Original Article |
Corresponding author: Ralitsa Raycheva ( dirdriem@gmail.com ) © 2024 Ralitsa Raycheva, Pavlina Pavlova, Rositsa Dimova.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Raycheva R, Pavlova P, Dimova R (2024) Evaluation of psychosocial work environment among healthcare professionals in cardiac care units. Folia Medica 66(6): 884-894. https://doi.org/10.3897/folmed.66.e131663
|
Introduction: Modern healthcare organizations and medical institutions depend on several factors, including the psychological environment as part of organizational culture. The psychological climate is multifaceted and difficult to quantify. The majority of scientific researchers agree that a good psychological climate supports teamwork, good communication, and a willingness to disclose errors and adverse events.
Aim: The objective of the study is to test a comprehensive and theory-based psychosocial work environment questionnaire and analyze the psychosocial climate among healthcare professionals in cardiac care units.
Material and methods: A survey-based cross-sectional study was done from November 2022 to March 2023 to analyze the psychological climate of cardiac ward professionals in South-Central Bulgarian hospitals. The study used the Bulgarian version of Koys and DeCotiis’ Inductive Measures of Psychological Climate (IMPC) questionnaire.
Results: The survey included 273 participants, 75.1% of whom were women (n=205). The respondents’ median age was 46, ranging from 35 to 54. They included 35.2% (n=96) with over 21 years of hospital experience. The highest proportion of in-hospital experience in a present hospital facility / present hospital unit was in the category 1 to 5 years – 27.5% (n=74) / 27.5% (n=74). The respondents were mostly registered nurses (40.3%, n=110). Specialist doctors were second at 23.8% (n=65), followed by paramedics at 14.7% (n=40), fellow doctors at 11.7% (n=32), and technical/medical personnel at 7.3% (n=20). Our study defines the psychological climate in cardiac units as having low pressure, moderate autonomy, recognition, and innovation, and high levels of trust, cohesion, support, and fairness.
Conclusion: The study focused on cardiac units, necessitating tailored approaches to address concerns across other wards. Establishing transparent and secure healthcare cultures, valuing employee input, and improving the psychological environment requires stakeholder collaboration.
cardiological wards, job satisfaction, medical personnel, psychological climate, work engagement
The effectiveness of modern healthcare organizations and medical institutions relies on various elements, one of which is the psychological climate as a component of organizational culture.[
Psychological climate is a complex and multidimensional entity, making it challenging to assess.[
Multiple studies, conducted both domestically and internationally, have demonstrated that individuals employed in the healthcare industry are susceptible to negative influences from their work environment. These influences include high demands and professional responsibilities, a heavy workload consisting of 12-hour shifts, altered and night work schedules, a substantial amount of work with a limited number of staff members, and exposure to hazardous biological agents and infectious microorganisms.[
Some authors extensively examine the significance and function of stress as a mediator of psychosocial climate, which serves as a predictor of workplace injuries, errors, and other related factors.[
Authors suggest that stressors encompass various circumstances and aspects, including physical (somatic, physiological), psychological, and behavioral elements, which serve as the root cause of professional stress.[
Research conducted in several nations has demonstrated that employees’ health and well-being are jeopardized when they encounter excessive job expectations without adequate resources to handle these needs.[
Based on the national survey on working conditions in Bulgaria, more than 57% of individuals employed in the healthcare industry perceive their health and safety to be in jeopardy while on the job.[
Performing several tasks at the same time while following strict procedures is a particularly common phenomenon in emergency and intensive care units, cardiology, etc., where health personnel may experience fear of committing a medical error and possible legal consequences.[
In addition, health care work is also characterized as emotionally demanding or exhausting.[
The objective of the study was to test a comprehensive and theory-based psychosocial work environment questionnaire and analyze the psychosocial climate among healthcare professionals in cardiac care units.
