University of Central Florida STARS Electronic Theses and Dissertations, 2004-2019 2006 The Effect Of Job Strain In The Hospital Environment: Applying Orem's Theory Of Self Care Diane Andrews University of Central Florida Part of the Public Affairs, Public Policy and Public Administration Commons Find similar works at: https://stars.library.ucf.edu/etd University of Central Florida Libraries http://library.ucf.edu This Doctoral Dissertation (Open Access) is brought to you for free and open access by STARS. It has been accepted for inclusion in Electronic Theses and Dissertations, 2004-2019 by an authorized administrator of STARS. For more information, please contact [email protected]. STARS Citation Andrews, Diane, "The Effect Of Job Strain In The Hospital Environment: Applying Orem's Theory Of Self Care" (2006). Electronic Theses and Dissertations, 2004-2019. 757. https://stars.library.ucf.edu/etd/757 THE EFFECT OF JOB STRAIN IN THE HOSPITAL ENVIRONMENT: APPLYING OREM’S THEORY OF SELF-CARE by DIANE RANDALL ANDREWS B.S.N. University of Iowa, 1976 M.S. University of Illinois, 1981 A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Public Affairs Program in the College of Health and Public Affairs at the University of Central Florida Orlando, Florida Spring Term 2006 Major Professor: Thomas T. H. Wan © 2006 Diane Randall Andrews ii ABSTRACT The purpose of this research was to evaluate the causal relationships between job strain, the practice environment and the use of coping skills in order to assist in the prediction of nurses who are at risk for voluntary turnover. It was conducted at the level of the individual nurse employee in order to better understand the health consequences associated with job strain, the factors in the professional practice environment which may contribute to the propensity to leave and the influence of coping behaviors in response to workplace stressors. It was undertaken with the intention of identifying intervention strategies which will promote a healthy workforce and the retention of nurses in the workplace. An exploratory cross-sectional survey of 1235 staff nurses employed on the intensive, progressive and general medical-surgical nursing units of seven hospitals associated with a major Central Florida healthcare network tested a client-centered model in an effort to identify nurses vulnerable to the health consequences of job strain using structural equation modeling. Human subject protection was assured. An 82 item questionnaire was used to collect demographic data and measure responses to items associated with the constructs of health status, autonomy, collaboration, decentralization, coping, satisfaction, absenteeism and intent to leave. A variety instruments that were previously demonstrated as valid and reliable were used in the construction of the instrument. Subjects were also given the option of including additional written comments. A total of 325 surveys were returned, of which 308 met inclusion criteria, for a response rate of 25%. iii Data analysis determined that the measurement of job strain as a function of self- assessed generic health status was predictive of propensity to leave (γ = -.21). The experience of job strain shared a strong association with indicators of mental health status. Job strain was significantly influenced by coping behavior (γ = .56) which targeted activities associated with sustaining and balancing. Anecdotal remarks suggested that the need for balance influenced perceptions regarding stressors in the workplace. The professional practice environment was associated negatively with the propensity to leave (γ = -.58). Those staff nurses who experienced higher levels of autonomy expressed a greater degree of satisfaction and lower intent to leave. The variables of collaboration and decentralization contributed minimally to the construct of professional practice. Anecdotal remarks suggested that the low contribution of collaboration and decentralization contributed to a sense of powerlessness and frustration with work related circumstances. The influence of job strain, coping and the professional practice environment upon staff nurses suggests that health promotion strategies, efforts to enhance coping behavior and promotion of a professional practice environment will increase employee satisfaction and reduce intent to leave. Adoption of policies and procedures which support the health and well-being of individual staff members will benefit employees, strengthen the organizations in which they practice and promote the overall retention of nurses in the face of looming nurse shortages. iv To my husband, Thomas W. Andrews, whose love and steadfast support made completion of this undertaking possible. v ACKNOWLEDGMENTS Completing this process fulfills a promise I made to myself 25 years ago. It would have not been possible without the commitment of faculty dedicated to academic excellence and the professional development of their students. In particular, I would like to acknowledge my dissertation committee: Thomas T.H. Wan, Ph.D., Committee Chair; Eileen Mazur Abel, Ph.D.; Angeline Bushy, Ph.D., RN, FAAN; and Janice Z. Peterson, Ph.D., RN. I am also grateful to my family, friends and colleagues who championed my efforts and forgave my shortcomings. I am especially thankful for the love and support of my husband, Tom, and my children, Christine and Charles. Finally, I would like to express appreciation to the Theta Epsilon Chapter of Sigma Theta Tau, Inc., and the Southern Nursing Research Society, both of which supported my research through small research grants. vi TABLE OF CONTENTS LIST OF FIGURES .......................................................................................................... xii LIST OF TABLES........................................................................................................... xiv LIST OF ACRONYMS/ABBREVIATIONS.................................................................. xvi CHAPTER ONE: INTRODUCTION................................................................................. 1 Market Forces ................................................................................................................. 1 Intervention Strategies .................................................................................................... 6 Nurse Retention and Job Satisfaction ......................................................................... 7 Personal Health ........................................................................................................... 9 Coping....................................................................................................................... 12 Professional Practice................................................................................................. 14 Self-Care ................................................................................................................... 15 CHAPTER TWO: LITERATURE REVIEW................................................................... 17 Current Circumstances.................................................................................................. 19 Factors Influencing Nurse Retention ............................................................................ 20 Job Satisfaction ......................................................................................................... 21 Professional Practice Environment........................................................................... 23 Manager Consideration............................................................................................. 26 Influence of the Work Environment on Health......................................................... 27 The Impact of Coping Behavior ............................................................................... 33 Self-Care and Coping Behavior................................................................................ 35 Coping, Self-Care and Satisfaction............................................................................... 37 vii The Role of Intent to Leave and Absenteeism.......................................................... 38 Research Questions....................................................................................................... 39 CHAPTER THREE: THEORETICAL FRAMEWORK.................................................. 41 Job Strain ...................................................................................................................... 43 Health Consequences................................................................................................ 49 Organization of the Work ..................................................................................... 49 Response of the Individual.................................................................................... 51 Job Strain and Health Status ................................................................................. 52 Professional Practice..................................................................................................... 55 Self-Care Demand......................................................................................................... 60 Self-Care Practice ..................................................................................................... 63 Well-Being and Satisfaction ....................................................................................