High Work Stress Research Articles

Moral disengagement, moral identity, and counterproductive work behavior among emergency nurses.

Morality is a fundamental component of nurses' daily work. Nurses' cognitive tendencies toward moral disengagement in high-stress work environments can easily lead them to engage in counterproductive work behaviors that are not conducive to the organization. However, there is limited research on how to mitigate the impact of moral disengagement on counterproductive work behavior. The objective was to explore the impact of moral disengagement on counterproductive work behavior, as well as the reverse regulatory mechanism of moral identity on the relationship between moral disengagement and counterproductive work behavior. This was a quantitative, cross-sectional study. From September to October 2023, nurses from emergency departments of major hospitals in Hunan Province were recruited, and 500 questionnaires were distributed and collected using the WeChat app Credamo Seeing Numbers. All study procedures were approved by the Ethics Committee of Hunan Normal University (No. 2023-388). Moral disengagement had a positive effect on counterproductive work behavior directed at the organization (CWB-O) as well as counterproductive work behavior directed at individuals (CWB-I). Moral identity was not significant in moderating the relationship between moral disengagement and CWB-O. Moral identity had an inverse moderating effect on the mechanism of action between moral disengagement and CWB-I. Counterproductive work behavior guided by moral disengagement is detrimental to organizations, and moral identity can inhibit the effect of moral disengagement on CWB-I. Nursing administrators should focus on improving nurses' moral identity and improving the healthcare workplace environment so that moral identity can better exert its inhibitory effect on counterproductive work behavior among nurses.

Who benefits from indirect prevention and treatment of depression using an online intervention for insomnia? Results from an individual-participant data meta-analysis.

Major depressive disorder (MDD) is highly prevalent and burdensome for individuals and society. While there are psychological interventions able to prevent and treat MDD, uptake remains low. To overcome structural and attitudinal barriers, an indirect approach of using online insomnia interventions seems promising because insomnia is less stigmatized, predicts MDD onset, is often comorbid and can outlast MDD treatment. This individual-participant-data meta-analysis evaluated the potential of the online insomnia intervention GET.ON Recovery as an indirect treatment to reduce depressive symptom severity (DSS) and potential MDD onset across a range of participant characteristics. Efficacy on depressive symptom outcomes was evaluated using multilevel regression models controlling for baseline severity. To identify potential effect moderators, clinical, sociodemographic, and work-related variables were investigated using univariable moderation and random-forest methodology before developing a multivariable decision tree. IPD were obtained from four of seven eligible studies (N = 561); concentrating on workers with high work-stress. DSS was significantly lower in the intervention group both at post-assessment (d = -0.71 [95% CI-0.92 to -0.51]) and at follow-up (d = -0.84 [95% CI -1.11 to -0.57]). In the subsample (n = 121) without potential MDD at baseline, there were no significant group differences in onset of potential MDD. Moderation analyses revealed that effects on DSS differed significantly across baseline severity groups with effect sizes between d = -0.48 and -0.87 (post) and d = - 0.66 to -0.99 (follow-up), while no other sociodemographic, clinical, or work-related characteristics were significant moderators. An online insomnia intervention is a promising approach to effectively reduce DSS in a preventive and treatment setting.

Mental Disorders Among Healthcare Workers During the Coronavirus Pandemic.

Coronavirus disease 2019 (COVID-19) is a disease that has become a regular part of care by health services. In the beginning, health services faced immense pressure due to new disease exposure, irregular schedules, and high work stress for healthcare workers. Unfortunately, their mental health was not adequately safeguarded, and there are few healthcare units that screen staff for depression and anxiety. The objective of this study is to describe the prevalence and factors associated with anxiety and depression diagnoses among healthcare workers during the coronavirus pandemic. Across-sectional study was conducted in which depression (Beck questionnaire) and anxiety (Hamilton questionnaire) were investigated in health staff, after providing informed consent. This study was carried out during November and December 2022. All workers in all areas of a first-level unit were invited to participate in this research, so no sample calculation or sampling technique was required. Statistical analysis was performed using X2 and Student's t-test. Among the 232 workers surveyed, the prevalence of mild anxiety, severe anxiety, and certain levels of depression was 42.1%, 33.5%, and 18.9%, respectively. The study revealed that smoking is associated with a higher risk of anxiety diagnosis (OR=4; CI95%=1.3-12.7). A higherscore on the Hamilton Anxiety Scale (OR=1.07; CI95%=1.04-1.11) as well as not being permanent staff (OR=3.34;CI95%=1.2-9.3) was found associated with depression diagnosis. The SARS-CoV-2 pandemic increased the stress and pressure on healthcare workers. Thus, early detection, timely treatment, and effective prevention measures are necessary for safeguarding health status and the provision of healthcare services.

