reported having undertaken 30min or more of physical activity on five or more days in the past week. In men, job control (-0.08) and peer support (-0.05) were weakly but significantly negatively correlated with LTPA, indicating that higher levels of exposure to these psychosocial hazards was associated with lower levels of LTPA. Job role (-0.05) was weakly but significantly negatively correlated with LTPA in women. These psychosocial work characteristics accounted for 1% or less of the variance in LTPA. CONCLUSIONS: Longitudinal research to examine cause-effect relations between psychosocial work characteristics and LTPA might identify opportunities for psychosocial job redesign to increase employees' physical activity during leisure time.

Ballet and stress. A pilot study.

BACKGROUND: Work-related stress is a complex problem requiring a work environment-based assessment. Artists like dancers represent a category of atypical workers potentially at high risk for work-related stress. Aim of our pilot study is to evaluate organizational stress in a population of professional dancers, using the HSE Indicator Tool for Work Related Stress. METHODS: We administered the Italian version of the HSE Indicator Tool to 38 ballet dancers, males and females. The questionnaire evaluates 7 key organizational dimensions: demand, control, managers' support, peer support, relationships, role and change. RESULTS: The standards required-ideal conditions are achieved in none of the above-mentioned dimensions. Change is the only dimension for which results fall between the 20th and the 50th percentile, while for other dimensions results fall below the 20th percentile suggesting the need for immediate corrective action. In male dancers an acceptable situation is highlighted for the dimension "change" compared to female dancers. In both sexes there is a high frequency of subjects complaining of verbal abuse, bullying and harassment. CONCLUSIONS: Despite the small sample size, our pilot study highlights the presence of heightened levels of organizational stress. Preventive measures targeted towards improving communication between managers and dancers and aimed at team building should be implemented.

Public service stress and burnout over 12 months.

BACKGROUND: Research indicates that workplace stress has the potential to harm employee health with stress and stress-related absence increasing significantly during economic recession and times of organizational change. AIMS: To explore whether psychosocial hazards and burnout changed over a 12 month period in a public sector organization during a period of severely reduced organizational finances. METHODS: The Management Standards Indicator Tool (MSIT) and the Maslach Burnout Inventory-General Scale (MBI-GS) were administered to employees of one local government department in July 2011 and July 2012. RESULTS: A total of 128 employees completed the questionnaires in July 2011 (response rate 67%) and 57 in July 2012 (response rate 54%). MSIT factor scores of demands, peer support and role worsened significantly over the period of study. Furthermore, all psychosocial hazards scored worse than the recommended level set by Health and Safety Executive. Two burnout dimensions, 'demands' and 'cynicism', significantly worsened over the 12 month period but professional efficacy increased. CONCLUSIONS: The MSIT and MBI-GS appeared to have utility in this comparison. Psychosocial hazards appeared to worsen over the 12 months of the study, as 'demands' and 'cynicism' increased. However, an increase in professional efficacy was also seen, which requires further investigation.

Systematic review: work-related stress and the HSE management standards.

BACKGROUND: The Health and Safety Executive (HSE) has defined six management standards representing aspects of work that, if poorly managed, are associated with lower levels of employee health and productivity, and increased sickness absence. The HSE indicator tool aims to measure organizations' performance in managing the primary stressors identified by the HSE management standards. AIMS: The aims of the study are to explore how the HSE indicator tool has been implemented within organizations and to identify contexts in which the tool has been used, its psychometric properties and relationships with alternative measures of well-being and stress. METHODS: Studies that matched specific criteria were included in the review. Abstracts were considered by two researchers to ensure a reliable process. Full texts were obtained when abstracts met the inclusion criteria. RESULTS: Thirteen papers were included in the review. Using factor analysis and measures of reliability, the studies suggest that the HSE indicator tool is a psychometrically sound measure. The tool has been used to measure work-related stress across different occupational groups, with a clear relationship between the HSE tool and alternative measures of well-being. Limitations of the tool and recommendations for future research are discussed. CONCLUSIONS: The HSE indicator tool is a psychometrically sound measure of organizational performance against the HSE management standards. As such it can provide a broad overview of sources of work-related stress within organizations. More research is required to explore the use of the tool in the design of interventions to reduce stress, and its use in different contexts and with different cultural and gender groups.