Content uploaded by Mohsen Poursadeghiyan
Author content
All content in this area was uploaded by Mohsen Poursadeghiyan on Jul 24, 2022
Content may be subject to copyright.
AUTHOR COPY
Work 72 (2022) 1129–1139
DOI:10.3233/WOR-213648
IOS Press
1129
Investigation of occupational fatigue and
safety climate among nurses using the
structural equation model
Fatemeh Nemati Dopolania, Maryam Feiz Arefib,c, Elham Akhlaghi Pirposhtehd,
Zahra Ghalichi Zavehb, Ali Sahlabadi Salehie, Farahnaz Khajehnasirif, Mahsa Hamig,
Mohsen Poursadeqiyanh,i,∗and Alireza Khammarj,∗
aDepartment of Nursing, Petrochemical Industries Hospital, Mahshahr, Iran
bDepartment of Occupational Health Engineering, Torbat Heydariyeh University of Medical Sciences, Torbat
Heydariyeh, Iran
cHealth Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
dDepartment of Occupational Health Engineering, School of Medical Sciences, Tarbiat Modares University,
Tehran, Iran
eDepartment of Occupational Health and Safety, School of Public Health and Safety, Shahid Beheshti University
of Medical Sciences, Tehran, Iran
fDepartment of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
gHealth Management and Economics Research Center, Health Management Research Institute, Iran University
of Medical Sciences, Tehran, Iran
hDepartment of Occupational Health and Safety Engineering, School of Health, Ardabil University of Medical
Sciences, Ardabil, Iran
iSocial Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
jDepartment of Occupational Health Engineering, School of Health, Zabol University of Medical Sciences,
Zabol, Iran
Received 24 March 2020
Accepted 31 October 2021
Abstract.
BACKGROUND: Nursing is associated with many stressful situations that can lead to fatigue, reduced efficiency, and
physical and mental illness. Safety climate is one of the most important indicators of safety management performance
assessment that assesses employees’ attitudes towards safety issues.
OBJECTIVE: The purpose of this study was to investigate the relationship between safety climate and occupational fatigue
in nurses.
METHOD: This descriptive-analytical study was performed on nurses working in hospitals affiliated to Zabol University of
Medical Sciences in 2019. 143 nurses were selected by the proportional sampling method and entered the study. Demographic
∗Address for correspondence: Mohsen Poursadeqiyan, E-mail:
poursadeghiyan@gmail.com. and Alireza Khammmar, E-mail:
alireza.khammar@zbmu.ac.ir.
ISSN 1051-9815/$35.00 © 2022 – IOS Press. All rights reserved.
AUTHOR COPY
1130 F.N. Dopolani et al. / Investigation of occupational fatigue and safety
questionnaires, Occupational Fatigue Inventory (SOFI), and Nurses’ Safety Assessment Questionnaire were used for data
collection. Statistical tests, including Independent T-Test, ANOVA, Mann-Whitney U, Kruskal-Wallis, and multivariate
analysis of variance (MANOVA) were used to analyze the results using SPSS software version 21, and the multivariate
structural equation was used for modeling.
RESULTS: The mean scores of safety climate and occupational fatigue were 67.15 ±12.73 and 85.09 ±41.49, respectively.
Job and demographic variables except for the second job (P-value= 0.065) had a significant effect on the variables of safety
climate and occupational fatigue. There were also higher scores for occupational fatigue and all of its subscales in the group
of women compared to the group of men.
CONCLUSION: The results showed that occupational and demographic variables have significant effects on safety climate
and occupational fatigue. There was a significant relationship between demographic variables of age, work experience,
and education level with safety climate. There was also a significant relationship between education level, job satisfaction,
satisfaction with colleagues and work experience with occupational fatigue. Therefore, paying attention to fatigue and safety
climate of nurses in workplaces is recommended.
Keywords: Safety culture, burn out, job satisfaction, health care
1. Introduction
One of the most important areas of sustainable
health development in human societies is the health
care sector, which has the vital task of maintain-
ing and restoring health to the human community.
Nurses are one of the largest health care providers
in the hospital wards, and patients have more contact
with nurses than other caregivers, so the failure of
this group due to their important role in improving
patients will lead to Irreversible consequences [1].
1.1. Fatigue
According to research on occupational accidents,
the nursing staff is the first working group with the
highest occupational stress and risk [2]. In the mean-
time, fatigue has been addressed in terms of the
effects that can have on performance and health [3].
Fatigue is an unpleasant mental feeling that forms the
spectrum from weakness to burnout and interferes
with the ability to play a role and a personal activ-
ity. This is a general, multi-causal, multidimensional
concept that everyone experiences. Fatigue, despite
having different mental, behavioral, and physiolog-
ical manifestations, has no clear definition [4, 5].
