Measuring limitations in activities of daily living: a population-based validation of a short questionnaire.

PURPOSE: A newly developed questionnaire assessing limitations in activity of daily living (LADL-Q) that should improve assessment of LADL is tested in a large population-based validation study. METHODS: This survey was paper-based. Overall, 16,634 individuals who were representative of the working population in the German-speaking part of Switzerland participated in the study. Item analysis was used the final version of the LADL-Q to four items per subscale that correspond to potential problems in three body regions (back and neck, upper extremities, lower extremities). Analysis included tests for reliability, internal consistency, dimensionality and convergent validity. RESULTS: Test-retest reliability coefficients after 2 weeks ranged from 0.82 to 0.99 (Mdn = 0.87), with no item having a coefficient below 0.60. The median item-total coefficients ranged between moderate and good. Correlation coefficients between LADL-Q subscales and three validated clinical instruments (Western Ontario and McMaster Universities osteoarthritis index, shoulder pain disability index, Oswestry) ranged from 0.63 to 0.81. In structural equation modeling the three subscales were significantly related with two important outcomes in occupational rehabilitation: self-reported general health and daily task performance. CONCLUSION: The new LADL-Q is a brief, reliable and valid tool for assessment of LADL in studies on musculoskeletal health.

Interruptions, Unreasonable Tasks, and Quality-Threatening Time Pressure in Home Care: Linked to Attention Deficits and Slips, Trips, and Falls.

BACKGROUND: In industrial countries, home care of community dwelling elderly people is rapidly growing. Frequent injuries in home caregivers result from slips, trips, and falls (STFs). The current study tests attentional cognitive failure to mediate the association between work stressors and STFs. METHODS: A sample of 125 home caregivers participated in a questionnaire study and reported work interruptions, unreasonable tasks, quality-threatening time pressure, conscientiousness, attentional cognitive failures, and STFs. RESULTS: In structural equation modeling, the mediation model was shown to fit empirical data. Indirect paths with attentional cognitive failures as the link between work stressors and STF were all significant in bootstrapping tests. An alternative accident-prone person model, that suggests individual differences in conscientiousness to predict attentional cognitive failures that predict more frequent work stressors and STFs, showed no significant paths between work conditions and STFs. CONCLUSION: To prevent occupational injury, work should be redesigned to reduce work interruptions, unreasonable tasks, and quality-threatening time pressure in home care.

Work-family conflict and neck and back pain in surgical nurses.

OBJECTIVE: Surgical nurses' work is physically and mentally demanding, possibly leading to work-family conflict (WFC). The current study tests WFC to be a risk factor for neck and lower back pain (LBP). Job influence and social support are tested as resources that could buffer the detrimental impact of WFC. METHODS: Forty-eight surgical nurses from two university hospitals in Germany and Switzerland were recruited. WFC was assessed with the Work-Family Conflict Scale. Job influence and social support were assessed with the Copenhagen Psychosocial Questionnaire, and back pain was assessed with the North American Spine Society Instrument. RESULTS: Multiple linear regression analyses confirmed WFC as a significant predictor of cervical pain (ß = 0.45, p < 0.001) and LBP (ß = 0.33, p = 0.012). Job influence and social support did not turn out to be significant predictors and were not found to buffer the impact of WFC in moderator analyses. CONCLUSION: WFC is likely to affect neck and back pain in surgery nurses. Work-life interventions may have the potential to reduce WFC in surgery nurses.

Lower back pain in nurses working in home care: linked to work-family conflict, emotional dissonance, and appreciation?

In industrial countries home care services for elderly people living in the community are growing rapidly. Home care nursing is intensive and the nurses often suffer from musculoskeletal pain. Time pressure and job control are job-related factors linked to the risk of experiencing lower back pain (LBP) and LBP-related work impairment. This survey investigated whether work-family conflict (WFC), emotional dissonance and being appreciated at work have incremental predictive value. Responses were obtained from 125 home care nurses (63% response rate). Multiple linear regression showed that emotional dissonance and being appreciated at work predicted LBP intensity and LBP-related disability independently of time pressure and job control. WFC was not a predictor of LBP-related disability in multiple regression analyses despite a zero-order correlation with it. Redesigning the working pattern of home care nurses to reduce the emotional demands and improve appreciation of their work might reduce the incidence of LBP in this group.

