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Work Organization, Economic Inequality, and Depression among Nursing Assistants: A Multilevel Modeling Approach
Abstract
To investigate the relationships among the nursing home work environment, emotional strain, and depression in Nursing Assistants in Ohio and West Virginia, this cross-sectional study was conducted with 395 Nurse Assistants in 49 nursing homes in Ohio and West Virginia. Organizational attributes were measured independently at the individual and organizational levels. Multilevel modeling techniques were used to analyze the data. Our methods examined nursing home organizational structure (ownership type, managerial style), and work organization (emotional strain) was examined in relation to the prevalence of depression among nursing assistants. Our findings suggest workplace emotional strain and age are associated with increased odds of depression. Implications of our work include that work in nursing homes for the environment it fosters has a strong effect on emotional strain and depression among Nursing Assistants.
... Findings were discussed following the PRISMA guidelines (Page et al., 2021). Given that Muntaner et al. (Muntaner et al., 2004(Muntaner et al., , 2011(Muntaner et al., , 2015Muntaner, Van Dussen, et al., 2006) used the same dataset in several studies, their studies were jointly evaluated based on the sample, rather than as different studies. Similarly, the Finnish studies (Heponiemi et al., 2011(Heponiemi et al., , 2012a(Heponiemi et al., , 2012b) also used the same dataset but with different outcomes for each study. ...
... Six studies were from Europe: Switzerland (Graf et al., 2016), Sweden (Höckertin, 2008), Germany (Wendsche et al., 2016), and Finland (Heponiemi et al., 2011(Heponiemi et al., , 2012a(Heponiemi et al., , 2012b. Nine were from the United States (Choi et al., 2012;Decker et al., 2009;Filipova, 2011;Hamann & Foster, 2014;Muntaner et al., 2004Muntaner et al., , 2011Muntaner et al., , 2015Muntaner, Van Dussen, et al., 2006). The remaining two articles were from Israel (Iecovich & Avivi, 2017) and Taiwan (Chen et al., 2015). ...
... Well-Being: Depression, General Health, and Profit Status. Muntaner et al. (Muntaner et al., 2004(Muntaner et al., , 2011(Muntaner et al., , 2015Muntaner, Van Dussen, et al., 2006) investigated depressive disorder and symptoms, and general health among 868 CNAs. Data were collected from 1999 to 2002 for five publications. ...
This systematic review investigated the psychosocial work environment and well-being of direct-care staff under different nursing home ownership types. Databases searched: Scopus, Web of Science, Cinahl, and PubMed, 1990-2020. Inclusion criteria: quantitative or mixed-method studies; population: direct-care staff in nursing homes; exposure: for-profit and non-profit ownership; and outcomes: psychosocial work environment and well-being. In total, 3896 articles were screened and 17(n = 12,843 participants) were assessed using the Joanna Briggs Institute Critical Appraisal tools and included in the narrative synthesis. The results were inconsistent, but findings favored non-profit over for-profit settings, for example, regarding leaving intentions, organizational commitment, and stress-related outcomes. There were no clear differences concerning job satisfaction. Job demands were higher in non-profit nursing homes but alleviated by better job resources in one study. The result highlights work environment issues, with regulations concerning for-profit incentives being discussed in terms of staff benefits.
... During the COVID-19 pandemic, U.S. nursing homes struggled to maintain sufficient staff and those with staffing challenges had greater difficulty containing the spread of COVID-19 among their residents [47]. Operating under difficult, understaffed conditions put the workforce at risk for depression [48], anxiety [49], and post-traumatic stress disorder (PTSD) [50]. ...
Objectives
To explore experiences of U.S. (United States) nursing home leadership during the COVID-19 pandemic in their efforts to address resident loneliness and social isolation and to elicit stories about personal and professional impacts on themselves and staff.
Design
Qualitative inquiry via three optional open-ended questions appended to a national self-administered survey of American nursing home leaders was employed. Textual data was analyzed using an iterative reflexive thematic approach.
