Volume 7, Issue 1 (3-2023)
EBHPME 2023, 7(1): 59-70 |
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Zolfaghari A, Niazi M, Vahedian M. Factors Affecting the General Health of Hospital Nurses in the Decade (2007-2017 in Iran): A Meta-Analysis Study. EBHPME 2023; 7 (1) :59-70
URL: http://jebhpme.ssu.ac.ir/article-1-371-en.html
URL: http://jebhpme.ssu.ac.ir/article-1-371-en.html
Department of Political Science, Faculty of Law and Social Sciences, Payame Noor University, Tehran, Iran , akbarzolfaghari@pnu.ac.ir
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A B S T R A C T
Background: Nurses constitute a large population of organizational workforce in the field of health. They experience a high level of job stress and workplace pressure. Therefore, paying attention to nurses’ health and reducing burnout, increase productivity, job satisfaction, and organizational commitment. Relying on meta-analysis method, this study seeks to investigate the factors related to the general health of nurses and measure the effect of each factor.
Methods: The method of this research is quantitative meta-analysis, which was carried out in the period of 2007-2017 with a sample size of 14 research documents. The statistical population of the study included all the studies conducted in Iran regarding the general health of nurses which have been published in scientific and research journals as IRANDOC, NORMAGS, and SID. The purposive sampling method was based on the inclusion and exclusion criteria, as well as considering the validity and reliability of the research. Compliance with validity, reliability and quality of research; the existence of correlation coefficient, sample size and significant level of research has been the criteria for entering the research into the Comprehensive Meta-Analysis Software version 2.
Results: In this study, the lack of diffusion bias and homogeneity of the effect size were first confirmed. In terms of bias, most of the studies under review were sub-funnel, indicating no propagation error. Based on the results of the N-error-free test, 253 studies should be performed to question the results of the present study. The results of I2 also indicated that the research in this field was homogeneous. Based on the results of effect size, strengthening communication skills, followed by stress management group therapy, had the greatest role in improving the general health of nurses. Finally, it was found that the average effect size of various factors on the general health of nurses was 0.164.
Conclusion: It can be concluded that strengthening communication skills among nurses has an important role in improving their general health followed by group therapy. Stress management has the next highest effect size and is one of the most important factors related to improving the health of nurses.
Key words: General health, Nurses, Group therapy, Job stress, Meta-analysis
Introduction
Today, most experts and thinkers focus on the importance and role of human resource as the development factor of Iran and the most important capital in every organization (1). One of the bases to evaluate the health of an organization is the health of that organization's human resources. Undoubtedly, this is essential for ensuring the dynamicity and efficacy of any organization. Studying this issue is of great importance in hospitals (2). Hospital staff is influenced by various stressful factors because of providing treatment and comfort to patients (3). Nurses are the largest expertise group in the health care system. 40 % of a hospital staff are made up of nurses, and 55 % of the staff costs is allocated to them (4). In fact, health care organizations can't succeed without effective nursing personnel (5). However, this working group is dealing with a lot of stress on a daily basis. It is caused by overwork, individual conflicts, shift work, dealing with mortality, lack of psychological support, conflict with doctors and ambiguity in their authority in the workplace (6). It has also been demonstrated that ,compared to other members of health team, nurses experience higher levels of burnout relating to the nature of their job (7, 8).
According to Winslow, general health is defined as "the science and art of disease prevention, life extension and health promotion through organized efforts and informed choices of society, organizations, public and private societies and individuals"(9). General health promotes and protects the health of people in their communities (10). General health operates to track disease outbreaks, and prevent injuries. It also explains why some of us suffer more from poor health (11). World Health Organization experts consider general health as an organized effort carried out through public institutions to improve, promote, and maintain general health (12). The European Commission considered general health as an organized process, which is carried out to ensure health, maintain health and promote general health. From their viewpoint, general health; including the relationship between social conditions and population health; and it includes measures that are taken to improve the health of the population (13). The Karolinska Institute as a research-led medical university in Solna of Sweden states that general health is a multidisciplinary field that purposes to study and deal with determinants of health at the population level. It suggests that social structure, life habits, work life, environment and health care system affect population health and health care efficiency (14). Policy development; gathering and disseminating evidence for health policies, strategies and practices; disease prevention and control; Intersectoral action for better health; and the development of human resources and capacity building is the major functions of general health (15). Building on these identified functions, the general health functions steering committee (16), identified six general health goals as follows (1), prevent epidemics and the spread of disease, (2) protect against environmental hazards, (3) prevent injuries, (4) promote and encourage healthy behaviors, (5) respond to disasters and help communities recover, and (6) ensuring quality and access to health services. Laros (17) introduces general health as the mental talent for pleasant coordination, effective working, and flexibility in difficult situations. Kaplan (18) considers general health a constant adaptation to various situations and an attempt to achieve balance between internal conflicts and changeable environmental requirements. Abstractly, general health is related to the way of thinking and expressing feelings, behaviors and actions (19). It is the basis of social and emotional development in individuals (20).
In Iran, 80 percent of the employees in the health care system are nurses (21). They are responsible for individuals' health and life and deal with patients and their incurable diseases. Therefore, nurses always experience high level of psychological stress (22). On the one hand, these psychological pressures are because of the emotional nature of the patient's needs, long hours of working, and interpersonal involvements in the nurses' workplace (23). On the other hand, it is nurses' obligation to inform patients of their disease and different dimensions of treatment. This is because having an effective and empathetic relationship with patients is necessary (24, 25). In sum, the workload of nursing decreases general health (26). Therefore, the general health status of this group, who are very much exposed to stress, should be taken seriously (24).
