\

PERGAMON

International Journal of Nursing Studies 24 "0887# 228234

Assessing occupational stress in psychiatric nurses using the

full job strain model] the value of social support to nurses
L[ Munroa\ J[ Rodwellb\\ L[ Hardingc
a
b

Centre for Nursin` Research\ Queensland University of Technolo`y\ Brisbane\ Australia

Bowater School of Mana`ement and Marketin`\ Deakin University\ Melbourne\ Australia
c
School of Psycholo`y\ Queensland University of Technolo`y\ Brisbane\ Australia
Received 18 July 0886^ received in revised form 0 June 0887^ accepted 03 August 0887

Abstract
The present research examined the e}ects of occupational stress in psychiatric nursing on employee well!being using
the full Job Strain Model[ The Job Strain Model was assessed for its ability to predict employee well!being in terms of
job satisfaction and mental health[ The original Job Strain Model was expanded to include social support based on
previous research concerning the impact of social support on well!being[ In the present study\ both work support and
non!work were assessed for their contribution to well!being[ The results of this study indicate that the full Job Strain
Model can be used to signi_cantly predict job satisfaction and mental health in this sample of Australian psychiatric
nurses[ Furthermore\ social support was shown to be an important component of the Job Strain Model[ 0887 Elsevier
Science Ltd[ All rights reserved[
Keywords] Occupational stress:work stress^ Job Strain Model^ Social support^ Job satisfaction^ Mental health[

0[ Introduction
It is well accepted that nurses work in a high stress
environment and a large amount of research has focussed
on the sources of this stress[ Additionally\ specialised
nurses such as psychiatric nurses\ have been identi_ed as
most likely to experience the negative consequences of
occupational stress such as physical and psychological
ill!health "Tyler et al[\ 0880#[ While research recognises
that psychiatric nurses are exposed to high levels of work
stress\ Karasek and Theorell "0889# and Bussing "0877#
propose that nursing is a low strain occupation when
assessed using the Job Strain Model "Karasek\ 0868#[
However\ there is little empirical research in nursing that
utilises the full Job Strain Model to test this assertion[
Recent studies testing the Job Strain Model support
the prediction that increased job control can reduce the
impact of job demands "Dwyer and Ganster\ 0880#[ In
addition to lessening the impact of job demands\ Hurrell
and McLaney "0878# found that increased job control

 E!mail] jrodwelldeakin[edu[au

"task control\ resource control and control over the physi!

cal environment# was associated with greater job sat!
isfaction[ The aim of this article is to examine the e}ects
of the occupational stressors on employee well!being\
speci_c to psychiatric nursing[ The Job Strain Model will
be used to examine the e}ects of occupational stress in
a sample of Australian psychiatric nurses and uses the
variables {worker health| and {job satisfaction| as indi!
cators of well!being "in a similar manner to Terry et al[\
0882#[ The present study expands on the original Job
Strain Model by assessing the impact of social support
on well!being[ The inclusion of social support is based
on previous _ndings regarding the bene_cial e}ects of
social support on strain "Karasek and Theorell\ 0889^
Landsbergis et al[\ 0881#[

1[ Job Strain Model

The relationship between job demand\ job control and
health outcomes\ with reference to occupational stress
and psychiatric nursing\ has received little attention in
the literature "Bussing\ 0877#[ The Job Strain Model\

S99196378:87:, ! see front matter 0887 Elsevier Science Ltd[ All rights reserved[
PII] S 9 9 1 9 6 3 7 8 " 8 7 # 9 9 9 3 8 1

239

L[ Munro et al[:International Journal of Nursin` Studies 24 "0887# 228234

developed by Karasek "0868# provides a two!dimensional

design examining the joint e}ects of individual job
demands and job control in order to predict stress!related
illness[ The model has been acclaimed as one of the most
promising for assessing occupational stress "Fox et al[\
0882#\ as it has the ability to predict a broad range of
health and behavioural consequences of the work
environment "Muntaner and O|Campo\ 0882#[
Central to Karasek|s "0868# Job Strain Model is the
distinction between stressors and strain[ Job strain is
evident in situations where the individual is presented
with high stress circumstances and has little control over
the responses "Karasek and Theorell\ 0889#[ Wallis and
de Wol} "0877# explain occupational stress in terms of
the action of\ con~icting internal and external pressures\
whose impact is to cause strains on the organisation\
altering the structure and operational e}ectiveness of the
organisation[
The Job Strain Model proposes that when the psycho!
logical demands of the job are high\ and the worker|s
control over the task is low\ then the most adverse reac!
tions of psychological strain will occur "fatigue\ anxiety\
depression\ risk of physical illness#[ Conversely\ it is when
the demands of the job are high and the worker|s control
over the task is high that learning occurs "Karasek\ 0878#[
A growing interest in the in~uence of social support in
worker health and psychological outcomes is re~ected by
the expansion of Karasek|s "0868# original Job Strain
Model to include social support "Beehr et al[\ 0889^
Cohen and Wills\ 0874#[ Karasek and Theorell "0889#
indicate a clear association between job strain and levels
of social support[ The expanded model demonstrates that
{the support of co!workers and supervisors may be one
of the most important factors ameliorating stress in the
working environment| "Karasek and Theorell\ 0889#[
Application of the Job Strain Model necessitates exam!
ination of the key variables^ job demand\ job control and
social support[

