Psychosocial factors in nursing work and occupational risks: a systematic review

Pousa, Patrícia Carneiro Pessoa; Lucca, Sérgio Roberto de

doi:10.1590/0034-7167-2020-0198

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 74 (suppl 3) • 2021 • https://doi.org/10.1590/0034-7167-2020-0198 copy

Psychosocial factors in nursing work and occupational risks: a systematic review

Factores psicosociales en el trabajo de enfermería y riesgos laborales: revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to identify, in international scientific production, the main psychosocial factors in nursing work, found through the Copenhagen Psychosocial Questionnaire (COPSOQ) application.

Methods:

a systematic review study of psychosocial factors at work among nursing professionals, who used COPSOQ in the assessment of work environments.

Results:

fifteen articles were identified, which highlighted as main psychosocial dimensions of nursing work demands, work organization, social relationships and leadership, work-home interface, workplace health and well-being and offensive behaviors.

Conclusion:

the high demands for cognitive, emotional work and work pace were identified in the nursing routine. Management support had a positive impact. Physical and psychological violence and shift work interfere in family life, aggravating the fatigue of these professionals. Interventions for reducing work stress presuppose the identification of psychosocial factors involved in nursing work.

Descriptors:
Nursing; Work; Occupational Health; Occupational Risks; Mental Health