According to previous studies, nursing, especially shift work, can have various negative effects on job performance, sleep, physical and mental health, social life, use of various drugs and the level of tolerance of job stress. Sleep disorders in shift nurses increase treatment errors, desire for drinking alcohol and other drugs, and decrease performance (27). Similarly, the results of other studies revealed that those who work as a nurse are at a higher risk of heartburn (28, 29). The prevalence of muscular-skeletal disorders, breast cancer and tuberculosis and the possible risk of blood diseases (HIV, hepatitis B, hepatitis C virus) are higher in nurses (30) who are more prone to occupational stress implications. Finally, according to the results of various studies, the amount of risk factors among nurses is higher than the general population (31, 32). It can be said that many biological, chemical, physical, ergonomic, psychological and organizational factors effect on the general health (33, 34). As research findings in this field suggest, ergonomic and psychosocial measures are effective in improving working and living conditions of this occupational group. They are important not only for the nurses' health and well-being, but also for patient outcomes. Physical and psychological demands should be reduced for nurses (35) so that they experience lower levels of stress compared to other health experts (36). Lack of attention to the general health of nurses prevents them from providing optimal care regarding physical and psychological support to patients. This increases the risk of making mistakes and occupational accident, which influences patients and nurses (37). This, in turn, exacerbates mental and physical distress (38). Another advantage of improving the general health of nurses is that it enables them to realize their place in the family, social groups and work environment correctly and can establish a constructive relationship with others (39). Hence, the continuous improvement the life quality of this group and raising their level of health is of great importance. According to aforementioned discussion, the main objective of this study is conducting a meta-analysis regarding nurses' general health and the effective factors in the decade of 2007-17 in Iran.
Materials and Methods
The research method is quantitative meta-analysis (cma2). Meta-analysis with a systematic review of previous researches; It seeks to estimate the effect size of independent variables on dependent variables. The present research method, steps: 1. Searching for the keyword “general health and hospital nurses 2. Collecting articles from Normags database, Magiran; Irandoc; Net Science and Academic Jihad Database (SID); 3. Screening and selection of articles with entry criteria conditions (correlation coefficient, sample size, significance level, validity and reliability of research, survey and use of questionnaire tools); 4. Entering the software and finally 5. Estimating the size of the research effect. It has gone through publication bias and mediating (modifying) variables. Research period from 2007 (the first published research article) to 2017 (the last article). The statistical population is 22 cases, of which 14 studies were selected by a deliberate method after methodical control and screening (having entry criteria). Finally, the final effect sizes of each study and the total final effect (effect size) have been estimated using the Fisher and Cohen formula in the meta-analysis software. To detect homogeneity or heterogeneity, the funnel plot and Q test were used, and after proving the assumption of heterogeneity between studies, the moderating (contextual) variable was used to measure its effect on the general health and hospital nurses. Meta-analysis with a research approach helps the researcher to combine contradictory and non-contradictory quantitative results in the past in a favorable way (40). This method does not have some of the limitations of the standard literature review; thus, it enables the researchers to statistically combine the results of a large number of studies and improve conflicting results bond (41). The research has provided the required statistical information. Finally, 14 papers related to the problem of the present study were selected, and meta-analysis was performed with regard to them. Therefore, many experts consider it permissible to perform meta-analysis even on a smaller number of studies compared to this study provided that the criteria and conditions are met (42, 43).
Table 1. General specifications reviewed in meta-analysis
.PNG)
Results
Effect size
The effect size is used for thse rejection or acceptance of the null hypothesis as shown in Figure 2. Via calculating the effect size, researchers can find that to what extent the independent variable has affected the dependent one. In a comprehensive statistical definition, the effect size is the ratio of a meaningful testing to the study size (56). Based on Table 2, all of the reviewed studies were significant except for Mashak et al. (55), and the highest effect size was related to Amini et al.'s (48) research in 2013. The effect size of Amini et al.'s (48) research was 0.561. On the other hand, the lowest effect size was related to the research by Mashak et al. (55). However, due to the insignificance of the results of this effect size, the researchers conclude that they cannot rely on the results of this project.
Release error or release bias
Lack of attention to all the conducted studies leads to publication bias. This can be due to reasons such as poor design and implementation of studies, including sample size, data reporting method, delay, language, non-acceptance by journals, database indexing, amount of documentation and public highlights, Even this non-publication can depend on the direction and strength of the scientific findings (57). When there is a publication bias, the results of the final meta-analysis will be affected; and the final estimates will be biased and erroneous. Therefore, it is necessary to identify and correct publication bias in the early stage of meta-analysis to increase the validity of the results (58). The most common way of identifying publication bias is using a two-dimensional publication diagram called funnel diagram. The funnel diagram is based on the fact that the statistical weight of the study increases by increasing its sample size. (57). In the absence of any bias, the diagram looks like an inverted funnel, and in the presence of a bias, the funnel diagram becomes asymmetric. Although visual evaluation of the funnel diagram helps the analyst to gain an understanding about the nature of data, it is optimal to use statistical tests to reduce subjective evaluations of the symmetry of the funnel diagram. Thus, in this research the authors have used the Beck-Mesomorphic method and bias-free N. The results of these methods are presented in the following sections.
Funnel diagram
The following Figure is a funnel diagram of the studies reviewed in the present study in order to investigate the publication bias.
Based on the above funnel diagram, it can be said that there is a relative symmetry between the studies performed, because most studies are at the top of the funnel. However, due to the relativeness of the funnel diagram results and the fact that a definite judgment can't be made in this case, the following statistical tests (the Beck and Mesomorphic rank correlation test, and N safe from bias) are used.
Beck and mesomorphic rank correlation results
This test examines the relationship between effect size and sample variances. Based on the interpretation of this test, if the asymmetry is due to publication bias, more standard bias is expected in relation to the larger effect size. The results of this method are shown in the Table 4.
If the significance level of the Beck and Mesomorphic test is greater than 0.050, it can be said that there is no publication bias. According to the P-value amounts in the above Table, the researchers concluded that the assumption of no publication bias is confirmed.
N safe results from bias
This test indicates the number of studies that should be added to the analysis in order to reach a statistically insignificant total effect of a research and change the research result. The basic idea of bias-free is that if a small number of meaningless studies are needed to reduce a result to a significant level, the research is unreliable. The results of this method are described in the following Table. Based on Table 5, the other 253 studies should be taken into account in order that the value of the combined bilateral P does not exceed 0.050. This means that another 253 studies must be considered in order that errors in the final results of calculations and analyzes occur.