Exploring Supervisor-Related Job Resources as Mediators between Supervisor Conflict and Job Attitudes in Hospital Employees.

BACKGROUND: Conservation of resources theory assumes loss of resources as a cause of job strain. In hospital work, conflicts with supervisors are tested to predict lower resources, that is, supervisory social support, participation possibilities, and appreciation. All three resources are expected to predict, in turn, experienced stress (job strain) and lower job satisfaction, lower affective commitment, and a higher resigned attitude towards the job (job attitudes). METHODS: The sample included 1,073 employees from 14 Swiss hospitals (n = 604 nurses, n = 81 physicians, n = 135 medical therapists, and n = 253 technical and administrative staff). Of the total sample, 83.1% were female and 38.9% worked full-time. The median tenure was between 7 years and 10 years. Constructs were assessed by online questionnaires. Structural equation modeling was used to test mediation. RESULTS: Structural equation modeling confirmed the negative association of conflict with supervisors and job resources. Tests of indirect paths to resources as a link between conflicts with supervisors and job attitudes were significant. For nurses, social support, participation and appreciation showed a significant indirect path, while among medical technicians the indirect paths included social support and appreciation, and among physicians only appreciation showed a significant indirect path. In medical therapists no indirect path was significant. Job resources did not mediate the link between conflict with supervisors and stress in any occupational group. CONCLUSION: Conflicts with supervisors are likely to reduce job resources and in turn to lower job attitudes. Work design in hospitals should, therefore, address interpersonal working conditions and conflict management in leadership development.

Quantitative work demands, emotional demands, and cognitive stress symptoms in surgery nurses.

In surgery, cognitive stress symptoms, including problems in concentrating, deciding, memorising, and reflecting are risks to patient safety. Recent evidence points to social stressors as antecedents of cognitive stress symptoms in surgery personnel. The current study tests whether cognitive stress symptoms are positively associated with emotional abuse, emotional- and task-related demands and resources in surgery work. Forty-eight surgery nurses from two hospitals filled out the Copenhagen Psychosocial Questionnaire in its German version. Task-related and emotional demands were positively related to cognitive stress symptoms. In a stepwise, multiple, linear regression of cognitive stress symptoms on task-related and emotional demands, emotional abuse and emotional demands were unique predictors (p < .05). Efforts to increase patient safety should address emotional abuse, emotional demands, and, therefore, communication and cooperation team climate in surgery personnel.

Taking the chance: Core self-evaluations predict relative gain in job resources following turnover.

Core self-evaluations (CSE) might account for relative gains in job resources across time, especially in situations when these individual differences affect behavior that is relevant for development of job resources. This longitudinal study tests CSE as an individual resource that predicts relative gain in job resources and job satisfaction among job beginners who change or stay with their employer. A questionnaire was filled in by 513 adolescents shortly before the end of vocational training and one year later. Our results replicate previous findings suggesting that job satisfaction is affected by CSE directly and indirectly through the perception of job resources. Multi-group structural equation analysis showed that only leavers had a longitudinal indirect effect of CSE on job satisfaction at the end of vocational training via job resources during their first year of employment. Our findings imply that turnover includes opportunities to optimize one's circumstances and that CSE helps to attain resourceful jobs.

Workflow interruptions, cognitive failure and near-accidents in health care.

