Psychosocial study about the consequences of work in hospital nurses as human resource management

Objectives: To analyze the relation between psychosocial and sociodemographic variables in nursing professionals. To discover the levels of job satisfaction, psychosomatic symptoms and psychological well-being in nurses. Method: The research was conducted in a sample of 476 nurses / as from nine hospitals in the region of Murcia (Spain). An occupational health protocol was distributed among the sample participants for completion, which contained tools for measuring and describing psychosocial and sociodemographic variables. Results: Although there is no high risk for psychological problems among the sample participants, psychosomatic symptoms, job dissatisfaction, and low psychological wellbeing are present. Conclusions: The results contribute to research on the subject by identifying the presence of psychosocial disorders in nursing professionals, associated with job conditions and certain psychosocial and sociodemographic variables.


Introduction
Human resource management is fundamental in any organization because of its utility.It is applicable directly to people, or indirectly to the functions they perform or to the programs the activities they are to practice are included in.This management is conditioned by the type of organizational system used (1) .Therefore, in service organization, it is increasingly necessary to propose a theoretical model that allows us to identify and diagnose the human capital available in an organization and the results of its work.

Certain management models, like the Human
System Audit or Human System Analysis Model (HSA) (2) , propose a systemic model that includes the so-called Theoretical Model of Organizational Behavior.
The author of that Model (2) defines the quality of the human system as "the extent to which certain factors characteristic of the job organization are present, which affect people, their level of satisfaction, wellbeing and quality of life, influencing their income and the product of their work".
The repercussion the psychosocial consequences of the job environment entail can affect the health and performance of nursing staff as well as patient safety, due to the possible association between those consequences and the quality of care delivery, in the framework of Patient Safety Policies, included in the Quality Plan of the National Health System in Spain (3) , elaborated as a declaration of support for the WHO Global Alliance for Patient Safety (4) .
Research on safety themes is mainly focused on knowledge about and the causal identification of adverse López-Montesinos MJ.
events, which supposes a barrier to the adoption of solutions today (5) .
The North American National Quality Forum (6) report on Safe Practices for Better Healthcare already demonstrated initial recommendations for the management and improvement of patient safety and, four years later (7) , other actions and recommendations from that report were presented with regard to patient safety.
Evidence on adverse situations and associated risk factors for patient safety in the hospital context (8) are interpreted as the need to undertake actions that address gaps in the current health system, putting more responsibility on the shortages and organizational design of the health system than on professionals themselves (9) .
Strategies like the patient classification system and its validation as an instrument to monitor the workload and identify care complexity, which enhances adverse effects, are used in countless countries, and even recommended.
That is the case in Brazil (10) , where the National Council of Nursing (COFEN) indicates its use as a nursing staff dimensioning instrument, despite acknowledging its slow implementation in daily professional nursing.

In the publication Nurse Staffing and Quality of
Patient Care by the Agency for Healthcare Research and Quality EUA (7) , a close association is manifested between the existence of appropriate nurse staffing, considering the number and type of patients (nurse/patient ratio), and the consequent appearance of stress, burnout, psychosomatic symptoms and loss of wellbeing and dissatisfaction in nursing professionals, as a risk factor that clearly affects patient safety.

Research
results (10)(11)(12) about the relation between human resource management, psychosocial consequences for workers and patient safety show increased patient morbidity and mortality rates, as well as the growing appearance of nosocomial infections (13)(14)(15) .

Similar studies have been undertaken in Brazil, showing
the mental and physical processes hospital nurses have suffered, related to the workload and environment (14) as well as to the management activities these professionals have assumed (16) .
In -To get to know the levels of job satisfaction, psychosomatic symptoms and psychological wellbeing in nursing professionals.

Sample population, origins and characteristics
Our research was focused on 2009 and involved a population of nursing professionals from the Autonomous Community of Murcia (Spain).From this population, an incidental sample was taken from the selected hospitals.
Six hundred Occupational Health Protocols were distributed for completion at nine public hospital centers.
This protocol contains questions on sociodemographic and psychosocial data and includes the items of the psychosocial study variables (job satisfaction, psychosomatic symptoms and psychological wellbeing).
Among the total number of protocols distributed, 457 were considered valid.The reason for excluding the remainder was the incorrect completion of the protocol.