Setting and participants
A stratified sample frame defined by facility size (beds: 30–99, 100+) and quality ratings (1, 2–4, 5) was employed. Web survey links and paper surveys were sent to 1,676 nursing home directors of nursing between February and May 2022.
Results
Open text responses were collected from 271 nursing homes. Broad themes included: 1) Addressing needs of residents & families; 2) Challenges; and 3) Personal experiences of nursing home leadership/staff. Respondents described trauma to residents, staff, and leadership. Resident loneliness was addressed using existing and newer technologies and innovative indoor and outdoor activities. Residents experienced fear, illness, loss, and sometimes death. Isolation from family and lack of touch were particularly difficult. Regulations were seen as punitive while ignoring emotional needs of residents. Staffing challenges and pressures to do more with less created additional stress. Leadership and staff made significant sacrifices resulting in physical, social, and emotional consequences. Beneficial outcomes included staff bonding, professional growth, and permanent implementation of new interventions.
Conclusions and implications
New and creative interventions were successfully implemented to address social isolation and loneliness. Improved Wi-Fi and other nursing home infrastructure upgrades are needed to maintain them. Reimagining often conflicting overlapping federal, state, and local regulations, grounding them in good clinical judgement, and incentivizing performance improvement should be considered. Trauma experienced by staff needs to be addressed to deal with current and future workforce needs.
... It seems that an increase in age is followed by a decrease in social connections due to less energy and a busy state of life. An increase in age is followed by an increase in physical problems, which is mutually related to psychological issues, which can justify the relationship between age and depression in the above-mentioned studies (24). In the present study, there was no statistically significant relationship between age and anxiety, which was consistent with the results of the study by Khamseh et al (25), and in conflict with the results of the study of Sarboozi Hosein Abadi et al (23). ...
Introduction: According to the crucial role of healthcare personnel in providing quality services to clients and patients, maintaining and taking care of their mental health is greatly important during the COVID-19 pandemic. Objectives: This study aimed to evaluate the health status of nurses, midwives and healthcare providers during the COVID-19 pandemic in Hormozgan province. Subjects and Methods: This is a cross-sectional study with a descriptive-analytical approach in which a sample of 368 nurses, midwives, and healthcare providers of Hormozgan university of medical sciences in Iran was selected through simple randomization from May to November 2020. Data collection instrument was a questionnaire consisting of demographic characteristics and depression, anxiety, and stress scale (DASS-21). Data were analyzed using SPSS 22, Mann-Whitney U test and Kruskal-Wallis statistical tests, and Spearman's rank-ordering correlation coefficient. Results: Out of 368 participants, 347 (94.3%) were female and 21 (5.7%) were male. There were 111 (30.2%) nurses, 209 (56.8%) midwives, and 48 (13%) healthcare providers.14.4% of the participants had a severe level of anxiety and 85.6% suffered from moderate to extremely severe depression. No correlation was found between gender and age with the psychological indicators of the research. Conclusion: Results showed that the multiple stressors during the COVID-19 pandemic caused the incidence of emotional reactions, including depression, anxiety, and stress; further studies and essential intervention proceedings to address them as a health priority seem to be necessary. Abstract Citation: Pormehr-yabandeh A,
... Aging is characterized by a set of structural and functional changes that arise as age increases, producing, among other things, changes in physical ability and psychological disposition of the subject, with various consequences in the workplace. [8][9][10] Evidence shows that older workers generally have better safety performance, with lower accident rates in some productive sectors, yet these workers are at greater risk of fatal accidents and take longer to recover from serious accidents. [11][12][13] A review of the evidence-based literature supports a productive aging framework for the workforce including the following elements: (1) having a life-course perspective; (2) considering comprehensive and integrated approaches to occupational safety and health; (3) emphasizing positive outcomes for workers and organizations; and 4) encouraging a supportive work culture for multigenerational issues. ...