A survey-based cross-sectional study was conducted to assess the psychological climate of medical specialists working in hospital care facilities. The study utilized the Bulgarian version of the Inductive Measures of Psychological Climate (IMPC) questionnaire, developed by Koys and DeCotiis.[
The study received approval from the Research Ethics Committee of the Medical University of Plovdiv under reference number #6/05.10.2023.
This study examines the psychological climate at cardiac units and wards located in the South-Central Region of Bulgaria. The region contains four administrative districts: Plovdiv, Pazardzhik, Smolyan, and Haskovo. There are a total of 14 medical facilities that provide inpatient care. Specifically, there are 9 hospital care facilities in the Plovdiv region, 3 hospital care facilities in Pazardzhik, 1 hospital care facility in Smolyan, and 1 hospital care facility in Haskovo. More precisely, in the Plovdiv region, there are a total of 7 hospital care facilities situated in the city of Plovdiv and there is 1 hospital care facility each in Asenovgrad and Parvomai. A total of 273 personnel, who are medical specialists from 4 out of the 28 administrative districts, participated in the empirical investigation.
The study was conducted from November 2022 to March 2023.
Anonymous survey was conducted using the Bulgarian version of the Inductive Measures of Psychological Climate (IMPC). The documents were disseminated via mail in four administrative regions – Plovdiv, Pazardzhik, Smolyan, and Haskovo – within the South-Central Region of the Republic of Bulgaria. The study was conducted in 14 cardiac units and words of hospital care facilities, with the help of executive directors and general managers from these organizations. A total of 273 healthcare professionals and personnel participated in the study on a voluntary and anonymous basis.
Koys and DeCotiis[
1. Autonomy (items 1-5)
2. Cohesion (items 6-10)
3. Trust (items 11-15)
4. Pressure (items 16-20)
5. Support (items 21-25)
6. Recognition (items 26-30)
7. Fairness (items 31-35)
8. Innovation (items 36-40)
Autonomy refers to the degree to which employees have the ability to structure their work and define their roles and responsibilities. Cohesion can be defined as the interconnectedness and harmonious interactions among coworkers, characterized by cooperation, friendliness, affection, sociability, absence of conflict, and equality in rank. Trust can be expressed by managers who demonstrate sensitivity and believe in their leaders, as well as by their transparency and warmth instead of aloofness. Pressure refers to the collective job stress resulting from factors such as one’s role, workload, role ambiguity, and conflict. Support encompasses the overall assistance that employees receive from their superiors. Recognition includes both positive feedback, such as praise and opportunities for advancement, as well as negative feedback, such as criticism and consequences for poor performance. Fairness encompasses the justness of the system for distributing rewards, the clarity of the procedures for promoting individuals, and the openness of the policies, among other factors. Innovation pertains to the capacity of the system to both incentivize and regulate employees. An organizational climate that prioritizes the well-being and satisfaction of its employees contributes to the establishment of a favorable psychological environment within the organization.
The quantitative data is displayed as the arithmetic mean±standard deviation (mean±SD) or as the median and interquartile range (median, IQR), depending on the distribution of the variables (determined by the Kolmogorov-Smirnov test). The categorical variables are summarized using absolute values (n) and relative proportions (%). Cronbach’s alpha is employed to assess the internal consistency of a set of Likert items that comprise a scale. Item-total correlation is calculated to indicate how correlated the corresponding item is to the total of all the items representing the subscale. If all the items consistently represent the construct, one would expect these item-total correlations to be positive and of at least moderate magnitude (i.e., at least 0.40). A p-value less than 0.05 (two-tailed test) was considered statistically significant for all tests. Statistical analysis was performed using SPSS, version 26.0 (IBM corp., NY, USA).
A total of 273 individuals took part in the survey, with women comprising 75.1% (n=205) of the respondents. Fig.