unsafe environments and dangerous work methods "Kar!

asek and Theorell\ 0889#[ Karasek "0878# argues that
job demands are associated with strain while job control
alleviates the negative impact of job demands[
1[1[ Job control
Karasek|s "0878# concept of control has been
developed in conjunction with the concept of psycho!
logical job demands "stressors or mental work load#[
Ganster de_nes control broadly as {{the ability to exert
some in~uence over one|s environment so that the
environment becomes more rewarding or less threat!
ening|| "0878\ p[2#[ The notion of {control| integrates the
workers| authority to make decisions on the job with the
workers| use of skills[ Fox et al[ "0882# emphasise that it
is the belief in personal control "perceived control# that
has the most signi_cant impact on experienced strain[
Applications of control in the workplace include the free!
dom to break from work routines by scheduling indi!
vidual restbreaks\ utilise ~exi!time\ choose holiday leave
and personalise work areas "Ganster\ 0878#[
1[2[ Job demand and job control*interactive effects
Primarily\ criticisms of the model are based on the
varying operational de_nitions for control "Dwyer and
Ganster\ 0880#\ the variation between results from occu!
pation!level and individual!level studies\ and uncertainty
regarding the interactive e}ects of job demand and job
control "Fox et al[\ 0882#[ Landsbergis et al[ "0881# sug!
gest that the most accurate way of testing for an inter!
action e}ect is to use the multiplicative term and that
inconsistencies in statistical testing of this term have
resulted in mixed _ndings[ The present study examines
both the additive and interactive e}ects of job demand
and job control[
1[3[ Social support

1[0[ Job demand

The construct of {Job demand| re~ects the organ!
isationally determined aspects of work[ These aspects
identi_ed in any given occupation can be further classi_ed
into two categories\ {qualitative| psychological\ or intel!
lectual demands and {quantitative| physical\ or time pres!
sure\ demands "Karasek and Theorell\ 0889#[ Psycho!
logical demands include deadlines\ challenges\ and
expected performance[ Other components of psycho!
logical demands are stresses that arise from personal con!
~ict that may have been caused by job insecurity and task
pressures[ Karasek and Theorell "0889# contend that task
requirements\ or workload\ are the central components of
psychological job demand[ Physical job demands include
physical exertion on the job\ physical hazards\ the pace
required to complete a task\ safety issues\ exposure to

Social support at work refers to positive\ or helpful\

social interaction available from superiors\ management
and co!workers in the workplace "Karasek and Theorell\
0889#[ The inclusion of social support in the Job Strain
Model is based on the growing body of evidence dem!
onstrating the positive e}ects of social support in the
workplace[ It was proposed by Landsbergis et al[ "0881#
that low social support is associated with greater symp!
tomatology\ and that social support "both at work and
outside work# has positive main e}ects on well!being[
Similarly\ the demands of a situation may be moderated
by the supportiveness of the situation {{[ [ [ so that a job
with high demands is not necessarily stressful\ par!
ticularly if accompanied by high support from fellow!
workers|| "Jones et al[\ 0876\ p[029#[
Despite the number of studies that promote the con!

