Participants characteristic
The response rate was 92.9% (n=715). Participants were generally in middle aged with a mean age of 34.63 (SD=8.050) years and a mean work tenure of 11.40 (SD=7.461) years. The majority of participants were married (87.0%) and have at least one child (76.2%). Most of them hold a position as community nurse or staff nurse (85.0%), work in hospital setting (64.8%) and involved in shift schedule (64.8%).
Group comparisons
Table 1 and Table 2 demonstrates the comparison of sociodemographic and occupational profiles, workplace and household stressors, and stress status between hospital and non-hospital nurses. There was no significant difference in the sociodemographic and occupational profiles of the two groups except for work schedule and job position. The proportion of participants working in shift and holding a job position as a community nurse or a staff nurse was significantly higher among hospital nurses as compared to non-hospital nurses. There was no significant difference in the overall score of household stressor between hospital and non-hospital nurses. However, hospital nurses had significantly higher level of household stressors related to ‘not enough money’, ‘no time with family’ and ‘personal problem cause strain’. With regards to workplace stressors, hospital nurses had significantly higher overall score of workplace stressors and each of its components namely ‘workload’, ‘death and dying’, ‘inadequate preparation’, lack of staff support’, ‘uncertain treatment’, ‘conflict with doctors’, and ‘conflict with nurses’. The overall prevalence of stress among participants was 27.3%. Although the hospital nurses had significantly higher level of stress score as compared to non-hospital nurses, there is no significant difference in the prevalence of stress between both groups.
Table 1: Comparison of numerical variables using Student’s T-test
Variables
|
Mean (SD)
|
Mean Difference
|
95% CI
|
t
|
df
|
p
|
Total
(n=715)
|
Non-Hospital
(n=252)
|
Hospital
(n=463)
|
|
|
|
|
|
|
|
|
|
Sociodemographic profile
|
|
|
|
|
|
|
|
|
Age, in years
|
34.63 (8.050)
|
34.42 (7.718)
|
34.74 (8.232)
|
-0.32
|
-1.56, 0.92
|
-0.508
|
713
|
0.61
|
No. of children
|
1.87 (1.497)
|
1.84 (1.464)
|
1.88 (1.516)
|
-0.04
|
-0.27, 0.19
|
-0.322
|
713
|
0.75
|
Work tenure, in years
|
11.40 (7.461)
|
11.11 (7.364)
|
11.56 (7.517)
|
-0.45
|
-1.60, 0.70
|
-0.767
|
713
|
0.44
|
|
|
|
|
|
|
|
|
|
Household stressors
|
5.91 (5.468)
|
5.71 (5.747)
|
6.02 (5.314)
|
-0.31
|
-1.15, 0.53
|
-0.727
|
713
|
0.47
|
Not enough money
|
0.68 (0.794)
|
0.62 (0.803)
|
0.72 (0.788)
|
-0.11
|
-0.23, 0.02
|
-1.712
|
713
|
0.09
|
Conflict with spouse
|
0.49 (0.689)
|
0.48 (0.676)
|
0.49 (0.696)
|
-0.02
|
-0.12, 0.09
|
-0.301
|
713
|
0.76
|
Conflict over household task
|
0.48 (0.678)
|
0.45 (0.675)
|
0.50 (0.680)
|
-0.05
|
-0.16, 0.05
|
-0.992
|
713
|
0.32
|
Conflict with children
|
0.37 (0.596)
|
0.41 (0.653)
|
0.34 (0.562)
|
0.07
|
-0.02, 0.17
|
1.511
|
453.79
|
0.13
|
Pressure from relatives
|
0.44 (0.712)
|
0.49 (0.770)
|
0.42 (0.678)
|
0.07
|
-0.04, 0.18
|
1.231
|
462.73
|
0.22
|
Fixing up house
|
0.42 (0.672)
|
0.48 (0.770)
|
0.39 (0.611)
|
0.09
|
-0.03, 0.20
|
1.517
|
425.11
|
0.13
|
No time with family
|
1.08 (0.961)
|
0.98 (0.972)
|
1.13 (0.951)
|
-0.15
|
-0.30, 0.00
|
-1.991
|
713
|
0.05
|
Sexual conflict
|
0.21 (0.510)
|
0.23 (0.560)
