|Year : 2017 | Volume
| Issue : 4 | Page : 143-148
The prevalence of job stress among nurses in Iran: A meta-analysis study
Reza Ghanei Gheshlagh1, Naser Parizad2, Sahar Dalvand3, Mozhdeh Zarei4, Mohammad Farajzadeh5, Maryam Karami6, Kourosh Sayehmiri7
1 Clinical Care Research Center, Kurdistan University of Medical Sciences, Tabriz, Iran
2 Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
4 Department of Nursing, School of Nursing and Midwifery, Clinical Care Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
5 Nursing and Midwifery Department, Imam Khomeini Hospital of Saqqez, Kurdistan University of Medical Sciences, Sanandaj, Iran
6 Department of Nursing, School of Nursing and Midwifery, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
7 Research Center for Prevention of Psychosocial Injuries, Medical Faculty, Ilam University of Medical Sciences, Ilam, Iran
|Date of Web Publication||18-Dec-2017|
Research Center for Prevention of Psychosocial Injuries, Medical Faculty, Ilam University of Medical Sciences, Ilam
Source of Support: None, Conflict of Interest: None
Background: Many nurses experience job stress in their workplace. Given the wide range of differences in the statistics about job stress among nurses, the question that arises is what is the general prevalence of job stress among Iranian nurses? Objective: The present study aimed to evaluate the prevalence of job stress among Iranian nurses through meta-analysis. Persian and English databases including SID, MagIran, IranMedex, Google Scholar, Sciencedirect, and PubMed were searched by using the keywords such as “job stress, occupational stress, work-related stress, job related stress” and their combinations and 30 articles were finally selected. All the observational research articles that had information regarding the prevalence of job-related stress, sample size, and job stress instruments were entered into the meta-analysis. The form used to extract information included variables such as the first author's name, publication year, the place where the study had been carried out, type of the study, sample size, data collection instruments, and the most important findings. Results: The general prevalence of job stress was estimated to be 69% (confidence interval [CI] 95%: 0.58–0.79) based on the report of 30 papers with sample size of 4630. By region, type of hospital and the type of study, the highest prevalence of nurses' job stress was 90% (CI 95%: 0.85–0.96) in region one (Provinces of Alborz, Tehran, Qazvin, Mazandaran, Semnan, Golestan, and Qom), 70% (CI 95%: 0.60–0.80) in public and private hospitals, and 79% (CI 95%: 0.58–1.01) in studies where the type of study had not been mentioned. Conclusion: Given the high prevalence of job stress among nurses, developing programs to reduce nurses' job-related stress seems to be essential.
Keywords: Iran, Job stress, Meta-analysis, Nurse, Prevalence
|How to cite this article:|
Gheshlagh RG, Parizad N, Dalvand S, Zarei M, Farajzadeh M, Karami M, Sayehmiri K. The prevalence of job stress among nurses in Iran: A meta-analysis study. Nurs Midwifery Stud 2017;6:143-8
|How to cite this URL:|
Gheshlagh RG, Parizad N, Dalvand S, Zarei M, Farajzadeh M, Karami M, Sayehmiri K. The prevalence of job stress among nurses in Iran: A meta-analysis study. Nurs Midwifery Stud [serial online] 2017 [cited 2019 Jan 17];6:143-8. Available from: http://www.nmsjournal.com/text.asp?2017/6/4/143/221001
| Introduction|| |
Stress is defined as being under psychological pressure. Stress, as the third cause of diseases, is commonly felt in the workplace so that all jobs are somewhat stressful. Job stress is a mental and physical arousal caused by job-related physical and psychological conditions.,, Studies showed that job stress occurs as a destructive physical and emotional response when one's skills, resources, and demands do not fit the requirements of a job.,, According to job demands-control theory, jobs with high mental demands and limited power to make decisions would create considerable job stress.
Although job stress appears in all professions, jobs dealing with people are associated with serious stress. Nursing is one of these jobs and nurses suffer from high levels of job stress., As recommended by the previous studies, job stress is related to decreased creativity and job satisfaction, lower rate of timely decision making, decreased quality of care, increased errors, decreased motivation, depression, detachment, decreased mental and physical well-being, sleep disorders, depression, burnout, absenteeism, lower job satisfaction, and physical problems.,,
Although several studies have been published on the causes and the prevalence of job stress among nurses working in different areas of Iran,,,,, the question of what the general prevalence of stress among Iranian nurses is, still remains unanswered.
