|Year : 2019 | Volume
| Issue : 1 | Page : 32-38
The professional quality of life among health-care providers and its related factors
Zohreh Keshavarz1, Maryam Gorji2, Zeinab Houshyar3, Zeinab Talebi Tamajani4, Jeno Martin1
1 Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Qazvin, Iran
2 Infertility Clinic, Velayat Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
3 Department of Midwifery, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran
4 Department of Midwifery, Alborz University of Medical Sciences, Karaj, Iran
|Date of Web Publication||29-Jan-2019|
Ms. Maryam Gorji
Qazvin University of Medical Sciences, Qazvin
Source of Support: None, Conflict of Interest: None
Introduction: The professional quality of life is a type of emotion that every person perceives to his/her job. This study aimed to evaluate the professional quality of life among health-care providers including physicians, nurses, and midwives and its related factors. Methods: This cross-sectional study was conducted in 2018. Participants were 464 doctors, nurses, and midwives working in educational hospitals of Qazvin University of Medical Sciences selected using a convenience method. Data were collected using demographic information questionnaire and Persian version of the professional quality of life questionnaire. Multivariate linear regression models were used to examine the related factors. Results: In the present study, 464 health-care providers including 150 doctors, 161 midwives, and 153 nurses participated. Their mean age was 32.29 ± 6.88 years. The majority of them (56.2%) reported a moderate job satisfaction. The mean (standard deviation) of participants' scores in the domains of compassion satisfaction, burnout, and secondary traumatic stress was 38.84 (6.23), 13.53 (4.34), and 27.05 (5.70), respectively. The regression model showed that high and medium job satisfaction, monthly income, and work shift arrangements were significant predictors for all domains of professional quality of life. Conclusion: Physicians, midwives, and nurses had a moderate professional quality of life. Factors such as high job satisfaction, monthly income, and work shift arrangements partly predicted their professional quality of life. Therefore, paying enough attention to improving job satisfaction and improving working conditions and income might improve the professional quality of life of health-care providers, and consequently, the quality of patient care.
Keywords: Midwife, nurse, physician, professional quality of life
|How to cite this article:|
Keshavarz Z, Gorji M, Houshyar Z, Tamajani ZT, Martin J. The professional quality of life among health-care providers and its related factors. Soc Health Behav 2019;2:32-8
|How to cite this URL:|
Keshavarz Z, Gorji M, Houshyar Z, Tamajani ZT, Martin J. The professional quality of life among health-care providers and its related factors. Soc Health Behav [serial online] 2019 [cited 2019 May 24];2:32-8. Available from: http://www.shbonweb.com/text.asp?2019/2/1/32/250995
| Introduction|| |
The increasing attention of managers to improve the quality of human resources has made the professional quality of life more important than before. The professional quality of life is defined as an emotional perception that each individual perceives from his/her own work and is consisted of two dimensions of satisfaction compassion and fatigue compassion. Satisfaction compassion indicates the positive dimensions of care provided by health-care professionals. Satisfaction compassion is a pleasure from the ability to do the job, which helps one to enjoy helping others through his/her work.
Employees with a good professional quality of life offer better services than those with poor quality of life and may remain longer in their jobs. While compassion fatigue is a job risk for individuals, who experience mental trauma., It is common in staffs who are faced with others' suffering, physical, and mental pain and receive no emotional support in the workplace. In fact, compassion fatigue is a psychological disorder characterized by a gradual reduction in compassion and emotion over time. Compassion fatigue was first diagnosed among nurses in 1950s. This is common in individuals that directly contact patients such as doctors, midwives, and nurses. Compassion fatigue is also known as debilitating fatigue due to repetitive responses to suffering and physical injury. Compassion fatigue is a result of the deep absorption of emotions and feelings of patients and sometimes colleagues. This disorder is a deep emotional, mental, and physical fatigue that is usually associated with acute emotional pain and suffering. Fatigue results from more compassion in health-care providers working in traumatic, psychiatric, surgical, emergency and obstetrics, and gynecology wards, besides rural general practitioners. A key sign of this phenomenon is burnout and stress secondary to the trauma. Exhaustion due to high levels of stress in the workplace for a long time might lead to disability and inability to work and consequently resignation and withdrawal of health-care providers from their job. It also makes it difficult for a person to manage his/her skills while interacting with the client and experiences the stress of secondary trauma as a negative feeling of work-related fear and trauma.