|
0.20 (0.482)
|
0.03
|
-0.04, 0.11
|
0.841
|
713
|
0.40
|
Dangerous surroundings
|
0.43 (0.675)
|
0.41 (0.683)
|
0.44 (0.671)
|
-0.02
|
-0.13, 0.08
|
-0.446
|
713
|
0.66
|
Conflict with close friends
|
0.40 (0.607)
|
0.36 (0.578)
|
0.42 (0.622)
|
-0.06
|
-0.16, 0.03
|
-1.302
|
713
|
0.19
|
Personal problem cause strain
|
0.41 (0.631)
|
0.34 (0.559)
|
0.44 (0.665)
|
-0.11
|
-0.20, -0.01
|
-2.252
|
595.07
|
0.02
|
No babysitter
|
0.51 (0.793)
|
0.48 (0.733)
|
0.54 (0.823)
|
-0.06
|
-0.18, 0.06
|
-0.958
|
713
|
0.34
|
|
|
|
|
|
|
|
|
|
Workplace stressors
|
25.86 (13.384)
|
20.85 (11.983)
|
28.59 (13.330)
|
-7.74
|
-9.66, -5.82
|
-7.924
|
563.98
|
0.00
|
Workload
|
8.36 (3.593)
|
7.63 (3.468)
|
8.75 (3.601)
|
-1.13
|
-1.67, -0.58
|
-4.049
|
713
|
0.00
|
Death and dying
|
4.35 (3.784)
|
2.44 (2.706)
|
5.39 (3.882)
|
-2.95
|
-3.44, -2.47
|
-11.896
|
670.90
|
0.00
|
Inadequate preparation
|
1.79 (1.570)
|
1.35 (1.405)
|
2.02 (1.605)
|
-0.67
|
-0.91, -0.43
|
-5.570
|
713
|
0.00
|
Lack of staff support
|
2.12 (1.895)
|
1.70 (1.734)
|
2.35 (1.941)
|
-0.65
|
-0.93, -0.36
|
-4.406
|
713
|
0.00
|
Uncertain treatment
|
3.20 (2.418)
|
2.51 (2.354)
|
3.57 (2.372)
|
-1.06
|
-1.42, -0.69
|
-5.714
|
713
|
0.00
|
Conflict with doctors
|
3.24 (2.493)
|
2.75 (2.412)
|
3.50 (2.499)
|
-0.76
|
-1.14, -0.38
|
-3.918
|
713
|
0.00
|
Conflict with nurses
|
2.81 (2.454)
|
2.47 (2.536)
|
3.00 (2.390)
|
-0.53
|
-0.90, -0.15
|
-2.758
|
713
|
0.01
|
|
|
|
|
|
|
|
|
|
Stress score
|
25.47 (20.704)
|
22.04 (18.472)
|
27.34 (21.613)
|
-5.31
|
-8.47, -2.15
|
-3.296
|
713
|
0.00
|
Table 2: Comparison of categorical variables using chi square test
|
|
n (%)†
|
|
n (%)‡
|
χ2
|
df
|
p
|
|
|
Total (n=715)
|
|
Non-Hospital (n=252)
|
Hospital (n=463)
|
|
|
|
|
|
|
|
|
|
Marital status
|
Never married
|
93 (13.0)
|
|
30 (32.3)
|
63 (67.7)
|
0.418
|
1
|
0.518
|
|
Ever married
|
622 (87.0)
|
|
222 (35.7)
|
400 (64.3)
|
|
|
|
|
|
|
|
|
|
|
|
|
Having children
|
None
|
170 (23.8)
|
|
55 (32.4)
|
115 (67.6)
|
0.817
|
1
|
0.366
|
|
At least one
|
545 (76.2)
|
|
197 (36.1)
|
348 (63.9)
|
|
|
|
|
|
|
|
|
|
|
|
|
Work tenure
|
Less than 10 years
|
332 (46.4)
|
|
123 (37.0)
|
209 (63.0)
|
0.883
|
1
|
0.347
|
|
10 years and above
|
383 (53.6)
|
|
129 (33.7)
|
254 (66.3)
|
|
|
|
|
|
|
|
|
|
|
|
|
Work schedule
|
Non-shift
|
252 (35.2)
|
|
176 (69.8)
|
76 (30.2)
|
204.090
|
1
|
<0.001
|
|
Shift
|
463 (64.8)
|
|
76 (16.4)
|
387 (83.6)
|
|
|
|
|
|
|
|
|
|
|
|
|
Position
|
Staff nurse / community nurse
|
608 (85.0)
|
|
229 (37.7)
|
379 (62.3)
|
10.423
|
1
|
0.001
|
|
Nurse manager
|
107 (15.0)
|
|
23 (21.5)
|
84 (78.5)
|
|
|
|
|
|
|
|
|
|
|
|
|
Stress status
|
Not stress
|
520 (72.7)
|
|
194 (37.3)
|
326 (62.7)
|
3.555
|
1
|
0.059
|
|
Stress
|
195 (27.3)
|
|
58 (29.7)
|
137 (70.3)
|
|
|
|
† column percent; ‡ row percent
Inter-correlation among the study measures in the two study groups
Table 3 shows the inter-correlation among sociodemographic profiles (i.e. age, children), occupational profiles (i.e. work tenure), stressors (i.e. workplace and household) and stress levels. Age, number of children, and work tenure were negatively correlated with workplace stressors. In contrast, number of children and workplace stressors were positively correlated with household stressors. Both workplace and household stressors were moderately and positively correlated with stress score.