Assumptive investigation of homogeneity of studies
Q test has been used to evaluate the homogeneity of the studies. The results of the test show that Q = 11.259 and P-value = 0.589. If P-value is greater than 0.050, the null hypothesis would be confirmed. So, the null hypothesis indicating the homogeneity of the studies is accepted. In other words, the significance of the Q index indicates the existence of homogeneity in a study. However, this index is sensitive to the increase of the number of effect sizes. As the number of effects increases, its power to reject homogeneity increases as well. Therefore, the I2 index is used. The closer this value is to 10, the higher the heterogeneity will be; and the farther from 10, the lower the heterogeneity is. The results of I2 demonstrated that there is no heterogeneity between the studies. In other words, the results of this test suggested that the factors related to the general health of nurses are not different in terms of characteristics and specifications of the studies.
Table 4. Results from the study of Beck and Mesomorphic rank correlation method
* The P-value in the table 4 confirms the non-emission bias assumption.
Table 5. Results of examining the n-safe method of error
Table 6. Results of Q Test
.PNG)
.PNG)
Discussion
Public health as a basic individual factor affects various aspects of personal, professional, and family life and plays a fundamental role in justifying and explaining the quality of life of a person and satisfaction with his position in life. This concept, as an important part of the concept of health, means the ability to create balanced relationships with others and the ability to participate in changes in the social environment. Meanwhile, nurses are one of the important strata of the social health field, and a major part of their life time is spent in the hospital environment and in communication with patients. Therefore, it is important to pay attention to the public health status and the effective indicators in improving their public health. In this research, meta-analysis was used to measure related indicators and factors. Meta-analysis offers a more comprehensive view by combining the results of research conducted in a subject area. Meta-analysis also shows the overall effect size and the effect size of mediating variables of each study. The research findings show that Amini et al.'s (48), research has the highest effect size. Therefore, strengthening communication skills among nurses plays an important role in improving their general health. The research of Kohraziet al. (59) has been carried out in this field and it has shown that life and communication skills training plays an essential role in reducing nurses' depression. Soleimani's research (60), also shows that people who are unable to communicate with others suffer from depression, anxiety, and impairment in social and physical functions more than other people. Research by Lee and Crockett (61), also shows that communication skills significantly reduce the level of occupational stress of nurses and the stress management group therapy has the next highest effect size and is considered one of the most important factors related to improving the general health of nurses. The research of Mohramami et al. (62), shows that after the group therapy intervention, a statistically significant difference was observed between the average scores of occupational stress and self-efficacy of the control and experimental groups. In addition that, the implementation of stress management group therapy among nurses is associated with reducing occupational stress and increasing self-efficacy. Research by James (62), shows that the schema-based approach plays a significant role in justifying the effectiveness of schema training in reducing occupational stress.
Conclusion
The results suggested that there is no publication bias in the field of nurses' health studies. Based on the results of the funnel diagram, most of the studies are considered at the bottom of the funnel, which indicates that there is no publication bias. The significance level of Beck and Mesomorphic test also confirmed the assumption of no publication bias. The results of I2 illustrated that the research in this field is homogeneous. In examining the hypothesis of homogeneity of these 14 studies, Q test with 99 % confidence, and null hypothesis based on homogeneity of studies was confirmed. So, the hypothesis of heterogeneity of effect size regarding performed studies was rejected. According to the results of this research and the effect size, Amini et al.'s (48) research has the highest effect size. It can be said that reinforcing communication skills among nurses has a critical role in improving their general health. The group therapy in stress management has the next highest effect size. It is one of the most important factors which are related to the improvement of the nurses' general health.
Acknowledgments
We would like to appreciate the experts and professors who helped the authors to identify original papers and keywords.
Conflict of interests
The authors declared no conflict of interests.
Authors' Contributions
Zolfaghari A, Niazi M, and Vahedian M designed research; Zolfaghari A and Vahedian M conducted data; Zolfaghari A, Niazi M, and Vahedian M analyzed data; and Zolfaghari A and Vahedian M wrote manuscript. All authors read and approved the final manuscript.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-profit sectors.
Background: Nurses constitute a large population of organizational workforce in the field of health. They experience a high level of job stress and workplace pressure. Therefore, paying attention to nurses’ health and reducing burnout, increase productivity, job satisfaction, and organizational commitment. Relying on meta-analysis method, this study seeks to investigate the factors related to the general health of nurses and measure the effect of each factor.
Methods: The method of this research is quantitative meta-analysis, which was carried out in the period of 2007-2017 with a sample size of 14 research documents. The statistical population of the study included all the studies conducted in Iran regarding the general health of nurses which have been published in scientific and research journals as IRANDOC, NORMAGS, and SID. The purposive sampling method was based on the inclusion and exclusion criteria, as well as considering the validity and reliability of the research. Compliance with validity, reliability and quality of research; the existence of correlation coefficient, sample size and significant level of research has been the criteria for entering the research into the Comprehensive Meta-Analysis Software version 2.
Results: In this study, the lack of diffusion bias and homogeneity of the effect size were first confirmed. In terms of bias, most of the studies under review were sub-funnel, indicating no propagation error. Based on the results of the N-error-free test, 253 studies should be performed to question the results of the present study. The results of I2 also indicated that the research in this field was homogeneous. Based on the results of effect size, strengthening communication skills, followed by stress management group therapy, had the greatest role in improving the general health of nurses. Finally, it was found that the average effect size of various factors on the general health of nurses was 0.164.
Conclusion: It can be concluded that strengthening communication skills among nurses has an important role in improving their general health followed by group therapy. Stress management has the next highest effect size and is one of the most important factors related to improving the health of nurses.
Key words: General health, Nurses, Group therapy, Job stress, Meta-analysis
Introduction
Today, most experts and thinkers focus on the importance and role of human resource as the development factor of Iran and the most important capital in every organization (1). One of the bases to evaluate the health of an organization is the health of that organization's human resources. Undoubtedly, this is essential for ensuring the dynamicity and efficacy of any organization. Studying this issue is of great importance in hospitals (2). Hospital staff is influenced by various stressful factors because of providing treatment and comfort to patients (3). Nurses are the largest expertise group in the health care system. 40 % of a hospital staff are made up of nurses, and 55 % of the staff costs is allocated to them (4). In fact, health care organizations can't succeed without effective nursing personnel (5). However, this working group is dealing with a lot of stress on a daily basis. It is caused by overwork, individual conflicts, shift work, dealing with mortality, lack of psychological support, conflict with doctors and ambiguity in their authority in the workplace (6). It has also been demonstrated that ,compared to other members of health team, nurses experience higher levels of burnout relating to the nature of their job (7, 8).
