Hardiness, psychosocial factors and shift work tolerance among nurses - a 2-year follow-up study.

AIM: To examine the predictive power of the subfactors of hardiness (commitment, control and challenge) on shift work tolerance (measured with sleepiness, fatigue, anxiety and depression) over 2 years in nurses working shifts. We also investigated the direct effects of psychosocial variables such as role conflict, social support and fair leadership on shift work tolerance, as well as their moderating role on the relationship between hardiness and shift work tolerance. BACKGROUND: Several scholars have discussed the role of individual differences and psychosocial variables in predicting shift work tolerance. The conclusions are not clear. DESIGN: Longitudinal questionnaire study. METHODS: A sample of Norwegian nurses employed in shift work including nights participated in this longitudinal questionnaire study: 1877 at baseline, 1228 at 1-year follow-up and 659 nurses at 2-year follow-up. Data were collected in three waves, first wave in 2008 and third in 2011 and were analysed with a series of hierarchical multiple regression analyses. RESULTS: We found that the subfactor commitment could predict fatigue over 1 year and anxiety and depression over 2 years. Challenge could predict anxiety over 1 year. Control was unrelated to shift work intolerance. Hardiness did not predict sleepiness. Social support, role conflict and fair leadership were important for some aspects of shift work tolerance; however, hardiness seemed to be more eminent for shift work tolerance than the psychosocial variables. Social support moderated the relationship between hardiness and shift work tolerance to some degree, but this interaction was weak. CONCLUSION: Hardiness can to some degree predict shift work tolerance over 2 years among nurses.

Health measures in prediction models for high sickness absence: single-item self-rated health versus multi-item SF-12.

BACKGROUND: Self-rated health (SRH) has been found to predict sickness absence (SA). The present study investigated the effect of replacing single-item SRH by a multi-item health measure on SA predictions. METHODS: Longitudinal study of 2059 Norwegian nurses with assessments in three waves each separated by 1 year. Health was measured by single-item SRH and multi-item SF-12 in waves 1 and 2. SA was self-reported in all three waves and high SA was defined as more than or equal to 31 SA days within the last 12 months. Predictions of high SA by a model including age, prior SA and single-item SRH were compared with predictions by a model including age, prior SA and multi-item SF-12. Both models were bootstrapped to correct for over-optimism and prospectively validated for their predictions in a new time frame. RESULTS: 1253 nurses (61%) had complete data for analysis. The SF-12 model predicted the risk of high SA more accurately (χ(2) = 4.294; df = 8) and was more stable over time than the SRH model (model χ(2) = 14.495; df = 8). Both prediction models correctly discriminated between high-risk and low-risk individuals in 73% of the cases at wave 2 and in 71% of the cases at wave 3. CONCLUSIONS: The accuracy of predictions increased when single-item SRH was replaced by multi-item SF-12, but the discriminative ability did not improve. Single-item SRH suffices to identify employees at increased risk of high SA.

Mental and physical health-related functioning mediates between psychological job demands and sickness absence among nurses.

AIMS: To investigate whether health-related functioning mediates the effect of psychological job demands on sickness absence in nurses. BACKGROUND: Nurses face high job demands that can have adverse health effects resulting in sickness absence. DESIGN: Prospective cohort study with 1-year follow-up. METHODS: Data for 2964 Norwegian nurses were collected in the period 2008-2010. At baseline, psychological job demands were measured with the Demand-Control-Support Questionnaire. Health-related functioning was assessed by the Mental Composite Score and the Physical Composite Score of the SF-12 Health Survey (2nd version). Sickness absence (no = 0, yes = 1) was self-reported at 1-year follow-up. Interaction and mediation analyses were conducted stratified by tenure (<1-year, 1-2 years, 3-6 years, >6 years) as a registered nurse. RESULTS: A total of 2180 nurses (74%) with complete data were eligible for analysis. A significant three-way interaction between job demands, control and support was found in newly licensed nurses (tenure <1-year). Baseline psychological job demands were positively associated with sickness absence at 1-year follow-up. This association was substantially weakened when Mental Composite Score and Physical Composite Score were introduced as mediator variables, indicating a partial mediation effect that was particularly pronounced in newly licensed nurses. Psychological job demands did not modify the effect of health-related functioning on sickness absence. CONCLUSION: Both mental and physical health-related functioning mediated between psychological job demands and sickness absence. Nurse managers should pay attention to health-related functioning, because poor health-related functioning may predict sickness absence, especially in newly licensed nurses.