Health-care providers are more vulnerable to mental illness and depression than normal individuals. It is believed that physical health is influenced by psychological growth and mental health promotion, which is affected by the prevention and treatment of emotional stress. Therefore, it is important to evaluate the professional quality of life among health-care providers. Regarding studies on compassion fatigue, Abendroth andFlannery conducted a research to determine the frequency of compassion fatigue among health-care providers in the United States and found that low, moderate, and high levels of compassion fatigue were present in 21.3%, 52.3%, and 26.6% of participants, respectively. Another study by Sodeke-Gregson et al. found that low, moderate, and high levels of compassion fatigue were present in zero, 30, and 70% of UK therapists who work with adult trauma clients.
Health-care providers as frontline staff for communication with patients are influenced by stress related to treatment and care and they endure this stress and fatigue. While patients experience a severe stressful physical, mental, or emotional condition, a health-care provider may also suffer from fatigue. It can directly affect the function of individuals and may interfere with the treatment process. Patients with compassion fatigue disorder have symptoms such as frustration, loss of enjoyment, anxiety, stress, and a negative attitude toward life. Compassion fatigue reduces the self-efficacy and self-confidence of the affected person and subsequently diminishes her/his effectiveness with services provided to others.
Considering the important role of health-care providers including doctors, nurses, and midwives in providing health services to a wide range of clients with various problems, working in stressful environments and the effect of compassion fatigue and burnout on quality of services, and examining the status of the professional quality of life in these groups and factors affecting it is required. It can help design and implement interventions to enhance their professional quality of life. Therefore, the present study was designed to assess the professional quality of life of doctors, nurses, and midwives in an urban area of Iran.
| Methods|| |
This cross-sectional study was conducted in 2018. The participants of the present study were 464 doctors, nurses, and midwives working in educational hospitals of Qazvin University of Medical Sciences, Qazvin, Iran. Sampling was conducted using a convenient method. A total of 500 questionnaires were distributed to the participants and 464 questionnaires were returned. Individuals with at least 6 months' work experience, no history of physical and psychological illness or any traumatic event in the past 6 months who were willing to participate in the study were included in the study.
In the present study, data were collected using a demographic questionnaire and the Stamm Professional Quality of Life Questionnaire. Age, work experience, type of employment, education level, occupation, marital status, working hours in 24 h, type of work shift, and salary were demographic characteristics. The professional quality of life questionnaire was first developed by Charles Figley in the late 1980s as the self-examination of compassion fatigue. In 1988, Stamm and Figley began collaborating. In 1993, Stamm added the concept of compassionate satisfaction to this questionnaire and changed its name to satisfaction from compassion and compassion fatigue. In the early 1990s, through a common agreement between Stamm and Figley, the index of measurement was completely changed by Stamm and was entitled the professional quality of life questionnaire. The original questionnaire consists of 30 questions in three subscales of compassion satisfaction (10 questions), burnout (10 questions), and secondary traumatic stress (10 questions). The five-point Likert scale from one (never) to five (most often) is used. Each domain is independent, and it is impossible to aggregate the scores of domains. The scores of each domain are derived from the sum of all questions. In the present study, the Farsi version of this questionnaire was used. It was validated by Ghorji et al. and using an exploratory factor analysis, five items were deleted from the questionnaire. Confirmatory factor analysis confirmed the existence of three domains of compassion satisfaction (10 items), burnout (5 items), and secondary traumatic stress (10 items). In total, the modified Farsi version of professional quality of life questionnaire with 25 items was used in this study.
Data were analyzed using the IBM SPSS statistics for windows, version 21.0. (IBM Corp., Armonk, New York, USA). The normal distribution of data was verified using the Kolmogorov–Smirnov test. For the analysis and comparison of the mean scores of the domains of the professional quality of life questionnaire based on demographic characteristics, the independent t-test and one-way ANOVA test were used. To examine the relationship between the professional quality of life and demographic variables, multiple regression analysis was performed using the stepwise method. In the regression model, the domains of professional quality of life including compassion satisfaction, burnout, and secondary traumatic stress as dependent variables and demographic variables as independent variables were entered to the model. Qualitative variables with more than two categories were defined as the dummy variable in the regression model. For regression analysis, assumptions including the normal distribution of data and the absence of outliers were tested. After applying the regression model, the variance inflation factor (VIF) index, tolerance values, and Durbin–Watson index were controlled. In all three models, VIF <10 and tolerance <1 and the Durbin–Watson index were reported to be between 1.5 and 2. Therefore, the assumptions for implementing the regression model were established. A significant level of 0.05 was considered statistically significant.
