Investigating work-related stress among health professionals at different hierarchical levels: A cross-sectional study

A conceptual framework for defining work disparities: A case of nurses in long term care

BackgroundIncreasing the recruitment and retention of nurses within long-term care (LTC) is a growing challenge faced by the healthcare community. Addressing this problem will require a greater understanding of the day-to-day experiences of nurses, including the disparities and unequal treatment experienced by this group of workers (e.g., pay parity, discrimination, and unfair job demands). However, while there is a need to better understand work disparities faced by nurses, a formalized definition and framework for examining work disparities do not exist within the literature.ObjectiveTo create a conceptual framework to define and analyze work disparities experienced by nurses in LTC.MethodsThis analysis was conducted in adherence to Podsakoff et al.'s four-stage series of recommendations. A partial survey of the literature and operationalizations of work disparities were analyzed to create a core list of attributes of work disparities among nurses in LTC. A definition and framework for classifying work disparities were then posited through a dialogic process and refined by testing on two studies.ResultsA definition of work disparities was posited and four categories of work disparities were identified: job security, work compensation, work opportunities, and workplace treatment. A matrix for classifying the variables of work disparities and comparator groups was refined.ConclusionWith the increasing recognition of unequal treatment of nurses in LTC, this framework can enable further research within this area to support and enhance opportunities for the retention and health of the LTC workforce.

Influence of Sociodemographic Factors on Level Stress and Coping Strategies of Nurses and Midwives Caring for Newborns with Lethal Defects

Introduction: Nurses and midwives caring for newborns with lethal defects experience significant emotional stress. Understanding coping strategies and the factors influencing stress is crucial for improving their well-being and ensuring high-quality care. Objectives: The aim of this study was to identify the coping strategies used by nurses and midwives in stressful situations and to analyse the relationship between stress levels and selected sociodemographic and professional factors. Methods: A cross-sectional study was conducted in the second quarter of 2023 among 307 nurses and midwives working in neonatal and obstetric wards in the Silesian metropolitan area, Poland. A diagnostic survey method was applied using a standardised questionnaire. The Perceived Stress Scale (PSS-10) and the MINI-COPE Inventory were used to assess stress levels and coping mechanisms. A stratified random sampling method was employed to ensure representation from various professional backgrounds. Data analysis was conducted using descriptive statistics, chi-square tests, Spearman's correlation, and Cohen's d coefficient, with statistical significance set at p < 0.05. Results: High stress levels were associated with shorter professional experience, frequent exposure to lethal defects, and emotional discomfort in interactions with grieving families. The most commonly used coping strategies were active coping (M = 2.06, SD = 0.635) and planning (M = 1.95, SD = 0.590), whereas self-blame (M = 1.20, SD = 0.714, p < 0.001) and denial (M = 0.88, SD = 0.751, p < 0.001) were linked to higher stress levels. Positive reinterpretation (r = -0.211, p < 0.001) and seeking emotional support (r = -0.129, p = 0.024) correlated with lower stress levels. Nurses and midwives with secondary education reported higher stress levels compared to those with higher education (χ2(10) = 30.651, p = 0.001). Work experience played a role, with moderate stress levels most frequently observed among those with 2-5 years of professional experience (χ2(14) = 24.023, p = 0.046). Emotional involvement, particularly supporting parents during their farewell to the child (69.1%), was identified as the most stressful aspect of their work. Conclusions: Promoting adaptive coping strategies, such as positive reinterpretation and emotional support, can help reduce stress and improve the well-being of nurses and midwives. Implementing psychological support programmes and stress management training is essential for maintaining high-quality neonatal care.

Translation and psychometric evaluation of the Chinese version of the Digital Competence Questionnaire for clinical nurses

Background

Adequate digital competence is crucial for clinical nurses to effectively adapt to the evolving digital technologies in their practice. Currently, there is a lack of a brief assessment tool in China that comprehensively measures the digital competence of nurses in clinical practice across the dimensions of knowledge, skills, and attitudes. Therefore, this study aims to translate the Digital Competence Questionnaire (DCQ) into Chinese and evaluate its psychometric properties.

Methods

Following Brislin's translation model, the DCQ was translated and back-translated, and cultural adaptation and revisions of the Chinese version were conducted through expert consultations and a pilot survey. A cross-sectional study was carried out from July to October 2024 to conduct a methodological investigation on the translation and validation of the DCQ.