According to Winslow, general health is defined as "the science and art of disease prevention, life extension and health promotion through organized efforts and informed choices of society, organizations, public and private societies and individuals"(9). General health promotes and protects the health of people in their communities (10). General health operates to track disease outbreaks, and prevent injuries. It also explains why some of us suffer more from poor health (11). World Health Organization experts consider general health as an organized effort carried out through public institutions to improve, promote, and maintain general health (12). The European Commission considered general health as an organized process, which is carried out to ensure health, maintain health and promote general health. From their viewpoint, general health; including the relationship between social conditions and population health; and it includes measures that are taken to improve the health of the population (13). The Karolinska Institute as a research-led medical university in Solna of Sweden states that general health is a multidisciplinary field that purposes to study and deal with determinants of health at the population level. It suggests that social structure, life habits, work life, environment and health care system affect population health and health care efficiency (14). Policy development; gathering and disseminating evidence for health policies, strategies and practices; disease prevention and control; Intersectoral action for better health; and the development of human resources and capacity building is the major functions of general health (15). Building on these identified functions, the general health functions steering committee (16), identified six general health goals as follows (1), prevent epidemics and the spread of disease, (2) protect against environmental hazards, (3) prevent injuries, (4) promote and encourage healthy behaviors, (5) respond to disasters and help communities recover, and (6) ensuring quality and access to health services. Laros (17) introduces general health as the mental talent for pleasant coordination, effective working, and flexibility in difficult situations. Kaplan (18) considers general health a constant adaptation to various situations and an attempt to achieve balance between internal conflicts and changeable environmental requirements. Abstractly, general health is related to the way of thinking and expressing feelings, behaviors and actions (19). It is the basis of social and emotional development in individuals (20).
In Iran, 80 percent of the employees in the health care system are nurses (21). They are responsible for individuals' health and life and deal with patients and their incurable diseases. Therefore, nurses always experience high level of psychological stress (22). On the one hand, these psychological pressures are because of the emotional nature of the patient's needs, long hours of working, and interpersonal involvements in the nurses' workplace (23). On the other hand, it is nurses' obligation to inform patients of their disease and different dimensions of treatment. This is because having an effective and empathetic relationship with patients is necessary (24, 25). In sum, the workload of nursing decreases general health (26). Therefore, the general health status of this group, who are very much exposed to stress, should be taken seriously (24).
According to previous studies, nursing, especially shift work, can have various negative effects on job performance, sleep, physical and mental health, social life, use of various drugs and the level of tolerance of job stress. Sleep disorders in shift nurses increase treatment errors, desire for drinking alcohol and other drugs, and decrease performance (27). Similarly, the results of other studies revealed that those who work as a nurse are at a higher risk of heartburn (28, 29). The prevalence of muscular-skeletal disorders, breast cancer and tuberculosis and the possible risk of blood diseases (HIV, hepatitis B, hepatitis C virus) are higher in nurses (30) who are more prone to occupational stress implications. Finally, according to the results of various studies, the amount of risk factors among nurses is higher than the general population (31, 32). It can be said that many biological, chemical, physical, ergonomic, psychological and organizational factors effect on the general health (33, 34). As research findings in this field suggest, ergonomic and psychosocial measures are effective in improving working and living conditions of this occupational group. They are important not only for the nurses' health and well-being, but also for patient outcomes. Physical and psychological demands should be reduced for nurses (35) so that they experience lower levels of stress compared to other health experts (36). Lack of attention to the general health of nurses prevents them from providing optimal care regarding physical and psychological support to patients. This increases the risk of making mistakes and occupational accident, which influences patients and nurses (37). This, in turn, exacerbates mental and physical distress (38). Another advantage of improving the general health of nurses is that it enables them to realize their place in the family, social groups and work environment correctly and can establish a constructive relationship with others (39). Hence, the continuous improvement the life quality of this group and raising their level of health is of great importance. According to aforementioned discussion, the main objective of this study is conducting a meta-analysis regarding nurses' general health and the effective factors in the decade of 2007-17 in Iran.
Materials and Methods
The research method is quantitative meta-analysis (cma2). Meta-analysis with a systematic review of previous researches; It seeks to estimate the effect size of independent variables on dependent variables. The present research method, steps: 1. Searching for the keyword “general health and hospital nurses 2. Collecting articles from Normags database, Magiran; Irandoc; Net Science and Academic Jihad Database (SID); 3. Screening and selection of articles with entry criteria conditions (correlation coefficient, sample size, significance level, validity and reliability of research, survey and use of questionnaire tools); 4. Entering the software and finally 5. Estimating the size of the research effect. It has gone through publication bias and mediating (modifying) variables. Research period from 2007 (the first published research article) to 2017 (the last article). The statistical population is 22 cases, of which 14 studies were selected by a deliberate method after methodical control and screening (having entry criteria). Finally, the final effect sizes of each study and the total final effect (effect size) have been estimated using the Fisher and Cohen formula in the meta-analysis software. To detect homogeneity or heterogeneity, the funnel plot and Q test were used, and after proving the assumption of heterogeneity between studies, the moderating (contextual) variable was used to measure its effect on the general health and hospital nurses. Meta-analysis with a research approach helps the researcher to combine contradictory and non-contradictory quantitative results in the past in a favorable way (40). This method does not have some of the limitations of the standard literature review; thus, it enables the researchers to statistically combine the results of a large number of studies and improve conflicting results bond (41). The research has provided the required statistical information. Finally, 14 papers related to the problem of the present study were selected, and meta-analysis was performed with regard to them. Therefore, many experts consider it permissible to perform meta-analysis even on a smaller number of studies compared to this study provided that the criteria and conditions are met (42, 43).