The impact of illegitimate tasks on burnout syndrome in a healthcare system: A cross-sectional study

BackgroundBurnout syndrome, characterized by physical, mental, and emotional exhaustion due to continuous exposure to high-stress work conditions, has been increasingly recognized as a serious occupational phenomenon, especially amongst healthcare professionals. Recent studies indicate that illegitimate tasks–activities unrelated to one's role are a significant factor contributing to burnout. However, given the variability of work environments across regions, these findings may not apply universally. ObjectiveTo investigate the behavior of the relationship between burnout and illegitimate tasks among healthcare professionals in Guayaquil, Ecuador. MethodsWe conducted a survey of 562 healthcare professionals, including physicians, nurses, and medical/nursing interns, employing the Copenhagen Burnout Inventory and Bern Illegitimate Task Scale. Regression models were developed to predict burnout levels based on multiple factors, including demographic characteristics, professional roles, and perceptions of illegitimate tasks. ResultsWe revealed a statistically significant positive correlation between burnout and illegitimate tasks, with correlation coefficients ranging from 0.320 to 0.588, with higher levels of illegitimate tasks leading to increased burnout. Interestingly, we also found that age and length of service were negatively correlated with burnout, suggesting that these factors may serve as protective elements against burnout. ConclusionsIllegitimate tasks had an impact on burnout amongst healthcare professionals and emphasized the need for organizational strategies aimed at better task management to mitigate burnout risk.

Physical activity and nutrition in relation to resilience: a cross-sectional study

A healthy lifestyle is often discussed as being a characteristic of or a prerequisite for quality of life. In phases of high subjective stress (work overload, negative thoughts), however, its protective function can be limited. The two present survey studies examined two facets of a health-related lifestyle (physical activity and nutritional awareness), in particular, the correlations with general life satisfaction and their adaptive function in respect to stress (resilience). In addition, because episodes of increased stress can have a negative effect on eating, the interactions with the consumption of less healthy food were examined. Two cross-sectional studies were conducted successively with adults aged between 18 and 72 in Germany. Study 1 (N = 685) examined the research questions with correlations, moderated regression analyses, and structural equation models. Study 2 (N = 628) differentiated between sport, occupational and daily activities. Study 1 showed that the amount of physical activity and nutritional awareness are correlated with life satisfaction. The relationship between stress appraisals and general life satisfaction was moderated by physical activity and nutritional awareness (stress-buffer effect). Study 2 replicated the stress-buffer effects of nutritional awareness, daily activities, and occupational activities. Both studies showed that stress is associated with consumption of less healthy food and found interactions with physical activity and nutritional awareness. Discussed are the adaptive role of physical activity and nutritional awareness in times of stress.Trial Registration EK UniBw M 23-06, 12/16/2022.

Correlates of Smoking, Work Stress, and Mindful Awareness among Private Hospital Workers in Istanbul

Background: The recent increase in workload and stress experienced by healthcare workers (HCW) is a significant global concern. Mindfulness enables one to be aware of emotions, thoughts, and present moment experiences. Objectives: The primary objective of this research is to investigate the correlates between smoking, occupational stress, and mindful awareness levels, among HCWs within the private healthcare sector. This study was conducted at a tertiary-level university-affiliated hospital in Istanbul between January – February 2023. 208 HCW participated, yielding a response rate of 20%. The participants were requested to complete a 61-item questionnaire consisting of demographics, General Work Stress Scale(GWS), Mindful Attention Awareness Scale (MAAS) and Test to Assess the Psychological Dependence on Smoking (TAPDS). Results: Smokers had significantly higher levels of mean GWS scores than nonsmokers. The mean MAAS scores of smokers were the lowest in the group with the highest scores of psychological dependence; it was highest in the group with the lowest scores. A negative correlation was found between general work stress and mindful awareness levels and between psychological dependence on smoking and mindfulness levels. HCWs aged 45 and older had significantly lower general stress than others. Conclusion: This study showed that the general work stress levels of smoker HCWs were higher than those of nonsmokers. Mindful awareness level was the lowest in the group, with the highest scores in psychological dependence on smoking. There was a negative correlation between psychological dependence on smoking and both work stress and mindful awareness levels. This study demonstrated that high work stress and low mindful awareness levels are not only related to each other but also to high psychological dependence on smoking.