Workplace bullying and subsequent health problems.

BACKGROUND: Cross-sectional studies demonstrate that exposure to bullying in the workplace is positively correlated with self-reported health problems. However, these studies do not provide a basis to draw conclusions on the extent to which bullying leads to increased health problems or whether health problems increase the risk of being bullied. To provide better indications of a causal relationship, knowledge from prospective studies on the association between bullying in the workplace and health outcomes is therefore summarised. MATERIAL AND METHOD: We conducted a systematic literature review of original articles from central literature databases on longitudinal associations between bullying in the workplace and health. Average associations between bullying and health outcomes are calculated using meta-analysis. RESULTS: A consistent finding across the studies is that exposure to bullying is significantly positively related to mental health problems (OR =1.68; 95% KI 1.35-2.09) and somatic symptoms (OR = 1.77; 95% KI 1.41-2.22) over time. Mental health problems are also associated with subsequent exposure to bullying (OR = 1.74; 95% KI 1.44-2.12). INTERPRETATION: Bullying is positively related to mental health problems and somatic symptoms. The association between mental health problems and subsequent bullying indicates a self-reinforcing process between mental health and bullying. The methodological quality of the studies that were conducted is relatively sound. However, based on the existing knowledge base there are no grounds for conclusions regarding an unambiguous causal relationship between bullying and health.

The relationship between shift work schedules and spillover in a sample of nurses.

The aim of the present study was to estimate spillover effects between the work and the family sphere in a sample of nurses (N = 2058). Hierarchical regression analyses investigated whether shift work schedules were associated with negative or positive spillover, both from family to work and vice versa, controlling for demographic factors, job demands and decision latitude. With daytime work as a reference group, all types of shift work (day and evening shift, night shift only and rotating 3 shift) were associated with higher negative work-to-family spillover. Night work was associated with significantly less negative family-to-work spillover. None of the different shift work schedules were related to any type of positive spillover. The results indicate that working outside of daytime hours is less compatible with workers' family lives, compared to working ordinary day shifts. On the other hand, working night shifts only was associated with reduced negative family-to-work spillover.

Shift-related sleep problems vary according to work schedule.

OBJECTIVES: Shift-related sleep and sleepiness problems may be due to characteristics of both shifts (ie, day, evening and night shifts) and work schedules (ie, permanent vs rotational schedules). The Bergen Shift Work Sleep Questionnaire (BSWSQ) was used to investigate associations between shift-related sleep problems and work schedules. METHODS: 1586 nurses completed the BSWSQ. Participants who, in relation to a shift, 'often' or 'always' experienced both a sleep problem and a tiredness/sleepiness problem were defined as having shift-related insomnia (separate for day, evening and night shifts and rest-days). Logistic regression analyses were conducted for day, evening, night, and rest-day insomnia with participants on both permanent and rotational schedules. RESULTS: Shift-related insomnia differed between the work schedules. The evening shift insomnia was more prevalent in the two-shift rotation schedule than the three-shift rotation schedule (29.8% and 19.8%, respectively). Night shift insomnia showed higher frequencies among three-shift rotation workers compared with permanent night workers (67.7% and 41.7%, respectively). Rest-day insomnia was more prevalent among permanent night workers compared with two- and three-shift rotations (11.4% compared with 4.2% and 3.6%, respectively). CONCLUSIONS: The prevalences of shift-related insomnia differed between the work schedules with higher frequencies for three-shift rotations and night shifts. However, sleep problems were present in all shifts and schedules. This suggests that both shifts and work schedules should be considered in the study of shift work-related sleep problems.

Individual, situational and lifestyle factors related to shift work tolerance among nurses who are new to and experienced in night work.