Proposal of this research was approved by the Ethics Committee affiliated with the Nursing and Midwifery Research Center of Shahid Beheshti University of Medical Sciences (decree code: IR.SBMU.PHNM.1395.474). After obtaining permissions from the university and hospitals, the researcher referred to the hospital wards and departments. A description of the aims and process of the study was provided to potentially eligible health-care providers. Then, they were asked to fill out the questionnaire in the next 3 days and send them back to the researcher.
| Results|| |
In this study, 464 health-care providers (150 doctors, 161 midwives, and 153 nurses) participated. The response rate was 92.8%. The mean age of the participants was 32.29 ± 6.88 years, and the mean (standard deviation) of their work experience was 6.87 (6.75) years. They were mainly women (89.7%), married (61.6%) and had bachelor degree (56.7%). Majority of participants (78.9%) worked in both day and night work shifts and had 12-h work shifts (52.2%). Monthly income in most of the participants (45.7%) was between 10 and 20 million Rials. Medium job satisfaction was reported by 56.2%. The mean and standard deviation of the participants' scores in compassion satisfaction, burnout, and secondary traumatic stress domains were 38.84 (6.23), 13.53 (4.34), and 27.05 (5.70), respectively. [Table 1] showed the frequency of demographic characteristics and the scores of the professional quality of life domains.
|Table 1: Distribution of demographic variables and mean (standard deviation) scores of professional quality of life subscales according to demographic variables among participants|
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It was found that the scores of compassion satisfaction domain were significantly different regarding age, work experience, monthly income, and perceived satisfaction of the job. Therefore, with increasing age, work experience, monthly income, and job satisfaction, the research participants achieved more scores in the compassion satisfaction domain, indicating an increased sense of satisfaction from the ability to do the job and enjoying helping others. Regarding the burnout domain, the type of employment, daily work hours, work shifts, and perceived job satisfaction significantly altered the scores of the participants. The individuals with a contract employment status, 6-h daily work, working day shift, and higher job satisfaction had the lowest scores in the burnout dimension. For the domain of secondary traumatic stress, women, night shift work shift, day and night work shifts, and lower job satisfaction achieved the highest score in this domain [Table 1].
A multivariate regression model using the stepwise method was used to examine the relationship between demographic characteristics and the professional quality of life domains. The regression model in the compassion satisfaction domain showed that high and medium job satisfaction, age 40–50 years, and monthly income of more than 40 million Rials could significantly predict compassion satisfaction. These variables explained 32% of the variance of compassion satisfaction [Table 2]. High and moderate job satisfaction, daily work shift, daily and night work shift combinations, contractual employment, and a 2–10-year work experience significantly predicted the burnout score. They account for 29% of variance related to the burnout domain [Table 3]. The results of the regression model in the secondary traumatic stress domain indicated that high and medium job satisfaction, daily work shifts, male gender, and monthly income more than 40 million Rials could significantly predict the secondary traumatic stress score. These variables, in total, explained for 12% of the variance of this domain [Table 4].
|Table 2: Results of multivariate linear regression through stepwise model between compassion satisfaction subscale of professional quality of life and demographic characteristics|
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|Table 3: Results of multivariate linear regression through stepwise model between burnout subscale of professional quality of life and demographic characteristics|
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|Table 4: Results of multivariate linear regression through stepwise model between secondary traumatic stress subscale of professional quality of life and demographic characteristics|
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| Discussion|| |
Assessing the professional quality of life including two important dimensions of compassion satisfaction and compassion fatigue is important for health-care providers. Compassion fatigue can have a negative impact on employees' health as well as patient care. Compassion satisfaction can increase the sense of responsibility of individuals and attention to patients' health. Hence, health-care providers listen to patients and understand their feelings, increase their confidence in clinical staff and patients' expectations. Hence, the assessment and consideration of compassion can provide valuable information to health-care policy-makers.