The respondents had a median age of 46 years, with a range of 35 years to 54 years. Among them, 35.2% (n=96) had over 21 years of in-hospital experience, while 20.5% (n=56) had 1 to 5 years. Regarding in-hospital experience in a present (1) hospital facility and (2) hospital unit, the observed frequencies were again in these categories: (1) from 1 to 5 years – 27.5% (n=74), followed by over 21 years – 20.5 % (n=56); (2) from 1 to 5 years – 27.5% (n=74), followed by over 21 years – 22.7% (n=62), respectively. The categories with the highest proportion of in-hospital working hours per week were those ranging from 41 to 60 hrs/wk, accounting for 45.5% (n=124), followed by the categories from 20 to 40 hrs/wk, which made up 39.2% (n=107). The professional qualification of the respondents is primarily composed of registered nurses, accounting for 40.3% (n=110) of the total. Specialist doctors made up the second highest percentage at 23.8% (n=65), followed by paramedics at 14.7% (n=40), fellow-doctors at 11.7% (n=32), technical/medical staff at 7.3% (n=20), and those who did not provide an answer at 2.2% (n=6). With respect to hospital ownership, 75.1% (n=205) of the survey respondents were employed in a hospital that is owned by the state or municipality.
Fig.
The IMPC includes 8 scales that measure the level of social cohesion, trust and support, as well as predictors of organizational culture and management style, such as autonomy, innovation, fairness, recognition, and pressure. The internal consistency of the measures utilized was evaluated as a comprehensive indicator of construct validity (Table
Item-total correlation was calculated to indicate how correlated the corresponding item was to the total of all the items representing the subscale. All the items consistently represented the construct, as evidenced by positive item-total correlations that exceeded 0.40 in magnitude, with the exception of the Pressure dimension (Table
Dimension and Item summary | Number of items n | Mean±SD | Cronbach α |
IMPC | 40 | 139.74±26.63 | 0.857 |
Autonomy | 5 | 16.85±4.97 | 0.893 |
1. I make most of the decisions that affect the way my job is performed. | 3.33±1.20 | ||
2. I determine my own work procedure. | 3.43±1.89 | ||
3. I schedule my own work activities. | 3.32±1.19 | ||
4. I set the performance standards for my job. | 3.32±1.21 | ||
5. I organize my work as I see best. | 3.45±1.15 | ||
Cohesion | 5 | 17.71±4.67 | 0.912 |
6. (Company name) people pitch in to help each other out. | 3.74±1.06 | ||
7. (Company name) people tend to get along with each other. | 3.70±1.06 | ||
8. (Company name) people take a personal interest in one another. | 3.46±1.11 | ||
9. There is a lot of “team spirit” among (company name) people. | 3.38±1.13 | ||
10. I feel like I have a lot in common with the (company name) people I know. | 3.42±1.07 | ||
Trust | 5 | 18.93±5.07 | 0.916 |
11. I can count on my boss to keep the things I tell him confidential. | 3.59±1.21 | ||
12. My boss has a lot of personal integrity. | 3.92±1.16 | ||
13. My boss is the kind of person I can level with. | 3.82±1.18 | ||
14. My boss follows through on his commitments to me. | 3.86±1.14 | ||
15. My boss is not likely to give me bad advice. | 3.73±1.17 | ||
Pressure | 5 | 14.81±4.19 | 0.706 |
16. I have too much work and too little time to do it in. | 3.22±1.11 | ||
17. (Company name) is a relaxed place to work (reversed). | 2.82±1.20 | ||
18. At home, I sometimes dread hearing the telephone ring because it might be someone calling about a job-related problem. | 2.82±1.33 | ||
19. I feel like I never have a day off. | 3.00±1.26 | ||
Support | 5 | 18.81±4.87 | 0.921 |
21. I can count on my boss to help me when I need it. | 3.95±1.08 | ||
22. My boss is interested in me getting ahead in the company. | 3.67±1.12 | ||
23. My boss is behind me 100%. | 3.70±1.17 | ||
24. My boss is easy to talk to about job-related problems. | 3.86±1.20 | ||
25. My boss backs me up and lets me learn from my mistakes. | 3.63±1.10 | ||
Recognition | 5 | 17.19±4.09 | 0.772 |
26. I can count on a pat on the back when I perform well. | 3.41±1.16 | ||
