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Work Stressors and the Quality of Life in Long-Term Care Units

Originally Published:
Key Point Summary
Key Concepts/Context

Research suggests that work stress adversely affects healthcare staff job performance. And this in turn can influence patients’ quality of care or quality of life. 


This study examined how structural factors (e.g., unit size), residents' needs for physical and psychosocial assistance, and employees’ work stressors are related to elderly residents’ quality of life in long-term care.


The researchers collected cross-sectional survey data from 1,194 employees and 1,079 relatives of residents in 107 residential-home units and health-center bed wards in Finland. They analyzed data using multilevel modeling and calculated Pearson correlations for the relations among physical and psychosocial needs of residents, unit size, staffing ratio, work stressors, and quality-of-life measures in both the employee and the relative samples.

The key measures included residents’ need for help and quality of life, as well as staff work stressors.

To measure the residents’ need for assistance, the researchers asked nursing home staff to assess the proportion of residents needing help with nine physical activities on a 4-point rating scale (ranging from none to most). These activities included eating and drinking, eliminating, personal cleansing, dressing, mobilizing, changing position for bedridden patients, sleeping, controlling body temperature, and pain relief. They also looked at residents’ need for help with seven psychosocial activities: recreation, maintaining a safe environment, contact with relatives, expressing sexuality, grief work, dying, and remembering. Researchers then used the ratings to calculate mean scores ranging from 1 to 4, with larger values indicating that most residents needed help with the activity. In addition, the researchers asked residents’ relatives to assess residents' needs for physical and psychosocial assistance using the same items.

To measure the participants’ quality of life, the researchers asked employees to assess if residents got the help they needed for their physical and psychosocial needs, using a 3-point scale (1 = totally insufficient, 3 = sufficient). The items covering residents' needs for assistance with physical and psychosocial activities form the basis of a nine-item scale on received physical help and a seven-item scale on received psychosocial help, with scores that range from 1 to 3. Larger values indicate that the residents got sufficient help.

The researchers measured client-centered practices using a 4-point rating scale (1 = totally disagree, 4 = totally agree) with four items for which employees were asked to rate the practices in the unit on kindness, individually tailored care, and autonomy. Larger values indicate that employees agree that the practices in the unit are client-centered.

The researchers also asked relatives to assess the quality of life of individual residents with the same measures the employees used, but relatives used divergent rating scales ranging from 1 to 4 (1 = totally insufficient or totally disagree, 4 = totally sufficient or totally agree).

Finally, the researchers assessed work stressors. To do so, they used three scales: (a) time pressure (five items), (b) interaction with troublesome residents (three items), and (c) role ambiguity (three items). The time pressure scale measured stress from scheduling problems and time shortages at work. The resident-related stressor scale asked employees to assess how often they had experienced stressful incidents from caring for complaining or passive residents. The three-item role ambiguity measure asked respondents to indicate how often they were uncertain about tasks, responsibilities, and requirements of their job. For all the items in the three scales, the researchers asked respondents to indicate on 5-point scale (1 = never, 5 = very often) how often they had experienced the work situation as stressful.

Design Implications
According to the study, small units seems to help employees cope with work stress, resulting in better quality of life for residents. Therefore, attention should be focused on unit size. 

Work stressors such as time pressure could explain the majority of differences in both employees' and relatives' perceptions of residents' quality of life across units. The researchers found that large unit size was related to increased time pressure among employees and reduced quality of life of residents.


The authors identified the following limitations:

  • Because the study relied on cross-sectional data, the results cannot make strong causal conclusions about the relationships between residents' needs, structural factors, work stressors, and quality of life.
  • The operational definition of quality of life is by no means comprehensive.
  • Using proxies can introduce bias into the measures of residents' quality of life.
Design Category
Unit configuration and layout
Residential healthcare facilities
Primary Author
Pekkarinen, L.