Table 1. General specifications reviewed in meta-analysis
| Row | Researcher name | Year of publication | Research method | Sample size | Significance level | Sampling method | Tools | Factors related to general health |
| 1 |
Mahdad, et al.(44) |
2016 | Descriptive- correlational | 0.182 | 0.050 | Random | Questionnaire | Religious beliefs |
| 2 |
Akbarizadeh et al. (25) |
2011 | Descriptive- cross-sectional | 0.125 | 0.050 | Random | Questionnaire | Spiritual intelligence, hardness |
| 3 |
Gholipour et al. (45) |
2012 | Clinical trial | 0.460 | 0.050 | Random | Questionnaire | Supplementary surface |
| 4 |
Soleimani et al. (37) |
2008 | Descriptive- analytical | 0.520 | 0.001 | Random | Questionnaire | Sleep quality, suitable management, shift work |
| 5 |
Hojjati, et al. (46) |
2009 | Descriptive- analytical | 0.124 | 0.050 | Random | Questionnaire | Sleep quality |
| 6 |
Rahmani et al. (47) |
2010 | Descriptive- correlational | 0.059 | 0.050 | Random | Questionnaire | Occupational stress |
| 7 |
Amini, et al. (48) |
2013 | Semi-experimental | 0.200 | 0.010 | Random Classified |
Questionnaire | Communicational skills instruction |
| 8 |
Rahimaghaei, et al. (49) |
2017 | Descriptive- correlational | 0.200 | 0.010 | Random | Questionnaire | Organizational citizenship behavior and social capital |
| 9 |
Rostami, et al. (50) |
2015 | Cross-sectional | 0.335 | 0.001 | Random | Questionnaire | Emotional intelligence |
| 10 |
Moharrami, et al. (51) |
2015 | Semi- experimental | 0.200 | 0.050 | Accessible sampling | Questionnaire | Group therapy Stress management |
| 11 |
Barzideh, et al. (52) |
2015 | Cross-sectional | 0.385 | 0.01 | Aimed sampling | Random Systematic |
Occupational stress dimensions, Authority in decision making |
| 12 |
Rahimpour, et al. (53) |
2012 | Cross-sectional | 0.240 | 0.001 | Random | Questionnaire | Sleep quality and sleep shift |
| 13 |
Fatehi et al. (54) |
2015 | Cross-sectional | 0.176 | 0.001 | Accessible sampling | Questionnaire | Occupational stress and self-efficacy |
| 14 |
Mushak et al. (55) |
2015 | Cross-sectional | 0.780 | 0.484 | Accessible | Questionnaire | Occupational stress |
Results
Effect size
The effect size is used for thse rejection or acceptance of the null hypothesis as shown in Figure 2. Via calculating the effect size, researchers can find that to what extent the independent variable has affected the dependent one. In a comprehensive statistical definition, the effect size is the ratio of a meaningful testing to the study size (56). Based on Table 2, all of the reviewed studies were significant except for Mashak et al. (55), and the highest effect size was related to Amini et al.'s (48) research in 2013. The effect size of Amini et al.'s (48) research was 0.561. On the other hand, the lowest effect size was related to the research by Mashak et al. (55). However, due to the insignificance of the results of this effect size, the researchers conclude that they cannot rely on the results of this project.
Release error or release bias
Lack of attention to all the conducted studies leads to publication bias. This can be due to reasons such as poor design and implementation of studies, including sample size, data reporting method, delay, language, non-acceptance by journals, database indexing, amount of documentation and public highlights, Even this non-publication can depend on the direction and strength of the scientific findings (57). When there is a publication bias, the results of the final meta-analysis will be affected; and the final estimates will be biased and erroneous. Therefore, it is necessary to identify and correct publication bias in the early stage of meta-analysis to increase the validity of the results (58). The most common way of identifying publication bias is using a two-dimensional publication diagram called funnel diagram. The funnel diagram is based on the fact that the statistical weight of the study increases by increasing its sample size. (57). In the absence of any bias, the diagram looks like an inverted funnel, and in the presence of a bias, the funnel diagram becomes asymmetric. Although visual evaluation of the funnel diagram helps the analyst to gain an understanding about the nature of data, it is optimal to use statistical tests to reduce subjective evaluations of the symmetry of the funnel diagram. Thus, in this research the authors have used the Beck-Mesomorphic method and bias-free N. The results of these methods are presented in the following sections.
Funnel diagram
The following Figure is a funnel diagram of the studies reviewed in the present study in order to investigate the publication bias.
Based on the above funnel diagram, it can be said that there is a relative symmetry between the studies performed, because most studies are at the top of the funnel. However, due to the relativeness of the funnel diagram results and the fact that a definite judgment can't be made in this case, the following statistical tests (the Beck and Mesomorphic rank correlation test, and N safe from bias) are used.
Beck and mesomorphic rank correlation results
This test examines the relationship between effect size and sample variances. Based on the interpretation of this test, if the asymmetry is due to publication bias, more standard bias is expected in relation to the larger effect size. The results of this method are shown in the Table 4.
If the significance level of the Beck and Mesomorphic test is greater than 0.050, it can be said that there is no publication bias. According to the P-value amounts in the above Table, the researchers concluded that the assumption of no publication bias is confirmed.
N safe results from bias
This test indicates the number of studies that should be added to the analysis in order to reach a statistically insignificant total effect of a research and change the research result. The basic idea of bias-free is that if a small number of meaningless studies are needed to reduce a result to a significant level, the research is unreliable. The results of this method are described in the following Table. Based on Table 5, the other 253 studies should be taken into account in order that the value of the combined bilateral P does not exceed 0.050. This means that another 253 studies must be considered in order that errors in the final results of calculations and analyzes occur.
Assumptive investigation of homogeneity of studies
Q test has been used to evaluate the homogeneity of the studies. The results of the test show that Q = 11.259 and P-value = 0.589. If P-value is greater than 0.050, the null hypothesis would be confirmed. So, the null hypothesis indicating the homogeneity of the studies is accepted. In other words, the significance of the Q index indicates the existence of homogeneity in a study. However, this index is sensitive to the increase of the number of effect sizes. As the number of effects increases, its power to reject homogeneity increases as well. Therefore, the I2 index is used. The closer this value is to 10, the higher the heterogeneity will be; and the farther from 10, the lower the heterogeneity is. The results of I2 demonstrated that there is no heterogeneity between the studies. In other words, the results of this test suggested that the factors related to the general health of nurses are not different in terms of characteristics and specifications of the studies.