	Reference	Year Country	Outlining/ sample	COPSOQ dimensions	Main results obtained
1	Freimann et al.⁽¹¹11 Freimann T, Merisalu E. Work-related psychosocial risk factors and mental health problems amongst nurses at a university hospital in Estonia: a cross-sectional study. Scand J Public Health. 2015;43(5): 447-52. doi: 10.1177/1403494815579477 https://doi.org/10.1177/1403494815579477... ⁾	2015 Estonia	Cross-sectional. n=404 Nurses	Requirements (quantitative/emotional demands/hide emotions); meaning of work; social relationships and leadership (rewards/gratuities/clarity of roles); values in the workplace (trust).	Sense of work, clarity of role, social relationships, mutual trust among workers were protective factors. Among the negative factors that refer to "hide" demands are emotions, cognitive and emotional, work pace, stress and exhaustion.
2	García- Rodríguez et al.⁽¹²12 García-Rodríguez A, Gutiérrez-Bedmar M, Bellón-Saameño JÁ, Muñoz-Bravo C, Navajas JFC. Psychosocial stress environment and health workers in public health: differences between primary and hospital care. Aten Prim. 2015;47(6):359-66. doi: 10.1016/j.aprim.2014.09.003 https://doi.org/10.1016/j.aprim.2014.09.... ⁾	2015 Spain	Cross-sectional with stratified random sampling n=498 Health workers^* * The term "health workers" was adopted because the articles do not specify the professional category, although all these articles are related to health care settings.	Requirements (cognitive/emotional and sensory demands); possibility of development at work/sense of the importance of work); social relations and leadership.	Sample with high levels of psychological, cognitive and emotional demands and possibilities for personal development and sense of work. The psychosocial environment was more unfavorable for the primary care team, although all groups have high levels of symptoms related to stress.
3	Ilic et al.⁽¹³13 Ilic IM, Arandjelovic MZ, Jovanovic JM, Nesic MM. Relationships of work-related psychosocial risks, stress, individual factors and burnout: questionnaire survey among emergency physicians and nurses. Med Pract. 2017;68(2): 167-78. doi: 10.13075/mp.5893.00516 https://doi.org/10.13075/mp.5893.00516... ⁾	2017 Serbia	Cross-sectional n=168 (80 nurses and 88 physicians)	Requirements (emotional and cognitive demands); meaning of work and autonomy; health and wellness (stress/burnout syndrome).	Physicians presented greater emotional and cognitive demands in relation to nurses. Both groups had high sensory demands and responsibility at work, despite the low degree of autonomy. The meaning of work, commitment to the workplace and job insecurity were high in both groups. The risk of patient-related burnout syndrome was high in both groups.
4	Li et al.⁽¹⁴14 Li J, Fu H, Hu Y, Shang L, Wu Y, Kristensen TS et al. Psychosocial work environment and intention to leave the nursing profession: results from the longitudinal Chinese study. Scand J Public Health. 2010;38(3 Suppl):69-80. doi: 10.1177/1403494809354361 https://doi.org/10.1177/1403494809354361... ⁾	2010 China	Longitudinal n=3,088 Nurses	Labor requirements (emotional demands); meaning and commitment at work; leadership (social support and feedback).	Positive correlation between "sense of work" with "commitment to the workplace" and "interpersonal relationships and leadership" with "social support" and "feedback".
5	Chanchai et al.⁽¹⁵15 Chanchai W, Songkham W, Ketsomporn P, Sappakitchanchai P, Siriwong W, Robson MG. The impact of an ergonomics intervention on psychosocial factors and musculoskeletal symptoms among Thai Hospital Orderlies. Int J Environ Res Public Health. 2016;13(5)464. doi: 10.3390/ijerph13050464 https://doi.org/10.3390/ijerph13050464... ⁾	2016 Thailand	Randomized controlled study n=100 Nurses	Requirements (work pace); meaning of work; social relationships and leadership (rewards/conflicts of roles/social support from supervisors).	The intervention resulted in a positive perception for the following psychosocial factors: work pace, influence at work, meaning of work, predictability, rewards, role conflicts and social support.
6	Ulusoy et al.⁽¹⁶16 Ulusoy N, Wirth T, Lincke HJ, Nienhaus A, Schablon A. Psychosocial burden and strains in geriatric nursing: comparison of nursing personnel with and without migration background. Z Gerontol Geriatr. 2019;52(6):589-97. doi: 10.1007/s00391-018-1414-8 https://doi.org/10.1007/s00391-018-1414-... ⁾	2019 Germany	Cross-sectional n=366 Nurses	Labor requirements;social relations and leadership;work-home interface; values in the workplace; health and well-being.	Nurses with experience in migration are less exposed to psychosocial burdens and demands than those without experience. Lack of development opportunities was a stress factor.
7	Kaltenbrunner et al.⁽¹⁷17 Kaltenbrunner M, Bengtsson L, Mathiassen SE, Hans Högberg H, Engström M. Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care. BMC Health Serv Res. 2019;19(1):652. doi: 10.1186/s12913-019-4502-6 https://doi.org/10.1186/s12913-019-4502-... ⁾	2019 Sweden	Longitudinal n=260 Health workers^* * The term "health workers" was adopted because the articles do not specify the professional category, although all these articles are related to health care settings.	Requirements (work demands); work-home interface (job satisfaction); health and wellness (exhaustion/Burnout Syndrome).	At the beginning of the study, symptoms of exhaustion and dissatisfaction were associated with high work demands. After the implementation of the Lean method in the perception of workers, there was an improvement in working conditions, satisfaction and a reduction in exhaustion.