AIM: To identify individual, situational and lifestyle variables related to shift work tolerance among nurses who have worked night shifts for less than 1 year and nurses who have worked night shift for more than 6 years, all engaged in rotating shift work. BACKGROUND: Working shifts is related to negative health consequences. Factors related to shift work tolerance may differ between nurses with little experience and nurses with extensive experience in night work. DESIGN: Cross-sectional questionnaire study. METHODS: A questionnaire including established instruments measuring shift work tolerance, personality, work schedule and lifestyle factors was administered between November 2008-May 2010. Randomly selected Norwegian nurses (n = 749) participated in the study; 322 were new and 427 were experienced in night work. RESULTS: There were no statistically significant differences in shift work tolerance between the new to night work nurses and the nurses who were experienced in night work. Young age was related to higher shift work tolerance. Hardiness was positively related to shift work tolerance in both groups. For the new to night work nurses, morningness was positively related to shift work tolerance. For the experienced in night work nurses, languidity, work hours per week and caffeine consumption were negatively, but flexibility was positively, related to shift work tolerance. CONCLUSION: Several variables were related to shift work tolerance among rotating shift working nurses, especially hardiness. Somewhat different variables were related to shift work tolerance for nurses who were new to night work than for nurses with more experience in night work.

Physical and mental fatigue as predictors of sickness absence among Norwegian nurses.

We investigated whether fatigue can be used to screen nursing populations for risk of sickness absence. Data were available from a prospective cohort study of 2,059 Norwegian nurses working in hospital care, psychiatric care, and nursing home/home care settings. Physical and mental fatigue were measured at baseline with Chalder's Fatigue Questionnaire (FQ). Self-rated sickness absence at 1-year follow-up was considered high if nurses reported >30 sick days in the past year. Physical fatigue accurately predicted high sickness absence and adequately discriminated between high- and low-risk nurses in nursing home/home care settings. Mental fatigue was not predictive in any setting. The FQ is suitable for screening specific nursing populations for the risk of high sickness absence.

Forte Fortissimo for amateur musicians: no effect on otoacoustic emissions.

Many amateur musicians are likely to be exposed to high sound levels during rehearsals. Measuring otoacoustic emissions (OAE) is an objective technique to assess hearing ability and can be used as an early predictor of hearing loss. This study aimed to record sound levels at an amateur brass band rehearsal and to examine the cochlear function of the musicians by evaluating distortion product (DP) OAE amplitudes before and after sound exposure. Twenty-four brass band musicians and 10 office workers were examined with personal noise measurements and DPOAE tests before and after a music rehearsal or one office workday, respectively. The sound levels in the brass band ranged from 92 to 100 dBA, LaEQ 96 dBA. However, the amateur brass band members had no change in DPOAEs after this exposure compared to pre-exposure levels and compared to office workers.

Airway symptoms and lung function in the local population after the oil tank explosion in Gulen, Norway.

BACKGROUND: Oil tanks containing a mixture of hydrocarbons, including sulphuric compounds, exploded and caught fire in an industrial harbour. This study assesses airway symptoms and lung function in the nearby population 1½ years after the explosion. METHODS: A cross-sectional study included individuals ≥18 years old. Individuals living <6 km (sub-groups <3km and 3-6 km) from the accident site formed the exposed group, individuals living >20 km away formed a control group. A questionnaire and spirometry tests were completed by 223 exposed individuals (response rate men 70%, women 75%) and 179 control individuals (response rate men 51%, women 65%). Regression analyses included adjustment for smoking, occupational exposure, atopy, infection in the preceding month and age. Analyses of symptoms were also adjusted for stress reactions related to the accident. RESULTS: Exposed individuals experienced significantly more blocked nose (odds ratio 1.7 [95% confidence interval 1.0, 2.8]), rhinorrhoea (1.6 [1.1, 3.3]), nose irritation (3.4 [2.0, 5.9]), sore throat (3.1 [1.8, 5.5]), morning cough (3.5 [2.0, 5.5]), daily cough (2.2 [1.4, 3.7]), cough >3 months a year (2.9 [1.5, 5.3]) and cough with phlegm (1.9 [1.2, 3.1]) than control individuals. A significantly increasing trend was found for nose symptoms and cough, depending on the proximity of home address to explosion site (daily cough, 3-6km 1.8 [1.0, 3.1], <3km 3.0 [1.7, 6.4]). Lung function measurements were significantly lower in the exposed group than in the control group, FEV1 adjusted mean difference -123 mL [95% confidence interval -232, -14]), FEV1% predicted -2.5 [-5.5, 0.5], FVC -173 mL [- 297, -50], FVC% predicted -3.1 [- 5.9, -0.4], and airway obstruction (GOLD II/III). CONCLUSIONS: Based on cross sectional analyses, individuals living in an area with air pollution from an oil tank explosion had more airway symptoms and lower lung function than a control group 1½ years after the incident.

Coping styles relate to health and work environment of Norwegian and Dutch hospital nurses: a comparative study.

