Work-related social support, job demands and burnout : studies of Swedish workers, predominantly employed in health care

Abstract

During the past decade, levels of work-related stress have increased not only in Sweden but in all of Europe. Health care workers in general and nurses in particular have been identified as having a risk of experiencing stress and burnout. Since the objective of health care work is to care for and help other human beings, the demanding elements of the job may involve both generic (e.g. high workload) and occupational specific aspects, e.g. intense interpersonal interactions with patients, being exposed to sickness and death and having substantial responsibilities of providing right treatment to patients, with no room for errors. One way to navigate the demands of the environment is to utilize the help and support provided by co-workers and supervisors.

The four empirical studies included in this thesis emphasize the concepts of work-related social support, job demands and burnout and the associations between these concepts, predominantly among health care workers.

The majority of previous social support research has investigated how social support affects health. Fewer studies have focused on identifying factors that relate to social support while assessing social support as a dependent variable. The main aim in Study I was to assess different correlates (sociodemographic, individual and organizational/psychosocial) to work-related social support using a diverse sample of private and public employees (n=16144). The result indicated that organisational correlates, particularly perceived job control, were strongest associated with work-related social support.

The main aim in Study II was to perform source-specific analyses of social support in relation to different sub-dimensions of burnout among a sample of registered and assistant nurses (n=1561). The results showed statistically significant correlations between co-worker (patient) support and all three burnout dimensions, whereas supervisor support was statistically significantly related to emotional exhaustion alone. In accordance with prior findings, high levels of job demands were most strongly related to high emotional exhaustion.

The main aim of Study III was to develop and psychometrically evaluate a job demand scale that captures specific job demands within health care work using two occupational groups, i.e. (n=795) registered nurses and (n=527) assistant nurses. A congruent component structure was obtained in both occupational samples, consisting of four job demand indices 'pain and death', 'patient and relatives needs', 'threats and violence' and 'professional worries'.

The main aim in Study IV was to longitudinally examine the association of generic- and occupational specific job demands and work-related social support on emotional exhaustion (EE) and depersonalization (DP) over time among a group of registered nurses (n=775). Those nurses with with low and medium scores on EE and DP at T1 were included in the analyses. The results indicated that initial high professional worry was associated with high emotional exhaustion at T2. Unchanged high scores over time in professional worry and quantitative job demands, as well as impaired quantitaive job demands over time were also associated to high emotional exhaustion at T2. Furthermore, initial poor co-worker support, unchanged poor co-worker support over time and improved co-worker support over time were associated with high depersonalization at T2.

This thesis demonstrates the significance of conducting source-specific analyses of social suppot in relation to burnout, as well as considering occupational specific job demands rather than solely concentrating on generic job demands. Lacking co-worker support seems relevant to acknowledge in order to avert the onset of burnout.