8	Ulhassan et al.⁽¹⁸18 Ulhassan W, von Thiele Schwarz U, Thor J, Westerlund H. Interactions between lean management and the psychosocial work environment in a hospital setting: a multi-method study. BMC Health Serv Res. 2014;14:480. doi: 10.1186/1472-6963-14-480 https://doi.org/10.1186/1472-6963-14-480... ⁾	2014 Sweden	Longitudinal multi-method observational n=201 Nurses and nursing assistants	Labor requirements; organization and content of work; social relations and leadership; values in the workplace.	All psychosocial factors were positively affected by the full Lean method implementation.
9	Dichter et al.⁽¹⁹19 Dichter MN, Trutschel D, Schwab CGG, Haastert B, Quasdorf T, Halek M. Dementia care mapping in nursing homes: effects on caregiver attitudes, job satisfaction, and burnout: a quasi-experimental trial. Int Psychogeriatr. 2017;29(12):1993-2006. doi: 10.1017/S104161021700148X https://doi.org/10.1017/S104161021700148... ⁾	2017 Germany	Cross-sectional n=201 Health workers^* * The term "health workers" was adopted because the articles do not specify the professional category, although all these articles are related to health care settings.	Work-home interface; job satisfaction; health and wellness; exhaustion.	All psychosocial factors were affected in the provision of care to patients with dementia.
10	Park et al.⁽²⁰20 Park M, Cho S- H, Hong H- J. Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence and the perceived work environment. J Nurs Scholarsh. 2015;47(1):87-95. doi: 10.1111/jnu.12112 https://doi.org/10.1111/jnu.12112... ⁾	2015 South Korea	Cross-sectional n=970 Nurses	Requirements (quantitative demands/work rate/emotional demands); values in the workplace (trust/justice); offensive behaviors (violence).	Physical violence, threats of violence and verbal abuse were more frequent in ICUs, and sexual harassment and bullying were higher in operating rooms. Patients, followed by physicians and patients' relatives, were the main perpetrators of the violence. Nurses with greater work demands and less confidence and justice were more prone to violence.
11	Januario et al.⁽²¹21 Januario LB, Karstad K, Rugulies R, Bergström G, Holtermann A, Hallman DM. Association between Psychosocial Working Conditions and Perceived Physical Exertion among Eldercare Workers: a cross-sectional multilevel analysis of nursing homes, wards and workers. Int J Environ Res Public Health. 2019;16(19):3610. doi: 10.3390/ijerph16193610 https://doi.org/10.3390/ijerph16193610... ⁾	2019 Denmark	Cross-sectional n=536 Health workers^* * The term "health workers" was adopted because the articles do not specify the professional category, although all these articles are related to health care settings.	Labor requirements (quantitative and emotional demands); social relations and leadership (social support/quality of leadership).	In nursing homes, workers reported greater physical effort and low support from leaders. In the wards, there was a predominance of high qualitative demand, high work pace and low level of justice.
12	Kwiatkowski⁽²²22 Kwiatkowski B. Effects on careers caring for residents who are limited in their everyday capabilities. A comparison of several measuring points in a pilot study. Pflege Z[Internet]. 2011 [cited 2019 Nov 30];64(5):286-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21638876 https://www.ncbi.nlm.nih.gov/pubmed/2163... ⁾	2011 Germany	Correlationaln =60 (30 nurses and 30 health workers^* * The term "health workers" was adopted because the articles do not specify the professional category, although all these articles are related to health care settings. )	Work-home interface; possibility of development and influence at work; social relations and leadership (social support and feedback).	Caregivers' psychosocial stress is greater compared to qualified nurses.
13	Nübling et al.⁽²³23 Nübling M, Vomstein M, Schmidt SG, Gregersen S, Dulon M, Nienhaus A. Psychosocial work load and stress in the geriatric care. BMC Public Health. 2010;10:428. doi: 10.1186/1471-2458-10-428 https://doi.org/10.1186/1471-2458-10-428... ⁾	2010 Germany	Cross-sectional n=889 Health workers^* * The term "health workers" was adopted because the articles do not specify the professional category, although all these articles are related to health care settings.	Labor requirements (demands); health and well-being (stress/tension); organization and control (autonomy); social relations and leadership (support).	Home care workers have less quantitative and emotional demands, less work conflict, privacy and better development possibilities.
14	Ismail et al.⁽²⁴24 Ismail KM, Malak MZ, Alamer RM. Psychosocial correlates of work-related fatigue among Jordanian emergency department nurses. Perspect Psychiatr Care. 2019;55(3):486-93. doi: 10.1111/ppc.12354 https://doi.org/10.1111/ppc.12354... ⁾	2019 Jordan	Cross-sectional. n=220 Nurses	Requirements (quantitative demands); work-home interface (conflicts between family and work); health and wellness; offensive behaviors (sexual harassment/physical violence and bullying).	Quantitative demands and sexual harassment were the main predictors of all types of work-related exhaustion and fatigue.
15	Carthy et al.⁽²⁵25 Mc Carthy VJC, Wills T, Crowley S. Nurses, age, job demands and physical activity at work and at leisure: a cross-sectional study. Appl Nurs Res. 2018;40:116-21. doi: 10.1016/j.apnr.2018.01.010 https://doi.org/10.1016/j.apnr.2018.01.0... ⁾	2016 Ireland	Cross-sectional n=210 Nurses	Labor requirements (cognitive demands).	Nurses with a high quantitative demand for work were more involved in healthy life activities than the same professionals aged 40 and over.

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[1] Corresponding author: Patrícia Carneiro Pessoa Pousa pcp.pousa@gmail.com