Fatigue can reduce the ability to process hazardous
information, can diminish the ability to respond to
hazardous conditions, and can increase the incidence
of human error [6–8]. Fatigue has a multidimensional
structure that includes the physical dimension (lack
of energy and need to rest), the cognitive dimen-
sion (deficits in mindfulness and attention), and the
emotional dimension (decreasing the motivation or
interest) [1, 9]. There are a variety of causes of fatigue,
including lack of sleep or inappropriate sleep, long
working hours, working in hours with low conscious-
ness (e.g., early morning hours) [10]. In 2010, the
Canadian Nurses Association and the Ontario Nurses
Association found that nurses experience significant
levels of fatigue that act as a major negative factor
in nursing occupation, decision making, creativity,
and problem-solving ability, all of which are essential
aspects of safe patient care in the health care system
[11]. Therefore, in order to increase the efficiency and
effectiveness of health organizations, paying particu-
lar attention to the needs of nurses, and providing their
mental and physical health is of particular importance
[12].
1.2. Work safety climate
Only managers that have created the appropriate
psychological atmosphere (organizational climate)
within the organization can provide the possibility
for high-level needs of supervised employees in the
field [13]. The organizational climate is a multidi-
mensional structure that encompasses a wide range
of individual evaluations of the workplace. The safety
climate is a special form of organizational climate
that describes people’s perceptions of safety values
in the workplace [14, 15]. Initially, Zohar studied the
safety climate in various industrial organizations and
identified 8 dimensions for it, such as management’s
attitude toward safety, the effects of implementing
safety guidelines on promotion, work pressure, social
AUTHOR COPY
F.N. Dopolani et al. / Investigation of occupational fatigue and safety 1131
status of individuals, safety compliance by the safety
officer, the status of the safety committee, the impor-
tance of safety training and the risks involved in the
workplace [14, 16]. A safety climate is a subset of the
safety culture and is actually a manifestation of the
safety culture in practice [17, 18] The safety climate is
a psychological phenomenon that examines employ-
ees’ attitudes to safety in a cross-sectional manner
and is relatively unstable and subject to changes
in the components of the current environment or
conditions. Whereas the safety culture analyzes the
common values of the entire organization or deals
with formal organizational safety discussions [19].
Statistics show that more than 300,000 deaths are
annually caused by work-related deaths worldwide
and occupational injuries are also the cause of many
disabilities [20]. The importance of the safety climate
is related to its ability to predict safe behavior [21,
22]. Studies have clarified that there is a significant
relationship between safety climate and predictions
of workplace injuries, so the higher the safety cli-
mate, the lower the accident rate [23]. In recent years,
the use of preventive indicators such as safety cli-
mate and observation of behaviors that emphasize
current safety activities have been considered along
with reactive indicators such as incident indicators,
and the combination of these two preventive and reac-
tive approaches have been able to help organizations
to better understand the effects of implemented safety
programs. Considering the role of fatigue and its con-
sequences (such as job burnout, increased medication
errors, decreased quality of nursing care) and due
to the importance of awareness of safety climate in
workplaces and limited safety climate studies related
to therapeutic settings of the country, this study aimed
to investigate the relationship between occupational
fatigue and safety climate in hospital nurses at the
Zabol University of Medical Sciences.
2. Methods
2.1. Participants
The study population consisted of nurses working
in hospitals affiliated to Zabol University of Medi-
cal Sciences. The proportional sampling method was
used in this study. Thus, after the determination of the
number of questionnaires allocated to each hospital,
the determined number of questionnaires (out of the
total number of 143) was assigned to that hospital.
In other words, given the total number of nurses in
each hospital (as the weight of that hospital), a portion
of the mentioned number was allocated to that hos-
pital. Trained individuals completed questionnaires
through interviewing nurses.
2.2. Measurements
This cross-sectional study was carried out in Zabol
Hospitals in 2019. Determination of safety climate
was carried out using the Nurses Safety Climate
Assessment Questionnaire, and occupational fatigue
was measured by Occupational Fatigue Inventory
(SOFI) [24] (questionnaires are provided in the
Appendix). Accordingly, data were collected from
people who were willing to participate in the study
and who had completed the consent form. Having
at least a bachelor’s or upper degree in nursing was
considered as the inclusion criterion, and individuals
could leave the study if they did not wish to cooperate.
A three-part questionnaire was used for data col-
lection. The first part of the questionnaire included
demographic and occupational characteristics (e.g.
age, gender, shift work).