Results

The Chinese version of the DCQ includes two dimensions-attitude and knowledge & skills-with a total of 12 items. The overall Cronbach's α value for the questionnaire is 0.970, while Cronbach's α for the individual dimensions ranges from 0.921 to 0.945. The split-half reliability of the entire scale is 0.912, and the test-retest reliability is 0.846. Confirmatory factor analysis supported the hypothesized first-order two-factor model, with all fit indices demonstrating satisfactory values and remaining within acceptable levels.

Conclusion

The Chinese version of the DCQ has been successfully introduced in China, demonstrating strong psychometric properties. It can be used in healthcare settings as a tool to assess the digital competence of nurses, providing a basis for developing subsequent digital technology training programs and targeted interventions.

Reducing work-related stress among health professionals by using a training-based intervention programme for leaders in a cluster randomised controlled trial

Healthcare organisations worldwide are affected by the shortage of health professionals due to work-related stress and health professional leaders play an important role by implementing effective strategies. Therefore, this study aims to investigate whether the STRAIN intervention program (using evidence-based training for health professional leaders) can reduce work-related stress among health professionals. This study is based on a cluster randomised controlled trial, consists of three measurements and includes 165 participating hospitals, nursing homes and home care organisations. A total of 206 health professional leaders took part in the intervention programme and 19,340 health professionals participated in the study. Results showed no significant differences (p > 0.05) between the intervention and control group regarding the effort-reward imbalance ratio, quantitative demands, opportunities for development, bond with the organisation, quality of leadership, social community, role clarity, rewards, difficulties with demarcation and work-private life conflict. Pre-/post-test analysis revealed a tendency for significant positive results (p < 0.05) for stressors, stress symptoms and long-term consequences for organisations with a leaders' participation rate of ≥ 75%. Leaders' awareness, commitment and readiness is essential to implement effective strategies reducing work-related stress.

Factors associated with health professionals' stress reactions, job satisfaction, intention to leave and health-related outcomes in acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organisations

The aim of this study is to identify (1) the extent of work-related stress and (2) stressors associated with cognitive and behavioral stress reactions, burnout symptoms, health status, quality of sleep, job satisfaction, and intention to leave the organization and the profession among health professionals working in acute care /rehabilitation hospitals, psychiatric hospitals, nursing homes, and home care organizations.

BACKGROUND

Health professionals are faced with various stressors at work and as a consequence are leaving their profession prematurely. This study aimed to identify the extent of work-related stress and stressors associated with stress reactions, job satisfaction, and intention to leave and health-related outcomes among health professionals working in different healthcare sectors (acute care, rehabilitation and psychiatric hospitals, nursing homes and home care organizations).

METHODS

This study is based on a repeated cross-sectional design, which includes three data measures between 2017 and 2020 and 19,340 participating health professionals from 26 acute care / rehabilitation hospitals, 12 psychiatric hospitals, 86 nursing homes and 41 home care organizations in Switzerland. For data analysis, hierarchical multilevel models (using AIC) were calculated separately for hospitals, nursing homes, and home care organizations, regarding health professionals' stress symptoms, job satisfaction, intention to leave the organization / profession, general health status, burnout symptoms, and quality of sleep.

RESULTS

The main findings reveal that the incompatibility of health professionals' work and private life was significantly associated (p < 0.05) with their stress reactions, job satisfaction, intention to leave, and health-related outcomes in all the included work areas. The direct supervisor's good leadership qualities were also associated with health professionals' job satisfaction regarding all work areas (B ≥ 0.22, p = 0.000). In addition, a positive perceived bond with the organization (B ≥ 0.13, p < 0.01) and better development opportunities (B ≥ 0.05, p < 0.05) were associated with higher job satisfaction and a lower intention to leave the organization and profession among health professionals. Also, a younger age of health professionals was associated with a higher intention to leave the organization and the profession prematurely in all the included work areas. High physical (B ≥ 0.04, p < 0.05) and quantitative demands (B ≥ 0.05, p = 0.000) at work were also associated with negative health-related outcomes.

Middle-Range Theory of Occupational Stress in Health Professionals

Introduction

Occupational stress affects health professionals; however, no literature was found on the middle-range theory for this outcome in health professionals.

Methods

Methodological study for the theoretical validation of a nursing diagnosis using the theoretical framework of Walker and Avant and the Betty Neuman systems models. The research was conducted in five stages: comprehension of the system model; selection and review of studies; development of the conceptual-theoretical-empirical structure; elaboration of a diagram and proposition of a nursing diagnosis; and evaluation of the empirical adequacy of the theory and validity of the system model. These steps were conducted using a scoping review and a sample of 138 articles selected in the Scopus, Web of Science, MEDLINE/PubMed, CINAHL, PsycINFO, LILACS, Science Direct, Cochrane Library, and Google Scholar databases. A data extraction instrument was developed, and study variables (attributes, antecedents, and clinical consequences) were analyzed using descriptive statistics (absolute and relative frequencies) and presented in tables.