27. The only time I hear about my performance is when I screw up (reversed). | 3.36±1.10 | ||
28. My boss knows what my strengths are and lets me know it. | 3.44±1.16 | ||
29. My boss is quick to recognize good performance. | 3.70±1.11 | ||
30. My boss uses me as an example of what to do. | 3.27±1.13 | ||
Fairness | 5 | 18.14±4.60 | 0.889 |
31. I can count on a fair shake from my boss. | 3.71±1.14 | ||
32. The objectives my boss sets for my job are reasonable. | 3.70±1.10 | ||
33. My boss is not likely to give me a “greasy meal.” | 3.79±1.01 | ||
34. My boss does not play favorites. | 3.37±1.18 | ||
35. If my boss terminates someone, the person probably deserved it. | 3.57±1.08 | ||
Innovation | 5 | 17.33±5.05 | 0.938 |
36. My boss encourages me to develop my ideas. | 3.51±1.16 | ||
37. My boss likes me to try new ways of doing my job. | 3.54±1.13 | ||
38. My boss encourages me to improve on his methods. | 3.49±1.14 | ||
39. My boss encourages me to find new ways around old problems. | 3.49±1.08 | ||
40. My boss “talks up” new ways of doing things. | 3.42±1.14 |
Dimension and Item summary | Number of items n | Item-total subscale correlation * |
Autonomy | 5 | 0.39 – 0.52 |
Cohesion | 5 | 0.58 – 0.70 |
Trust | 5 | 0.67 – 0.78 |
Pressure | 5 | 0.13 – -0.42 |
Support | 5 | 0.74 – 0.81 |
Recognition | 5 | 0.63 – 0.81 |
Fairness | 5 | 0.62 – 0.82 |
Innovation | 5 | 0.73 – 0.79 |
In the subscales of the Autonomy dimension, over half of the participants affirmed that they independently decided how to plan, organize, and perform their day-to-day work activities; they also made the majority of decisions that had an impact on how their job was carried out. Less than half of them made their own decisions on what they must accomplish to finish their work-related tasks.
According to the Cohesion dimension’s subscales, over 60% of respondents said that all of the organization’s staff members assisted, attempted to understand, and showed interest in one another. Less than half of the respondents said they felt they had a lot in common with their coworkers and that there was a strong sense of “team spirit” in the company.
About 60% of respondents had positive impressions of their supervisor according to the sub-scales of the Trust dimension: 58.3% trusted that their supervisor would use discretion to keep information shared private; 68.8% believed that their superior was honest; 65.6% believed that they can be open and honest with their boss; 67.8% affirmed that promises made to them in advance had been fulfilled; and 63.7% would trust their supervisor’s advice.
The neutral response, which was neither true nor untrue, had the biggest relative share (about a third and above) in the sub-scales of the Pressure dimension for all queries. Of the respondents, 40.7% reported being overly committed at work, and 37.7% thought their daily lives were dynamic. Due to the likelihood of receiving a call regarding a work-related issue, more than 30% of respondents admitted to feeling restless at home. This provided the impression that there was never a day off and led to an excessive number of professionally burned-out employees as a result of the demands of the job.
In the sub-scales of the Support dimension, more than 60% of the respondents relied on their manager when necessary, and more than 50% felt his unreserved support and the freedom to learn from their mistakes. Nearly 60% were of the opinion that their supervisor helped them in their professional growth. With the same relative share were the respondents who shared about facilitated communication with their supervisor regarding problematic work-related situations.
In the sub-scales of the Recognition dimension, nearly 50% of the survey participants felt encouraged when they did well in their professional tasks and were of the opinion that their supervisor recognized their strengths and celebrates them, and nearly 40% had self-esteem to be set as an example to others for quality work performed. About 60% of respondents said that their supervisor quickly noticed good work, and a third testified to low levels of recognition because their work was only commented on when they make a mistake.