Nurses’ safety climate: The Nurses Safety Climate
Assessment Questionnaire was used to assess nurses’
safety climate. This 22-item questionnaire examined
6 factors of nurse’s safety climate including cumu-
lative burnout (5 questions), training (5 questions),
communication with physicians (3 questions), com-
munication with nurses (3 questions), supervisor’s
attitude (3 questions), and reporting errors and mis-
takes (3 questions). The responses of the questions
were designed based on a 5-point Likert scale (score
of 1 for strongly disagree, score of 2 for disagree,
score of 3 for neither agree nor disagree, score of
4 for agree, and score of 5 for strongly agree). The
mean of the responses of the questions for each factor
is considered as the score of that factor, and accord-
ing to the scale used, the score of each factor is in
the range of 1 to 5. Given all the positive aspects of
the questionnaire, higher safety climate scores indi-
cated better safety status. In addition, the validity and
reliability index of this questionnaire is approved.
Swedish Occupational Fatigue Inventory (SOFI):
The SOFI questionnaire is a multidimensional tool
for measuring the quality and severity of perceived
acute fatigue. This questionnaire has an 11-item Lik-
ert scale (0 = not at all, 10 =very high agreement) and
has five dimensions including lack of energy, phys-
ical effort, physical discomfort, lack of motivation,
and drowsiness; each of these dimensions consisted
of 4 questions, and the scores of each dimension were
AUTHOR COPY
1132 F.N. Dopolani et al. / Investigation of occupational fatigue and safety
Table 1
Descriptive statistics of occupational fatigue and safety climate in hospital nurses
Variable Subscale Mean Standard Min Max
deviation
Fatigue Oocupational fatigue 85.09 41.49 14.00 200.00
Lack of energy 20.17 9.65 2.00 40.00
Physical effort 13.57 9.24 0.00 40.00
Physical discomfort 15.73 9.97 0.00 40.00
Lack of motivation 16.87 9.09 0.00 40.00
Drowsiness 18.96 9.37 3.00 40.00
Safety climate Safety climate 67.15 12.73 35.00 96.00
Cumulative burnout 13.47 4.40 5.00 25.00
Nursing education 15.07 4.54 5.00 25.00
Communication with physican 8.76 2.54 3.00 15.00
communication with nurses 9.79 2.83 3.00 15.00
Supervisors attitude 9.73 2.59 4.00 15.00
Reporting 10.31 2.39 4.00 15.00
between 0 and 40. Total occupational fatigue also
ranged from 0 to 200, and the higher scores of occu-
pational fatigue and its dimensions indicate a higher
level of occupational fatigue. The SOFI question-
naire has been studied in several surveys on different
occupations and has been identified as a reliable tool
[18].
2.3. Structural equation model
Structural equation model was used to test the
hypotheses presented in this study. SEM is a robust
causal modeling method that simultaneously esti-
mates multiple and related dependencies between
variables. SEM was used to investigate the relation-
ship between safety climate and occupational fatigue
in nurses. Multivariate linear regression was used
to examine the factors related to occupational and
demographic variables. Multiple correlation coeffi-
cient (R2) was used to evaluate the predictive power
of the model.
2.4. Statistical analysis
After data collection, data were entered into Spss
software version 21. Then the normality of the data
was checked. The analysis of results was carried out
by parametric tests (such as two-sample t-test and
analysis of variance) or nonparametric tests (such as
Mann-Whitney U and Kruskal-Wallis). Central incli-
nation and dispersion indices were used to describe
the data. Analyzes were performed at a confidence
level of 95%.
3. Results
In the present study, out of the 143 participants,
57.3% were women, and 42.7% were men. The mean
age was 30.75 ±6.77. The lowest work experience
was 12 months, and the highest was 360 months; the
average work experience was 50.39±62.39 months.
89.51% of the subjects had a bachelor’s degree, and
10.49% had a master’s degree. 67.1% were single,
and 32.9% were married. Individual shifts consisted
of the morning (21%), evening (16.8%), night (7.7%),
and rotating shift (54.5%). Statistical indices related
to occupational fatigue and safety climate of partici-
pants as continuous variables were follows:
According to Table 1, the lowest score for the occu-
pational fatigue score was 14, and the highest score
was 200. The average occupational fatigue score was
85.09 ±41.49. The lowest value for the safety cli-
mate score was 35 and the highest score was 96.
The average safety climate score was 67.75 ±12.73.
The following results were obtained to test the effect
of occupational and demographic characteristics on
the dependent variable, namely, safety climate, using
multiple linear regression.
The results of the regression of occupational and
demographic characteristics on the dependent vari-
able, namely safety climate, showed that the above
variables could justify about 95% of the response
variable, i.e., safety climate (Table 2). In order to test
the effect of occupational and demographic character-
istics on the dependent variable, namely occupational
fatigue, multiple linear regression, was used.