Results

The middle-range theory comprised 16 concepts, 20 propositions, and one diagram. A total of 15 related factors, 29 defining characteristics, six at-risk populations, and one associated condition were indicated to propose the nursing diagnosis for occupational stress.

Conclusion

The middle-range theory supported elaborating elements to propose a nursing diagnosis for occupational stress.

Content Validation of a Questionnaire to Measure Digital Competence of Nurses in Clinical Practice

Clinical practice nurses need adequate digital competence to use technologies appropriately at work. Questionnaires measuring clinical practice nurses' digital competence lack content validity because attitude is not included as a measure of digital competence. The aim of the current study was to identify items for an item pool of a questionnaire to measure clinical practice nurses' digital competence and to evaluate the content validity. A normative Delphi study was conducted, and the content validity index on item and scale levels was calculated. In each round, 21 to 24 panelists (medical informatics specialists, nurse informatics specialists, digital managers, and researchers) were asked to rate the items on a 4-point Likert scale ranging from "not relevant" to "very relevant." Within three rounds, the panelists reached high consensus and rated 26 items of the initial 37 items as relevant. The average content validity index of 0.95 (SD, 0.07) demonstrates that the item pool showed high content validity. The final item pool included items to measure knowledge, skills, and attitude. The items included represent the international recommendations of core competences for clinical nursing. Future research should conduct psychometric testing for construct validity and internal consistency of the generated item pool.

Extent and predictors of presenteeism among healthcare professionals working in Swiss hospitals, nursing homes and home care organizations

Presenteeism can have negative impacts on employees' health and organizational productivity. It occurs more often among occupations with high attendance demands, such as healthcare professionals. Information is lacking regarding the extent to which presenteeism differs between disciplines and settings in the health sector and what the reasons are for presenteeism as well as influencing factors. This study used cross-sectional data on 15,185 healthcare professionals (nursing staff, midwives, physicians, medical-technical and medical-therapeutic professionals) from various settings (acute care, rehabilitation or psychiatric hospitals, nursing homes and home care organizations). Presenteeism was measured by examining how many days participants had gone to work despite feeling sick during the past 12 months. Kruskal-Wallis was used to test for significant differences between healthcare professions/settings and regression analysis to identify significant predictors of presenteeism. Nursing assistants with a formal education reported the most days of presenteeism in the past 12 months (mean = 4.3, SD = 12.0). Healthcare professionals working in nursing homes reported the most days of presenteeism in the past 12 months (mean = 4.2, SD = 8.7). The majority of healthcare professionals had been present at work while being ill due to a sense of duty (83.7%), followed by consideration for colleagues and/or managers (76.5%). In particular, the psychiatric hospitals (β = 0.139; p < 0.001), nursing homes (β = 0.168; p < 0.001) and home care organizations (β = 0.092; p < 0.001), as well as the language regions of Swiss French (β = - 0.304; p < 0.001) and Italian (β = - 0.154; p < 0.001), were significantly associated with presenteeism. Presenteeism differs between disciplines and settings in the health sector. The reasons for presenteeism and its influencing factors in the health sector are mostly consistent with those in other sectors. Cultural differences should be afforded greater relevance in future presenteeism research.

Preparing students to deal with the consequences of the workforce shortage among health professionals: a qualitative approach

BACKGROUND

Healthcare is facing a shortage of qualified healthcare professionals. The pandemic has brought to light the fragile balance that affects all healthcare systems. Governments have realized that these systems and the professionals working in them need support at different levels to strengthen the retention of the workforce. Health professionals' education can play an important role in ensuring that new generations of workers have sound personal and professional competencies to successfully face the challenges of professional practice. These challenges are described in the literature, but the extent to which they are considered in health professionals' education is less clear.

METHODS

This qualitative study compares the professional challenges and educational needs described in the literature with the current curricula for health professionals offered in Switzerland. Data were collected nationally through focus group interviews with 65% of Switzerland's directors of bachelor's and master's programs of health professions (nursing, physiotherapy, occupational therapy, midwifery, nutrition and dietetics, osteopathy, radiologic medical imaging technology, health promotion and prevention, and health sciences). The data attained were analyzed using knowledge mapping.