Errors are frequent in health care. A specific model was tested that affirms failure in cognitive action regulation to mediate the influence of nurses' workflow interruptions and safety conscientiousness on near-accidents in health care. One hundred and sixty-five nurses from seven Swiss hospitals participated in a questionnaire survey. Structural equation modelling confirmed the hypothesised mediation model. Cognitive failure in action regulation significantly mediated the influence of workflow interruptions on near-accidents (p < .05). An indirect path from conscientiousness to near-accidents via cognitive failure in action regulation was also significant (p < .05). Compliance with safety regulations was significantly related to cognitive failure and near-accidents; moreover, cognitive failure mediated the association between compliance and near-accidents (p < .05). Contrary to expectations, compliance with safety regulations was not related to workflow interruptions. Workflow interruptions caused by colleagues, patients and organisational constraints are likely to trigger errors in nursing. Work redesign is recommended to reduce cognitive failure and improve safety of nurses and patients.

Social stress at work and change in women's body weight.

Social stressors at work (such as conflict or animosities) imply disrespect or a lack of appreciation and thus a threat to self. Stress induced by this offence to self might result, over time, in a change in body weight. The current study investigated the impact of changing working conditions--specifically social stressors, demands, and control at work--on women's change in weighted Body-Mass-Index over the course of a year. Fifty-seven women in their first year of occupational life participated at baseline and thirty-eight at follow-up. Working conditions were assessed by self-reports and observer-ratings. Body-Mass-Index at baseline and change in Body-Mass-Index one year later were regressed on self-reported social stressors as well as observed work stressors, observed job control, and their interaction. Seen individually, social stressors at work predicted Body-Mass-Index. Moreover, increase in social stressors and decrease of job control during the first year of occupational life predicted increase in Body-Mass-Index. Work redesign that reduces social stressors at work and increases job control could help to prevent obesity epidemic.

Learning to drive: learners' self-reported cognitive failure level predicts driving instructor's observation rating of driving performance.

OBJECTIVES: Evidence increases that cognitive failure may be used to screen for drivers at risk. Until now, most studies have relied on driving learners. This exploratory pilot study examines self-report of cognitive failure in driving beginners and error during real driving as observed by driving instructors. METHODS: Forty-two driving learners of 14 driving instructors filled out a work-related cognitive failure questionnaire. Driving instructors observed driving errors during the next driving lesson. In multiple linear regression analysis, driving errors were regressed on cognitive failure with the number of driving lessons as an estimator of driving experience controlled. RESULTS: Higher cognitive failure predicted more driving errors (p < .01) when age, gender and driving experience were controlled in analysis. CONCLUSIONS: Cognitive failure was significantly associated with observed driving errors. Systematic research on cognitive failure in driving beginners is recommended.

Railway-controller-perceived mental work load, cognitive failure and risky commuting.

This questionnaire study tests cognitive failures as a mediator of the potential influence of mental work demands and conscientiousness on risky commuting. Participants were 104 railway-controllers (19% female). Failure of memory, attention regulation and action execution were assessed with the Workplace Cognitive Failure (WCF) scale. Mental work demands were measured by the Instrument for Stress-Oriented Task Analysis (ISTA). A structural equation model testing WCF as the mediator of (1) the relationship between mental work demands and risky commuting (p < 0.05) and (2) the link between conscientiousness and risky commuting (p < 0.05) fitted well with empirical data. In railway-controllers frequent interruptions, time pressure, and high concentration demands are likely to increase cognitive load and thereby boost WCF during work and also during commuting, thereby reducing commuting safety. The results underline the need for work redesign to improve commuting safety. PRACTITIONER SUMMARY: Commuting accidents occur frequently and at high cost. This study shows that mental work demands of railway staff are related to cognitive failure and risky commuting behaviour such as failing to give way and overlooking stop signs. Primary prevention of commuting accidents should include reduction of mental workload.

Getting used to academic public speaking: global self-esteem predicts habituation in blood pressure response to repeated thesis presentations.