The results of the regression of occupational and
demographic characteristics on the dependent vari-
able (Table 3), i.e., occupational fatigue showed that
AUTHOR COPY
F.N. Dopolani et al. / Investigation of occupational fatigue and safety 1133
Table 2
Multivariate regression of occupational and demographic characteristics and safety climate variable in hospital nurses
Independent Coefficients of the model t statistics P-value R2
variable Regression Standard Standardized
coefficient (B) deviation regression
error coefficient
()
Gender 3.93 2.54 0.087 1.55 0.123 0.95
Marital status 3.02 3.26 0.062 0.927 0.355
Level of education 11.53 4.17 0.201 2.77 0.006
Working shifts 0.47 1.07 0.022 0.44 0.663
Job satisfication 5.60 2.92 0.114 1.92 0.057
Satisfaction with colleagues 0.19 2.93 0.004 0.065 0.948
Second job 2.28 3.28 0.062 0.69 0.489
Age 1.16 0.26 0.535 4.48 <0.001
Work experience –0.1 0.031 –0.118 –3.25 0.001
Table 3
Regression test of occupational and demographic characteristics and occupational fatigue variable in hospital nurses
Independent Coefficients of the model t statistics P-value R2
variable Regression Standard Standardized
coefficient (B) deviation regression
error coefficient
()
Gender 21.82 5.94 0.348 3.68 0.001< 0.87
Marital status 5.01 7.62 0.075 0.658 0.512
Level of education –20.45 9.74 –0.258 –2.09 0.038
Working shifts –4.49 2.5 –0.15 –1.79 0.075
Job satisfication –14.08 6.84 –0.208 –2.06 0.041
Satisfaction with colleagues –13.82 6.85 –0.199 –2.02 0.046
Second job 14.07 7.68 0.28 1.83 0.069
Age 0.247 0.61 0.082 0.41 0.684
Work experience 0.279 0.07 0.236 3.84 0.001<
the above variables could justify about 87% of the
variance of the response variable, namely occupa-
tional fatigue. It is noteworthy that the effectof gender
on occupational fatigue was about 0.35, which means
that, by keeping constant other variables, if gender
increases one unit occupational fatigue shows a 35%
decrease, in other words, women experience occu-
pational fatigue more than 35%, Also, because the
P-value is less than 0.05, there is a significant rela-
tionship between gender and occupational fatigue.
The effect of education level variable on occupational
fatigue was about –0.26, which means that by keeping
constant the other variables, if the level of educa-
tion increases one unit, the occupational fatigue rate
will decrease by 26%, in other words, because the
P-value is less than 0.05, there is a significant rela-
tionship between education level and occupational
fatigue. Moreover, the effect of the job satisfaction
variable on occupational fatigue was about –0.208,
which means that by keeping constant the other
variables, if job satisfaction increases one unit, the
occupational fatigue rate would decrease by 20.8%.
In addition, the effect of satisfaction with colleagues
variable on occupational fatigue was about –0.199,
which means that by keeping constant other variables,
one unit increase in satisfaction with colleagues leads
to decrease occupational fatigue by 19.9%. Finally,
the effect of the work experience variable on occupa-
tional fatigue was about 0.236, which means that by
keeping constant the other variables, one unit increase
in work experience increases the occupational fatigue
by 23.6%. In general, there is a significant relation-
ship between gender, education level, job satisfaction,
satisfaction with colleagues, and work experience
with occupational fatigue because the p-value is
less than 0.05. Also, there is a significant rela-
tionship between education level, age, and work
experience with safety climate because the p-value
is less than 0.05. The results of the research hypothe-
ses are summarized in the following model. In
Fig. 1, black lines indicate a significant relationship
between the two variables, and red lines indicate
that the relationship between the two variables is not
significant.
AUTHOR COPY
1134 F.N. Dopolani et al. / Investigation of occupational fatigue and safety
Fig. 1. Relationship between safety climate variables and occupational fatigue among nurses. The black lines indicate a significant relationship
between the two variables and the red lines indicate that there is no significant relationship between the two variables.
4. Discussion
The purpose of this study was to investigate the
relationship between occupational fatigue and safety
Climate in nurses. The results showed that the mean
scores of occupational fatigue and safety climate were
85.09 ±41.49 and 67.15 ±12.73, respectively. The
results showed that there was a significant relation-
ship between education level and safety climate so
that those with higher education felt a higher safety
climate, which is in line with the results of Yeung et
al. [25]. The reason for this similarity is that the par-
ticipants in the present study had a bachelor’s degree
and higher. In the study by Haj Aghazadeh, the study
population consisted of workers of one of the ports
which were not highly educated. Therefore, there
was not a strong relationship between safety climate
and education level. It can also be stated that people
with higher education have a better understanding
of safety, and they better follow the policies of the
organization and are more aware of the safety cli-
mate and its effects. The results of our study showed
that there was no statistically significant difference
between gender and safety climate, which was con-
sistent with Kho et al. [26]. But our results were
not in line with Wu et al. [27], which can be partly
attributed to the gender distribution of the partici-
pants. In a study conducted by Basha et al. [28], no
significant relationship was found between safety cli-
mate and age groups, which was inconsistent with the
results of the present study. However, Vinodkumar et
al. [29] found an effective relationship between age
and dimensions of safety climate, which was consis-
tent with the present study; this could indicate that,
by increasing age, people work more cautiously in
the hospital and their social and occupational experi-
ences increase, and their risk-taking levels decrease.