Why did middle-aged and older people retire since the first COVID-19 lockdown? A qualitative study of participants from the Health and Employment After Fifty study

BackgroundGovernments of Western countries need people to work to older ages, however the COVID-19 pandemic impacted the workforce by pushing older adults to retire. Socio-demographic factors that influence the decision to retire in the pre-pandemic period were, poor or good health, finances, marital status, and gender. The aim of this study was to explore aspects that contributed to the decision to retire among middle-aged and older people in England who retired during the COVID-19 pandemic.MethodsIn September 2022 semi-structured interviews were conducted with a sample of participants from the Health and Employment After Fifty (HEAF) study who retired since March 2020. Consenting participants were purposively selected to achieve a wide spread of characteristics deemed important in the retirement process. Telephone interviews were conducted, audio-recorded, transcribed and then thematically analysed.Results24 interviews were conducted (10 men and 14 women, mean age 65 years). Six themes were identified: four of them were non-COVID-19 aspects while two can be interpreted as impact of COVID-19 on the workforce. Work-related factors were of major importance. A sense of appreciation and attachment in relation to their employer, and conversely high work demands and stress, as well as changes in work responsibilities and work practices since lockdown and/or perception of personal safety in the workplace during the pandemic influenced their retirement decision, as did physical and mental health issues. Another theme suggested that some participants felt they had reached the ‘right’ age and needed to spend more time with family. Having the financial capacity to retire was widely mentioned but was never the main factor.ConclusionsThe decision to retire during the pandemic was multi-factorial although changes to work during lockdown were of great importance. Post-pandemic, our findings suggest that there are modifiable aspects of work, including appreciation and fair pay and work conditions, that employers and policy makers could encourage to retain their older workers.

Wear performance of GGG60 ductile iron rollers coated with WC-Co by electro spark deposition

Nodular cast irons are used in many industrial applications such as machine frames and body, rollers and engine blocks due to their higher strengths and ductility with good machinability comparable to grey cast irons. In this study, the outer surface of nodular cast irons (GGG-60) was coated with WC/Co using electro spark deposition (ESD). The aim of the study is to improve both the surface quality and wear behaviour with the coatings formed on the surface of the plastic deformation rollers, whose wear resistance decreases over the time due to high stress working conditions. Heat treatment at 950 ºC for 2 h was applied to the GGG60 specimen rollers and half of the rollers were uncoated and the other half was coated with WC-Co electrodes. The wear behaviour of the heat treated and coated surfaces was measured by ball-on-disc wear method using Al2O3 ball bearing with a diameter of 6 mm for a sliding distance of 250 m at a sliding rate of 6.5 m·s-1 under a dry condition, and using a load of 40 N. WC/Co coatings were successfully applied to rollers. In the SEM/EDS images, the presence of W, Fe, C, Co and Al elements in the coated part of the rollers and Fe, C and Al elements in the uncoated region were detected. It was concluded that Coating and heat treatment increased the wear resistance by nearly 5 times and decreased the friction coefficient by 2.13 times.

Audit Quality Reduction Behavior: A Literature Review

Audit quality has become an important issue for accounting professionals. The phenomenon of audit quality criticism from stakeholders such as users of financial statements and the government who shows dissatisfaction with financial statements will pressure auditors to improve audit quality. Auditors do not always apply audit procedures in the audit program. Audit quality behavior is defined as the auditor's actions during the audit process by reducing the effectiveness of existing audit evidence. This study aims to discuss the behavior of audit quality reduction a review of the existing literature related to that issues and then identify empirical evidence from previous research. Data collection techniques through search in national and international journals and selected based on related keywords, audit quality reduction. Based on the results of previous research, it is known that time pressure, work-family conflict, high work stress levels, audit fees, and experience can affect the behavior of decreasing audit quality. In contrast, work-family conflict and experience have no significant effect. The implications of the results of this study are expected to provide an in-depth understanding of the factors that affect the reduction of audit quality so that it can be used as evaluation material to improve audit quality.