Global self-esteem was tested to predict quicker cardiovascular adaptation during stressful oral thesis presentation and faster habituation from the first to the second and third thesis presentations. Nineteen graduate students initially rated their global self-esteem and afterwards orally presented their theses proposals in 20-min presentations to their thesis supervisor and peers. A second and third presentation of the revised thesis concepts took place at 4-weeks intervals. Ambulatory blood pressure and heart rate were assessed repeatedly during the presentations. Post-talk self ratings of stressfulness indicated presentations to be a strong public speaking stressor. One hundred and thirty-eight measurements of systolic (SBP), diastolic blood pressure (DBP), and heart rate (HR) showed a significant adaptation (decrease) during presentations. There was an overall mean level decrease from the first to the second, and the second to the third presentations in HR, but not in SBP and DBP. However, habituation in SBP and DBP across three presentations was significantly faster (p < .05) in those participants who initially reported higher levels of global self-esteem. Higher global self-esteem did not foster adaptation within the presentations. Self-esteem is discussed as an important individual resource that allows successful coping with recurring evaluative threats.

A new faces scale in pain measurement: a test of bias from current mood, trait affectivity, and scale range.

BACKGROUND AND PURPOSE: Faces pain rating scales used among children have been criticized to confound affective states with pain when smiling faces are included. This experimental study is an attempt to examine the possible confounding of affective states with pain when smiling faces are used as part of a faces scale. The meaning of the faces was tested to depend on current mood, current pain, trait affectivity, and inclusion versus exclusion of smiling faces. METHODS: Sixty-four participants made 6,720 two-categorical pain judgments on faces with different mouth curvature. RESULTS: In multilevel regression analysis, current level of pain and negative trait affectivity biased faces' meaning only when the smiling faces were excluded from the scale. CONCLUSIONS: In adults, the new full range faces pain scale including a midpoint neutral face and smiling faces was more robust than the restricted scale. The faces scale that was tested in this study is not applicable for patient measurement but it is an interesting tool for psychological research.

Ambulatory assessment of skin conductivity during first thesis presentation: lower self-confidence predicts prolonged stress response.

In this field study self-confidence was tested to predict the course of galvanic electrodermal stress response prior, during and after public speaking. Ten graduate students initially rated their self-confidence and afterwards presented their thesis proposals orally in a 10-min presentation to their supervisor and peers. Galvanic skin response level was measured throughout and analysed for 10 min prior to, during, and 10 min after the presentation. Two major galvanic electrodermal stress response types were observed. Five students showed a 'healthy response', i.e. an anticipatory increase in electrodermal conductance, followed by a decrease after termination of the presentation. The other five students showed a steady increase of skin conductance during and after their presentation ('prolonged response'). In line with the allostatic load model the 'prolonged response' group reported significantly lower self-confidence before presentation than the 'healthy response' group (p < 0.01). Self-confidence is a resource in novices facing an unfamiliar stressor.

Job characteristics in nursing and cognitive failure at work.

OBJECTIVES: Stressors in nursing put high demands on cognitive control and, therefore, may increase the risk of cognitive failures that put patients at risk. Task-related stressors were expected to be positively associated with cognitive failure at work and job control was expected to be negatively associated with cognitive failure at work. METHODS: Ninety-six registered nurses from 11 Swiss hospitals were investigated (89 women, 7 men, mean age = 36 years, standard deviation = 12 years, 80% supervisors, response rate 48%). A new German version of the Workplace Cognitive Failure Scale (WCFS) was employed to assess failure in memory function, failure in attention regulation, and failure in action exertion. In linear regression analyses, WCFS was related to work characteristics, neuroticism, and conscientiousness. RESULTS: The German WCFS was valid and reliable. The factorial structure of the original WCF could be replicated. Multilevel regression task-related stressors and conscientiousness were significantly related to attention control and action exertion. CONCLUSION: The study sheds light on the association between job characteristics and work-related cognitive failure. These associations were unique, i.e. associations were shown even when individual differences in conscientiousness and neuroticism were controlled for. A job redesign in nursing should address task stressors.

Workplace observation of work stressors, catecholamines and musculoskeletal pain among male employees.