Do factors impacting life satisfaction remain stable, or do they change, during the life course of workers? This study analyses the relationships between life satisfaction and age. This study is a secondary analysis of data from ENETS a health and working conditions survey. Workers were grouped into 5 age ranges. A scale of life satisfaction was analyzed, investigating aspects such as income, level of debt, physical and mental health, among others. The confirmatory factor analysis (CFA) showed that 4 of the 5 age ranges have a unifactorial structure, but for those under 30 years of age, 2 factors associated with "psychophysical well-being" and "material well-being" were identified. Thus, at different stages of productive life different priorities affect life satisfaction, this should be considered to optimize the human resources management.
... With increasing age and approaching retirement, it seems that the incidence of burnout due to activity on holidays and away from family increases. On the other hand, due to lack of manpower and intensive shift work in the morning, evening, night, sleep patterns are disrupted, indicating physical problems and underlying diseases that are interrelated with psychological problems, and can explain the relationship between age and depression [28]. ...
Background
Pre-hospital emergency medicine (PHEM) personnel are at risk of developing psychological disorders during the Covid-19 pandemic. This study aimed to investigate depression, anxiety, and stress levels of the Iranian PHEM personnel during the Covid-19 pandemic.
Methods
This descriptive cross-sectional study was performed on 544 PHEM personnel chosen by purposive sampling in North Khorasan, Khorasan-Razavi, South Khorasan, Sistan-Baluchestan, and Kerman provinces in eastern Iran from August to September 2021. Data collection tools included a demographic information questionnaire and the standardized 21-item Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed in SPSS 16 using one-way analysis of variance and linear regression.
Results
The mean scores of depression, anxiety, and stress were 8.7 ± 9.2, 7.0 ± 7.8, and 11.6 ± 9.2, respectively. Depression, stress, and anxiety were more prevalent in the age group of 41-55 years, people with master’s and higher degrees, people with a history of underlying diseases, and people with over 10 years of work experience( p < 0.05). Depression and stress also showed a significant relationship with the type of employment. Stress alone was also significantly associated with working less than 35 hours a week and living separately from family( p < 0.05).
Conclusions
PHEM personnel suffer from significant levels of depression, anxiety, and stress during the Covid-19 pandemic. Therefore, in order to improve the mental condition, it is recommended that the work schedule and services provided to these people be designed in such a way that they have more time for rest and communication with their family members. The personnel should also have easier access to the expert team in the fields of counseling and psychiatry.
... Also in the study of neurosurgery and colleagues who examined the general health and emotional reactions of nurses working in the intensive care units of two hospitals of Baqiyatallah University of Medical Sciences, the rate of stress, anxiety and depression in nurses were 33%, 33.9% and 30.8%, respectively (21). Due to the nature of the work, heavy protective clothing, N-95 mask, risk of infection and contamination of others are at risk of psychological disorders (22). They should support the staff financially and spiritually to achieve the desirable outcomes as far as the organizational commitment is concerned (23). ...
