Types of behaviors and experiences at work and health condition in the group of nurses at Accident and Emergency Units

doi:10.21203/rs.3.rs-3298770/v1

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Research Article

Types of behaviors and experiences at work and health condition in the group of nurses at Accident and Emergency Units

https://doi.org/10.21203/rs.3.rs-3298770/v1

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Introduction

Nursing is a profession associated with a high workload and high levels of emotional tension. The way an employee functions in a professional environment is one of the many health risks. Schaarschmid and Fischer distinguished patterns of behavior and experiences in the area of professional activity.

Material and Methods

The study included 150 nurses employed in Hospital Emergency Departments in central Poland. The AVEM questionnaire was used to assess the types of behavior and experiences at work, and the GHQ-28 questionnaire was used to assess the general state of mental health.

Results

The surveyed nurses most often functioned at work according to type S - economical or B - burned out, and least frequently according to type A - overloaded. The mean severity of health abnormalities was at the average level of M = 4.72 sten (SD = 1.56). The surveyed nurses did not reveal any depressive disorders, the most common health problems were social functioning disorders and complaints about somatic ailments. There were significant differences in health between nurses working in a healthy, economical or burned-out manner, especially in the experienced anxiety and insomnia as well as in the scope of depressive symptoms. Individuals functioning in accordance with type B – burned-out significantly more often complained of perceived anxiety and sleep problems than individuals functioning in accordance with type G - healthy. The analyzes showed that the intensification of complaints about the health condition can be inferred from lower education, low perfectionism in the performance of professional tasks and an increased tendency to resign in the event of failure.

Conclusion

Employers should conduct an individual analysis of the types of work behavior in the group of nurses in order to eliminate factors contributing to the deterioration of their health condition.

Nurses

work enviromental

types of behawior

AVEM

Effective professional functioning of an employee is an important point of interest in many scientific fields - psychology, organization and management, and medicine. Currently, this issue mainly concerns professions from the group of the so-called "Helping professions", the performance of which is important to society [1]. Healthcare professionals, including nurses, are at significant risk of multiple occupational burdens and stress [2]. The work of nurses is associated with constant time pressure, the occurrence of sudden and unpredictable situations, as well as the need to make immediate decisions and quick actions. It is necessary to have high manual dexterity in the treatment and care activities. In addition, nurses are required to professionally assess the patient's health, keep records, operate medical equipment and devices, constant contact with the patient, pro-health education, and health promotion. Each of these activities requires different abilities, predispositions, and skills [3]. Contemporary global trends in health care and the need for non-material investment in employees encourage the search for positive personality predispositions that are related to work performance, and commitment and protect against burnout [4, 5]. There are many difficult and health-threatening situations in the work of nursing staff. It is worth emphasizing that not all people who are exposed to strong, negative effects of overload and stress or situations of crisis will react in the same way. Individual immunity is an important protective factor. The ability of an individual to approach adversity as a challenge has been shown to reduce the impact of traumatic events and reduce the likelihood of developing post-traumatic stress disorders. Resilience can be understood as the process of positive adaptation to a stressful situation in which personal resources interact with the environment. It is varied and depends on several factors, such as personality, interpersonal and social background [6].

Personality predispositions and attitude to professional requirements determine the attitude that an individual takes in difficult situations. Scharschmidt and Fischer - the German authors of the AVEM questionnaire (Work-Related Behavior and Experience Patterns) – made an attempt to determine some characteristic patterns of human behavior – both with beneficial and harmful health repercussions - in the face of increasing professional requirements and expectations [7]. The AVEM questionnaire allows to identify of behavior patterns and experiences at work that pose a threat to the health of an individual. They are considered depending on the relationship in the work environment and the immediate environment [8]. The areas in which the questionnaire is applicable are occupational psychology and health psychology. The composition of the variables employed in the testing tool takes into account three basic spheres of work-related personality: professional commitment, mental resilience and strategies to combat problem situations, and an emotional attitude to work. Each of them has specific aspects of behavior and functioning in life and at work [7, 9, 10]. The configuration of the spheres mentioned, and their aspects determines the effective functioning at work or the lack of it. It allows the identification of patterns and types of professional functioning that are very important both in terms of health and motivation. We can distinguish two types perceived as conducive to healthy functioning - type G - healthy and type S - economical, and two types that are hazardous to the health of the individual - type A - overloaded and type B - burned out.

