Work environment-related factors and nurses' health outcomes: a cross-sectional study in Lebanese hospitals

Martine Elbejjani; Mary Abed Al Ahad; Michael Simon; Dietmar Ausserhofer; Nuhad Dumit; Huda Abu-Saad Huijer; Suzanne R Dhaini

doi:10.1186/s12912-020-00485-z

Work environment-related factors and nurses' health outcomes: a cross-sectional study in Lebanese hospitals

BMC Nurs. 2020 Oct 8:19:95. doi: 10.1186/s12912-020-00485-z. eCollection 2020.

Authors

Martine Elbejjani¹, Mary Abed Al Ahad², Michael Simon^{3

4}, Dietmar Ausserhofer^{3

5}, Nuhad Dumit², Huda Abu-Saad Huijer², Suzanne R Dhaini²

Affiliations

¹ Clinical Research Institute, and Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
² Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
³ Institute of Nursing Science, University of Basel, Basel, Switzerland.
⁴ Inselspital, Bern, Switzerland.
⁵ College of Health-Care Professions Claudiana, Bozen, Italy.

Abstract

Background: Worldwide, studies show a relationship between nurses' health and some work environment factors; however, data on nurses' health and self-perceived workload and nursing task allocation are lacking, particularly for Lebanese nurses. We assessed the relationship of several work environment factors: overall workload and specific temporal, physical, mental, effort, frustration, and performance demands (NASA Task Load Index), staffing resources and adequacy and leadership (Practice Environment Scale of Nursing Work Index), teamwork climate (Safety Attitudes Questionnaire), and nursing task allocation (Basel Extent of Rationing of Nursing Care)) with self-reported musculoskeletal, cardiovascular, skin, and mental health diseases (Work Ability Index) and emotional exhaustion (Maslach Burnout Inventory) among Lebanese nurses.

Methods: A cross-sectional self-report survey was distributed to all 289 registered nurses (RNs) in the medical, surgical, and pediatric units in two Lebanese university-affiliated hospitals; 170 RNs had complete data. Adjusted multivariable logistic regression models were used to estimate the association between work environment factors and health outcomes.

Results: The most prevalent outcomes were musculoskeletal disease (69%), emotional exhaustion (59%), and mental health problems (56%); 70% of RNs had ≥2 and 35.29% had ≥4 co-occurring health problems. Musculoskeletal disease was associated with higher overall (OR = 1.36 (95%CI = 1.03, 1.80)), temporal (OR = 1.30 (95%CI = 1.09, 1.55)), and physical demands (OR = 1.20 (95%CI = 1.03, 1.49)), higher task allocation to RNs (OR = 1.11 (95%CI = 1.01, 1.23)) and lower teamwork climate (OR = 0.60 (95%CI = 0.36, 0.98). Higher odds of mental/emotional problems were associated with higher overall, temporal, frustration, and effort demands, and lower teamwork climate, performance satisfaction, and resources adequacy (increased odds ranging from 18 to 88%). Work environment indicators were associated with higher co-occurrence of health problems.

Conclusions: Results show elevated health burden and co-morbidity among Lebanese RNs and highlight the value of comprehensive approaches that can simultaneously improve several work environment factors (namely self-perceived workload, teamwork,, resources, and nursing task allocation) to reduce this burden.

Keywords: Nurses’ health; Nurses’ mental health; Nurses’ physical health; Work environment indicators; nurse’s work environment.