Table 4. Results from the study of Beck and Mesomorphic rank correlation method
| Statistical indicator | Kendall coefficient value | Z-value | P* | ||
| One domain | Two domains | ||||
| Results | 0.549 | 0.727 | 0.310 | 0.620 | |
Table 5. Results of examining the n-safe method of error
| Indicator | Value |
| Amount of z for observed studies | 8.550 |
| Amount of P for observed studies | 0.001 |
| Alpha | 0.050 |
| The rest | 0.002 |
| Z for alpha | 1.959 |
| The number of observed studies | 0.014 |
| The number of lost studies which reached the amount of P to alpha | 0.253 |
| Statistical indicator of results | The amount of Q-test | Degree of freedom | Meaningful level of P-value | (l2)-Square 5 |
| 11.259 | 0.013 | 0.589 | 0.000 |
Discussion
Public health as a basic individual factor affects various aspects of personal, professional, and family life and plays a fundamental role in justifying and explaining the quality of life of a person and satisfaction with his position in life. This concept, as an important part of the concept of health, means the ability to create balanced relationships with others and the ability to participate in changes in the social environment. Meanwhile, nurses are one of the important strata of the social health field, and a major part of their life time is spent in the hospital environment and in communication with patients. Therefore, it is important to pay attention to the public health status and the effective indicators in improving their public health. In this research, meta-analysis was used to measure related indicators and factors. Meta-analysis offers a more comprehensive view by combining the results of research conducted in a subject area. Meta-analysis also shows the overall effect size and the effect size of mediating variables of each study. The research findings show that Amini et al.'s (48), research has the highest effect size. Therefore, strengthening communication skills among nurses plays an important role in improving their general health. The research of Kohraziet al. (59) has been carried out in this field and it has shown that life and communication skills training plays an essential role in reducing nurses' depression. Soleimani's research (60), also shows that people who are unable to communicate with others suffer from depression, anxiety, and impairment in social and physical functions more than other people. Research by Lee and Crockett (61), also shows that communication skills significantly reduce the level of occupational stress of nurses and the stress management group therapy has the next highest effect size and is considered one of the most important factors related to improving the general health of nurses. The research of Mohramami et al. (62), shows that after the group therapy intervention, a statistically significant difference was observed between the average scores of occupational stress and self-efficacy of the control and experimental groups. In addition that, the implementation of stress management group therapy among nurses is associated with reducing occupational stress and increasing self-efficacy. Research by James (62), shows that the schema-based approach plays a significant role in justifying the effectiveness of schema training in reducing occupational stress.
Conclusion
The results suggested that there is no publication bias in the field of nurses' health studies. Based on the results of the funnel diagram, most of the studies are considered at the bottom of the funnel, which indicates that there is no publication bias. The significance level of Beck and Mesomorphic test also confirmed the assumption of no publication bias. The results of I2 illustrated that the research in this field is homogeneous. In examining the hypothesis of homogeneity of these 14 studies, Q test with 99 % confidence, and null hypothesis based on homogeneity of studies was confirmed. So, the hypothesis of heterogeneity of effect size regarding performed studies was rejected. According to the results of this research and the effect size, Amini et al.'s (48) research has the highest effect size. It can be said that reinforcing communication skills among nurses has a critical role in improving their general health. The group therapy in stress management has the next highest effect size. It is one of the most important factors which are related to the improvement of the nurses' general health.
Acknowledgments
We would like to appreciate the experts and professors who helped the authors to identify original papers and keywords.
Conflict of interests
The authors declared no conflict of interests.
Authors' Contributions
Zolfaghari A, Niazi M, and Vahedian M designed research; Zolfaghari A and Vahedian M conducted data; Zolfaghari A, Niazi M, and Vahedian M analyzed data; and Zolfaghari A and Vahedian M wrote manuscript. All authors read and approved the final manuscript.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-profit sectors.
Type of Study: Review Article |
Subject:
Healt care Management
Received: 2021/12/24 | Accepted: 2023/03/28 | Published: 2023/03/30
Received: 2021/12/24 | Accepted: 2023/03/28 | Published: 2023/03/30
References
1. Rouhi G, Asayesh H, Rahmani H, Abbasi A. The relationship job satisfaction and organizational commitment of nurses in hospitals of Golestan University of Medical Sciences. Journal of Payesh. 2011; 10(2): 285-94. [In Persian] [DOI: 20.1001.1.16807626. 1390.10.2.16.3]
2. Moghadam Dizaj Herik N, Asl Fattahi B, Taghizadeh H. Effectiveness of stress management training on mental health, job satisfaction and quality of sleep of day work and shift work employees of Tabriz petrochemical company. Journal of Productivity Management. 2014; 7(27): 133-52. [In Persian]
3. Shakerinia I, Mohammadpour M. Relationship between job stress and resiliency with occupational burnout among nurses. Journal of Kermanshah University of Medical Sciences. 2010; 14(2): 161-9.
4. Sullivan EJ, Decker PJ. Effective Leadership and Management in Nursing. The American Journal of Nursing. 1998; 98(6): 16. [DOI: 10.1097/00000446-199806000-00014]
5. Sangari AR. Educational administrator's Job commitment. Journal of Educational Administration. 1996; 14 (4): 38-40. [In Persian]
6. Hurst S, Koplin-Baucum S. A pilot qualitative study relating to hardiness in ICU nurses: Hardiness in ICU nurses. Dimensions of Critical Care Nursing. 2005; 24(2): 97-100. [DOI: 10.1097/00003465-200503000-00011]
7. Rada RE, Johnson-Leong Ch. Stress, burnout, anxiety and depression among dentists. The Journal of the American Dental Association. 2004; 135: 788-94.
