Occupational stress, work ability and quality of life among health care workers (Stres, radna sposobnost i kvaliteta

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Occupational stress, work ability and quality of
life among health care workers(Stres, radna
sposobnost i kvaliteta života zdravstvenih
djelatnika)

• Rajna Golubic, MD
• "Andrija Stampar" School of Public Health
• Zagreb University School of Medicine

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Outline (pregled)

• Impact of work on health (Utjecaj rada na
  zdravlje)
• Research project Work-related stress and work
  ability of health care workers in Croatia
  (Znanstveni projekt Stres na radnom mjestu i
  radna sposobnost zdravstvenih djelatnika)
• Future research plans and possible interventions
  (Planovi za buduca istraživanja i moguce
  intervencije)

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Impact of work on health (Utjecaj rada na
zdravlje)

• 4th European Working Conditions Survey,
  2007-perceived impact of work on health and type
  of health problems vary significantly among
  countries
• (4.europsko istraživanju o uvjetima rada- opažen
  utjecaj rada na zdravlje i vrtste zdravstvenih
  problema znacajno se razlikuju u pojedinim
  zemljama)

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(No Transcript)
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The most common symptoms reported by workers in
the EU (najcešci simptomi na koje se žale radnici
EU)

• Backache (bol u ledima) 24.7
• Muscular pain (mišicna bol) 22.8
• Fatigue (iscrpljenost) 22.6
• Stress (stres) 22.3
• Headache (glavobolja) 15.5
• Irritability (razdražljivost) 10.5
• 4th European Working Conditions Survey

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Workplace stress- a growing problem (stres na
radnom mjestu-rastuci problem)

• Work-related stress a pattern of
• emotional,
• cognitive,
• behavioral and
• physiological reactions
• to adverse and harmful aspects of work content,
  work organization and the working environment
• (Stres na radnom mjestu je obrazac emocionalnih,
  kognitivnih, bihevioralnih i fizioloških reakcija
  na štetne znacajke posla u smislu sadržaja,
  organizacije i radnog okruženja)

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Occupational stress concepts models (modeli i
koncepti stresa na radnom mjestu)

• Demand-control model- Karasek, 1979 (Stres raste
  kako raste zbroj povecanih zahtjeva i niske
  razine odlucivanja )
• Effort-reward imbalance model (Stres je
  posljedica neravnoteže izmedu napora i nagrade za
  uloženi napor)
• One in three European workers is affected by
  work-related stress (European Agency for Safety
  and Health at Work)- trecina Europljana pati od
  stresa na radnom mjestu

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Reaction to stress depends on (reakcija na stres
ovisi o)

• External circumstances (vanjskim okolnostima)
• Environment, working atmosphere, family, friends
  (okoliš, radna atmosfera, obitelj, prijatelji)

• Individual susceptibility to stress
  (individualnoj osjetljivosti)
• Age, gender, personality type, lifestyle (dob,
  spol, struktura licnosti, životni stil)

• Stressors (stresnim cimbenicima)

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Healthcare workers (zdravstveni djelatnici)

• High responsiblity (velika odgovornost)
• Care for patients (skrb za bolesnike)
• Shift work (smjenski rad)
• 24h duties (24h dežurstva)
• Biological and chemical hazards (biološki i
  kemijski štetni cimbenici)

STRESS, DISEASES, EARLY RETIREMENT
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Research project

• TitleWork-related stress and work ability of
  health care workers in Croatia (Znanstveni
  projekt Stres na radnom mjestu i radna
  sposobnost zdravstvenih djelatnika)
• Part of the project Heath at the workplace and
  healthy working environment principal
  investigator- Professor Jadranka Mustajbegovic,
  MD, PhD (Dio projekta Zdravlje na radu i zdravi
  okoliš)
• Funded by the Ministry of Science, Education and
  Sports of the Republic of Croatia (financiran od
  Ministarstva znanosti, obrazovanja i športa RH)

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Aim (Cilj)

• To investigate stressors to which health care
  workers are exposed (Istražiti stresne cimbenike
  kojima su izloženi zdravstveni djelatnici)
• To investigate work ability of health care
  workers (Istražiti radnu sposobnost zdravstvenih
  djelatnika)
• To investigate which stressors influence the work
  ability of health care workers and to what extent
  (Istražiti koji stresori i koliko utjecu na radnu
  sposobnost)