This study aimed to estimate the general prevalence of job stress among Iranian nurses.
| Methods|| |
This meta-analysis was conducted on articles collected from national and international databases of SID, MagIran, Google Scholar, IranMedex, Science Direct, PubMed, and Scopus between 2000 and 2016. PRISMA guidelines were used to direct the reporting process. The following keywords were searched: (Job stress) OR (occupational stress) OR (work related stress) OR (job-related stress) and combinations of these terms. Farsi equivalent keywords were also searched in Iranian databases. Moreover, references of the articles were reviewed to find other related research papers.
The exclusion criteria were unrelated interventional and review articles; gray literature; unavailability of the full-text articles; focus on other groups such as physicians, midwives, and students, and failure to report frequency or prevalence of job stress. Full-text observational studies were entered in the analysis. Fifty-nine articles were discovered initially. The researchers reviewed a summary of the articles to determine relevant studies. In the case of disagreement between the researchers, an experienced researcher (K. Sayehmiri) with sufficient knowledge regarding meta-analysis studies made the final decision. Eventually, 30 research papers out of the primary 126 articles were selected.
Data were extracted using a form including variables such as publication year, study location, sample size, sampling method, job stress status, the type of hospital (public, private, or military) and the type of study. In studies that job stress was reported in the form of ratings (mild, moderate, and severe), moderate, and severe stress were considered as job stress.
Since prevalence has a binomial distribution, the variance of every article was calculated through the binomial distribution variance. The weight was allocated to each study using the inverse variance method. I2 index was used to assess the heterogeneity of the data. The heterogeneity was divided into three categories of <25% (low heterogeneity), 25%–75% (moderate heterogeneity), and >75% (high heterogeneity). The random effects model was used due to the heterogeneity of the data. Data were analyzed using STATA software version 12 (Stata Corp, College Station, TX).
| Results|| |
In total, 30 articles that were published between 2000 and 2016 were reviewed based on four steps of PRISMA statement  [Figure 1].
|Figure 1: Flowchart of selecting and reviewing of articles based on PRISMA statement|
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The total sample size of the reviewed studies was 4630 individuals with an average sample size of 154 people for each study. The highest stress levels were reported by Shahraki Vahed (97.4%), Mortaghi Ghasemi (97.4%), and Rahimi (98.2%);,, and the lowest stress levels were reported by Bahrami (4.7%) and Khaghanizadeh (10%)., Further details of the articles are listed in [Table 1].
The prevalence of job stress among Iranian nurses with sample size of 4630 was estimated to be 69% (confidence interval [CI] 95%: 0.58–0.79) by using random effect model. Heterogeneity was 99.4%, which is considerable compared to similar studies. Further, surveys were carried out using random effect model; the model assumed that differences between studies are due to differences in sampling and the frequency of job stresses. The studies were categorized based on the zoning of the provinces. Accordingly, 6 studies had been conducted in region 1, 7 studies in region 2, 6 studies in region 3, 4 studies in region 4 and 3 studies in region 5. Region of the study had not been mentioned in 4 studies. The highest prevalence rate of job stress was in region 1 (prevalence of 90%, CI 95%: 85%–96%) and the lowest prevalence rate was observed in region 4 (46%; CI 95%: 37%–56%). The prevalence of job stress based on geographical region and the CIs is illustrated in [Figure 2].
|Figure 2: Job stress prevalence based on geographical region. 1Horizontal lines around the main mean indicate the confidence interval of 95% for each study. The dotted line in the middle shows the estimated total prevalence, and the lozenge shows the confidence interval of the total prevalence. 2Region 1: Alborz, Tehran, Qazvin, Mazandaran, Semnan, Golestan, and Gom. Region 2: Esfahan, Fars, Bushehr, Hormozgan, Kohgiluyeh and Boyer-Ahmad, and Chaharmahal and Bakhtiari Region 3: West Azerbaijan, East Azerbaijan, Ardabil, Zanjan, Gilan, and Kurdistan. Region 4: Kermanshah, Ilam, Lorestan, Hadaman, Markazi, and Khuzestan. Region 5: Razavi Khorasan, North Khorasan, South Khorasan, Kerman, Yazd, and Sistan and Baluchestan|
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Gray-Taft nursing stress scale and Osipow's Job Stress tool were used in 11 and 6 studies, respectively. The estimated prevalence of job stress was calculated to be 85% (CI 95%: 0.79–0.91) and 38% (CI 95%: 13%–63%) by the first and the second tool. [Table 2] lists the studies based on the type of study and hospital.