Six out of nine hospitals in the Autonomous
Community of Murcia are regional.To measure job satisfaction, the S10/12 (17) questionnaire was applied, in a previously validated version that was elaborated based on the General Satisfaction Questionnaire in Job Organizations (S4/82) (18) , showing improvements in six exclusive criteria, two related to the relevance and pertinence of the item across roles and organizations; another to its relation with the global satisfaction construct; and three to its criterion validity.As a result of this process, the S10/12 questionnaire was elaborated.The contents of its organization and valued on a seven-point Likert scale (from 1 to 7), ranging from "very dissatisfied" to "very satisfied", and covers three dimensions: a) "Satisfaction with supervision or superiors".b) "Satisfaction with the work means and context, its physical environment, characteristics and existing spaces".c) "Satisfaction with compensations received in the work sphere".
To measure psychosomatic symptoms associated with stress in the work environment, we used the Golembiewski scale, adapted from Hock (19) .This scale consists of 12 items, and answers are valued on a response scale ranging from 0 to 6, between "never" and "very frequently", with a maximum score of 72.
For the level of psychological wellbeing, Goldberg's General Health Questionnaire GHQ-28 (20) was used, adapted and validated by Lobo, Pérez Echeverria and Artal (21) , which assesses the participants' general health measure through 28 items, which are scored on a fourpoint Likert scale (from 0 to 3), distributed among four subscales with seven items each.
These subscales allow us to get to know the four dimensions in which individuals can suffer: "Somatic symptoms", "anguish/insomnia", "Social dysfunction" and "Severe depression".

Data collection and analysis procedure
SPSS statistical software for Windows was used.
The variables were subject to descriptive analysis; bivariate and multivariate analyses were applied between the psychosocial, sociodemographic and socio-employment variables; as well as the analysis of absolute frequencies and percentages for psychosocial, sociodemographic and socio-occupational variables.

Sociodemographic and socio-employment variables
women and 16% men) and divorced/separated women than men (12.7% women and 4.6% men).As regards marital status and gender variables, a statistically significant difference is observed (p<0.05)

Socio-employment variables
Time on the job: The mean time on the job is 12.14 years, ranging between one and 35 years, with a standard deviation of 8.61.A majority (n=136) of participants in the total sample (n=445) has less than six years on the job (29.8%).
As regards gender differences, a higher percentage is found for women with five years on the job (32.6%) when compared to men (25.6%), but the comparison of distributions through the chi-square test does not reveal significant differences between men and women (χ 2 =5.09; n.s.; p=0.078).

Time in the company:
The mean company time is No statistically significant association exists in the distribution of these variables (χ 2 =3.37; p=0.066)

Measurement of psychosocial variables
As regards Job satisfaction, the S10/12 (17) questionnaire consists of three dimensions: Satisfaction with supervision, with the physical environment and with the compensations received.
Concerning point is seven or higher, it is observed that three percent of the sample does not experience any psychological wellbeing problems, while 97% does.Among the four subscales, the GHQ_D subscale, "severe depression", shows the lowest mean score, translated as greater psychological wellbeing, followed by GHQ_B, related to the "anguish and insomnia" dimension".Scales GHQ_A and GHQ_C, "somatic symptoms" and "social dysfunction", respectively, manifest the lowest level of psychological wellbeing, with higher mean scores.

Correlation between psychosocial variables
The psychosocial variables show a significant difference (p<0.05).A significant inverse linear correlation is observed among total satisfaction, psychosomatic symptoms and Total GHQ, which indicates that increased satisfaction is associated with a drop in the other psychosocial indicators.On the opposite, all indicators of the remaining variables show significant positive mutual correlations.

Sociodemographic and socio-employment variables related to psychosocial indicators
To obtain these data, we have used bivariate correlation analysis to establish the association between each of the psychosocial variables and the With a view to a further understanding, the following table summarizes the association between variables and greater or lesser job satisfaction, presence of psychosomatic symptoms and state of wellbeing (Table 1).