Nurses exposed to high nursing stress report no health complaints as long as they have high coping abilities. The purpose of this study was to investigate coping styles in relation to the health status and work environment of Norwegian and Dutch hospital nurses. This comparative study included a random sample of 5400 Norwegian nurses and a convenience sample of 588 Dutch nurses. Coping, health, and work environment were assessed by questionnaire in both samples and associations were investigated bivariately and multivariately. We found that active problem-solving coping was associated with the health and work environment of Norwegian nurses but not with the health and work environment of Dutch. Passive coping (avoiding problems or waiting to see what happens) was found to relate to poor general health, poor mental health, low job control, and low job support in both Norwegian and Dutch nurses. Improvements in the nursing work environment may not only result in better mental health, but may also reduce passive coping.

Coping with life-threatening events was associated with better self-perceived health in a naval cross-sectional study.

OBJECTIVE: We studied the relationship between experiencing and coping with life-threatening events and self-perceived health in navy personnel operating mainly under peaceful circumstances. METHODS: The data were collected in a cross-sectional study from a questionnaire sent by mail at the end of 2002 to all employees in the Royal Norwegian Navy (N=3878) as part of a general health study. Both military and civilian personnel with different types of work on ships and ashore participated in the study. Logistic regression analyses were performed to study the relationship between the number of life-threatening events, occupational status, sex, age, and the extent of putting these events behind. The possible trends between the degree of putting the events behind and each of the eight SF-36 scales were calculated by bivariate correlations. RESULTS: Military personnel had experienced life-threatening events more often than civilians, but the military personnel appeared 5.5 times more likely to have put such events behind themselves than the civilians. The extent of having put life-threatening events behind oneself was clearly correlated to self-perceived health as measured by the SF-36 subscales bodily pain, general health, vitality, social functioning, role-emotional, and mental health. These associations had linear appearances. CONCLUSION: Navy personnel who have experienced a life-threatening event and have not been able to put this event behind them are more likely to report a reduced self-perceived health.

Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study.

BACKGROUND: Despite considerable knowledge about musculoskeletal disorders (MSD) and physical, psychosocial and individual risk factors there is limited knowledge about physical activity as a factor in preventing MSD. In addition, studies of physical activity are often limited to either leisure activity or physical activity at work. Studies among military personnel on the association between physical activity at work and at leisure and MSD are lacking. This study was conducted to find the prevalence of MSD among personnel in the Royal Norwegian Navy and to assess the association between physical activity at work and at leisure and MSD. METHODS: A questionnaire about musculoskeletal disorders, physical activity and background data (employment status, age, gender, body mass index, smoking, education and physical stressors) was completed by 2265 workers (58%) 18 to 70 years old in the Royal Norwegian Navy. Multiple logistic regression with 95% confidence intervals was used to assess the relationship between physical activity and musculoskeletal disorders. RESULTS: A total of 32% of the workers reported musculoskeletal disorders often or very often in one or more parts of the body in the past year. The most common musculoskeletal disorders were in the lower back (15% often or very often), shoulders (12% often or very often) and neck (11% often or very often). After adjustment for confounders, physical activity was inversely associated with musculoskeletal disorders for all body sites except elbows, knees and feet. CONCLUSION: The one-year prevalence of musculoskeletal disorders among workers in the Royal Norwegian Navy was rather low. A physically active lifestyle both at work and at leisure was associated with fewer musculoskeletal disorders among personnel in the Royal Norwegian Navy. Prospective studies are necessary to confirm the cause and effect in this association.

Health-related quality of life in the Royal Norwegian Navy: does officer rank matter?

The health-related quality of life of Royal Norwegian Navy officers was compared with that of the general population and the association between health-related quality of life and the rank of the officers was estimated in a cross-sectional survey of 1,316 male officers, 25 to 62 years of age, in September 2002. Standardized scores for the SF-36 Health Survey were used for the comparison with the general population, and the mean raw scores for the eight SF-36 subscales were used for the association within the Navy study population. The health-related quality of life of the Navy officers was similar to that of the general population of Norway when adjusted for age, gender, having a job, and educational level. Higher military rank among male Navy officers was associated with better health-related quality of life when adjusted for age but not when adjusted for other sociodemographic variables and lifestyle factors. Physical activity seemed to be the most important positive lifestyle factor.