L[ Munro et al[:International Journal of Nursin` Studies 24 "0887# 228234

cept of social support as a moderator for occupational

stress\ other research suggests that the _ndings to date
are not consistent "Chay\ 0882#[ Beehr et al[ "0889# sug!
gest that the inconsistencies in de_ning and oper!
ationalising social support contribute to mixed _ndings
regarding the link between social support and well!being[
Furthermore\ studies in the occupational stress literature
use a diverse range of instruments\ designed to measure
di}erent aspects of the construct "Terry et al[\ 0883#[
Cohen and Wills "0874# suggest that researchers inves!
tigate social support by distinguishing between the types
of support available to meet the speci_c needs of the
situation[ Based on calls for more speci_city in the oper!
ationalisation and measure of social support\ the present
study will examine the main e}ects of work support and
non!work support as distinct variables[

2[ Employee well!being
2[0[ Worker health
Psychological stressors\ job demands in particular\
have an important impact on the well!being of the worker
"Caplan et al[\ 0879#[ Stress has a wide range of e}ects
on worker behaviour including adaptive and maladaptive
responses resulting in short! and long!term health impli!
cations\ including substance abuse\ depression\ anxiety\
sleep disorders\ and eating habits "Smith\ 0889#[ Tyler et
al[ "0880# found a signi_cant correlation between overall
nursing stress scores and symptomatology\ and con!
cluded that workload could be a principal predictor of
health and well!being[ The relationship between psycho!
logical stressors at work and adverse health outcomes\
and the need to develop coping patterns\ are in~uenced
by both the e}ects of support in the work!place and social
support away from the work environment[
2[1[ Job satisfaction
Job satisfaction has been shown to play a signi_cant
role in both worker health "Jackson\ 0872# and per!
formance "Chay\ 0882#[ Low levels of job satisfaction
have been associated with high levels of perceived work
stress "Jones et al[\ 0876^ Perrewe and Ganster\ 0878#[
Job satisfaction has been linked with health outcomes
including depression\ anxiety\ and tension "Caplan et al[\
0879#[
In Karasek|s "0868# original tests of the Job Strain
Model\ job demand and job control were found to have
signi_cant impacts on satisfaction measures for both life
and work[ Fox et al[ "0882# tested the Job Strain Model
in a hospital setting and found support for the model
using job satisfaction and physiological health indices as
outcome variables[ Landsbergis et al[ "0881# found that
workers in low strain jobs reported the lowest job dis!

230

satisfaction and that workers in high strain jobs reported

the highest job dissatisfaction[ Furthermore\ Hurrell and
McLaney "0878# found that job demand and job control
did not exhibit an interactive e}ect on job satisfaction\
and that job control appears to increase job satisfaction
regardless of the perceived levels of job demands[

3[ The present study

The focus of this study is the predictive capabilities of
the Job Strain Model for employee well!being\ par!
ticularly in psychiatric nursing[ The most common stres!
sors identi_ed in psychiatric nursing include increased job
demands "Jones et al[\ 0876# and relationships between
nurses in the hierarchy of management "McGrath\ 0877#\
workload\ work pressures\ "Tyler et al[\ 0880#\ peer and
managerial support "Sullivan\ 0882# and levels of dis!
cretion "Trygstad\ 0875#[
The Job Strain Model is tested by investigating whether
perceived work demands and job control can predict
employee well!being in terms of worker health and job
satisfaction[ Furthermore\ it is hypothesised that social
support "work support and non!work support# will have
a signi_cant main e}ect on well!being[ Finally\ the study
will address the criticisms raised by Landsbergis et al[
"0881# regarding the statistical techniques previously
employed to test the interaction between job demands
and job control\ by comparing the multiplicative
approach with the above additive model[

4[ Method
4[0[ Sample
The study was conducted at a private inpatient facility
for psychiatric patients[ The sample consisted of psy!
chiatric nursing sta} drawn from each of the _ve units of
an Australian private psychiatric hospital[ Sta} were
given two weeks to complete and return the questionnaire
to the sealed boxes provided[
A response rate of 59) "N  59# was obtained from
the sta} rostered to work over the two week period during
which the study was conducted[ The participants rep!
resented all grades of registered nursing sta}[ Seventy!
three percent "N  32# of the participants were female\
42) were aged 2039 years\ and 58) of participants
worked less than seven shifts per fortnight[
4[1[ Measures
The demographic variables\ gender and position\ were
included in the analyses with the scales below[ Gender
was coded one for males and two for females[ The pos!
ition variable was coded zero for junior sta} "e[g[ Regis!