OBJECTIVES: Prolonged activation of the sympathetic-adrenal medullary system during work and the lack of recovery after work may indicate a risk for musculoskeletal pain (ie, neck, shoulder, or low-back pain). This field study tested whether a high level of work stressors are associated with musculoskeletal pain and higher urinary norepinephrine excretion rates at work, after work, and on Sundays. METHODS: Altogether 32 male employees working in adult education took part in a three-phase repeated-measures field study including workplace observation, self-report of musculoskeletal pain, and measurement of urinary catecholamine at work, in the evening after work, and at corresponding times on Sundays. RESULTS: In univariate analyses, work stressors and workday levels of norepinephrine were significantly higher in the participants with high levels of musculoskeletal pain. Moreover, regressing workday norepinephrine excretion rates on predictor variables in the multilevel regression analysis showed a significant interaction between work stressors and musculoskeletal pain (P=0.011) with elevated excretion rates of norepinephrine in those exposed to a high level of work stressors and, at the same time, reporting higher levels of musculoskeletal pain. CONCLUSIONS: High work stressors turned out to be associated with musculoskeletal pain and norepinephrine concentration in male employees. Increased activity of the sympathetic-adrenal medullary system seems to play an important role in work-related musculoskeletal pain.

Working conditions and three types of well-being: a longitudinal study with self-report and rating data.

The mean of self-report and observer ratings of working conditions was used to predict 3 types of well-being in 52 young workers: general well-being, job-related well-being, and spillover from work to nonwork domains. Longitudinally, job control predicted spillover. There was no strong evidence for reverse causation. Synchronously, Time 2 job stressors predicted all types of well-being, and job control predicted general well-being. Because dependent variables at Time 1 are controlled for, this indicates short-term effects. Results for stressors are in line with a stress reaction model, indicating a rather quick symptom development but reversibility. The effect of control on spillover, however, suggests a sleeper effect model, with symptoms appearing with delay.

Two urinary catecholamine measurement indices for applied stress research: effects of time and temperature until freezing.

Research on stress at work often involves the analysis of urinary adrenaline and noradrenaline. It is usually assumed that samples have to be cooled quickly and stored at refrigerator temperature before freezing. This is often difficult to achieve in field studies. This experimental study therefore tests the robustness of results when samples are not cooled immediately. Samples of 9 men and women, collected at 3 points in time, were immediately frozen, kept for a variable delay in a warm room, or stored in a refrigerator before freezing. Two indices were calculated: (a) the ratio of hormones to liquid volume, period of excretion, and body weight; and (b) the ratio of hormones to urinary creatinine. The reliability of high performance liquid chromatography analysis was satisfactory, as was the comparability of the 2 indices. Unfavorable storage up to 24 hr did not cause bacteria-driven decreases of catecholamines, regardless of storage temperature or sampling time. Results suggest high stability for at least 24 hr without cooling, provided the samples are immediately acidified. Cooling may therefore be handled less restrictively than has been assumed. The application of this research is to facilitate research in settings where samples are collected at different places, such as participants' homes or different workplaces.

Time control, catecholamines and back pain among young nurses.

OBJECTIVES: This study had two objectives. First, it addressed concern with the contribution of work stressors and resources to the development of back pain, over and above the influence of biomechanical work factors. Second, using recent models about the role of the sympathetic-adrenal medullar system in musculoskeletal problems as its basis, it tested whether low-back pain is associated with higher levels of catecholamines. METHODS: Altogether 114 nurses filled out a questionnaire in their first year of practice and again one year later. In addition, in a subsample of 24 nurses studied intensively at follow-up, urinary catecholamines were assessed at noon, before the end of work, in the evening, and at corresponding times on a day off. Daily stressful experiences and daily mood were also recorded. RESULTS: With control for baseline pain, biomechanical workload, and other potentially confounding variables, time control at the beginning of the study predicted low-back pain a year later. In the subsample, the epinephrine and norepinephrine levels were higher in those reporting more frequent episodes of back pain, the largest differences occurring at the end of work. In addition, control over stressful events at work was lower in this group. CONCLUSIONS: Time control is a risk factor for low-back pain among nurses beyond the influence of physical work load. Low control at work may increase the activity of the sympathetic-adrenal medullar system, which seems to play an important role in the development of musculoskeletal pain.