An Experimental Study on the Attribution of Personality Traits to Bullies and Targets in a Workplace Setting.

Previous studies on the personality of bullies and targets have exclusively been based on self-report. Against this backdrop we conducted a between group experimental vignette study with three conditions, describing a bully, a target and a control, respectively. Students (n = 242) were recruited as participants and rated the target on the observer rating version of the NEO Five Factor Inventory-Revised reflecting the personality dimensions Neuroticism, Extroversion, Openness to experience, Agreeableness and Conscientiousness. A MANOVA showed an overall significant effect of the experimental conditions. On Neuroticism significant differences between all conditions were found with targets rated highest and the control lowest. In terms of Extroversion the target was rated as lower than the control and the bully. No main effect was found for Openness. On Agreeableness the bully was rated as lower than both the target and the control. The bully was rated lower on Conscientiousness than the control. The significant differences reflected medium to large effect sizes. By and large the results are in agreement with comparable self-report data. The results are discussed in terms of practical implications and directions for future research are outlined.

Odour as a determinant of persistent symptoms after a chemical explosion, a longitudinal study.

Foul-smelling environmental pollution was a major concern following a chemical workplace explosion. Malodorous pollution has previously been associated with aggravated physical and psychological health, and in persons affected by a trauma, an incidence-related odour can act as a traumatic reminder. Olfaction may even be of significance in the development and persistence of post-traumatic stress symptoms (PTSS). The present longitudinal study assessed whether perceived smell related to malodorous environmental pollution in the aftermath of the explosion was a determinant of subjective health complaints (SHC) and PTSS among gainfully employed adults, when the malodorous pollution was present, and after pollution clean-up. Questionnaire data from validated instruments were analysed using mixed effects models. Individual odour scores were computed, and the participants (n=486) were divided into high and low odour score groups, respectively. Participants in the high odour score group (n=233) reported more SHC and PTSS than those in the low odour score group (n=253), before and even after the pollution was eliminated. These associations lasted for at least three years after the pollution was removed, and might indicate that prompt clean-up is important to avoid persistent health effects after malodorous chemical spills.

Aggression from Patients or Next of Kin and Exposure to Bullying Behaviors: A Conglomerate Experience?

Although workplace violence and aggression have been identified as important stressors in the nursing profession, studies simultaneously comparing patient-initiated aggression and exposure to bullying behaviors at work are rather scarce. The aim of this study was to compare aggression from patients or next of kin and exposure to bullying behaviors in terms of prevalence, health-related quality of life outcomes, and potential overlap in those targeted. In the period of 2008-2009, data were collected among 2059 members of the Norwegian Nurses Organization. Latent class (LC) analysis and a multivariate analysis of variance (MANOVA) were used to investigate the proposed relationships. The results showed that aggression from patients or next of kin and exposure to bullying behaviors were perceived as separate and independent stressors. Although aggression from patients or next of kin was more frequent than workplace bullying, the latter was the only significant stressor related to health-related quality of life in terms of reduced mental health functioning. Although being a rather infrequent experience, exposure to bullying behaviors seems to have more severe health-related outcomes for nurses than aggression from patients or next of kin. Hence, the results of the study strengthen previous findings and suggest that managers must aim to maintain a positive psychosocial work environment with zero-tolerance for bullying.

Working Conditions and Individual Differences Are Weakly Associated with Workaholism: A 2-3-Year Prospective Study of Shift-Working Nurses.

This study focuses on individual differences and the demand-support-control model in relation to workaholism. We hypothesized that unfavorable working conditions (high job demands, low job control/decision latitude, and low social support at work) and individual differences concerning sleep/wake-related variables (high flexibility, high morningness, and low languidity) would be related to workaholism measured 2-3 years later. Survey data stemmed from a prospective cohort of shift-working nurses (N = 1,308). The results showed that social support at work was negatively related to workaholism, whereas job demands were positively related to workaholism. Flexibility in terms of time for working/sleeping was also positively related to workaholism. The analyses further revealed that workaholism was inversely associated with age as well as having a child or having a child move in. Conjointly, the independent variables explained 6.4% of the variance in workaholism, while their relative importance was small overall. After controlling for all other independent variables, high job demands had the strongest relationship (small-to-medium) with workaholism. This implies that less pressure from the external environment to work excessively hard may prevent an increase in workaholic behaviors. Overall, the study adds to our understanding of the relationships between working conditions, individual differences, and workaholism.