Introduction: Coronavirus is an infection disease with respiratory symptoms and it is a virus that can be transmitted between humans as a mutated virus. Coronavirus-19 disease can lead to stress and anxiety among hospital staff. At present, one of the most important factors affected the occupational performance of the treatment staff and their ability to perform the overshadowed tasks effectively is Covid-19 disease. Therefore, this study was conducted to investigate the relationship between job stress and job performance of nurses in the covid-19 epidemic from the perspective of nurses in Zahedan teaching hospitals in 2021. Materials and Methods: This descriptive-analytical study was performed by available sampling method. Data were obtained using forms collected during three months in the inpatient ward of covid-19 in Zahedan teaching hospitals. The research samples were 235 nurses working in different wards of the hospital participated in this study and answered the three-part questionnaire containing demographic and job information, stress resulted by covid-19 and job performance. The collected data were statistically analyzed using SPSS software, version 20. There were used the descriptive and analytical statistics including frequency, mean, standard deviation and t test. Results: Most of the participants in this study were women (68%) under the age of 30 (59.4%). There is a significant relationship between the effect of Covid-19 on job stress and job performance. Thus, the effect of Covid-19 on job stress is direct, i.e. with the greater effect of Covid-19, the amount of stress increases by 39% ) p = 0.00, r = 0.39(. The effect of Covid-19 on the job performance was inversely so that with increasing the effect of Covid-19, job performance decreased by -20% (-r= 0.20, p=0.01). The findings showed there is a significant relationship between stress resulted by Covid-19 and the job performance. Discussion: The level of stress in nurses working in Covid-19-related wards in Zahedan teaching hospitals is moderate. It seems that paying attention to nurses' education to deal with critical situations similar to Covid-19 and increasing personal protective equipment can be effective in preventing nurses from developing stress and anxiety, and then their job performance will be improved. Keywords: Nurses, Covid-19, Job stress, Job performance
... The process of ageing involves progressive structural and functional changes, including reductions of bodily performance and changes in psychological disposition, entailing various consequences for working life. (5)(6)(7) This process results in a gradual and progressive deterioration of physical and mental health conditions, and may be associated with an increase in some chronic health problems which, if appropriate preventive measures are not established in a timely manner, may lead to functional limitations and progressive loss of autonomy. (8) Evidence from occupational health research shows that older workers generally have better safety performance, with lower accident rates in some productive sectors; however, these workers are at greater risk of fatal accidents and take longer to recover from serious incidents. ...
Chile has one of the highest effective retirement ages among the countries of the Organisation for Economic Cooperation and Development (OECD). This could be associated with retirement at older ages, as low pensions encourage people to remain active in the workforce.
People undergo several changes due to the passage of time, and they have an impact on their health from a biological, psychological and social point of view. However, there is not enough knowledge on how these changes impact and interact with working, employment and health conditions of workers as they get older.
This article aims to contribute to the critical debate on the extension of working life and its implications for occupational health. Some reflections in this regard are proposed based on a review of the most recent relevant literature.
BACKGROUND: Health and Social Care (HSC) workers face psychological health risks in the workplace. While many studies have described psychological injuries in HSC workers, few have examined the determinants. Previous research has primarily focused on hospitals, lacking systematic reviews of community-based settings. OBJECTIVE: To systematically identify and appraise current evidence on the determinants of psychological injuries among HSC workers in community settings. METHODS: Searches were conducted in three bibliographic databases, supplemented by citation searches. Included studies focused on community-based HSC workers, reporting statistical associations between psychological injury and personal, health, occupational, or organizational factors. Quantitative studies published in English between January 1, 2000 and August 15, 2023 were included. Quality appraisal was undertaken using the JBI critical appraisal checklist. RESULTS: Sixty-six studies were included. Study quality was highly variable, and all studies were cross-sectional. Twenty-three studies linked psychological injury with occupational factors (e.g. low job control, high job demands and low job satisfaction). Thirteen studies observed an association between work environment and psychological injury, and a further eleven between workplace social support and psychological injury. Fewer studies have examined the relationship between psychological injury and personal/individual factors. CONCLUSION: Occupational and organisational factors are significantly associated with psychological health among HSA workers, in community settings. These aspects of job design, work environment and workplace relationships are modifiable, suggesting an opportunity for work design interventions to improve workers’ psychological health and reduce the prevalence of psychological injury in this sector.
Always clinical nurses are in healthy risk, because of their work identity. Nurses who are not healthy in physical and
psychological domains they could not delivery nursing care to
patients.
aim: This study was done to identify factors associated with
depression and quality of life nurses who worked in Ilam city
hospitals.