[Figure 3] and [Figure 4] indicate that there is no relationship between the prevalence of nurses' job stress and sample size (P = 0.921) and also date of publishing (P = 0.720).
|Figure 3: Meta-regression of the prevalence of job stress based on the sample size|
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|Figure 4: Meta-regression of prevalence of job stress based on date of publishing|
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As shown in [Figure 5], Egger regression test showed that publication bias was not statistically significant (P = 0.06).
| Discussion|| |
By using the random effects model, the general prevalence of job stress among Iranian nurses was estimated to be 69% (CI 95%: 0.58–0.79). The results indicated a high prevalence of job stress among Iranian nurses. Mwinga and Mugala reported that job stress among Zambian nurses was about 93%, which is consistent with our findings. Given the stressful nature of the nursing profession, high level of job stress among nurses is not surprising. Al Hosis et al. studied 152 nurses working in Saudi Arabia and concluded that 34.2% of them suffered from moderate to severe job stress. This result is not consistent with our finding. This inconsistency could be because of the organizational structure and management system of hospitals in different countries. The optimum level of stress is required to improve mental readiness and the performance of the staff for dealing with the workplace challenges. However, higher stress levels would lead to extreme expectations and decreased performance.
A survey showed that patient's death ,,, and conflict with physicians ,, was among the top stressors. Because the nature of the nurses' job required them to build a close relationship with patients and their families. Thus, watching patients on their death bed has always been stressful for nurses. Regarding conflicts between physicians and nurses, it is notable that nurses and physicians seek the same medical goal; however, because of their professional role, they tend to have different perceptions of the patient's needs so that they adopt different health care approaches.
No meta-analysis studies were discovered regarding the prevalence of job stress in national and international databases. Based on Gray-Taft nursing stress scale, the highest level of job stress was reported 85% (CI 95%: 0.79–0.91) among the studies. The highest stress level among nurses was reported 90% (CI 95%: 0.85–0.96) according to the studies conducted in region 1 of the country. According to Rahimi's findings, the highest level of stress was 98%. Shahraki Vahed and Mortaghi Ghasemi both reported that the highest stress level among nurses was 97.4%.,
Estimating the general prevalence of job stress among Iranian nurses is a distinguishing feature of the present study. Some limitations of this study were failure to appraise the methodological quality of the articles, unavailability of the full text of some articles, and lack of a conventional report system for domestic articles. Despite different reports about the prevalence of job stress among nurses in different studies, the general prevalence of job stress among Iranian nurses is considerably high so that three-fourths of nurses complain about job stress. Therefore, it is vital to take effective measures to reduce job stress among nurses.
The researchers would like to express their gratitude to the Deputy of Research of the Ilam University of Medical Sciences for acceptance, approval, and financial support of this research project.
Financial support and sponsorship
This article was granted by Ilam University of Medical Sciences Research Council, Ilam, Iran.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Yamani N, Shahabi M, Haghani F. The relationship between emotional intelligence and job stress in the faculty of medicine in Isfahan University of Medical Sciences. J Adv Med Educ Prof 2014;2:20-6.
Tausig M, Fenwick R. The social stratification of job stress: How social structures create health disparity. In: Special Social Groups, Social Factors and Disparities in Health and Health Care. Emerald Group Publishing Limited; 2016. p. 261-86.
Lavasani M, Keyvanzade M, Arjmand N. Spirituality, job stress, organizational commitment, and job satisfaction among nurses in Tehran. J Contemp Psychol 2008;3:61-73.