More than 60% of responders to the Fairness dimension’s subscales depended on their employer treating them fairly and giving them opportunity for growth; they also felt that their superiors would be loyal to them and that their objectives were legitimate. Roughly half of the workforce believed that their boss did not show preference to specific workers and that if an employee must be let go, it would probably be for valid, significant reasons.
Just over 50% of respondents indicated on the Innovation dimension’s subscales that their supervisor had encouraged them to pursue their ideas. Less than 50% of respondents believed that their manager was satisfied when creative solutions were used to carry out routine tasks; they got encouragement and support from their manager to advance and enhance the approaches suggested by their manager; they were challenged to come up with fresh answers to age-old issues, and their efforts were acknowledged and appreciated.
The present study confirmed that the presence of incentives provided by the organization is a crucial factor in creating a favorable organizational environment.[
Tair’s[
Our findings reflect those of Weziak-Bialowolska et al.[
There are similarities between the results obtained in Pressure domain in our study and those described by Zutautiene et al.[
Research[
In an effort to increase their productivity and the caliber of the services they provide, health care facilities have recently begun conducting organizational climate assessments more frequently as a result of pressure from shifting legal requirements and socioeconomic conditions. This is significant, but much more so is ensuring that the employees involved in the assessment process understand the value of their productive participation in this study and its possible advantages.[
Finally, if the results of the curvilinear analysis of Dawson et al.[
There are contradictory findings in the research that examines the impact of organizational size on innovation. The findings of Imran et al.[
Finally, the psychosocial consequences of the workplace on staff members at cardiac units can be significant, given the high-stress nature of the environment and the emotional weight of patient care. The key areas to consider are: 1) Emotional Stress and Burnout – cardiac care often involves critical situations where staff must make quick, life-altering decisions, leading to chronic stress as well as prolonged exposure to high-stress situations can lead to burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment; 2) Compassion Fatigue – continuous exposure to patients with severe health issues can lead to compassion fatigue, where caregivers feel overwhelmed and emotionally drained; this fatigue can affect the quality of care provided, as staff may struggle to connect emotionally with patients; 3) Team Dynamics and Support Systems – strong teamwork can mitigate some negative psychosocial effects, promoting a sense of community and shared responsibility; conversely, a lack of communication and support can lead to feelings of isolation and decreased morale; 4) Job Satisfaction and Engagement – many staff members find fulfillment in helping patients recover, which can enhance job satisfaction; however, the emotional and physical demands can lead to disparities in job engagement, especially if support systems are lacking; 5) Work-Life Balance – the demands of cardiac units often require long shifts, making it challenging for staff to maintain a healthy work-life balance; strain on personal relationships and time for self-care can lead to additional stress and mental health issues; 6) Psychological Safety – in high-pressure environments, staff may fear repercussions for voicing concerns, leading to a culture of silence that can exacerbate stress and anxiety; a psychologically safe environment encourages staff to share concerns and seek help, promoting overall well-being; 7) Training and Preparedness – adequate training can help staff feel more competent and confident in handling emergencies, reducing anxiety and stress levels; Ongoing professional development can enhance staff resilience and adaptability to changing circumstances; 8) Coping Mechanisms – encouraging staff to engage in physical activity, mindfulness, or peer support groups can help mitigate stress; providing resources like counseling and stress management programs can support staff mental health. The psychosocial consequences of working in cardiac units are multifaceted, influencing both individual staff members and the overall work environment. Addressing these challenges through supportive leadership, effective communication, and mental health resources can promote a healthier workplace, ultimately benefiting both staff and patients.
Our study defines the psychological climate in cardiac units as having low pressure, moderate autonomy, recognition, and innovation, and high levels of trust, cohesion, support, and fairness. The study specifically targeted cardiac units, hence requiring tailored approaches to tackle the distinct issues in different units or ward settings. Effective collaboration among stakeholders is essential for establishing transparent and secure healthcare cultures, prioritizing employee input, and ensuring continuous improvement of the psychological environment.
The authors have no support to report.
The authors have no funding to report.
The authors have declared that no competing interests exist.