Method: This was a cross-sectional study that was done for all
nurses who were working in Ilam city hospitals in 2011. Data
gathering was done by BDI= Beck Depression Inventory, Short form-QOL12 and demographic questionnaire. Path analysis as a
statistical method was used to test the causal model. For path
analysis depression and quality of life, a hypothetical causal model designed, so was used of regression multivariate analysis and was
obtained final model of the depression and quality of life. In this study
depression variable was independent variable and the others were independent variables and also, SPSS18 software used for data
analysis.
Results: According to path analysis, important related variables with depression were respectively, mental domain QOL (28%),
married status(25%), physical domain QOL(24%), shift
working (18%), age (16%), and overtime hours working (12%), that direct effect of these variables were more than indirect effect through of mental and physical domains of nurses’ QOL on their depression .Also, in this model depression variables and QOL could be predicted (48%) variance depression to other variables.
Conclusion: Nurse managers must be planning to increase nurses’ mental health, attention to variety aspects of family such as marriage, decrease and distribution of times working especially in night shift could be increased quality of life in nurses and decreased their
depression.
Background and Aim: The lack of any definitive treatment or prevention of COVID-19 has caused a great deal of stress and anxiety in communities. In the present study, depression, stress and anxiety of nurses working in corona wards of hospital were evaluated. Methods: This cross-sectional study was performed with the participation of 125 nurses working in COVID-19 wards of Nohe-Dey Hospital in Torbat-e-Heydariyeh city, Iran in 2020. Data collection tools included a demographic questionnaire and DASS-21 standardized questionnaire. Results: There were 125 nurses with a mean age of 29.4±6.5 years. The Chi-square test showed that depression, anxiety and stress of nurses were moderate. The one-way analysis of variance test showed that depression with age (P=0.002), anxiety with age (P=0.018), employment status (P=0.009) and satisfaction with personal protective equipment (p=0.015) and stress with age (P=0.011), employment status (P=0.023) are significantly associated. Conclusion: The rate of depression, anxiety and stress in nurses working in COVID-19 wards in Torbat-e-Heydariyeh Hospital is moderate. It seems that paying attention to training nurses to deal with critical situations similar to COVID-19, and increasing personal protective equipment can be effective in preventing nurses from developing depression, stress, and anxiety.
Social support is a widely used construct in the psychological literature. Although multiple conceptions of the construct have been offered, an issue common to many analyses is the extent to which support is perceived or experienced by recipients of “supportive” behaviors. In this chapter, we offer a cognitive framework designed to illuminate the construct of “perceived support.” Our analysis focuses on perceived support in marriage, as this relationship provides a relatively homogeneous context within which to examine a number of important issues regarding social support, the resolution of which may have implications for the literature on social support in general. This chapter does not attempt, however, to redefine social support, provide a new theory of social support processes in marriage, or argue that support processes in marriage are fundamentally different from support obtained in other enduring, intimate relationships. Mindful of the need for new perspectives in the social support area that integrate the influences of social context with concern for the match of specific Stressors to socially supportive responses and the cognitive component of support (e. g., Pierce, Sarason, & Sarason, 1990; I. G. Sarason, B. R. Sarason, & Pierce, 1994), we provide herein a cognitive framework for examining the impact of supportive (and nonsupportive) transactions on “perceived support.”
Objectives.
—To identify recent national trends in the employment and earnings of nursing personnel and determine whether managed care is associated with changes in the employment and wage growth of nursing personnel.Design.
—Retrospective analysis of trends in data on employment and earnings of nursing personnel based on monthly US Bureau of the Census Current Population Surveys between 1983 and 1994, and comparison of trends between states with high and low rates of enrollment in health maintenance organizations (HMOs).Population.
—Registered nurses (RNs), licensed practical nurses (LPNs), and nurse aides/assistants, orderlies, and attendants (referred to collectively as aides) between the ages of 21 and 64 years.Outcome Measures.
—Full- and part-time employment, unemployment, percentage of nursing personnel employed in key sectors of the nurse labor market, and inflation-adjusted hourly wages.Results.