Pulido-Martos M, Augusto-Landa JM, Lopez-Zafra E. Sources of stress in nursing students: A systematic review of quantitative studies. Int Nurs Rev 2012;59:15-25.
Kohler JM, Munz DC, Grawitch MJ. Test of a dynamic stress model for organisational change: Do males and females require different models? Appl Psychol 2006;55:168-91.
Kikuchi Y, Nakaya M, Ikeda M, Okuzumi S, Takeda M, Nishi M, et al.
Relationship between depressive state, job stress, and sense of coherence among female nurses. Indian J Occup Environ Med 2014;18:32-5.
] [Full text]
Shin SY, Lee SG. Effects of hospital workers' friendship networks on job stress. PLoS One 2016;11:e0149428.
Rhezaii S, Hosseini AM, Fallahi M. Evaluating impact of communication skills training on level of job stress among nursing personnel working at rehabilitation centers in cities: Ray-Tehran-Shemiranat. Tehran Univ Med J 2006;64:21-6.
Farhadi M, Hemmati Maslakpak M, Khalkhali H. Job stressors in critical care nurses. J Nurs Midwifery Urmia Univ Med Sci 2014;11:1-10.
Littlejohn P. The missing link: Using emotional intelligence to reduce workplace stress and workplace violence in our nursing and other health care professions. J Prof Nurs 2012;28:360-8.
Silva AM, Guimarães LA. Occupational stress and quality of life in nursing. Paidéia (Ribeirão Preto) 2016;26:63-70.
Moradi T, Maghaminejad F, Azizi-Fini I. Quality of working life of nurses and its related factors. Nurs Midwifery Stud 2014;3:e19450.
Adib-Hajbaghery M, Khamechian M, Alavi NM. Nurses' perception of occupational stress and its influencing factors: A qualitative study. Iran J Nurs Midwifery Res 2012;17:352-9.
Ghanei Gheshlagh R, Valiei S, Rezaei M, Rezaei K. The relationship between personality characteristics and nursing occupational stress. J Nurs Educ 2013;1:27-34.
Donyavi V, Koohyan K, Soleiman Meigooni S, Akbari M. Survey of occupational stress scale on nurses in a military hospital in Tehran – 2012. J Nurs Physicians War 2013;2:9-13.
Golparvar M, Vaseghi Z, Mosahebi MR. The model of organizational injustice, stress and emotional exhaustion among female nurses. Iran Occup Health J 2012;9:83-95.
Moher DL, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med 2009;151:264-9.
Mortaghi Ghasemi M, Ghahramani Z, Vahedian Azimi A, Ghorbani F. Nurses job stress in therapeutic educational centers in Zanjan. J Res Dev Nurs Midwifery 2011;8:42-51.
Rahimi A, Ahmadi F, Akhond M. An investigation of amount and factors affecting nurses' job stress in some hospitals in Tehran. Hayat 2004;10:13-22.
Shahraki Vahed A, Mardani Hamuleh M, Sanchuli J, Hamidi Shahraki S. Assessment of the relationship between mental health and job stress among nurses. J Jahrom Univ Med Sci 2010;8:34-40.
Bahrami A, Akbari H, Mousavi MG, Hannani M, Ramezani Y. Job stress among the nursing staff of Kashan hospitals. FEYZ 2011;15:366-73.
Khaghanizadeh M, Ebadi A, Cirati-Nair M, Rahmani M. The study of relationship between job stress and quality of work life of nurses in military hospitals. J Mil Med 2008;10:175-84.
Esfahani MN, Masoumi B, Mohamadirizi S, Mohamadirizi S. Job stress and work ability among emergency nurses in Isfahan, Iran. Nurs Midwifery Stud 2016;6:e28717.
Masoumy M, Tahmasebi R, Jalali M, Jafari S. The Study of the relationship between Job stress and spiritual health of nurses working in Intensive Care ward at Bushehr Hospitals. Nurs J Vulnerable 2016;8:37-47.
Moallemi S, Adroom M. Comparison of job stress and job satisfaction amongst nurses of different units. Military Caring Sci 2016;3:165-73.
Mohebbifar R, Kiaei MZ, Khosravizadeh O, Sadeghi T, Ahansazan H. Job stress and its related factors in nurses of Qazvin University of Medical Sciences. J Med Educ Dev 2015;7:55-63.