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Subjects (Ispitanici)

• 4 clinical hospitals at the Zagreb University
  School of Medicine (4 klinicke bolnice
  Sveucilišta u Zagrebu)
• All employed health care workers were invited to
  partcipate in the study (Svi zaposleni
  zdravstveni djelatnici bili su pozvani da
  sudjeluju u istraživanju)
• Overall response rate 78 (ukupni odaziv78)
• Participation was anonimous and voluntary
  (Sudjelovanje- anonimno i dobrovoljno )

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Methods (Metode)

• Questionnaires (Upitnici)
• Occupational stress assesment questionnaire
  (Upitnik o stresorima na radnom mjestu)
• Work Ability Index Questionnaire, WAI (Upitnik za
  procjenu indeksa radne sposobnosti)
• Additional questions on satisfaction (Dodatna
  pitanja o zadovoljstvu)

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Methods (Metode)

• Occupational stress assessment questionnaire
  (Upitnik o stresorima na radnom mjestu)
• General information- gender, age, marital status,
  number of children, education level, workplace,
  years of service, working time(Opci podaci -spol,
  dob, bracni status, broj djece,strucni stupanj,
  radno mjesto, duljina radnog staža, radno
  vrijeme)
• Stressors at the workplace- 37 stressors Likert
  Scale (1-5) (Stresori na radnom mjestu- 37
  stresora, Likertova skala 1-5)

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Methods (Metode)

• 37 stressors at the workplace related to (37
  stresora na radno mjestu vezano uz )
• Organization of the work (organizaciju rada),
• Resourses to work with (financijske mogucnosti),
• Career progressing (napredovanje),
• Education (edukaciju),
• Interpersonal relations (meduljudske odnose),
• Attitude towards patients (odnos s pacijentima),
• Health hazards (štetnostima za zdravlje)

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Work Ability (radna sposobnost)

• Work ability is a concept which emphasizes that
  working environment should be adjusted according
  to abilities and competencies of workers
• (Radna sposobnost je koncept koji naglašava
  potrebu prilagodavanja radnih uvjeta
  sposobnostima i mogucnostima djelatnika)

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Work Ability (radna sposobnost)

• Takes into account
• Physical and psychological demands of the
  workplace
• Physical and psychological abilities of workers
  and health status of workers
• Workers health status
• (Uzima u obzir
• Fizicke i psihicke zahtjeve radnog mjesta
• Fizicke i psihicke sposobnosti djelatnika
• Zdravstveno stanje djelatnika)

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Work Ability (radna sposobnost)

• Is expressed by the Work Ability Index (WAI)
  which was developed at the Finish Institite for
  Occupational Health (Izražava se Indeksom radne
  sposobnosti koji je konstruiran na Finskom
  institutu za medicinu rada)
• Purpose early detection of workers and working
  environments that require support and improvement
  (Svrha rano otkrivanje djelatnika i radnih
  okružja kojima je potrebna podrška i unapredenje.)

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Work Ability Index, WAI (Indeks radne sposobnosti)

• Current work ability (1-10)
• (Sadašnja radna sposobnost (0-10) )
• Work ability in relation to the demands of the
  job(Radna sposobnost u odnosu sa zahtjevima
  posla)
• Number of current diseases diagnosed by a
  physician (Broj bolesti dijagnosticiranih od
  strane lijecnika)
• Estimated work impairment due to diseases (Koliko
  zdravstvene tegobe ometaju rad?)