Enhancing the work engagement of frontline nurses during the COVID-19 pandemic: the mediating role of affective commitment and perceived organizational support

BackgroundOverload and anxiety were common phenomena among frontline nurses during the pandemic. Understanding the potential pathway for fostering engagement in high-stress working conditions can provide evidence of targeted intervention to facilitate nurses’ well-being and safety practices. This study aims to investigate the level of nurses’ work engagement during nucleic acid collection tasks in the COVID-19 pandemic and identify its potential antecedents.MethodsA cross-sectional design was adopted. A sample of 824 nurses who engaged in nucleic acid collection tasks completed an online self-report questionnaire between 1 March and 31 May 2022. Descriptive and path analyses were utilized to analyse the interrelationships among anxiety, perceived workload, affective commitment, perceived organizational support and work engagement. This study was conducted and reported under the guidelines for Strengthening the Reporting of Observational Studies in Epidemiology.ResultsThe results showed that frontline nurses engaged in such tasks reported high levels of anxiety and task load and low levels of work engagement. Path analysis identified anxiety symptoms, perceived workload, perceived organizational support, and affective commitment as associated with work engagement, and among these factors, perceived organizational support and affective commitment played key roles in mediating the relationship of anxiety, workload and work engagement in high-stress working conditions.ConclusionsAffective commitment and perceived organizational support were associated with frontline nurses’ level of work engagement during the COVID-19 pandemic; these two variables might explain how engagement is generated in high-anxiety and high-workload situations. When healthcare organizations give more attention to frontline nurses’ physical and psychological conditions and are able to innovatively motivate affective commitment and facilitate organizational support, nurses’ work engagement in high-level tasks may increase, thus enhancing work safety and personal well-being.

THE ASSOCIATION BETWEEN INDIVIDUAL, PHYSICAL, AND PSYCHOSOCIAL RISK FACTORS AND OCCUPATIONAL FATIGUE AMONG COMMUTER LINE TRAIN WORKERS

Introduction: Occupational fatigue affects workers in various industries including transportation. Commuter train drivers and office workers are subjected to high levels of physical and psychosocial stress, which can lead to occupational fatigue. Aims: to examine the relationship between individual, physical, and psychosocial risk factors and occupational fatigue in commuter train workers in Jakarta, Bogor, Tangerang, and Bekasi. Methods: Individual (i.e., age, gender, marital status, type of work, duration of work, and smoking status), psychosocial (i.e., effort, reward, overcommitment, monotonous work, social support, job satisfaction, and work stress) factors, and occupational fatigue were investigated in 78 commuter line train workers (both drivers and officers). Observing workers' activities yielded physical factors (awkward posture, repetitive work, prolonged work, and material manual handling activities). The association between each risk factor and occupational fatigue was investigated using a logistic regression model. Results: Commuter line officers (OR 4.96, 95% CI 1.77 – 13.85), those with high overcommitment (OR 3.16, 95% CI 1.25 – 8.00), and those with high work stress (OR 1.54, 95% CI 1.19 – 2.00) were more likely to report occupational fatigue than train drivers, who reported low overcommitment and low work stress, respectively. When compared to those who reported low job satisfaction, those who reported high job satisfaction were less likely to report occupational fatigue (OR 0.19, 95% CI 0.07 – 0.52). Conclusion: Job position, overcommitment, and work stress were associated with occupational fatigue.