Discussion
Results concerning satisfaction levels are in accordance with other authors' contributions (16)(17)(21)(22)(23)(24)(25) about the feelings and emotions workers feel towards their work, with regarding to the pleasure or displeasure subjects feel towards what they do and their personal relations in their workplace. This rrs to their perception of their role they play, in combination with how they are acknowledged and treated in the company, in accordance with the Role Affect model, which addresses the satisfaction resulting from the link between the role the worker plays and the positive results achieved after playing that role, recognized by others and in relation to the service or unit where the work is done (23)(24)(25) .Our results about the importance attributed to satisfaction with supervision also coincide with other studies, affirming that the organization, represented by its health, satisfaction and wellbeing (23)(24)(25)(26) .In our sample, results evidences that "social dysfunction" is one of the dimensions that most presents problems related to wellbeing, that health and social service workers act more emotionally in their professional activity when compared to other professional groups who behave rationally and get less involved in help relations and less physically and mainly psychologically exhausted.It is no coincidence therefore that the item showing the lowest psychological wellbeing score in this dimension is "Does it take you more time to do things?",related to job performance.

Conclusions
As the main conclusion for the advancement of scientific knowledge, we can affirm that its results

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the present study, we analyze psychosocial symptoms, levels of job satisfaction and psychological wellbeing as psychosocial consequences for nursing professionals working in hospitals in the Autonomous Community of Murcia.This research is justified by the close link among the organizational system of health work, the psychosocial consequences of this management system for workers and their potential repercussions for patient safety.MethodObjectives To analyze the relation between the psychosocial and sociodemographic variables of nursing professionals.
Cronbach's alpha was used to determine the reliability of each scale and subscales of all questionnaires.The relation between each of the psychosocial variables is established through Pearson's chi-square statistics.The association between the psychosocial variables and the other sociodemographic and socio-employment variables was analyzed.Correlations were determined through Pearson's chi-square, one-factor ANOVA for qualitative variables, and Student's T-test for quantitative variables.
have offered new data in the research developed by the Region of Murcia and the Spanish Ministry of Health and Consumption "Indicators of best practices in patient safety", as well as in the achievement of the qualitative research project "Participatory evaluation of the nursing team work process at a hospital in Murcia (Spain)", in cooperation with the Nursing Department at the Brazilian Federal University of Pelotas (UFP), produced based on the quantitative results obtained in the present study, as part of the University of Murcia Nursing Department's research area "Health service administration and quality management.Psychological factors related to occupational health and human resource management", funded by a Carolina Grant at the Federal University of Pelotas.This project started in the context of a Framework Cooperation Agreement closed between both universities.In conclusion, in this study, we highlight the presence of Psychosomatic Symptoms, Job dissatisfaction and Psychological wellbeing problems, associated with somatic symptoms and social dysfunction.The psychosocial consequences of work affect job performance and absenteeism.Participants are satisfied with their good relations with superiors but, at the same time, perceive that they are treated and recognized unfairly with regard to the role they play.At the same time, they take great interest in work and are motivated by the achievement of objectives.They manifest dissatisfaction with their work conditions, considering the physical space and work environment.Psychosocial consequences were verified in view of the impossibility to participate in continuing education.The professional stability of an indefinite job contract does not correspond to professional wellbeing and satisfaction.Shift work, night work and changing work times are associated with psychosocial consequences.The professional's family situation, age, time on the job and company time entail psychological consequences.Differences between men and women need further research, considering certain job and demographic conditions, due to the psychosocial consequences verified among women.The psychosocial consequences of work for Nursing professionals affect their health levels and job performance.The association between the psychosocial consequences for Nursing professionals and patient morbidity and mortality levels needs to be investigated.We will propose the inclusion of these psychosocial consequences of work as Patient Safety indicators.

employment variables (age, time on the job and company time) and psychosocial variables
sociodemographic and socio-employment variables (age, time on the job and company time).Student's t-test was applied to the association between two-level psychosocial and qualitative variables Shift work-psychosocial variables: As regards to whether the professionals do shift work or not, the higher mean satisfaction score indicates that satisfaction levels are higher among professionals not doing shift López-Montesinos MJ.On Duty-psychosocial variables: As to whether they are sometimes on duty, higher mean scores are found among professionals who do not (t=-393; p>0.05), as well as lower mean scores on psychosomatic symptoms (t=1.05;p>0.05).Participants who are sometimes on duty, in turn, reveals lower mean scores for psychological wellbeing, that is, greater psychological wellbeing (t=.373; p>0.05).