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Work Ability Index, WAI (Indeks radne sposobnosti)

• Sick leave during last year (Bolovanja u
  protekloj godini)
• Personal prognosis of work ability for the
  following 2 years (Vlastita prognoza radne
  sposobnosti za 2 godine)
• Mental resources- pleasure, activity, hope
• (Psihicke sposobnosti- uživanje , aktivnost,
  nada)

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Work Ability Index, WAI values (Indeks radne
sposobnosti, vrijednosti)

• 44 - 49 ? excellent, the work ability (WA) should
  be maintained (odlicno, održati radnu sposobnost
  (RS))
• 37- 43 ? very good, the WA should be improved
  (vrlo dobro,unaprijediti RS)
• 28 - 36 ? good, the WA should be improved (dobro,
  poboljšati RS)
• 7 - 27 ? poor, the WA should be reestablished
  (loše, ponovo uspostaviti RS)

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Preliminary results (Preliminarni rezultati)
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Subjects (Ispitanici)

• Physicians ,N395 (Lijecnici)
• Females (žene) 218 (55.2)
• Males (muškarci) 177 (44.8)
• Age median 42 years (Median dobi 42 godine)
• 66 of physicians were specialists (66
  specijalista)
• Average period of service 17 years (Prosjek
  ukupnog radnog staža 17 godina)

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Subjects (Ispitanici)

• Nurses/Medical technicians (Medicinske sestre /
  Tehnicari), N1082
• Females (žene) 1007 (92.7)
• Males (muškarci ) 79 (7.3)
• Age median 39 years (Median dobi 39 godina)
• 73 had only secondary school education (73 SSS)
• Average period of service 19 years (Prosjek
  ukupnog radnog staža 19 godina)

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Subjects (Ispitanici)
Physicians (Lijecnici) N
KBC Zagreb 98 24.8
OB Sveti Duh 82 20.8
KB Sestre milosrdnice 170 43.0
KB Dubrava 45 11.4
Nurses/technicians (Medicinske sestre/tehnicari) N
KBC Zagreb 270 24.9
OB Sveti Duh 181 16.7
KB Sestre milosrdnice 494 45.5
KB Dubrava 141 13.0
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Physicians- specialties (Lijecnici-specijalizacije
)
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Nurses/technicians-specialties (Medicinske
sestre/tehnicari-specijalizacije)
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Physicians- perception of stressors (Lijecnici-
percepcija stresora)
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Nurses/technicians- perception of stressors
(Med.sestre/tehnicari- percepcija stresora)
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Health care workers satisfaction (Zadovoljstvo
zdravstvenih djelatnika)
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Overall indicator of work ability (Ukupni
pokazatelj radne sposobnosti)

• Satisfactory (zadovoljavajuci)
• Physicians have significantly higher WAI than
  other health care workers (Lijecnici imaju
  statisticki znacajno veci WAI od ostalih
  zdravstvenih djelatnika)
• ANCOVA, Plt0.001, covariate- age (kovarijanca -
  dob)
• Mean WAI (srednja vrijednost za WAI)
• Physicians (lijecnici) 39.87
• Nurses and technicians (Med. Sestre i
  tehnicari) 38.01

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Overall indicator of work ability (Ukupni
pokazatelj radne sposobnosti)

• Mean WAI (srednja vrijednost za WAI)
• Physicians (lijecnici)
• Males (muški) 40.49
• Females (žene) 38.62
• Nurses/technicians (med. sestre/tehnicari)
• Males (muški) 40.64
• Females (žene) 37.98
• ANCOVA analysis was performed, age was used as
  the covariate (provedena je ANCOVA, kovarijanca-
  dob)

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Conclusions (Zakljucci)

• Main stressors in hospitals are related to work
  management, financial issues, patients and shift
  work (Glavni stresori u bolnici vezani su uz
  organizacijska i financijska pitanja, pacijente i
  smjenski rad)
• Overall WAI is satisfactory among health care
  workers (Ukupni WAI zdravstvenih djelatnika je
  zadovoljavajuci)

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Conclusions (Zakljucci)

• Significant predictors for better work ability
  among physicians (logistic regression) (Znacajni
  prediktori za bolju radnu sposobnost u lijecnika
  (logisticka regresija))
• Job satisfaction (Zadovoljstvo poslom) OR3.45
  (95CI1.5-4.3)
• Male gender (Muški spol) OR2.35 (95CI1.2-3.3)
• Higher intelectual demands (Veci intelektualni
  zahtjevi) OR1.56 (95CI1.2-2.3)
• Lower exposure to chemical/biological/physical
  hazards (Manja izloženost kemijskim/biološkim/fizi
  kalnihm štetnostima) OR1.5 (95CI1.1-3.2)
• Younger age (Mlada dob) OR1.10 (95CI1.05-1.7)