8. Chopra SS, Sotile WM, Sotile MO. Physician Burnout. Jama Journal. 2004; 135(6): 788-94. [DOI: 10.14219/ jada.archive.2004.0279]
9. Winslow CE. The untilled fields of general health. Science Journal. 1920; 51(1306): 23-33. [DOI: 10.1126/science.51.1306.23]
10. Satter DE, Kollar LMM. American indian and alaska native knowledge and general health for the primary prevention of missing or murdered indigenous persons. Journal of Federal Law and Practice. 2021; 69(2): 149-88.
11. Sarah Decato MR, Janet Morrissette MR. General Health Nursing. In: Gillespie D. The Many Roles Of The Registered Nurse. British Library Cataloguing: Cambridge Scholars; 2020. p. 75-90.
12. Mowat D. Evidence-based decision-making in general health. Ethos Gubernamental. 2007; 4: 231-48.
13. The European :union: of Medical Specialists, Training Requirements for the Specialty of General Health. European Standards of Postgraduate Medical Specialist Training. Specialists Team, Editor. Brussels: The European :union: of Medical Specialists; 2019.
14. Marks L, Hunter DJ, Alderslade R. Strengthening General Health Capacity and Services in Europe. Denmark: World Health Organization; 2011.
15. World Bank Team. The Human Development Network, Health, Nutrition, and Population Series. Washington, D.C.USA; 2002.
16. Sharma M. Theoretical foundations of health education and health promotion. London: Jones & Bartlett Publishers; 2016.
17. Deater-Deckard K. Parenting stress and child adjustment: Some old hypotheses and new questions. Clinical Psychology: Science and Practice. 1998; 5(3): 314-32. [DOI: 10.1111/j.1468-2850.1998.tb00152.x]
18. Soorgi S. The mental health and academic failure. Roshd Moshver Madreseh. 2013; 9(1): 44-9. [In Persian]
19. Hosseini HS, Sadeghi A, Rajab Zadeh R, Rezazadeh J, Nabavi SH, Ranaei M, et al. Mental health and related factor in students of North Khorasan University of Medical Sciences. Journal of North Khorasan University of Medical Sciences. 2011; 3(2): 23-8. [In Persian] [DOI: 10.29252/jnkums.3.2.23]
20. Jenaabadi H. Investigation of the Mental Health of Payamnoor and Azad University Students in Saravan City. In: 2nd International Conference on New Trends in Education and Their Implications. ntalya-Turkey: 2nd International Conference on New Trends in Education and Their Implications; 2011.
21. Mehrabi T, Ghazavi Z. Survey general health of woman nurses in hospitals of Isfahan University of Medical Science. Journal of Health. 2005; 1(2): 1-5. [In Persian]
22. Esfandiari GR. Survey of the rate of occupational burnout between nursing staff of Sanandaj hospitals affiliated to Kurdistan University of Medical Sciences In 2001. Scientific Journal of Kurdistan University of Medical Sciences. 2001; 1(21): 31-5. [In Persian]
23. Jennings BM. Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions. In: Hughes R, Patient Safety and Quality: An Evidence-Based Handbook for Nurses. USA: Agency for Healthcare Research and Quality; 2008.
24. Baumann SL. Balancing life as a nurse in Iran. Nursing Science Quarterly. 2010; 23(2): 164-5. [DOI: 10.1177/0894318410362542]
25. Akbarizadeh F, Bagheri F, Hatami HR, Hajivandi A. Relationship between nurses’spiritual intelligence with hardiness and general health. Journal of Kermanshah University of Medical Sciences. 2011; 15(6): 466-72. [In Persian]
26. Khamisa N, Peltzer K, Ilic D, Oldenburg B. Work related stress, burnout, job satisfaction and general health of nurses: A followâ€up study. International Journal of Nursing Practice. 2016; 22(6): 538-45. [DOI: 10.1111/ijn.12455]
27. Ohida T, Kamal AMM, Sone T, Ishii T, Uchiyama M, Minowa M, et al. NightShift work related problems in young female nurses in Japan. Journal of Occupational Health. 2001; 43(3): 150-6. [DOI: 10.1539/joh.43.150]
28. Epp K. Burnout in critical care nurses: A literature review. Dynamics Journal. 2012; 23(4): 25-31.
29. Adriaenssens J, De Gucht V, Maes S. Determinants and prevalence of burnout in emergency nurses: A systematic review of 25 years of research. International Journal of Nursing Studies. 2015; 52(2): 649-61. [DOI: 10.1016/j.ijnurstu.2014.11.004]
30. Fronteira I, Ferrinho P. Do nurses have a different physical health profile? A systematic review of experimental and observational studies on nurses' physical health. Journal of Clinical Nursing. 2011; 20(17-18): 2404-24. [DOI: 10.1111/j.1365-2702.2011. 03721.x]
31. Tucker ShJ, Harris MR, Pipe TB, Stevens SR. Nurses' ratings of their health and professional work environments. AAOHN Journal. 2010; 58(6): 253-67. [DOI: 10.3928/08910162-20100526-03]
32. Schluter PJ, Turner C, Huntington AD, Bain CJ, McClure RJ. Work/life balance and health: The nurses and midwives e-cohort study. International Nursing Review. 2011; 58(1): 28-36. [DOI: 10.1111/j.1466-7657.2010.00849.x]
33. Bank HSD. Canadian centre for occupational health and safety. Available from URL: https://scholar.google. com/ scholar_lookuptitle=Canadian%20centre%20for%20occupational%20health%20and%20safety&author=H.S.D.%20Bank&publication_year=1998. Last access: December 30, 2020.
34. Jordan G, Nowrouzi-Kia B, Gohar B, Nowrouzi B. Obesity as a possible risk factor for lost-time injury in registered nurses: A literature review. Safety and Health at Work. 2015; 6(1): 1-8. [DOI: 10.1016/j.shaw.2014.12.006]
35. Bazazan A, Dianat I, Rastgoo L, Mombeini Z. Factors associated with mental health status of hospital nurses. International Journal of Industrial Ergonomics. 2018; 66: 194-9. [DOI: 10.1016/j.ergon.2018.03.008]
36. Williams Jo, Smith AP. "Stress, job satisfaction and mental health of NHS nurses." In Contemporary Ergonomics and Human Factors 2013: Proceedings of the international conference on Ergonomics & Human Factors 2013. Cambridge, UK: CRC Press; 2013: 15-18.
