| As the world undergoing rapid development in economy, people are suffering from great stress more than ever when facing the severer competition, busier schedule, higer requirement in new knowledge, information and technics. This type of stress, coming from the working environment and so called the "Occupational Stress", were defined by the National Institute of Occupational Safety and Health (NIOSH) as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resouces, or needs of the worker. Over stress from working environment can lead to the poor health and even injury, including fatigue, anxiety, depressure, decreasing job capabilities, occupational burnout, Karoshi desease, et al.Literatures both from national and international studies have demonstrated that health professioners are exposed to higher levels of occupational stress for the reasons of the great job duties and busy schedules. Over stress in health professionners has been reported to influence both the individual health and the service quality to the patients in the hospitals. Shanghai is one of the most developed cities in China and is facting the challenge of both high population and relative few numbers of health professioners. The levels of occupational stress are supposed to be higher in doctors and nurses, but somewhat were not discussed in most studies. Therefore, this study aimed to investigate the stress profiles and burnout outcomes in health professioners from Pudong New Area and their major influencing factors. The results will provide basic data in this area and give supports to policy making. 1. Stress profiles and their influencing factors in health professionners in Pudong New AreaThe JCQ and ERI questionnaires were applied to investigate the levels of occupational stress in 1128 health professionners in Pudong New Area. The 24-item JCQ questionnaire emphasized in self esteem of subjects and consists of 3 scales including 6 items of "psychological demand",10 items of "job control" and 8 items of "workplace social support". Items were scored on a five-point scale ranging from 1 (never) to 5 (always). The value of the demand-control ratio (D/C ratio) was also assessed to evaluate the balance between psychological demand and job control. The D/C ration higher than 1 denotes high level of occupational stress. The 23-item ERI questionnaire consists of 3 scales including 6 items of "job effort",11 items of "job reward" and 6 items of "overcommitment". Items were scored on a Likert five scale ranging from 1 (no) to 5 (yes, I am very distressed). The value of the effort-reward ratio (E/R ratio) was also assessed to evaluate the balance between job effort and reward. The E/R ration higher than 1 denotes high level of occupational stress.Results showed that 916 (81.2%) health professionners had high level of occupational stress according to the JCQ questionnaire. Monthly family income, working hours per week, and rotation shift were three major factors that influencing occupational stress in JCQ models (P<0.05). The ERI questionnaire showed that 262 (23.2) health professionners had higher stress. Individual month income, monthly family income, hospital type, job type, employ type, working time per week and rotation shift were the major factors than were related to stress scales in ERI models (P<0.05).Both the JCQ and ERI models revealed that health professionners in Pudong New Area had high occupational stress, which was mainly related to hospital type, job type, employ type, working time per week and job policy in the hospitals. 2. Cross-sectional investigation on occupational burnout (the early health effects of occupational stress) in health professioners in Pudong New AreaThe MBI questionnaire was applied to the 1128 health professionals to investigate their burnout status and to expore the burnout relationship to occupational stress. The 19-item MBI questionnaire consistes of 3 scales including 7 items of "emotional exhaust",5 items of "depersonalization" and 7 items of "personal accomplishment". Items were scored on a Likert seven-point scale ranging from 1 (never) to 7 (every day). Scores of "emotional exhaust" and "depersonalization" higher than 66.7 percerntile, together with scores of "personal accomplishiment" lower than 33.3 percentile, were used to differentiate risk population. A defined score combined different contribution of the above three scales was used to assess the burnout feeling in study subjects.Results showed that 792 (70.2%) health professionners had bad feeling of occupational burnout. Monthly family income, hospital type, working hours per week and whether or ont had a currently second job were the major factors that were relatied to occupational burnout in health professionners (P<0.05).Interetaionship analyses showed that occupational burnout was related to the JCQ scales with the odds ratio (OR) of 1.93 corresponding to low psychological demand and low job control, and 2.76 corresponding to high psychological demand and low job control. Lower burnout status was found to be related to high social support (OR=0.70). In regard to ERI models, higher occupational burnout was related to low job effort together with low job reward, high job effort together with high reward, and high job reward together with low reward, and also with high overcommitment with a highest OR of 6.05. In the logistic analyses regarding to the feeling of occupational burnout, the JCQ model had an OR of 1.69 and the ERI model had an OR of 4.17.In conclusion, health professionners in Pudong New Area were suffered from high levels of occupational stress and burnout, both of them were influenced by the monthly family income, hosptital types, job type, working hours per week and rotation shift. Strategies should be fulfilled to reduce their stress status and burnout feeling. Possible strategies may include increasing the economy support in medication area and the individual income of health professionners, better configuring the medical resourses, encouraging most people to be a health professionner, reducing their working time, and emphasizing the humanistic care. |
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