231

L[ Munro et al[:International Journal of Nursin` Studies 24 "0887# 228234

tered\ Student\ Enrolled and Assistant Nurses# and one

for senior sta} "e[g[ Clinical Nurse\ Clinical Nurse Con!
sultant\ and Nurse Manager#[
4[2[ Health
The GHQ!01 measures the experienced stress of the
respondents "Goldberg and Williams\ 0877#[ The GHQ!
01 is comprised of six items that deal with healthy func!
tioning and a further six items that deal with abnormal
functioning[ The test itself was designed to be a valid
indicator of present mental health "Banks et al[\ 0879#[
Participants were asked to respond on a _ve!point scale
ranging from {not at all| to {rather more than usual|[ Six
items in the GHQ!01 scale were reverse coded[ Cron!
bach|s a coe.cient for the scale was 9[77[
4[3[ Job satisfaction[
The job satisfaction section used a scale developed by
Warr et al[ "0868#[ The 04!item scale was designed to
measure the level of satisfaction:dissatisfaction felt by
subjects in relation to various features of work
conditions\ management\ promotion\ salary\ job security\
and coworkers[ Participants were asked to respond on a
_ve point scale ranging from {very dissatis_ed| to {very
satis_ed|[ Cronbach|s a coe.cient for job satisfaction
was 9[80[
4[4[ Job control
The job control scale evaluated the degree of perceived
decision latitude "control# the nurses had over di}erent
aspects of their work[ The 19 questions were drawn from
the 11 item scale developed by Dwyer and Ganster "0880#[
The content of the two items omitted from the original
scale had no relevance in the psychiatric nursing setting[
The scale was designed to explore control over the fol!
lowing work domains^ the variety of tasks performed\ the
order of task performance\ procedures and policies in
the work place\ scheduling of breaks\ pacing\ and the
arrangement of the physical environment "Dwyer and
Ganster\ 0880#[ Participants were asked to respond on a
_ve!point scale ranging from {not at all| to {a great deal|[
The Cronbach a coe.cient for the 19 item job control
scale was 9[80[
4[5[ Job demand
The 00 items used to assess job demands were based
on the Quantitative Workload scale "Caplan et al[\ 0879#[
The job demand scale measured perceptions of the
amount and the pace of each subject|s workload\ and
encompassed both psychological and physical job
demands[ Participants were asked to respond on a _ve!
point scale ranging from {rarely| to {very often|[ Four

items were reverse coded and the scale had a Cronbach|s

a coe.cient of 9[77[
4[6[ Social support
The social support scale assessed perceived levels of
social support\ and speci_cally\ distinguished between
work support and non!work support[ The 06 items used
in this scale have been drawn from Etzion|s "0873# study
into the moderating e}ects of social support on work
stress and burnout[ The _rst three items assessed the
quality of the relationship between subjects and super!
visors\ co!workers\ and subordinates[ The subsequent
seven items assessed support features present in the work
environment[ The remaining seven questions correspond
to support features present outside the work environ!
ment[ Participants were asked to respond on a _ve point
scale ranging from {always present| to {never present|[
The Cronbach a coe.cient for the social support scale
was 9[84[

5[ Results
Descriptive statistics and correlations are shown in
Table 0[ All analyses were performed using the SPSS
package[ To begin with\ the correlations were analysed
to highlight the pattern of relationships among the vari!
ables in the analysis[ Hierarchical regressions are used to
explore the predictive nature of the relationships
described in the propositions above[
The large number of signi_cant correlations in Table
0 is explored in more detail by employing multiple
regression analyses[ A three step hierarchical regression
was performed on both of the measures of well!being\
worker health "N  34# and job satisfaction "N  33#[
Social support was entered in the _rst step\ ahead of job
demand and job control in the second block\ to determine
the main e}ects of support on well!being[ The demo!
graphics were entered with the support variables in order
to account for personal and position di}erences in the
outcome variables[ The job demand by job control inter!
action term was entered in the third and _nal block so as
to ascertain the independent contribution of the inter!
action term[ The overall demand equation signi_cantly
explains the variance in worker health\ R1adj  9[4099\
F"6\26#  6[43\ P 9[9990[ The overall demand equa!
tion also proved signi_cant for the outcome measure
job satisfaction with R1adj  9[5587\ F"6\25#  02[35\
P 9[9990[
Non!work support and work support had signi_cant
main e}ects for both worker health and job satisfaction[
Job control was a signi_cant predictor of both health
and satisfaction[ The demand:control interaction term in
block three was not signi_cant and did not contribute

232

L[ Munro et al[:International Journal of Nursin` Studies 24 "0887# 228234

Table 0
Correlations and descriptive statistics
Variable

Health

Satisfaction

Work support

Non!work support

Job demand

Job control

Satisfaction
Work support
Non!work support
Job demand
Job control
Mean
Standard deviation

9[1194
9[2800
9[3015
9[9649
9[9088
19[08
5[90

9[5599
9[5434
9[2314
9[5818
49[77
09[57

9[5839
9[2033
9[3317
22[54
6[45

9[2303
9[2505
12[15
4[88

9[1342
24[87
5[86

46[39
00[00

Note]   P 9[94[

Table 1
Hierarchical multiple regression analyses of worker health and job satisfaction
"Block# Predictor

