Lawrence R. Murphy

Organizational risk factors for job stress

Job stress and stress-related illness have reached epidemic proportions in the US and are a major concern for employer and employee alike. This edited book presents the latest research on how the structure of the organisation and attributes of the job contribute to or ameliorate stress. Major themes examined by the contributing authors include the importance of organisational culture and climate, the nature of job stress and burnout, the issue of electronic performance monitoring, the impact of particular kinds of high-risk occupations, and new methodological developments that are improving research design.

Job stress interventions.

Reported job stress in the US workforce is on the increase. Among the causes are downsizing, reorganisation and changing technology. This collection of empirical studies presents models for job stress intervention at both the individual level and at the organisational and policy level.

Stress & well-being at work: Assessments and interventions for occupational mental health.

This synthesis of empirical research efforts, idiographic inquiries and conceptual reviews brings epidemiological and public health concepts of prevention into the arena of occupational mental health. It is intended as a resource book for those interested in work design and mental health.

Worksite Health Promotion Programs in the U.S.: Factors Associated with Availability and Participation

Purpose. To examine how the availability of and participation in worksite health promotion programs varies as a function of individual (e.g., age), organizational (e.g., occupation), and health (e.g., high blood pressure) characteristics. Availability of worksite programs was also compared to that reported in two previous national surveys of private companies. Design. Data analyzed were from the 1994 National Health Interview Survey (NHIS), a national cross-sectional probability sample of the U.S. civilian population. Subjects. Five thousand two hundred nineteen NHIS respondents met the inclusion criteria of (1) being currently employed in a company of at least 50 employees, and (2) completing the NHIS section on worksite health promotion. Measures. Employees indicated the availability of, and their participation in, 33 different types of worksite programs. National Health Interview Survey data were also available regarding general health, blood pressure, body mass index, and medical conditions. Results. Smoking cessation programs had the highest mean availability (43 %), followed by health education programs (31 %) and screening tests (31 %). Overall, availability of worksite programs appeared comparable to that reported in a recent national survey. Participation ranged from 32% for health education programs to 5% for smoking cessation programs. Compared to availability, participation depended less on individual and organizational characteristics. Healthy employees were not consistently more likely to participate in worksite health promotion programs than nonhealthy employees. Conclusions. Although availability of worksite health promotion programs remains high, participation by employees in specific types of programs can vary widely. Attempts to increase participation should look beyond individual, health, and organizational variables, to specific features of the work environment that encourage involvement in health promotion activities.

Compliance with universal precautions among physicians

This study characterized and assessed self-reported levels of compliance with universal precautions (UP) among hospital-based physicians, and determined significant factors associated with both compliance and noncompliance. The physicians (n = 322) were a subgroup of a larger study population of hospital-based health care workers recruited from three geographically distinct locations (n = 1746), and were surveyed using a detailed confidential questionnaire that assessed personal, work-related, and organizational factors. Compliance with UP was measured through 11 items that examined how often physicians followed specific recommended work practices. Compliance was found to vary among the 11 items: they were high for certain activities (eg, glove use, 94%; disposal of sharps, 92%) and low for others (eg, wearing protective clothing, 55%; not recapping needles, 56%). Compliance with all items was low (31% to 38%). Stepwise logistic regression revealed that noncompliant physicians were likely to be age 37 or older, to report high work stress, and to perceive a conflict of interest between providing patient care and protecting themselves. Compliant physicians were more likely to be knowledgeable and to have been trained in universal precautions, to perceive protective measures as being effective, and to perceive an organizational commitment to safety.

Occupational stress intervention

The topic of occupational stress has received considerable research attention during the last decade and has emerged as an important occupational safety and health concern. Worker compensation claims for stress-related illnesses, for example, were the fastest growing type of claim in the 1980s, comprising more that 11% of all such claims. Concern over problems associated with occupational stress and their costs has fostered interest in intervention strategies. While specific work stressors and their resulting physical and mental health consequences have been identified, relatively few successful interventions have been documented in the literature. This article discusses primary, secondary, and tertiary interventions efforts in the area of occupational stress and argues for efforts to increase understanding of the occupational stress intervention process.

Behavioral-diagnostic analysis of compliance with universal precautions among nurses.

This study used the PRECEDE model (L.W. Green, M.W. Kreuter, S.G. Deeds, & K.B. Partridge, 1980) to examine individual, job-task, and environmental-organizational factors related to compliance with universal precautions (UP) among nurses. Structural equation modeling showed that the hypothesized model did a better job predicting general compliance (R2 = .41) than compliance with personal protective equipment (PPE; R2 = .18). All 3 categories of diagnostic factors (predisposing, enabling, and reinforcing) influenced general compliance, but predisposing factors were relatively unimportant for compliance with PPE. With a set of nested models, the greatest improvement in model fit occurred when the indirect effects of reinforcing factors were added. A positive safety climate may increase the likelihood that the work environment will contain features that enable workers to comply with safe work practices.

The influence of employee, job/task, and organizational factors on adherence to universal precautions among nurses

Abstract Universal precautions (UP) refer to recommended work practices designed to help prevent occupational exposure to HIV/AIDS and other blood-borne pathogens in health care settings. However, despite widespread dissemination of UP guidelines and subsequent government regulatory action, worker adherence remains less than satisfactory. The present study used hierarchical, multiple regression analysis to examine the relative influence of four sets of factors on worker adherence to UP: demographics, personal characteristics, job/task factors, and organization-level factors. Data were analyzed on a sample of 451 nurses employed at a large U.S. medical center. Consistent with the general hypothesis of the study, job/task and organization-level factors were the best predictors of adherence. Using the results from the study, a heuristic model of the adherence process is proposed that highlights the contributions of job hindrances and organizational safety climate to UP-related behavior. A three-pronged intervention strategy is also presented that emphasizes (1) the availability and accessibility of personal protective devices, (2) the reduction of UP-related job hindrances and barriers, and (3) improvements in safety performance feedback and related communications. Given the preliminary nature of this study, several recommendations for future research are also offered.

Discrimination and occupational mental health

Background: Racial and ethnic discrimination has been shown to occur in work organizations, yet little is known about the relationship of this stressor to occupational mental health. Aims: This paper explores the degree to which racial and ethnic groups may be subjected to discrimination at work and examines associations between discrimination and mental health indicators. Methods: In a national study, 1728 American workers were interviewed about aspects of their jobs, their exposure to racial and ethnic discrimination at work, and dimensions of their mental health. Results: American minorities reported perceptions of discrimination at work at greater frequencies than White Americans, and findings suggested some indication of institutional discrimination against minorities. Further, White, Black, and Hispanic-Americans, who reported that they had been discriminated against, were found to have poorer mental health outcomes than their same-race counterparts, who did not acknowledge being discriminated against. Conclusions: These findings may be used to inform the development of occupational stress and health models that are more cross-culturally applicable. Declaration of interest: None

Work organization interventions: state of knowledge and future directions

SummaryChanges taking place in the modern workplace, such as more flexible and lean production technologies, flatter management structures, and nontraditional employment practices fundamentally alter work organization factors and raise concerns about potentially negative influences on worker health and safety. These changes raise concerns about adverse effects on worker safety and health and call attention to the need for interventions to counter these effects. This forum article provides an overview of work organization intervention research, highlights gaps in the research literature, and sets forth an agenda for future intervention research. Research to date has focused primarily on individual-level interventions, with far less attention to interventions at the legislative/policy level, employer/ organization level, and job/task level. Future research is recommended to establish the effectiveness of work organization interventions using improved methodological designs and giving increased attention to the circumstances within organizations that promote the adoption of such interventions.