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Conclusions (Zakljucci)

• Significant predictors for better work ability
  among nurses/technicians (Znacajni prediktori za
  bolju radnu sposobnost u medicinskih
  sestara/tehnicara)
• Job satisfaction (Zadovoljstvo poslom) OR2.43
  (95CI1.6-3.3)
• Male gender (Muški spol) OR2.4 (95CI1.3-3.4)
• Lower exposure to chemical/biological/physical
  hazards (Manja izloženost kemijskim/biološkim/fizi
  kalnihm štetnostima) OR1.2 (95CI1.1-2.1)
• Lower frequency of shift work (Manja ucestalost
  smjenskog rada) OR1.2 (95CI1.1-2.3)
• Younger age (Mlada dob) OR1.10 (95CI1.05-1.7)

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Future plans (Planovi za buducnost)
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Aims of the future plans (Ciljevi buducih planova)

• To objectify health care workers quality of life
  (objektivizirati kvalitetu života zdravstvenih
  djelatnika)
• To estimate/quantify the relation between each
  domain of the quality of life and work ability
  (procijeniti povezanost izmedu pojedinih domena
  kvalitete života i radne sposobnosti)
• To assess health care workers salutogenic
  productivity (procijeniti salutogenu
  produktivnost zdravstvenih djelatnika)

• To objectify health care workers quality of life
  (objektivizirati kvalitetu života zdravstvenih
  djelatnika)
• To estimate/quantify the relation between each
  domain of the quality of life and work ability
  (procijeniti povezanost izmedu pojedinih domena
  kvalitete života i radne sposobnosti)
• To assess health care workers salutogenic
  productivity (procijeniti salutogenu
  produktivnost zdravstvenih djelatnika)

• To objectify health care workers quality of life
  (objektivizirati kvalitetu života zdravstvenih
  djelatnika)
• To estimate/quantify the relation between each
  domain of the quality of life and work ability
  (procijeniti povezanost izmedu pojedinih domena
  kvalitete života i radne sposobnosti)
• To assess health care workers salutogenic
  productivity (procijeniti salutogenu
  produktivnost zdravstvenih djelatnika)

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Implementation of new instruments (Uvodenje novih
instrumenata)

• WHOQOL-BREF questionnaire
• Assesses the quality of life (Procjena kvalitete
  života)
• 4 domains (4 domene)
• Physical health (fizicko zdravlje)
• Psychological health (psihološko zdravlje)
• Social relationships (društvene veze)
• Environment (okoliš)
• 26 items (26 pitanja)

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Implementation of new instruments (Uvodenje novih
instrumenata)

• Human Work Index, HWI (Indeks ljudskog rada)
• HWI- indicator of salutogenetic productivity
  (pokazatelj salutogene produktivnosti)
• Salutogenesis- concept based on the factors which
  improve health, not on the ones that cause
  diseases (koncept salutogeneze- temelji se na
  faktorima koji poboljšavaju zdravlje, a ne na
  onima koji uzrokuju bolesti)
• Developed at the Institute of Occupational Health
  Promotion, Vienna (konstruiran na Institutu za
  promociju zdravlja na radnom mjestu, Bec)

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Human Work Index (Indeks ljudskog rada)
I can (mogu) Work Ability (radna sposobnost)
I will (hocu) Work Interest (interes za rad)
I may (smijem) Cooperation (suradnja)
We should (mi trebamo) Leadership (rukovodenje)
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Possible interventions (Moguce intervencije)

• Creation of the programme aiming at health
  promotion and sustainable work ability of health
  care workers (izrada programa za promociju i
  ocuvanje zdravlja i radne sposobnosti
  zdravstvenih djelatnika)
• Prevention of stress-related diseases and early
  retirement (prevencija bolesti vezanih uz stres i
  preranog odlaska u mirovinu)

• Creation of the programme aiming at health
  promotion and sustainable work ability of health
  care workers (izrada programa za promociju i
  ocuvanje zdravlja i radne sposobnosti
  zdravstvenih djelatnika)
• Prevention of stress-related diseases and early
  retirement (prevencija bolesti vezanih uz stres i
  preranog odlaska u mirovinu)

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Thank you for your attention!!!(Hvala na
pozornosti!!!)