The results of our study showed that there was no sig-
nificant relationship between marital status and safety
climate, which was in agreement with the results of
Mohammadi Zeidi; this indicates that one’s marital
status does not influence his/her safety climate in the
workplace. The results also showed that there is a
significant relationship between job satisfaction and
AUTHOR COPY
F.N. Dopolani et al. / Investigation of occupational fatigue and safety 1135
safety climate, which is consistent with the study by
Lee et al. [30]. To rationalize this result, it can be
expressed that the individual with higher job satisfac-
tion usually feel more safety in their job because these
individuals have a more stable employment status
than their colleagues, receive more salary and ben-
efits, have better organizational positions, and have
a higher education level and their physical activity,
workload, and shifts are less. In the studies conducted
by Haj Aghazadeh, Mohammadi Zeidi, Sarsangi and
Raftopoulos, no significant relationship was observed
between safety climate and work experience, which
was not in line with the results of the present study.
This difference should be sought in the statistical
population under study and the type of organization
in which employees were employed; so that, in the
study conducted by Haj Aghazadeh, 83% of the stud-
ied population had less than ten years of experience.
Also, his research population was workers, and their
low experience and lack of safety training courses
for all individuals could lead to a lack of difference
in safety climate scores among the work experience
groups.
The results of the evaluation of safety climate fac-
tors showed that the training factor among nurses
had the highest value, which indicates that educa-
tion is one of the most critical factors influencing
safety climate and has been widely and extensively
studied by other researchers [31]. On the importance
of staff training, it should be stated that trained staff
will respond to organizational change as well as com-
munity change, compared to employees who do not
benefit from this index and will play a more effec-
tive and efficient role in organizations. On the other
hand, by increasing the levels of information, knowl-
edge, skills, and capabilities of staff, they will be
more prepared and equipped to carry out their duties
and accept heavier responsibilities. But, in the study
by Sarsangi et al. [32], the communication between
nurses had the highest score, which the difference in
factors can be due to the different working condi-
tions in the hospital; so that, in some hospitals, there
is usually an intimate atmosphere among nurses, and
they talk about all the issues and problems of work
together.
The lowest rank, among the factors of safety cli-
mate, was related to communication with physicians,
which was not in line with the study by Sarsangi
[32]. To justify this, it should be noted that good
and close communication is not existed between
nurses and doctors in the hospitals studied. It should
also be noted that, in these studies, reporting among
nurses was introduced as the least factor, which seems
that, in the hospitals under study, there is no well-
established system for recording and reporting errors
that could cause injury to nurses or patients.
The results of the present study showed that
85.09% of nurses reported occupational fatigue while
Saki et al. [33] observed 47.61% occupational fatigue
in nurses and Saremi et al. [7] reported 59% occupa-
tional fatigue in nurses; based on these results, the
occupational fatigue in the present study was higher
than the mentioned studies, which seems to be due
to long-term dealing with patients, different work
divisions, long-term shift work, prolonged physical
activity, more stress and anxiety, Low number of per-
sonnel needed in hospital wards, and these can be the
reasons for the high level of occupational fatigue in
nurses in this study compared to other studies.
In the following, the results related to the rela-
tionship between occupational fatigue and each of
the study variables are presented separately based on
the results of Tables and Fig. 1. The results showed
that there was a significant relationship between
occupational fatigue and educational level, which
was consistent with the findings of the study by
Choobineh et al. [34]. While a high prevalence of
fatigue was reported in a study conducted by Azad
et al., for justification of this difference, it can be
said that the study population was steel industry
workers who were different from our study popu-
lation in terms of education. The level of education
of the nurses studied in this study was the bache-
lor’s and master’s degrees. The nurses with higher
education levels generally have less work shift, have
less workload, and they are mostly working in occu-
pations requiring less physical activity. Thus, their
occupational fatigue is lower compared to their lower-
educated colleagues.
Nurses with higher levels of education have fewer
work shifts and workloads and are more likely to
work in jobs that require less physical activity, so
their occupational fatigue is lower than their lower-
educated colleagues. Bultmann et al. [35] reported
that the possibility of a perception of fatigue in peo-
ple who do not have a university education is more
significant.
The findings also showed a significant relationship
between occupational fatigue and job satisfaction.
Usually, people who are satisfied about their job have
a good job based on their knowledge, skills, experi-
ence, interest, and personal ability; these individuals
are also highly motivated to work. On the other hand,
these staffs usually have higher occupational levels
AUTHOR COPY
1136 F.N. Dopolani et al. / Investigation of occupational fatigue and safety
and do less physical activity. Therefore, fatigue is
lower in these individuals.