Table 3: Correlation among sociodemographic profile, occupational profile, stressors and stress score
Variables
|
Age
|
Children
|
Work tenure
|
Workplace stressors
|
Household stressors
|
Stress score
|
|
|
|
|
|
|
|
Age
|
1
|
|
|
|
|
|
|
|
|
|
|
|
|
Children
|
.479**
|
1
|
|
|
|
|
|
|
|
|
|
|
|
Work tenure
|
.949**
|
.481**
|
1
|
|
|
|
|
|
|
|
|
|
|
Workplace stressors
|
-.110**
|
-.090*
|
-.101**
|
1
|
|
|
|
|
|
|
|
|
|
Household stressors
|
-0.015
|
.085*
|
-0.017
|
.449**
|
1
|
|
|
|
|
|
|
|
|
Stress score
|
-0.059
|
-0.034
|
-.076*
|
.535**
|
.561**
|
1
|
** Correlation is significant at the 0.01 level (2-tailed); * Correlation is significant at the 0.05 level (2-tailed).
Linear regression analysis predicting stressors among the two study groups
Table 4 demonstrates the determinants of household and workplace stressors. Marriage is associated with higher household stressors regardless of workplace. In contrast, job position of nurse manager and involvement in shift schedule are associated with higher workplace stressors only among hospital nurses. Shift work is also associated with higher household stressors only among hospital nurses.
Table 4: Multiple linear regression to identify determinants of stressors
Variables
|
Adj. β (95%CI)
|
Household Stressors
|
|
Workplace Stressors
|
All (n=715)
|
Non-Hospital (n=252)
|
Hospital (n=463)
|
|
All (n=715)
|
Non-Hospital (n=252)
|
Hospital (n=463)
|
|
|
|
|
|
|
|
|
Age
|
-0.029
(-0.187, 0.129)
|
0.041
(-0.257, 0.340)
|
-0.052
(-0.239, 0.136)
|
|
-0.205
(-0.577, 0.167)
|
-0.132
(-0.756, 0.493)
|
-0.194
(-0.652, 0.264)
|
|
|
|
|
|
|
|
|
Marital status†
|
2.250
(0.905, 3.595) ***
|
2.932
(0.421, 5.444) *
|
1.883
(0.280, 3.485) *
|
|
0.585
(-2.581, 3.752)
|
-1.222
(-6.479, 4.036)
|
1.219
(-2.696, 5.134)
|
|
|
|
|
|
|
|
|
No. of children
|
0.266
(-0.057, 0.589)
|
0.154
(-0.431, 0.738)
|
0.319
(-0.618, 0.707)
|
|
-0.384
(-1.145, 0.377)
|
0.227
(-0.996, 1.449)
|
-0.791
(-1.737, 0.156)
|
|
|
|
|
|
|
|
|
Work tenure
|
-0.031
(-0.204, 0.142)
|
-0.009
(-0.319, 0.300)
|
-0.050
(-0.262, 0.163)
|
|
-0.049
(-0.457, 0.359)
|
-0.200
(-0.848, 0.447)
|
0.046
(-0.473, 0.565)
|
|
|
|
|
|
|
|
|
Job position‡
|
-0.122
(-1.497, 1.254)
|
-1.589
(-4.571, 1.393)
|
0.510
(-1.056, 2.076)
|
|
6.310
(3.070, 9.550) ***
|
1.730
(-4.511, 7.971)
|
6.086
(2.260, 9.912) **
|
|
|
|
|
|
|
|
|
Work schedule§
|
0.896
(0.056, 1.737) *
|
0.316
(-1.237, 1.869)
|
1.370
(0.020, 2.719) *
|
|
7.470
(5.491, 9.449) ***
|
0.759
(-2.491, 4.010)
|
8.647
(5.349, 11.944) ***
|
|
|
|
|
|
|
|
|
R2
|
0.024
|
0.020
|
0.026
|
|
0.097
|
0.012
|
0.076
|
*** p <0.001 (2-tailed); ** p <0.01 (2-tailed); * p <0.05 (2-tailed); † Marital status (0=never married, 1=ever married); ‡ Job position (0=staff nurse/community nurse, 1=nurse manager); § Work schedule (0=non-shift, 1=shift)
Hierarchical regression analysis predicting stress among the two study groups
Table 5 demonstrates the hierarchical linear regression analysis which aims to identify the determinants of stress level among hospital and non-hospital nurses. It was found that workplace and household stressors significantly explained about 38% to 40% variance of the stress level of all participants regardless of their workplace. The stress level is higher among those non-hospital nurses who are of older age, and those who were junior, with concurrent higher magnitude of workplace and household stressors. In contrast, the stress level is higher among nurse managers in hospital settings and those hospital nurses who had higher magnitudes of workplace and household stressors. The interaction between workplace and household stressors did not significantly influence the stress level.