37. Soleimany M, Nasiri-ziba F, Kermani A, Hoseini F. A comparative study of the general health among staff nurses with fixed or rotating working shift. Iran Journal of Nursing. 2007; 20(49): 29-38. [In Persian]
38. Nakao M. Work-related stress and psychosomatic medicine. BioPsychoSocial Medicine. 2010; 4: 4.
39. Goldberg DP, Hillier VF. A scaled version of the general health questionnaire. Psychological Medicine. 1979; 9(1): 139-45. [DOI: 10.1017/s0033291700021644]
40. Mueller V, Rosenbusch N, Bausch A. Success patterns of exploratory and exploitative innovation: A meta-analysis of the influence of institutional factors. Journal of Management. 2013; 39(6): 1606-36. [DOI: 10.1177/0149206313484516]
41. Caird JK, Willness CR, Steel P, Scialfa Ch. A meta-analysis of the effects of cell phones on driver performance. Accident Analysis and Prevention Journal. 2008; 40(4): 1282-93. [DOI: 10.1016/j.aap. 2008.01.009]
42. Hooman HA. Handbook on meta-analysis in scientific research. Tehran: Samt; 2008. [In Persian]
43. Borenstein M, Hedges L, Higgins JPT, Rothstein HR. Guide to the comprehensive meta-analysis software-2. Allameh Tabatabaei University; 2014. [In Persian].
44. Mahdad A, Asadi M, Golparvar M. Prospect of psycological capital through spirituality in workplace and ethical leadership. Ethics in Science and Technology Journal. 2015; 10(1): 51-60. [In Persian]
45. Gholipour Baradari A, Alipour A, Mahdavi A, Sharifi H, Nouraei SM, Emami Zeydi A. The effect of Zinc supplementation on sleep quality of ICU nurses: A double blinded randomized controlled trial. Workplace Health & Safety. 2018; 66(4): 191-200. [DOI: 10.1177/2165079917734880]
46. Hojati H, Jalalmanesh Sh, Fesharaki M. Sleeplessness effect on the general health of hospitals nightshift nurses in Gorgan, Iran. Journal of Gorgan University of Medical Sciences. 2009; 11(3): 70-5. [In Persian]
47. Rahmani F, Behshid M, Zamanzadeh V, Rahmani F. Relationship between general health, occupational stress and burnout in critical care nurses of Tabriz teaching hospitals. Iran Journal of Nursing. 2010; 23(66): 54-63. [In Persian]
48. Amini M, Nouri A, Samavatyan H. Effect of communication skills training on general health of nurses. The Health Information Management Journal. 2013; 10(1): 1-9. [In Persian]
49. Rahimaghaee F, Hoveida F, Hatamipour K. The relationship between social capital and organizational citizenship behavior with nurses' general health in governmental hospitals of West Mazandaran. Journal of Nursing Education. 2017; 5(4): 1-7. [In Persian] [DOI: 10.21859/ijpn-05041]
50. Allameh SM, Abbasi Rostami N, Safari Shad F. Investigating the effect of social intelligence and emotional intelligence on managers' leadership style. Development and Transformation Management. 2005; 9(29):123-42. [In Persian]
51. Moharrami IS, Pashib M, Tatari M, Mohammadi S. The efficiency of stress management group therapy in job stress and self-efficacy of nurses. Journal of Torbat Heydariyeh University of Medical Sciences. 2017; 5(1): 42-9. [In Persian]
52. Barzideh M, Choobineh A, Tabatabaei SH. Dimensions of job stress and its relationship to General health nurses. Journal of Occupational Medicine Specialist. 2012; 4(3): 17-27. [In Persian]
53. Rahimpoor F, Saeedi F, Fazli A, Mohammadi S. The relationship of sleep quality and general health in shift working nurses. Occupational Medicine Quarterly Journal. 2013; 4(4): 8-13. [In Persian]
54. Fatehi F, Mohammadi M, Karimian M, Azmon M, Shahabi H, Gharibi F. The relationship between job stress and self-efficacy and general health of nurses and midwives in the Besat hospital. Shenakht Journal of Psychology and Psychiatry. 2015; 2(3): 100-11. [In Persian]
55. Mashak B, Farhand B, Moghadam S, Pazhoom Z, Hajalikhani T, Taghipoor N, et al. Relationship between job stress among nurses with their general health status in Kamali hospital in 1392. Alborz University Medical Journal. 2015; 4: 231-6. [In Persian] [DOI: 10.18869/ acadpub.aums.4.4.231]
56. Høye AK, Elvik R. Publication bias in road safety evaluation: How can it be detected and how common is it?. Transportation Research Record. 2010; 2147(1): 1-8. [DOI: 10.3141/2147-01]
57. Møller AP, Jennions MD. Testing and adjusting for publication bias. Trends in Ecology & Evolution. 2001; 16(10): 580-6. doi: . [DOI: 10.1016/S0169-5347(01)02235-2]
58. Macaskill P, Walter SD, Irwig L. A comparison of methods to detect publication bias in meta-analysis. Statistics in Medicine. 2001; 20(4): 641-54. [DOI: 10.1002/sim.698]
59. Kahrazei F, Azadfallah P, Allahyari A. Studying the effects of problem solving training in decreasing the depression among students. J Psychol. 2003; 7(2): 127-42. [In Persian]
60. Soleimani I. Comparison of the prevalence of somatic symptoms, anxiety, depression and social dysfunction in addicts and those addicted to Internet. In: Proceedings of The 1st National Conference of Student Social factors affecting health. Tehran: Proceedings of The 1st National Conference of Student Social factors affecting health; 2010. [In Persian]
61. Lee S, Crockett MS. Effect of assertiveness training on levels of stress and assertiveness experied by nurses in Taiwan, republic of China. Issues Ment Health Nurs. 1994; 15(4): 419-32. [DOI: 10.3109/01612849409006918]
62. James IA. Schema therapy: The next generation, but should it carry a health warning?. Behav Cogn Psychother. 2001; 29(4): 401-7. [DOI: 10.1017/ S1352465801004015]
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