The findings of our study showed that there was a
significant relationship between work experience and
occupational fatigue, which was consistent with the
study conducted by Habibi et al. [36]. This relation-
ship indicates that staff with more work experience
are naturally older and do not have enough mobil-
ity and energy to perform physical activity, so their
occupational fatigue is higher compared to their col-
leagues who have less work experience.
Habibi et al. [36] showed that the level of occu-
pational fatigue was significantly related to gender,
so that the rate of occupational fatigue was higher in
men than women, which is consistent with the present
study in terms of the meaningfulness of occupational
fatigue and gender. However, in the present study,
occupational fatigue in women was higher than in
men which one of the reasons is the higher number
of women participating in the study compared to men.
It should also be noted that working women, in addi-
tion to working in the hospital, should be involved
in housekeeping at home, which will double their
occupational fatigue.
The results showed that there is no significant
relationship between age and occupational fatigue,
which is thought that older people have higher job
satisfaction and better morale to their job and that
socioeconomic factors have a more significant impact
on young people in society, and they find themselves
under pressure. Akerstedt et al. [37] stated that work-
loads are likely to be higher in younger staff, and
on the other hand, older staff can choose jobs with
less fatigue. The results of the evaluation of occupa-
tional fatigue factors showed that, among the nurses,
the lack of energy had the highest values, and the
physical effort factor had the lowest values, indicating
the importance of energy in the nurses’ occupational
fatigue.
4.1. Limitations of this study
Since the present study was a cross-sectional study,
the researcher is always concerned about losing expo-
sure to research samples that could lead to a decrease
in the statistical power of the study. In addition,
because the study population was nurses of hospitals
affiliated to Zabol University of Medical Sciences, so
its generalizability to other hospitals in the country
should be done cautiously.
5. Conclusion
The results of this study showed that demographic
variables such as education level, age, and work expe-
rience had a significant effect on safety climate, and
education level, job satisfaction, satisfaction with col-
leagues, and work experience had a remarkable effect
on occupational fatigue. Individual factors, such as
age, gender, work experience, education level, and
safety climate, also seem to be influential.
Acknowledgments
The authors express their gratitude to the Research
Department of the Zabol University of Medical Sci-
ences for the financial support and support from the
study Chancellor for Treatment and Management of
Zabol Hospitals for the cooperation in conducting this
research.
Conflict of interest
There are no conflicts of interest.
Ethics approval
Ethical approval for this study was obtained
from the Zabol University of Medical Sciences
(IR.ZBMU.REC.1398.153). It should be noted that
the information of the individuals was kept confiden-
tial by the researcher and an anonymous and coded
questionnaire was used.
Funding
This study was financially supported by the
Zabol University of Medical Sciences (grant number:
400000117).
References
[1] Khajehnasiri F, Zaroushani V, Poursadeqiyan M. Macroer-
gonomics and health workers during Covid-19 pandemic.
Work. 2021;69(3):713-4.
[2] Saberinia A, Abdolshahi A, Khaleghi S, Moradi Y,
Jafarizadeh H, Sadeghi Moghaddam A, et al. Investigation
of relationship between occupational stress and cardiovas-
cular risk factors among nurses. Iran J Public Health.2020,
49(10):1954-1958.
AUTHOR COPY
F.N. Dopolani et al. / Investigation of occupational fatigue and safety 1137
[3] Johnston DW, Allan JL, Powell DJ, Jones MC, Farquhar-
son B, Bell C, Johnston M. Why does work cause fatigue?
A real-time investigation of fatigue, and determinants of
fatigue in nurses working 12-hour shifts. Annals of Behav-
ioral Medicine. 2019;53(6):551-562.
[4] Menon SA, Abraham D, editors. A Descriptive study to
Assess the Fatigue among Nurses Working in Hospital. pie;
2021.
[5] khajehnasiri F, khazarloo L, Poursadeghiyan M, Dabiran
S. Burnout level in Iranian teachers and its related fac-
tors: A health promotion approach. J Edu Health Promot.
2022;11:38.
[6] Poursadeqiyan M, Arefi MF, Pouya AB, Jafari M. The qual-
ity of life in Iranian elderly population with health approach:
A systematic review. J Edu Health Promot. 2021;10:
449.
[7] Saremi M, Fallah MR. Subjective fatigue and medical errors
among nurses in an educational hospital. Iran Occupational
Health. 2013;10(4):1-8.
[8] Caldwell JA, Caldwell JL, Thompson LA, Lieberman HR.
Fatigue and its management in the workplace. Neuroscience
& Biobehavioral Reviews. 2019;96:272-89.
[9] Sohrabi Y, Yarmohammadi H, pouya AB, arefi MF,
poursadeqiyan M, Prevalence of job burnout in Iranian
nurses: A systematic review and meta-analysis. WORK.