In the present study, the scores of compassion satisfaction, burnout, and secondary traumatic stress domains were reported as 38.84 (6.23), 13.53 (4.34), and 27.05 (5.70), respectively. There was no significant difference between the health-care providers (nurses, midwives, and doctors) in different domains of the professional quality of life. When comparing this result with previous studies, inconsistency was observed which might be due to a variety of reasons including working conditions, workload, patient illness, etc., For example, in another study in Iran, the professional quality of life of Iranian nurses working in hospitals in Torbat Heydarieh (2016) was investigated by Pashib et al., they reported the mean scores of dimensions of the professional quality of life as 26.41 (4.71), 36.17 (7.79), 31.73 (7.75), respectively, for compassion satisfaction, burnout, and secondary traumatic stress. Although our study and the Pashib's study were conducted in that same cultural and social context, the results were not consistent. In the present study, individuals reported higher scores in compassion satisfaction and lower scores in burnout and secondary traumatic stress domains than those of the Pashib's study. Kim et al. reported Korean nurses' scores as 32.59 (4.97) in compassion satisfaction, 29.04 (4.32) in burnout, and 27.04 (4.91) in secondary traumatic stress. In another study, the professional quality of life of nurses was reported as 37.42 (6.67) in compassion satisfaction, 23.50 (6.38) in burnout, and 19.59 (6.58) in secondary traumatic stress dimensions. This difference indicates that various factors can affect the professional quality of life among individuals working in the health-care sector. In the present study, the relation of some of these factors on the professional quality of life was examined. The results of the present study showed that with an increase of age, work experience, monthly income, and job satisfaction led to higher scores in the compassion satisfaction domain. In the multivariate regression model, high and medium job satisfaction, increase of age, and monthly income of more than 40 million Rials significantly predicted the professional quality of life of health-care providers. Having higher scores in the compassion satisfaction dimension represented an increased sense of satisfaction and ability to do the job, which made the person enjoy helping others. Potter et al., Kim et al., and Ravani Pour et al.'s studies were in line with the results of the present study. Potter et al. observed that there is a significant relationship between the work experience and burnout and compassion fatigue in nurses in the oncology ward. In another study in Korea, nurses with higher work experience had a higher professional quality of life, which could be due to higher levels of self-esteem and work experience. This study also showed that individuals with higher education and work experience had a higher professional quality of life because of work shift conditions and less work hours than the past and better working conditions. Ravani Pour et al., in a qualitative study, also suggested that nurses with more self-confidence and self-esteem felt more control on their job and have a better professional performance. Conversely, Mizuno reported that work experience had no statistically significant correlation with the quality of life of nurses and midwives in the abortion and delivery wards. Regarding income, the results of this study also showed that economic factors such as timely and appropriate nonpayment in comparison with physicians influenced nurses' stress and job pressure. Moreover, Mohammadi et al. suggested that higher salaries and responsibilities made that employees considered being more successful and had a better job satisfaction. Furthermore, Pashib et al. reported that professional rules, workloads, and discriminations in health-care workers were accompanied with higher job-related fatigue in the health-care system.
Given the different results of studies, high workloads, harsh working environment, inappropriate rules, unjust salaries, and work benefits can lead to higher fatigue and job stress. Good working conditions that ensure the safety of employees can improve the emotions of staff help them to improve their mental and physical health in the workplace, and thereby increase the sense of competence and job satisfaction. It also seems that an emphasis on the ability of health-care providers to make decisions and provision of facilities to improve their working condition can improve their professional performance, increase job satisfaction and consequently, increase the professional quality of life. Attention is needed to provide solutions for improving the professional quality of life of health-care providers.
The results of this study showed that individuals with contractual employment status, 6 h of daily work, daily work shift, and higher job satisfaction had the lowest scores in the burnout dimension. In the regression model, high and moderate job satisfaction, daily work shift, daily and night work shift combinations, contractual employment, and 2–10 years' work experience significantly predicted the burnout score. Individuals with a contractual employment status are more motivated to work due to the potential opportunity for permanent job placement, long-term employment, and future career advancement. Therefore, they achieve fewer score in the burnout dimension. In line with the present study, Mohammadi et al. reported the relationship between the type of employment and the professional quality of life was significant. While this relationship was not observed in the Yadollahi's research. Differences in the working environment and the motivation of individuals could be the reasons for differences in results.
In the present study, women, night work shifts, and day and night work shifts, as well as less job satisfaction predicted the highest score in the secondary traumatic stress domain. The results of the regression model indicated that high and medium job satisfaction such as daily work shift, male gender, and monthly income more than 40 million Rials significantly predict the secondary traumatic stress score. Consistently, Pashib et al. observed a significant difference between the mean score of compassion satisfaction and secondary stress based on gender. Concerning the effect of work shifts on the experience of secondary traumatic stress, Uddin et al., similarly, reported that nurses working in the morning and afternoon work shifts had a higher professional quality of life than nurses working in evening and night work shifts. Irregular work shifts and more night work shift might have negative impacts on nurses' performance and lead to the high rate of depression in them.
The main limitation of this study was the cross-sectional design of the study and the collection of data using the self-report method. The simultaneous analysis and comparison of data of the professional quality of life collected from three groups of physicians, nurses, and midwives make the opportunity to compare these groups. The concurrent comparison of these groups can guide health-care policy-makers and health-care providers to design and implement interventions to improve the quality of their professional life.
| Conclusion|| |
The results of this study showed that physicians, midwives, and nurses had a moderate quality of life. Factors such as high job satisfaction, monthly income, and work shift arrangements predicted the professional quality of life of health-care providers. Therefore, paying attention to improving job satisfaction and improving their working conditions and income can improve their professional quality of life that consequently improves the quality of patient care.
Hereby, the researchers thank all authorities and participants of the present study.
Financial support and sponsorship
The project was financially supported by Research vice-chancellor of Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]