Subjective and objective measurements of nurses’ stress and recovery

Abstract Objectives High workloads and stress of healthcare workforce are global phenomena. We aimed to study work related stress and recovery of nurses with both subjective and objective methods, also aiming to examine if associations exist between subjective high work stress and need for recovery, and objectively measured stress and recovery. Methods Study sample comprised 65 nurses employed in the City of Helsinki. Heart rate variability (HRV) measurements were conducted for 3 consecutive days with ECG-based device in real-life setting, including 2 workdays and 1 day off. Objective stress and recovery were assessed from HRV and HRV-based stress and recovery variables. Participants filled out an electronic survey, where work stress was measured with Effort-reward imbalance scale and recovery after work with Need for recovery scale. Results Proportion of nurses with effort-reward ratio >1, indicating work stress, was high (84.6%), as was proportion of those with high need for recovery (64.6%). High need for recovery (score ≥54.5) was associated with lower RMSSD during sleep (p = 0.014) and higher absolute stress index (p = 0.009) on workdays. In high need for recovery group, stress balance (p = 0.040) and relaxation percentage (p = 0.033) were significantly lower on workdays than day off. In moderate work stress group, stress balance (p = 0.042), relaxation percentage (p = 0.041) and absolute relaxation index (p = 0.035) were lower on workdays than day off. No significant differences were observed within other groups. Conclusions Majority of participants suffered from work stress or high need for recovery. Based on our results, nurses’ high need for recovery is reflected in lower sleep time HRV, indicating worse physiological recovery. In those with high need for recovery, physiological recovery was also worse on workdays when compared with day off. Our findings highlight the importance of recovery, and in the future, nurses’ recovery and work stress should be increasingly monitored. Key messages • Nurses’ high need for recovery is reflected in lower sleep time heart rate variability. • Nurses’ recovery and work stress should be increasingly monitored.

Construction and evaluation of a predictive model for compassion fatigue among emergency department nurses: A cross-sectional study

BackgroundCompassion fatigue is a syndrome resulting from long-term work-related traumatic event stress exposure of medical staff. The emergency department is considered to be a high-risk, high-intensity and high-stress work environment, with a high prevalence of trauma and violence. Nurses in the emergency department are more prone to compassion fatigue than nurses in other departments. Compassion fatigue not only affects the physical and mental health, and job satisfaction of emergency department nurses, but also causes serious consequences for patients, such as poor patient outcome, medical errors, and increased patient mortality during hospitalization. ObjectivesOur study aims to develop and evaluate a predictive model for compassion fatigue among emergency department nurses. DesignA cross-sectional study. Data sourcesThe emergency department nurses (N = 1014) were recruited from 21 tertiary hospitals (from Chengdu, Chongqing, Guiyang, Guangzhou and Shanghai) in central, southwestern, southern, and eastern China from July 25, 2022 to October 30, 2022. MethodsUnivariate and multiple logistic regression analyses were used to determine the potential predictive factors associated with compassion fatigue in emergency department nurses. A nomogram was built based on the predictive factors and internally evaluated using a bootstrap resampling method (1000 bootstrap resamples). The performance of the predictive model was evaluated by measuring the Hosmer–Lemeshow goodness of fit test and calibration curve. ResultsThe prevalence of compassion fatigue among emergency department nurses was 75.9 %. The multiple logistic regression analysis revealed that the independent predictive factors for compassion fatigue among emergency department nurses were working position, job satisfaction, diet habit, sleep hours per day, occupational stress, physical harassment and the level of workplace violence, all of which were identified to create the nomogram. The Hosmer–Lemeshow goodness of fit test indicated that the predictive model was well calibrated (χ2 = 11.520, P = 0.174). The bootstrap-corrected concordance index of nomogram was 0.821 (95 % CI: 0.791–0.851). The calibration curve of the nomogram showed good consistency between the predicted and actual probabilities. ConclusionsA predictive model of compassion fatigue among emergency department nurses has been developed, based on the general demographic, work-related and lifestyle characteristics, occupational stress, and workplace violence, with satisfactory predictive ability. This model can identify emergency department nurses who are at high risk of compassion fatigue. Our study provides an empirical basis for early detection, early diagnosis and early intervention of emergency department nurses at high risk of compassion fatigue.

Association Between COVID-19 Anxiety, Psychological Distress, and Decision-making Styles in Nurses of a Selected Hospital in Yazd Province, Iran

Background and aims: During the COVID-19 pandemic, nursing was known as a stressful occupation. This high work pressure and stress can make nurses susceptible to psychological consequences. The state of mental health of nurses can be effectively related to their job performance. This study aimed to investigate the relationship between COVID-19 anxiety, psychological distress, and general decision-making styles in nurses. Methods: This cross-sectional study was conducted in a selected hospital in Yazd province in 2022. An available sampling method was used in this research, and 100 nurses were included in the study. Corona Disease Anxiety Scale, Kessler’s Questionnaire (K10), and Scott, and Bruce’s decision-making styles questionnaire were employed to collect data. The obtained data were analyzed using Mann-Whitney and correlation test in SPSS-24. Results: Based on the results, a positive relationship was found between COVID-19 anxiety and psychological distress (P=0.05, r=0.19). In this study, a positive correlation was observed between COVID-19 anxiety in nurses and spontaneous (P=0.008) and dependent (P<0.001) decision-making styles. Eventually, psychological distress was significantly correlated with avoidant (P=0.005) and dependent (P=0.005) decision-making styles. Conclusion: Considering the importance of mental health and nurses’ job performance, it is recommended that measures should be taken to reduce anxiety and improve their mental health. Holding mental health training workshops and increasing social and organizational support can also be effective in this regard.