2022;73(3).XX
[10] Jepsen JR, Zhao Z, van Leeuwen WM. Seafarer fatigue: A
review of risk factors, consequences for seafarers’ health
and safety and options for mitigation. International Mar-
itime Health. 2015;66(2):106-17.
[11] Dashti E, Rassouli M, Khanali Mojen L, Shirinabady Fara-
hani A, Sarvi F. Nurses’ fatigue in neonatal intensive care
units and premature infants’ readmissions. Iranian Journal
of Nursing Research. 2015;10(2):1-10.
[12] Habibi H, Mooghali A, Bagheri Lankarani K, Habibi F.
Relationship between nurses’ job satisfaction and burnout
with patients satisfaction in Shiraz, 2012. Journal of Hayat.
2014;20(3):30-42.
[13] Vatani J, Arami M, Khanikosarkhizi Z, Shahabi Rabori MA,
Khandan M, Dehghan N, Aminizadeh M, Poursadeqiyan M,
Jafari M. Safety climate and related factors in rehabilitation
nurses of hospitals in Iran. Work. 2021;68(1):189-96.
[14] Borgheipour H, Eskandari D, Barkhordari A, Tehrani
M. Predicting the relationship between safety climate
and safety performance in cement industry. Work.
2020(Preprint):1-9.
[15] Tasouj SNN, Bardsiri TI, Arefi MF, Poya AB, Rahimi S,
Mazloumi E, Raei M, Dehghan N, Poursadeqiyan M. Anal-
yses and anticipating the future trend of accidents in an
electricity distribution company of Iran: A time series anal-
ysis. Work. 2021;68(4):1273-1278.
[16] Zohar D. Safety climate in industrial organizations: The-
oretical and applied implications. Journal of Applied
Psychology. 1980;65(1):96.
[17] Zohar D. Thirty years of safety climate research: Reflec-
tions and future directions. Accident Analysis & Prevention.
2010;42(5):1517-22.
[18] Jari A, Niazmand-Aghdam N, Mazhin SA, Poursadeqiyan
M, Salehi Sahlabadi A. Effectiveness of training program
in manual material handling: A health promotion approach.
J Edu Health Promot. 2022;11:81.
[19] Yari S, Naseri MH, Akbari H, Shahsavari S, Akbari H. Inter-
action of safety climate and safety culture: A model for
cancer treatment centers. Asian Pacific Journal of Cancer
Prevention: APJCP. 2019;20(3):961.
[20] Amidi Mazaheri M, Heydarnia AR, Ghofranipour F. The
effect of intervention on the implementation of an inci-
dent reporting system in isfahan steel company. Iranian Red
Crescent Medical Journal (Ircmj). 2010;12(5):529-34.
[21] Jafari MJ, Eskandari D, Valipour F, Mehrabi Y, Chark-
hand H, Mirghotbi M. Development and validation of a
new safety climate scale for petrochemical industries. Work.
2017;58(3):309-17.
[22] Soltaninejad M, Babaei-Pouya A, Poursadeqiyan M, Feiz
Arefi M. Ergonomics factors influencing school education
during the COVID-19 pandemic: A literature review. Work.
2021;68(1):69-75.
[23] Lyu S, Hon CK, Chan AP, Wong FK, Javed AA. Rela-
tionships among safety climate, safety behavior, and safety
outcomes for ethnic minority construction workers. Inter-
national Journal of Environmental Research and Public
Health. 2018;15(3):484.
[24] Poursadeqiyan M, Feiz Arefi M, Khaleghi S, Sadeghi
Moghaddam A, Mazloumi E, Raei M, et al. Investigation
of the relationship between the safety climate and occupa-
tional fatigue among the nurses of educational hospitals in
Zabol. Journal of Education and Health Promotion. 2020;9:
238.
[25] Yeung K-C, Chan CC. Measuring safety climate in elderly
homes. Journal of Safety Research. 2012;43(1):9-20.
[26] Kho ME, Perri D, McDonald E, Waugh L, Orlicki C, Mon-
aghan E, et al. The climate of patient safety in a Canadian
intensive care unit. J Crit Care. 2009;24(3):469.e7-13.
[27] Wu TC, Liu CW, Lu MC. Safety climate in university and
college laboratories: Impact of organizational and individual
factors. J Safety Res. 2007;38(1):91-102.
[28] Basha SA, Maiti J. Relationships of demographic factors,
job risk perception and work injury in a steel plant in India.
Safety science. 2013;51(1):374-81.
[29] Vinodkumar M, Bhasi M. Safety climate factors and its
relationship with accidents and personal attributes in the
chemical industry. Safety Science. 2009;47(5):659-67.