—From 1983 through 1994, there was strong overall growth in both RN employment (37%) and inflation-adjusted wages (22%). Beginning in the early 1990s, however, RNs experienced stagnant wages and a small but steady shift toward employment in lower-paying nonhospital settings, particularly in home health care. In states with high HMO enrollment, RN and LPN employment has grown more slowly since 1990, and the shift of RN employment out of the hospital was strongest. For aides and LPNs, the shift out of hospital employment occurred years before that of RNs and at a much greater rate. Since 1990 the employment of aides has grown rapidly in nursing homes and in home health care settings, whereas employment of LPNs has shifted primarily into physician offices and nursing homes. Overall, the movement toward nonhospital employment has had a modest negative impact on wages for all nursing personnel.Conclusions.
—Managed care is associated with slower employment growth for RNs in hospitals and a shift toward employment in nonhospital settings, but its effect on earnings has been overshadowed by other forces impacting nurse wages.
The associations between nurse-aide empathy and self-rated depressive symptoms were examined in a sample of 62 cognitively intact elderly nursing home residents in six nursing home settings. Depressive symptoms were assessed with the Geriatric Depression Scale. Nurse-aide empathy was measured from the perspective of the aide (resonated empathy), their supervisor (expressed empathy) and the patient (perceived empathy) using the Barrett-Lennard Relationship Inventory Empathy Subscales. Resonated, expressed and perceived empathy were relatively independent of each other. Multiple regression analyses indicated that only perceived empathy was associated with residents' self-rated depression. The need to assess staff empathy in the nursing home, in conjunction with the specific role of the aide, as well as patient and staff perspectives on the importance of empathy, as they pertain to psychological outcomes, is discussed.
This article proposes a social causation explanation for the association between SES and depression/distress. The model links SES, occupational direction, control, and planning (DCP), personality factors, and depression/distress in a causal sequence. The data to test the social causation model against alternative, social selection models are derived from samples of psychiatric patients and community residents in Washington Heights, New York City. The key factor of DCP is operationalized using ratings from the Dictionary of Occupational Titles. The results support the social causation model and cannot be accounted for by several tests derived from social selection models. Thus the results increase the plausibility of the social causation model and suggest the need for further research on the links between occupational conditions and mental disorder.
Although both scholars and practitioners continue to privilege the “rational” aspects of organization, this article demonstrates the centrality of emotion in the organizing process. The case study method combines observation at a 911 center, interviews with dispatchers, and analysis of selected calls. Departing from most treatments of emotional labor, this article features workers who not only suffer through, cope with, and resist emotional labor but sometimes also seek it out. For these 911 dispatchers, emotional labor is a fun, exciting, and rewarding part of their work. In addition to providing a description of these neglected positive functions of emotional labor, this article speaks to a broader issue: the role of emotional labor in the construction of organizational community.
The present study investigates the dimensional structure of the psychosocial work environment as assessed by Karasek's job characteristics scales and a set of factorial scales derived from the Dictionary of Occupational Titles (DOT) observers' ratings of occupational characteristics for census occupations. Scale scores on the Karasek and DOT were linked to information on occupation from the Epidemiologc Catchment Area (ECA) study sample. Scale intercorreladons and factor analysis were performed on those ECA subjects who reported ever having a full-time job (n=11,789). DOT'sS Substantive Complexity scale was positively correlated with Karasek's Skill Discretion and Decision Authority scales, and DOT's Physical Demands and Hazards scale was positively correlated with Karasek's Physical Demands scale. In addition, the DOT system compared to the Karasek system seems to assess psychosocial work domains less characteristic of traditional industrial jobs (interpersonal stress, expressive work). The content validity of the Karasek scales might be increased with the assessment of these domains. Giving support to Karasek's Demand/Control Model, the factor structure of the psychosocial work enviromnent in the probability sample of five US metropolitan populations yielded two major dimensions: Control, and Physical Demands.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.