RESULTS

The results reveal a gap among education programs with regard to occupational health promotion and cultural diversity. Both topics are taught with a sole focus on patients, and students are expected to adopt similar strategies for their health promotion and stress management. Physicians are insufficiently involved in interprofessional education. The programs fail to enhance health professionals' political, economic and digital competencies.

CONCLUSION

The results of this study offer clear guidance about what topics need to be integrated into curricula to improve health professionals' well-being at work and their preparedness to face daily professional challenges.

The Application of Nurse Stratified Management in Nursing Management

Objective

To explore the application value of nurse stratified management in nursing management.

Methods

One hundred nurses who worked in our hospital from June 2019 to September 2021 were recruited and assigned via the random number table method to an observation group (n = 50) and the control group (n = 50). The control group received routine nursing management, and the experimental group received stratified nursing management. The nursing quality, practice happiness, error rate, patient complaint, and patient satisfaction were compared between the two groups.

Results

The experimental group showed a significantly higher nursing quality than the control group (P < 0.05). The experimental group had significantly higher practice happiness among nurses than the control group (P < 0.05). Stratified nursing management mode resulted in a significantly lower error rate and patient complaint versus routine nursing management mode (P < 0.05). Patients were more satisfied with stratified nursing management than with the routine nursing management (P < 0.05).

Conclusion

The nurse stratified management method effectively improves the nursing quality and practice happiness of nurses, reduces the error rate of nursing and patient complaint, and increases nursing satisfaction.

The Mental Health of Malaysia’s Northwest Healthcare Workers during the Relaxation of COVID-19 Restrictions and Its Associated Factors

The COVID-19 pandemic has affected people in many ways, including mental health status. Depression, anxiety, and stress (DAS) are terms often used to describe mental health status worldwide. The present study describes the prevalence of DAS and its associated factors among healthcare workers (HCWs) in the northwest region of Malaysia, during the early phase of recovery of movement control order (RMCO), where some restrictions were lifted, and cases are reducing in number. This cross-sectional study used HCW’s mental health surveillance data using the DASS-21 questionnaire. A total of 981 data collected between 1 July and 31 August 2020 were randomly sampled. Socio-demographic factors, occupational characteristics, and health backgrounds were extracted and analyzed using multiple logistic regression. The prevalences of DAS are 8.4% (6.7, 10.3), 17.1% (14.8, 19.6), and 6.4% (5.0, 8.1), respectively. Age is significantly associated with depression (Adjusted Odd Ratio (Adj.OR) 0.96 (0.93, 0.99)) and stress (Adj.OR 0.96 (0.93, 0.997)). Working at the hospital is associated with depression (Adj.OR 1.88 (1.19, 2.97)) as well as anxiety (Adj.OR 1.91 (1.36, 2.68). HCWs with a degree or postgraduate education level are more stressed compared to those with lower educational levels (Adj.OR 8.43 (1.95, 36.37)). Mental health surveillance helps to identify those at risk. Those younger in age, working in hospitals, and with more responsibility in management are the most affected. With the easing of COVID-19 pandemic restrictions, which lead to the release of certain movement control, the mental health status of HCWs was less affected. Those working directly with COVID-19 patients and with more responsibility in management are the most affected.

Analysis of the Effect of Rational Emotional Intervention Combined with Hierarchical Management Mode on Improving the Psychological Stress of Emergency Nurses and Trainee Nurses

Purpose

To explore the effect of rational emotional intervention combined with hierarchical management mode on improving the psychological stress of emergency nurses and trainee nurses.

Methods

50 emergency nurses who worked or practiced in our hospital from June 2019 to May 2021 were selected as the research object. From June 2019 to May 2020, our hospital adopted the traditional management mode. From June 2020 to May 2021, our hospital adopted the rational emotional intervention combined with hierarchical management mode. The psychological state, work stress, stress response, job burnout, and sleep quality of emergency nurses were compared before and after intervention.

Results

Compared with before intervention, the scores of self-rating anxiety scale and self-rating depression scale, the work stress scores, the Maslach burnout inventory score, the Pittsburgh sleep quality index score of emergency nurses decreased after intervention (P < 0.05). Compared with before intervention, the stress coping scores of emergency nurses increased after intervention (P < 0.05).

Conclusion

The rational emotional intervention combined with hierarchical management mode can improve the psychological pressure of emergency nurses and trainee nurses, reduce job burnout, improve stress coping ability, and improve sleep quality.

