Achim Elfering

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 (pu2009<u2009.05). An indirect path from conscientiousness to near-accidents via cognitive failure in action regulation was also significant (pu2009<u2009.05). Compliance with safety regulations was significantly related to cognitive failure and near-accidents; moreover, cognitive failure mediated the association between compliance and near-accidents (pu2009<u2009.05). 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.

Does work stress make you shorter? An ambulatory field study of daily work stressors, job control, and spinal shrinkage.

Body height decreases throughout the day due to fluid loss from the intervertebral disk. This study investigated whether spinal shrinkage was greater during workdays compared with nonwork days, whether daily work stressors were positively related to spinal shrinkage, and whether job control was negatively related to spinal shrinkage. In a consecutive 2-week ambulatory field study, including 39 office employees and 512 days of observation, spinal shrinkage was measured by a stadiometer, and calculated as body height in the morning minus body height in the evening. Physical activity was monitored throughout the 14 days by accelerometry. Daily work stressors, daily job control, biomechanical workload, and recreational activities after work were measured with daily surveys. Multilevel regression analyses showed that spinal disks shrank more during workdays than during nonwork days. After adjustment for sex, age, body weight, smoking status, biomechanical work strain, and time spent on physical and low-effort activities during the day, lower levels of daily job control significantly predicted increased spinal shrinkage. Findings add to knowledge on how work redesign that increases job control may possibly contribute to preserving intervertebral disk function and preventing occupational back pain.

Pessimistic back beliefs and lack of exercise: a longitudinal risk study in relation to shoulder, neck, and back pain

This cross-lagged-panel study tested the validity of the German version of the back beliefs questionnaire (BBQ) in predicting pain in the shoulders, neck, and back. A random sample of 2860 individuals participated at baseline, and 73% responded at one-year follow-up. Structural equation modeling was used to carry out a model comparison to evaluate whether paths differed between individuals with and without initial back pain and between those who exercised at baseline and those who did not. Factor analysis showed eight of the nine original items loaded on the expected common factor. High BBQ scores at baseline significantly predicted an increase in shoulder, neck, and back pain in individuals with current back pain (β = .11, p < .05), but not in other respondents (β = .02, p = .259). Similarly, baseline BBQ scores predicted the increase in shoulder, neck, and back pain among those who did not exercise (β = .15, p < .05), but not in those who did (β = .04, ns). The risk of negative back beliefs preceding an increase in shoulder, neck, and back pain was greatest for those with current back pain who did not exercise (β = .29, p < .05). The findings confirmed the validity of the German BBQ. Cognitive behavioral interventions should address pessimistic back beliefs in high-risk groups.

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.

Work–Family Conflict, Task Interruptions, and Influence at Work Predict Musculoskeletal Pain in Operating Room Nurses

Background The aim of this study is to examine the prevalence of musculoskeletal complaints in Swiss operating room (OR) nurses, and to investigate how work–family conflict, work interruptions, and influence at work are related to lumbar and cervical back pain. Methods Participants in this correlational questionnaire study included 116 OR nurses from eight different hospitals in Switzerland. Results We found that 66% of the OR staff suffered from musculoskeletal problems. The most prevalent musculoskeletal complaints were lumbar (52.7%) and cervical pain (38.4%). Furthermore, 20.5% reported pain in the mid spine region, 20.5% in the knees and legs, and 9.8% in the hands and feet. Multiple linear regression analyses showed that work–family conflict (p < 0.05) and interruptions (p < 0.05) significantly predicted lumbar and cervical pain in OR nurses, while influence at work (p < 0.05) only predicted lumbar pain. Conclusion These results suggest that reducing the work–family conflict and interruptions at work, as well as offering opportunities to influence ones workplace, help to promote OR nurses health.

Workflow interruptions, social stressors from supervisor(s) and attention failure in surgery personnel

Workflow interruptions and social stressors among surgery personnel may cause attention failure at work that may increase rumination about work issues during leisure time. The test of these assumptions should contribute to the understanding of exhaustion in surgery personnel and patient safety. Workflow interruptions and supervisor-related social stressors were tested to predict attention failure that predicts work-related rumination during leisure time. One hundred ninety-four theatre nurses, anaesthetists and surgeons from a Swiss University hospital participated in a cross-sectional survey. The participation rate was 58%. Structural equation modelling confirmed both indirect paths from workflow interruptions and social stressors via attention failure on rumination (both p<0.05). An alternative model, assuming the reversed indirect causation—from attention failure via workflow interruptions and social stressors on rumination—could not be empirically supported. Workflow interruptions and social stressors at work are likely to trigger attention failure in surgery personnel. Work redesign and team intervention could help surgery personnel to maintain a high level of quality and patient safety and detach from work related issues to recover during leisure time.

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 (βu2009=u20090.45, pu2009<u20090.001) and LBP (βu2009=u20090.33, pu2009=u20090.012). 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.

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

Abstract 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.

Gesellschaftliche Bedeutung und Kosten von Stress

Hohe Anforderungen, Hindernisse bei der Zielerreichung sowie mangelnde Gestaltungsmoglichkeiten sind heute kennzeichnend fur den Arbeitsalltag vieler Erwerbstatiger. Dieses Kapitel gibt hierzu einen Uberblick und zeigt den Zusammenhang solcher Arbeitsbedingungen mit wichtigen Gesundheitsindikatoren und daraus resultierenden Produktivitatsverlusten auf. Den Kosten des Stresses wird eine Nutzenkalkulation von stressreduzierenden Interventionen gegenubergestellt. Das Kapitel gibt einen Einblick in erfolgreiche Interventionsmoglichkeiten und schliest mit einem Ausblick auf stressrelevante Herausforderungen einer sich schnell wandelnden Arbeitswelt.

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.