Table 5: Hierarchical linear regression to identify determinants of stress level
Variables
|
All (n=715)
|
Non-Hospital (n=252)
|
Hospital (n=463)
|
|
β in step … †
|
Final β ‡
|
β in step … †
|
Final β ‡
|
β in step … †
|
Final β ‡
|
Step 1
|
|
|
|
|
|
|
Age
|
-0.157
(-0.375, 0.062)
|
0.477
(0.014, 0.939) *
|
0.014
(-0.326, 0.354)
|
1.074
(0.337, 1.812) **
|
-0.249
(-0.527, 0.030)
|
0.212
(-0.381, 0.804)
|
Marital status§
|
1.966
(-3.168, 7.100)
|
-1.300
(-5.267, 2.667)
|
7.537
(-0.436, 15.511)
|
3.138
(-3.188, 9.464)
|
-0.271
(-6.828., 6.286)
|
-3.441
(-8.528, 1.646)
|
Having children¶
|
-0.268
(-1.500, 0.964)
|
-0.327
(-1.276, 0.622)
|
-0.710
(-2.590, 1.169)
|
-0.823
(-2.267, 0.620)
|
-0.086
(-1.672, 1.500)
|
-0.106
(-1.343, 1.130)
|
Δ R2
|
0.004
|
0.014
|
0.010
|
Δ F
|
1.026
|
1.209
|
1.530
|
Step 2
|
|
|
|
|
|
|
Work tenure
|
-0.741
(-1.396, -0.085) *
|
-0.665
(-1.172, -0.158) **
|
-1.084
(-2.084, -0.085) *
|
-0.978
(-1.743, -0.214) *
|
-0.573
(-1.435, 0.289)
|
-0.496
(-1.167, 0.175)
|
Job position††
|
7.755
(2.553, 12.957) **
|
4.644
(0.565, 8.723) *
|
-1.574
(-11.204, 8.056)
|
-0.128
(-7.542, 7.286)
|
10.192
(3.840, 16.545) **
|
6.156
(1.158, 11.155) *
|
Work schedule‡‡
|
5.250
(2.073, 8.428) ***
|
-0.057
(-2.612, 2.497)
|
-0.654
(-5.670, 4.362)
|
-1.385
(-5.223, 2.452)
|
6.556
(1.081, 12.031) *
|
-0.236
(-4.617, 4.146)
|
Δ R2
|
0.031
|
0.020
|
0.034
|
Δ F
|
7.562 ***
|
1.653
|
5.365 ***
|
Step 3
|
|
|
|
|
|
|
Workplace stressor (WS)
|
0.522
(0.419, 0.625) ***
|
0.514
(0.376, 0.652) ***
|
0.543
(0.370, 0.716) ***
|
0.678
(0.449, 0.907) ***
|
0.513
(0.379, 0.647) ***
|
0.446
(0.263, 0.628) ***
|
Household stressor (HS)
|
1.573
(1.330, 1.817) ***
|
1.531
(1.006, 2.055) ***
|
1.260
(0.898, 1.622) ***
|
1.722
(1.091, 2.352) ***
|
1.725
(1.397, 2.052) ***
|
1.310
(0.480, 2.139) **
|
Δ R2
|
0.390
|
0.401
|
0.380
|
Δ F
|
239.816 ***
|
86.347 ***
|
149.765 ***
|
Step 4
|
|
|
|
|
|
|
WS*HS
|
0.001
(-0.014, 0.017)
|
0.001
(-0.014, 0.017)
|
-0.018
(-0.039, 0.002)
|
-0.018
(-0.039, 0.002)
|
0.012
(-0.011, 0.035)
|
0.012
(-0.011, 0.035)
|
Δ R2
|
0.000
|
0.007
|
0.001
|
Δ F
|
0.032
|
23.089
|
1.147
|
*** p <0.001 (2-tailed); ** p <0.01 (2-tailed); * p <0.05 (2-tailed); † β in step.. = β of the particular step at which the variable initially entered the equation; ‡ Final β = β in the final (4th step); § Marital status (0=never married, 1=ever married); ¶ Having children (0=none, 1=at least one child); †† Job position (0=staff nurse/community nurse, 1=nurse manager); ‡‡ Work schedule (0=non-shift, 1=shift)