[30] Lee T.Assessment of safety culture at a nuclear reprocessing
plant. Work & Stress. 1998;12(3):217-37.
[31] Evans B, Glendon AI, Creed PA. Development and initial
validation of an Aviation Safety Climate Scale. Journal of
Safety Research. 2007;38(6):675-82.
[32] Sarsangi V, Khalevandi AA, Zarei E, Mehrizi E, Abadi M,
Honarjoo F. Attitude of the nurses of kashan educational
hospitals toward workplace safety climate in 2014. Com-
munity Health Journal. 2014;8(1):18-27.
[33] Saki K, Khezri Azar J, Mohebbi I. Nursing errors and its
relationship with fatigue among nurses of the emergency
ward. Nursing and Midwifery Journal. 2016;13(10):835-42.
[34] Azad P, Barkhordari A, Choobineh A, kohnavard B,
barkhordari M. Evaluation of fatigue in yazd steel industry
workers and its relation with some demographic variables
in 2014. Tolooebehdasht. 2016;14(6):87-97.
[35] Beurskens AJ, B¨
ultmann U, Kant I, Vercoulen JH, Blei-
jenberg G, Swaen GM. Fatigue among working people:
Validity of a questionnaire measure. Occupational and Envi-
ronmental Medicine. 2000;57(5):353-7.
[36] habibi p, Soury Laky M, habibi E, Janizadeh R. The relation-
ship between individual strength with job stress and fatigue
in nurses of lorestan province. Rahavard Salamat Journal.
2016;2(3):15-26.
[37] ˚
Akerstedt T, Knutsson A, Westerholm P, Theorell T,
Alfredsson L, Kecklund G. Mental fatigue, work and
sleep. Journal of Psychosomatic Research. 2004;57(5):
427-33.
AUTHOR COPY
1138 F.N. Dopolani et al. / Investigation of occupational fatigue and safety
Appendix A: Nurses Safety Climate Assessment Questionnaire
The answers to the questions are based on a 5-point Likert scale (number 1 for strongly disagree, number 2 for
disagree, number 3 for neither agree nor disagree, number 4 for agree, and number 5 for strongly agree) Average
answers to questions related to each factor The factor is considered as the score.
Questions Strongly Disagree Neither Agree Strongly
disagree agree nor agree
disagree
1 If I make a mistake or error, the supervisor does not
blame me before he hears me.
2 My supervisor provides me with appropriate
instructions on nursing skills.
3 The supervisor also talks to me when people come up
with patient safety measures.
4 When someone makes a mistake, nurses discuss ways to
improve the situation.
5 There is a good atmosphere among nurses to prevent
errors from becoming proactive.
6 Nurses help each other.
7 Doctors do not give vague instructions to nurses or the
nursing team.
8 Information about errors and mistakes that may occur is
shared among nurses and physicians.
9 If I make a mistake, the doctors will not reprimand or
reprimand me before they hear me.
10 In our department there is enough time to rest between
work cycles.
11 Even though I work in this hospital, I have enough time
to sleep.
12 I have time to get tired even though I work at this
hospital.
13 I do not feel mentally exhausted.
14 In general, I do not feel physically exhausted.
15 The results of the report of errors and mistakes in the
workplace are reflected.
16 Reports of errors and mistakes are related to safety
training.
17 Reports of errors and mistakes have raised awareness of
the patient’s immunotherapy.
18 In this hospital, there are many educational
opportunities to improve the abilities of nurses.
19 At this hospital, I can access the latest healthcare
knowledge.
20 In this hospital, appropriate skills training is provided
for new nurses.
21 At this hospital, nurses receive ongoing training to
improve their nursing skills.
22 In this hospital, appropriate training is given to each
nurse according to nursing skills.
The questionnaires used in this study were in Persian. The validity and reliability of each of them have been confirmed.
Appendix B: Occupational Fatigue Inventory (SOFI)
Think of how it felt when you were most tired. To what extent do the expressions below describe how you
felt? For every expression, answer spontaneously, and mark the number that corresponds to how you feel right
now. The numbers vary between 0 (not at all) and 6 (to a very high degree).
AUTHOR COPY
F.N. Dopolani et al. / Investigation of occupational fatigue and safety 1139
Not at all To a very high degree
Palpitations 0 12345 6
Lack of concern 0 12345 6
Wornout 0 12345 6
Tense muscles 0 12345 6
Falling asleep 0 12345 6
Numbness 0 12345 6
Sweaty 0 12345 6
Spent 0 12345 6
Drowsy 0 12345 6
Passive 0 12345 6
Stiff joints 0 12345 6
Indifferent 0 12345 6
Out of breath 0 12345 6
Yawning 0 12345 6
Drained 0 12345 6
Sleepy 0 12345 6
Overworked 0 12345 6
Aching 0 12345 6
Breathing heavily 0 12345 6
Uninterested 0 12345 6