Worker health
B

"0# Gender
"0# Position
"0# Non!work support
"0# Work support
"1# Job demand
"1# Job control
"2# Job demand
Job control
Constant

1[1498
9[3693
9[3671
9[1175
9[9957
9[0352
9[9931

Satisfaction
b
9[0617
9[9265
9[3674
9[2995
9[9967
9[1639 
9[2763

R1 "cum#

9[4249
9[4752
9[4768

03[8449

B
1[8166
9[7262
9[7254
9[3376
9[0950
9[4070
9[9938

R1 "cum#

9[0123
9[9265
9[3539
9[2040
9[9614
9[4240
9[1495

9[4251
9[6117
9[6125

07[3147

Note]   P 9[94^   P 9[90\ all cumulative R1 are signi_cant at P 9[9990[

beyond the variance explained by the additive "blocks 0

and 1# model[

interactive e}ect of job demands and job control in the

present study\ is consistent with previous _ndings "Fox
et al[\ 0882^ Hurrell and McLaney\ 0878#[

6[ Discussion

6[0[ Demand and control variables

The results provide strong support for the predictive

capabilities of the Job Strain Model on well!being[ For
this sample of psychiatric nurses\ the increase in control
over tasks\ job execution and the work environment dim!
inish the ill!e}ects of their work[ Social support dem!
onstrated a signi_cant main e}ect on well!being\ pro!
viding evidence for the inclusion of social support in the
Job Strain Model[ Furthermore\ the results indicate that
social support makes the greatest contribution to both
worker health and job satisfaction for these psychiatric
nurses[ In addition to examining the additive e}ects of
the Job Strain Model\ this study explored the interactive
e}ects of job demand and job control[ Using the multi!
plicative term\ the di}erences between the additive and
interactive models for worker health and job satisfaction
were modest[ The lack of convincing evidence for the

The Job Strain Model emerged as a signi_cant pre!

dictor for worker health and\ to a greater extent\ for
job satisfaction[ The variable job control demonstrated
a signi_cant main e}ect on job satisfaction\ consistent
with previous _ndings regarding perceived job control
and job satisfaction among nurses "Fox et al[\ 0882^ Hur!
rell and McLaney\ 0878#[ The level of job control experi!
enced by the nurses in this sample may be related to the
team!oriented approach adopted by the hospital[ This
proposition is supported by Karasek|s suggestion that job
control is related to an organisation|s structure "Karasek\
0868#[ Nursing in team!oriented organisational struc!
tures o}ers greater opportunities for participation\ higher
levels of job demands and greater job control than tra!
ditional hierarchical nursing structures "Bussing\ 0877#[
Bussing|s analysis demonstrates the link between job sat!

233

L[ Munro et al[:International Journal of Nursin` Studies 24 "0887# 228234

isfaction in nursing\ the level of control determined by

the organisation\ and the extent to which nurses can
maximise this control "Conway\ 0877#[
Productivity is maintained through the high demand
component of an active job and\ furthermore\ enhanced
by the high control component of an active job[ Accord!
ingly\ any attempts to decrease the amount of control
workers perceive themselves as having\ can result in
decreased problem!solving skills\ poor judgements and
learned helplessness[ In a psychiatric hospital where
demand levels are unpredictable and\ as the present study
indicates\ generally high\ maximising worker control is
clearly necessary to promote employee well!being[
6[1[ Social support
The signi_cance of social support in the Job Strain
Model supports the inclusion of this variable in future
research testing this model[ Social support demonstrated
signi_cant main e}ects in both equations\ however\ sup!
port from outside the work environment was more sig!
ni_cant than work support[ The impact of non!work
support is not consistent with previous research into
occupational stress and highlights the need to apply a
more uni_ed approach to the operationalisation of the
construct social support[ However\ regardless of the
source of support\ the present study demonstrates that
social support protects these nurses against the ill!e}ects
of occupational stress[
The results of the present study provide strong evidence
for the inclusion of social support in the Job Strain
Model[ Additionally\ social support was shown to pro!
vide more meaningful information when broken down
into non!work and work support[
In summary\ those nurses who perceive themselves as
having greater job control and social support both in
the workplace and in their lives are healthier and more
satis_ed[ Working in a multidisciplinary team\ and max!
imising job control in the workplace are likely to have
contributed to classifying these psychiatric nurses in an
active job[ While team!oriented approaches contribute to
employee well!being in nursing\ these multidisciplinary
approaches have important implications regarding the
development of nurses| professional roles\ implications
that need to be explored to enhance the working lives of
nurses[

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