Management of Non-Physical Violence against Registered Nurses in Hospital Acute Care Setting

BACKGROUND: The issue of non-physical violence against registered nurses in acute care hospital settings is a pressing concern. As per 2021 CDC figures, there is a prevalence of 38.8 incidents of non-physical violence per 100 nurses annually. Such incidents can lead to serious consequences, including behavioral changes and decreased job effectiveness. Addressing this challenge is essential for ensuring a safe and efficient working environment for healthcare professionals.  
 
 AIM: The study aims to explore management practices related to non-physical violence against registered nurses (RNs) in hospital acute care (AC) settings. It aims to answer the following main question: What are the effective management practices that can identify the reasons for, and evaluate measures to prevent, non-physical violence against registered nurses in hospital acute care settings?
 
 METHODOLOGY: The study employed a systematic examination of electronic databases, utilizing sources from ProQuest, PsycINFO, and the Medline library for the period between 2016 and 2022. Six paramount studies that scrutinized non-physical violence against healthcare professionals were included, with relevant articles meticulously analyzed to yield valid conclusions. Thematic analysis was employed to decipher the patterns emerging from the selected studies. 
 
 RESULTS: Notable themes encompassed the causative factors behind non-physical violence against registered nurses in hospitals and the strategies employed to alleviate such incidents. These factors include high work pressure and stress, inadequate training and professionalism, absence of person-centered care, and unawareness and issues with patient family members.
 
 CONCLUSION: This study affirms that targeted training programs could significantly augment nurses’ capabilities to handle non-physical violence effectively. A heightened level of synergy between healthcare personnel and hospital management is crucial to enable immediate reporting of incidents and pave the way for safer working conditions.

Health profile of workers from different industries in Singapore.

Workplace safety and health are interrelated - a worker who is not healthy may cause safety lapses at the workplace; conversely, safety lapses could affect the health of the workers. This study was part of a larger Total Workplace Safety and Health (WSH) programme run by the Workplace Safety and Health Council, Singapore. The objectives were to obtain a baseline health profile of workers across four major industries and identify important health risks for targeted workplace interventions. Five service providers (SPs) were appointed to run the Total WSH programme. As part of the programme, SPs conducted an anonymous basic health survey among workers of participating companies. The responses of 6,373 respondents from the cleaning, construction, manufacturing, and transport and storage industries were studied. The overall response rate was 62%. Key health issues identified were high rates of obesity (22%) and smoking (24%) and low prevalence of regular exercise and healthy dietary habits. Chronic disease rates were similar to population self-reported rates (hypertension 15%, high lipid 12% and diabetes mellitus 6%). The workers reported high work stress (13%). Health issues are prevalent in the workforce and may affect work and employee safety. It is increasingly important for employees' health to be considered in risk assessments and prioritised in workplace safety and health management systems and strategies. Health promotion interventions should be targeted, and multilevel and multicomponent initiatives should be integrated with pre-existing occupational safety programmes.

Pengaruh Workplace dan Manajemen Stres terhadap Burnout pada Perawat di Masa Pandemi Covid 19

During the COVID-19 pandemic, nurses have a high risk of burnout, due to high work stress, workload, risk of COVID-19 infection, through close contact with patients. This study aims to analyze the effect of workplace factors and stress management on burnout in UPT Tarogong Health Center nurses during the COVID-19 pandemic. This research is a verifiative descriptive research, with a census sampling method or whole sampling, namely all nurses at UPT Puskesmas Tarogong. Primary data were collected through interviews and surveys using the Maslach Burnout Inventory questionnaire, Quick Burnout Assessment questionnaire, and stress management questionnaire. The workplace questionnaire for aspects of workload, control, reward, and fairness is at a sufficient level, while community values and values are at a high level, meaning that improvements are still needed in workload management, decision making, communication, and a more transparent reward system for nurses at UPT Puskesmas Tarogong. Nurses tend to use individual stress management methods, primarily using personal relaxation techniques as well as discussions with spouses or families to manage work stress levels. Burnout is at a considerable level that is characterized by a degree of depersonalization and a mild decrease in performance. Workplace and stress management affect the burnout of nurses UPT Puskesmas Tarogong, and the effect of workplace on burnout is greater than the influence of stress management so that improvements are needed in workload management, decision making, and effective communication with nurses, also workplace intervention and stress management are needed in Puskesmas to reduce the level of burnout, so management needs to implement a stress management program, both organizationally such as holding recreation for nurses, and it is necessary to divide the distribution of workload fairly and actively discuss with nurses.

