Susan ayers cambridge handbook of psychology he

R.H. Moos et al.
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Fig 1 Conceptual model of healthcare system, staff members’ personal characteristics and staff and patient outcomes.
work stressors transmit and alter the influence of other sets of
healthcare system factors on staff and patient outcomes.
Work climate and work stressors
The underlying facets of work climates and specific work stressors
can be organized into relationship, task and system maintenance
dimensions (Moos, 1994). Relationship dimensions measure the
extent to which employees and supervisors are involved with and
supportive of one another. Relationship stressors arise from interactions
with co-workers, supervisors and other healthcare staff and
typically include communication problems, lack of teamwork and
interpersonal conflicts among employees.
Task dimensions cover the goals and responsibilities in the work
setting, such as the level of autonomy, task orientation and work
pressure. Task-related stressors stem from the duties staff members
perform in their job and how well prepared they are to handle them.
Some salient task stressors are caring for dying, chronically ill or
uncooperative patients; facing distraught and angry family members;
and learning how to use increasingly complex equipment.
System maintenance dimensions assess the amount of structure,
clarity and openness to change in the workplace. System stressors
stem from problems in how the work unit or facility is managed and
the lack of resources available to staff. Staff members frequently cite
heavy workload and understaffing as major stressors. Other system
stressors arise from scheduling problems; scarcity of equipment and
supplies; and adverse aspects of the physical environment, such as
too little space and too much noise.
Work-related stressors have increased exponentially in the last
decade. Healthcare staff members are confronted with increasingly
heavy responsibilities; more acutely ill patients and higher
caseloads; a shortfall of resources; lack of management concern
and support; and continual restructuring of the workplace.
Extensive cross-cultural research highlights these special problems.
Compared with employees in other types of work settings, healthcare
employees report less job involvement, co-worker cohesion
and supervisor support. Moreover, they see healthcare settings as
lacking in autonomy and clarity, characterized by high work
demands and managerial control and short on physical amenities
that make for a pleasant workplace (Aiken et al., 2002a;
Moos, 1994).
As the model indicates, these aspects of the work climate elicit
specific work stressors. A difficult work climate typically is associated
with more relationship and task stressors. For example,
when the workplace has high work pressure and managerial control
and lacks support, autonomy and clarity, staff members are likely to
experience conflicts with co-workers and supervisors and problems
associated with patient care tasks, such as incongruence between
multiple job demands and distress resulting from patients’ suffering
and death (Hemingway & Smith, 1999) (see ‘Burnout in health
professionals’).
Determinants of work climates and work stressors
Healthcare work settings vary widely in the quality of interpersonal
relationships, the level of task stressors and work demands and the
adequacy of clarity and management support. Organizational structure
and policies, and staffing and related patient care tasks account
for these differences.
Organizational structure and policies
The guiding policies of a healthcare organization can affect the
workplace. Compared with healthcare facilities that follow a
professional model, those with a bureaucratic model are likely to
have more centralized decision-making and formalized jobs, which
are associated with a lack of support and autonomy, ambiguous
work-related practices and high work demands and managerial
control. In contrast, participative leadership helps to foster a clearer,
more task-focused and innovative work climate.
The organization of nursing services also influences the work
environment. In primary nursing, each nurse is responsible for
the care of specific patients; in team and functional nursing,
however, the head nurse retains overall responsibility for patient
care and each nurse performs specific limited tasks for a group of