Perceived stigma, substance use and self-medication in night-shift healthcare workers: a qualitative study

Background

Many risk factors related to altered circadian rhythms impact the health of night-shift hospital workers (NSHW), resulting in mental and somatic disorders. Easy access to psychoactive substances (PS) may facilitate addictive behaviors in NSHW. They are also exposed to a stressful work environment, which may further affect sleep quality. This study aimed to explore the link between sleep deprivation, work-related psychosocial stress and psychoactive substance use as a self-medication response in NSHW.

Methods

Qualitative study to verify the plausibility of the self-medication theory applied to addictive behaviors. Semi-structured interviews (N = 18 NSHW) and thematic analysis, following consolidated criteria for reporting qualitative research recommendations.

Results

Stigma against NSHW was a primary element of a stressful work environment. The stressful and stigmatizing environment, together with night-shift work, further affected NSHW sleep and their mental and physical health. The use of PS appeared to be for self-medication, encouraged by social and professional environments, source(s) of stress, discrimination, and isolation. The work environment, through aggravated sleep disorders, led NSHW to use non-prescribed sleeping pills. Alcohol after work and smoking were used as a social break but also as a means to reduce stress.

Conclusion

Anti-stigma interventions in the healthcare setting and screening of mental/somatic disorders in NSHW can help reduce harmful self-medication behaviors and improve hospital care in the COVID-19 era.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08018-x.

Assessing the psychosocial work environment in the health care setting: translation and psychometric testing of the French and Italian Copenhagen Psychosocial Questionnaires (COPSOQ) in a large sample of health professionals in Switzerland

Background

Measuring work-related stress in a reliable way is important in the development of appropriate prevention and intervention strategies. Especially in multilingual studies the use of comparable and reliable instruments is crucial. Therefore, the aim of this study was to translate selected scales and single items from the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ) into French and Italian and psychometrically test them in a sample of health professionals.

Methods

This study used cross-sectional data from health professionals at 163 randomised selected health organisations in Switzerland. Selected COPSOQ items/scales were backwards- and forwards- translated and cross-culturally adapted from German to French and Italian. Reliability was assessed with Cronbach alpha and intraclass correlation coefficients, construct validity with confirmatory factor analysis (CFA) and structural equation modelling as well as comparative fit index.

Results

Responses from 12,754 health professionals were included in the analysis. Of the overall 24 scales, 20 in the German version, 19 in the French version and 17 in the Italian version attained sufficient internal consistency with a threshold of 0.7 for Cronbach’s alpha. Predominantly high factor loadings on scale level are reported (> 0.35), as well as good and satisfactory fit values with RMSEA below 0.1, SRMR below 0.08 and CFI above 0.95. For 10 out of 15 scales, the test for factor invariance revealed a significant difference regarding the psychological constructs of the scales across the language versions.

Conclusions

The psychometric properties verify the underlying theoretical model of the COPSOQ questionnaire, which is to some extent comparable across the three language versions. Of the 10 scales with significant factor variance, four showed large differences, implying that revision is needed for better comparability. Potential cultural issues as well as regional differences may have led to the factor variance and the different reliability scores per scale across language versions. One known influencing factor for regional differences is culture, which should be considered in scale development. Moreover, emerging topics such as digitization should be considered in further development of the questionnaire.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07924-4.

Measures to reduce stress in the workplace – results from focus group interviews with health professionals / Maßnahmen zur Reduktion von Stress am Arbeitsplatz – Resultate aus Fokusgruppeninterviews mit Gesundheitsfachpersonen

Introduction

Stress and poor working conditions can affect the health and satisfaction of health professionals. Until now, the perspective of the staff has not been sufficiently considered in the development of solutions. The aim was to capture the wishes and recommendations of health professionals that could contribute to an improvement of the work situation from their perspective.

Method

Semistructured focus group interviews with health professionals (nurses, midwifes, medical-technical-therapeutic professions and physicians) were conducted and analyzed using knowledge mapping and a deductive approach.

Results

Between June and November 2018, 128 health professionals from Swiss acute hospitals, psychiatric hospitals, nursing homes, and outpatient services participated in a total of 24 focus group interviews. They expressed the need to incorporate wishes into staff scheduling and to address vacation planning at an early stage. Other suggestions were to be able to take advantage of further training opportunities and to live a positive feedback and error culture, as well as to establish a clear division of roles and tasks.

Conclusions

The healthcare staff interviewed showed clear ideas about what should be improved to reduce workload. There is a great need for action in the general conditions as well as in leadership and management.