Pengaruh Stres Kerja dan Beban Kerja Terhadap Turnover Intention Karyawan Pada PT Panasonic Manufacturing Indonesia

This study aims to determine the effect of work stress, workload on employee turnover intention. This research method is quantitative, and the population used is employees of PT Panasonic Manufacturing Indonesia with a sample size of 50 respondents to Business Unit X employees. Researchers used data collection techniques in the form of observation, questionnaires, literature study. The instrument test results in this study used multiple regression analysis, t test, and then f test and the results obtained from this study are that on the Job Stress variable (X1), positive and significant results are obtained for the employee turnover intention variable (Y), which can be interpreted as having high work stress for employees, so will high turnover intention. the workload variable (X2) has a positive and significant relationship to employee turnover intention, which means that there is a high workload, the higher the turnover intention.

Study of functional fatigue in surgeons and nurses of children's medical organizations

Introduction. The impact of high work stress loads on medical workers of children's medical organizations contributes to the formation of fatigue and overwork, especially in modern working conditions, which determines the relevance of these studies.
 The study aims to develop methodological approaches to the quantitative assessment of functional fatigue under the influence of neuropsychiatric and visually stressful loads in medical workers for the differentiated justification of preventive 
 measures.
 Materials and methods. The researchers conducted comprehensive physiological and hygienic studies of medical workers in various work activities (in pediatric intensive care, surgery), aimed at hygienic assessment of the intensity of the labor process, physiological study of the state of the cardiovascular system with the study of the characteristics of the response to functional load (ECG registration on a 12-channel electrocardiograph and continuously using Holter monitoring). The authors have studied the physiological state of the central nervous system and the visual analyzer according to generally accepted methods. We have carried out a total of 2,700 measurements of psychophysiological indicators. Static processing of the received data was carried out using statistical programs STATISTICA 10, Microsoft Excel 2010.
 Results. Medical workers have high nervous-emotional and visual loads when watching video terminal screens. This leads to negative dynamics of the time of perception of sequential contrast (TPSC), a decrease in visual function. The time of onset and the depth of adverse changes depend on the degree of intensity of visual labor.
 We have established the same level of effectiveness of the functions of concentration of attention, short-term memory, perception of simple and complex visual signals in the daytime and at night. The daily curve of indicators does not correspond to the natural curve of the daily rhythm.
 Surgeons and nurses had a strain on the regulatory mechanisms of the circulatory system, a slowdown in the recovery period of all indicators after functional load in the night shift compared with daytime hours of work.
 Conclusion. Pronounced loads on the visual analyzer when watching video terminal screens against the background of nervous and emotional labor stress are the leading professional factors and determine the formation of the functional state of overwork of the first degree in nurses and the second degree in surgeons.
 Limitations. There are quantitative restrictions due to the number of medical personnel in the intensive care unit.
 Ethics. The study was approved by the local Ethics Committee of Izmerov Research Institute of Occupational Health (Protocol No. 4 of 04/14/2021).

The Effect of Stress and Environment on Nursing Performance

The development of service organizations in the health sector is a top priority for every consumer to get the best service. Every health institution is competing to provide health facilities and infrastructure to serve consumers as well as possible. This study aimed at the influence of stress and environment on nursing performance. The quantitative research method is a method in this study using a causal research design. Results showed variable work stress: 0.013 and work environment: 0.000. It can be concluded that stress and environment affect nurse performance. High work stress and poor work environment can interfere with nurses' concentration and focus in carrying out their duties and the work environment positively affects nurses' performance. Things that can affect either indirectly or directly the performance of employees and organizations in a company are the work environment.