Komeili-Sani M, Etemadi A, Boustani H, Bahreini M, Hakim A. The relationship between nurses' clinical competency and job stress in Ahvaz university hospital, 2013. J Clin Nurs Midwifery 2015;4:39-49.
Karchani M, Abbasi M, Mehri A, Hami M, Raei M, Ebrahimi MH. Effect of job stress on mental health among nurses in Iran. J Curr Res Sci 2015;3:22-30.
Karimyar Jahromi M, Hojat M. The Etiology of burnout syndrome and the levels of stress among nurses. J Jahrom Univ Med Sci 2014;12:50.
Karchani M, Barkhordari A, Pornajaf A, Raei M, Asaadi Z, Khobi J, et al
. Job stress and related factors in nurses in Ilam. Electron Physician 2012;4:465-9.
Mehrabi T, Parvin N, Yazdani M, Rafat A. A study of the severity of some occupational stresses in nurses. Iran J Nurs Midwifery Res 2007;12:21-4.
Samadi S, Golmohammadi A, Seid Ahmadian SM, Rezapour T, Panahi H. The relationship between job stress and occupational empowerment of nurses in selected military hospitals of the country. J Police Med 2013;2:31-7.
Faraji A, Valiee S, Mazidi G, Ramazanh A, Rezaee Farahani M. Relationship between job characteristic and job stress in nurses of Kurdistan University of Medical Sciences educational hospitals. Iran J Nurs Res 2012;7:54-63.
Hossini SE, Hossini M. Relationship between job stress, catecholamine and physical diseases in nurses. Hormozgan Med J 2012;16:189-96.
Hazavehei SM, Hosseini Z, Moeini B, Moghimbeigi A, Hamidi Y. Assessing stress level and stress management among Hamadan hospital nurses based on PRECED model. Ofogh e Danesh 2012;18:78-86.
Zeighami Mohammadi S, Asgharzadeh Haghighi S. Relation between job stress and burnout among nursing staff. J Nurs Midwifery Hamadan Univ Med Sci 2;19:42-52.
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 J Nurs 2010;23:54-63.
Noorian C, Parvin N, Mehrabi T. Evaluation of the relationship between occupational stress and general health condition in nurses working in Isfahan university hospitals 2005. J Community Health 2010;1,2:45-52.
Sherbafinezhad J, Lak-Dizaji S, Namdar H, Ghojazadeh M, Fartash Naeimi A. Occupational stressors in nursing. J Nurs Midwifery Tabriz Univ Med Sci 2008;10:26-30.
Pourghane P, Gafakesh S, Shahbazy A. Nurses' stress level in CCU wards of east Guilan hospital. Aflak 2006;8,9:23-9.
Kohestani HR, Baghcheghi N, Abed Saeidi JH, Ghezelghash A, Alavi Majd H. Determining the accosiation between low back pain and occupational stress in nurses. J Arak Univ Med Sci 2006;9:73-81.
Khalilzadeh R, Yavarian R, Khalkhali H. The relationship of job stress, depression and anxiety of nursing staff of urmia university of medical sciences. J Nurs Midwifery Urmia Univ Med Sci 2005;3:10-7.
Khodaveisi M, Mohammadi N, Omidi A. Frequency of job stress in clinical nurses. J Nurs Midwifery Hamadan Univ Med Sci 2005;13:44-55.
Abdi H, Shahbazi L. Occupational stress in ICU nurses and their relationship with burnout. J Shaheed Sadoughi Univ Med Sci 2001;9:64-70.
Mwinga C, Mugala D. Prevalence and causes of stress among nurses at Ndola Central Hospital – A nurses' perspective. Int J Novel Res Healthc Nurs 2015;2:158-65.
Al Hosis KF, Mersal FA, Keshk LI. Effects of job stress on health of Saudi nurses working in Ministry of Health hospitals in Qassim region in KSA. Life Sci J 2013;10:1036-44.
Darvish H, Shabani F. Study of the relationship between job stress and intention to leave the nursing profession. J Nurs Midwifery Shahid Beheshti Univ Med Sci 2012;79:29-35.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]