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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. Outline (pregled).

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Rajna golubic md andrija stampar school of public health zagreb university school of medicine

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

Rajna Golubic, MD

"AndrijaStampar" School of Public Health

Zagreb University School of Medicine


Outline pregled
Outline health care workers(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 buduća istraživanja i moguće intervencije)


Impact of work on health utjecaj rada na zdravlje
Impact of work on health health care workers(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 značajno se razlikuju u pojedinim zemljama)


The most common symptoms reported by workers in the eu naj e i simptomi na koje se ale radnici eu
The most common symptoms reported by workers in the EU health care workers(najčešći simptomi na koje se žale radnici EU):

  • Backache (bol u leđima): 24.7%

  • Muscular pain (mišićna bol): 22.8%

  • Fatigue (iscrpljenost): 22.6%

  • Stress (stres): 22.3%

  • Headache (glavobolja): 15.5%

  • Irritability (razdražljivost): 10.5%

    4th European Working Conditions Survey


Workplace stress a growing problem stres na radnom mjestu rastu i problem
Workplace stress- a growing problem health care workers(stres na radnom mjestu-rastući problem)

  • Work-related stress: a pattern of

    • emotional,

    • cognitive,

    • behavioral and

    • physiological reactions

  • toadverse 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 značajke posla u smislu sadržaja, organizacije i radnog okruženja)


Occupational stress concepts models modeli i koncepti stresa na radnom mjestu
Occupational stress concepts & models health care workers(modeli i koncepti stresa na radnom mjestu)

  • Demand-control model- Karasek, 1979 (Stres raste kako raste zbroj povećanih zahtjeva i niske razine odlučivanja )

  • Effort-reward imbalance model (Stres je posljedica neravnoteže između 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)- trećina Europljana pati od stresa na radnom mjestu


Reaction to stress depends on reakcija na stres ovisi o
Reaction to stress depends on health care workers(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 ličnosti, životni stil)

  • Stressors(stresnim čimbenicima)


Healthcare workers zdravstveni djelatnici
Healthcare workers health care 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 čimbenici)

STRESS, DISEASES, EARLY RETIREMENT


Research project
Research project health care workers

  • Title:‘Work-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 Mustajbegović, 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)


Aim cilj
Aim health care workers(Cilj)

  • To investigatestressorstowhich health care workers are exposed(Istražiti stresne čimbenike kojima su izloženi zdravstveni djelatnici)

  • To investigate work abilityof health care workers(Istražiti radnu sposobnost zdravstvenih djelatnika)

  • To investigatewhichstressors influence the work abilityofhealth care workersand to whatextent(Istražiti koji stresori i koliko utječu na radnu sposobnost)


Subjects ispitanici
Subjects health care workers(Ispitanici)

  • 4 clinicalhospitals at the Zagreb UniversitySchoolof Medicine (4 kliničke bolnice Sveučilišta u Zagrebu)

  • Allemployed health care workerswereinvited to partcipateinthestudy(Svi zaposleni zdravstveni djelatnici bili su pozvani da sudjeluju u istraživanju)

  • Overallresponse rate: 78% (ukupni odaziv:78%)

  • Participationwasanonimousandvoluntary(Sudjelovanje- anonimno i dobrovoljno )


Methods metode
Methods health care workers(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)


Methods metode1
Methods health care workers(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(Opći podaci -spol, dob, bračni status, broj djece,stručni 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)


Methods metode2
Methods health care workers(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 mogućnosti),

    • Career progressing (napredovanje),

    • Education (edukaciju),

    • Interpersonal relations (međuljudske odnose),

    • Attitude towards patients (odnos s pacijentima),

    • Health hazards (štetnostima za zdravlje)


Work ability radna sposobnost
Work Ability health care workers(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 prilagođavanja radnih uvjeta sposobnostima i mogućnostima djelatnika)


Work ability radna sposobnost1
Work Ability health care workers(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:

    • Fizičke i psihičke zahtjeve radnog mjesta

    • Fizičke i psihičke sposobnosti djelatnika

    • Zdravstveno stanje djelatnika)


Work ability radna sposobnost2
Work Ability health care workers(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 unapređenje.)


Work ability index wai indeks radne sposobnosti
Work Ability Index, WAI health care workers(Indeks radne sposobnosti)

  • Current work ability (1-10)

    (Sadašnja radna sposobnost (0-10) )

  • Work ability in relation to the demands of the job(Radnasposobnost u odnosu sa zahtjevima posla)

  • Number of current diseases diagnosed by a physician (Broj bolesti dijagnosticiranih od strane liječnika)

  • Estimated work impairment due to diseases (Koliko zdravstvene tegobe ometaju rad?)