Work-related stress and intention to leave among midwives working in Swiss maternity hospitals - a cross-sectional study

Background

Health systems around the globe are struggling to recruit qualified health professionals. Work-related stress plays an important role in why health professionals leave their profession prematurely. However, little is known about midwives’ working conditions and intentions to leave their profession, although this knowledge is key to work force retention. Therefore, we aimed to investigate work-related stress among midwives working in Swiss maternity hospitals, as well as differences between midwives and other health professionals and the stressors associated with midwives’ intention to leave the profession.

Methods

We conducted a data analysis of two cross-sectional studies encompassing midwives working in labour, postpartum and/or gynaecology wards of 12 public Swiss maternity hospitals. Data was collected by self-report questionnaire assessing potential stressors and long-term consequences of stress at work. Data were analysed using descriptive statistics, Kruskal Wallis tests and logistic regression modelling.

Results

A total of 98 midwives took part in the study and one in three midwives reported doing overtime sometimes-always. Also, the score for work-private life conflicts was significantly higher among midwives than among other health professionals, with the exception of physicians (M = 37.0 versus 50.2, p < .001). Midwives’ meaning of work score (M = 89.4) was significantly higher than that of other health professionals (e.g. nurses (M = 83.0, p < .001) or physicians (M = 82.5, p < .01)). Generation Y midwives showed a significantly higher intention to leave their organisation than did the baby boomers (Mean scores 29.3 versus 10.0, p < .01). Results of the regression model revealed that if midwives could compensate for their overtime in the same month, their intention to leave the profession was lower (OR = 0.23, p < .05). Additionally, the more midwives were affected by work-private life conflicts (OR = 3.01, p < .05) and thoughts about leaving their organisation (OR = 6.81, p < .05), the higher was their intention to leave their profession prematurely.

Conclusions

The comparison with other health professions and the higher intention to leave the profession of younger midwife generations are important findings for heads of institutions as well as policy makers, and should stimulate them to develop strategies for keeping midwives on their staff. More extensive studies should implement and test interventions for reducing work-related stress and increasing the job and occupational satisfaction of midwives.

Technostress Among Health Professionals - A Multilevel Model and Group Comparisons between Settings and Professions

OBJECTIVE

Health organizations increasingly digitize. However, studies reveal contradictory findings regarding the impact of healthcare information technology on health professionals. Therefore, the aim of this study is to describe the prevalence of technostress among health professionals and elaborate on the influencing factors.

PARTICIPANTS

A secondary analysis was conducted utilizing cross-sectional data from the study, "Work-related stress among health professionals in Switzerland", which included 8,112 health professionals from 163 health organizations in Switzerland.

METHODS

ANOVA for group comparisons followed by post-hoc analyses, along with a Multilevel Model to identify influencing factors for technostress ranging from "0" (never/almost never) to "100" (always), were conducted.

RESULTS

Health professionals experienced moderate technostress (mean 39.06, SD 32.54). Technostress differed between settings (p <.001) and health professions (p < .001). The model explains 18.1% of the variance with fixed effects, or 24.7% of the variance with fixed and random effects. Being a physician (β = 12.96), a nurse (β = 6.49), or the presence of an effort-reward-imbalance, increased technostress most (β = 6.11). A professional with no professional qualification (β = -7.94) showed the most reduction.

CONCLUSION

Health professionals experience moderate technostress. However, decision-makers should consider the cognitive and social aspects surrounding digitalization, to reach a beneficial and sustainable level of usage.

Development and psychometric testing of an observation-based assessment tool focusing on work-related stressors among health professionals: the STRAIN-External Observation of work Stressors

Background

Health professionals are especially affected by various stressors in their daily work, such as a high workload, physical and emotional challenges. The aim of this study was to develop and test the validity, reliability and usability of an observation-based instrument designed to assess work stressors in the healthcare sector.

Methods

Using a cross sectional design, 110 health professionals were observed during one entire shift by an external observer. Factor analysis was used to test construct validity, Cronbach's alpha to test internal consistency and correlations using Kendall's Tau were computed to test for convergent validity.

Results

For 9 out of 10 tested scales the results showed a one-factor solution for all observation scales (explained variance ranged from 55.5 to 80.2%), satisfactory reliability (Cronbach's alpha between .67 and .92), sufficient usability and satisfactory convergent validity.

Conclusions

The newly developed STRAIN-EOS, an observation-based assessment tool designed to assess stressors specifically in the healthcare sector, was shown to be potentially useful. However, further refinement and testing is necessary before it can be widely used.