Work ability index wai indeks radne sposobnosti1
Work Ability Index, WAI health care workers(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

    (Psihičke sposobnosti- uživanje , aktivnost, nada)


Work ability index wai values indeks radne sposobnosti vrijednosti
Work Ability Index, WAI; values health care workers(Indeks radne sposobnosti, vrijednosti)

  • 44 - 49 → excellent, the work ability (WA) should be maintained (odlično, 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)


Preliminary results preliminarni rezultati
Preliminary results health care workers(Preliminarni rezultati)


Subjects ispitanici1
Subjects health care workers(Ispitanici)

  • Physicians ,N=395 (Liječnici)

    • 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)


Subjects ispitanici2
Subjects health care workers(Ispitanici)

  • Nurses/Medical technicians (Medicinske sestre / Tehničari), N=1082

    • 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)


Subjects ispitanici3
Subjects health care workers(Ispitanici)


Physicians specialties lije nici specijalizacije
Physicians- specialties health care workers(Liječnici-specijalizacije)


Nurses technicians specialties medicinske sestre tehni ari specijalizacije
Nurses/technicians-specialties health care workers(Medicinske sestre/tehničari-specijalizacije)


Physicians perception of stressors lije nici percepcija stresora
Physicians- perception of stressors health care workers(Liječnici- percepcija stresora)


Nurses technicians perception of stressors med sestre tehni ari percepcija stresora
Nurses/technicians- perception of stressors health care workers(Med.sestre/tehničari- percepcija stresora)


Health care workers satisfaction zadovoljstvo zdravstvenih djelatnika
Health care workers’ satisfaction health care workers(Zadovoljstvo zdravstvenih djelatnika)


Overall indicator of work ability ukupni pokazatelj radne sposobnosti
Overall indicator of work ability health care workers(Ukupni pokazatelj radne sposobnosti)

  • Satisfactory (zadovoljavajući)

  • Physicians have significantly higher WAI than other health care workers (Liječnici imaju statistički značajno veći WAI od ostalih zdravstvenih djelatnika)

    • ANCOVA, P<0.001, covariate- age (kovarijanca - dob)

    • Mean WAI (srednja vrijednost za WAI):

      • Physicians (liječnici): 39.87

      • Nurses and technicians (Med. Sestre i tehničari:): 38.01


Overall indicator of work ability ukupni pokazatelj radne sposobnosti1
Overall indicator of work ability health care workers(Ukupni pokazatelj radne sposobnosti)

  • Mean WAI (srednja vrijednost za WAI)

    • Physicians (liječnici)

      • Males (muški): 40.49

      • Females (žene): 38.62

    • Nurses/technicians (med. sestre/tehničari)

      • Males (muški): 40.64

      • Females (žene): 37.98

    • ANCOVA analysis was performed, age was used as the covariate (provedena je ANCOVA, kovarijanca- dob)


Conclusions zaklju ci
Conclusions health care workers(Zaključci)

  • 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 zadovoljavajući)


Conclusions zaklju ci1
Conclusions health care workers(Zaključci)

  • Significant predictors for better work ability among physicians (logistic regression) (Značajni prediktori za bolju radnu sposobnost u liječnika (logistička regresija)):

    • Job satisfaction (Zadovoljstvo poslom): OR=3.45 (95%CI:1.5-4.3)

    • Male gender (Muški spol): OR=2.35 (95%CI:1.2-3.3)

    • Higher intelectual demands (Veći intelektualni zahtjevi): OR=1.56 (95%CI:1.2-2.3)

    • Lower exposure to chemical/biological/physical hazards (Manja izloženost kemijskim/biološkim/fizikalnihm štetnostima):OR=1.5 (95%CI:1.1-3.2)

    • Younger age (Mlađa dob): OR=1.10 (95%CI:1.05-1.7)


Conclusions zaklju ci2
Conclusions health care workers(Zaključci)

  • Significant predictors for better work ability among nurses/technicians (Značajni prediktori za bolju radnu sposobnost u medicinskih sestara/tehničara):

    • Job satisfaction (Zadovoljstvo poslom): OR=2.43 (95%CI:1.6-3.3)

    • Male gender (Muški spol): OR=2.4 (95%CI:1.3-3.4)

    • Lower exposure to chemical/biological/physical hazards (Manja izloženost kemijskim/biološkim/fizikalnihm štetnostima): OR=1.2 (95%CI:1.1-2.1)

    • Lower frequency of shift work (Manja učestalost smjenskog rada): OR=1.2 (95%CI:1.1-2.3)

    • Younger age (Mlađa dob): OR=1.10 (95%CI:1.05-1.7)


Future plans planovi za budu nost
Future plans health care workers(Planovi za budućnost)


Aims of the future plans ciljevi budu ih planova
Aims health care workersofthe future plans(Ciljevi budućih 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 između 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 između 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 između pojedinih domena kvalitete života i radne sposobnosti)

  • To assess health care workers’ salutogenic productivity (procijeniti salutogenu produktivnost zdravstvenih djelatnika)


Implementation of new instruments uvo enje novih instrumenata
Implementation of new instruments health care workers(Uvođenje novih instrumenata)

  • WHOQOL-BREF questionnaire

    • Assesses the quality of life (Procjena kvalitete života)

    • 4 domains (4 domene):

      • Physical health (fizičko zdravlje)

      • Psychological health (psihološko zdravlje)

      • Social relationships (društvene veze)

      • Environment (okoliš)

    • 26 items (26 pitanja)


Implementation of new instruments uvo enje novih instrumenata1
Implementation of new instruments health care workers(Uvođenje 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, Beč)


Human work index indeks ljudskog rada
Human health care workersWorkIndex(Indeks ljudskog rada)


Possible interventions mogu e intervencije
Possible health care workersinterventions(Moguće intervencije)

  • Creation of the programme aiming at health promotion and sustainable work ability of health care workers (izrada programa za promociju i očuvanje 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 očuvanje zdravlja i radne sposobnosti zdravstvenih djelatnika)

  • Prevention of stress-related diseases and early retirement (prevencija bolesti vezanih uz stres i preranog odlaska u mirovinu)


Thank you for your attention hvala na pozornosti
Thank health care workersyou for yourattention!!!(Hvala na pozornosti!!!)


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