Type G - healthy - identifies with the performed profession, shows a positive attitude to work, which is treated as a source of satisfaction. Individuals who are characterized by this pattern and type of functioning are able to keep a distance from problems related to work, and when they fail, they take an offensive attitude. It is conditioned by a sufficiently high level of internal balance.

Type S - economical - characterizes those individuals who do not expect professional success, and who see satisfaction with life in situations not related to work (family, hobbies, volunteering). This type has a clear tendency to distance themselves from work-related problems.

Risk type A - overloaded - is characterized by the intensity of negative emotions, low mental resistance, high professional commitment and perfectionism at work. The professional sphere of their lives is of high importance, but the diminished ability to maintain a distance between work and personal life is particularly worrying.

Risk type B – burn out - shows low subjective importance of work, low resistance to stress and low ability to distance oneself from problems at work. This type is characterized by a tendency to give up in difficult situations and a very low sense of inner balance [4, 7, 11, 12].

The characteristics of the presented patterns of behavior and experiences in the work environment reflect the human attitude towards the performed professional duties. It is not a passive, imposed relation, determined by laws and regulations. An individual pattern of behavior and experiences is created by a person who, by taking actions and adopting characteristic attitudes, is jointly responsible for what is happening at work. The pattern of behavior and experiences can be considered as indicators of the currently existing expectations and requirements of an individual in relation to the work environment or as a dimension of behaviors that result from previous experiences. They allow providing a better insight at a person from the point of view of their past successes or failures and mistakes made by him, thus giving the opportunity to implement educational programs [7, 13, 14].

Work, as an important element of the social functioning of adults, can be a source of satisfaction and an area of self-fulfillment for a person, but it can also have a negative impact on health. Due to exposure to occupational risk factors, nurses fall ill, bear the risk of injuries, and accidents at the workplace, and become incapable of professional activity [15]. Representatives of medical professions, including nurses, are exposed to numerous health hazards due to their duties and the risk of contact with harmful and dangerous factors in the work environment, as well as due to psychosocial burdens related to their work. A serious threat to physical health is an excessive overload of the locomotor system, in particular, the spine, and the associated pain, motor limitations, and absenteeism at work [16]. A characteristic feature of the work of nurses is a shift and lack of regularity. It leads to disturbance of biological rhythms, sleep, and disruption of family and social life, and is a source of additional psychophysical burdens. They are accompanied by functional dysfunctions, e.g., easy fatigue, headaches, irritability, difficulty concentrating attention and making decisions. The research report of the European NEXT project (Nurses Early Exit Study) shows that night work with nurses should be treated as a factor contributing to, accelerating, or exacerbating the occurrence of many diseases and pathological conditions. Research shows that 70% of shift employees are not able to make it to the statutory retirement pension due to various ailments resulting from such a work rhythm. It has also been found that shift and night work can contribute to cancer formation [17]. Nurses' health problems should be analyzed in the context of an aging professional group. The average age of surveyed registered nurses worldwide is 51 years, while the average age of a nurse in Poland in 2020 was 53 years [18, 19]. In the elderly, the risk of cardiovascular, musculoskeletal, and respiratory diseases increases. Research conducted among nurses also confirms that this professional group is particularly exposed to the occurrence of burnout syndrome [20, 21, 22]. The high standard of moral, emotional, and professional requirements is not balanced by the level of earnings, social status, and professional prestige in this group. Frustration and dissatisfaction are sources of chronic stress. The profession of nurse is one of the most burdened jobs due to the specific type of stress that the other person causes. The nurse works in an interdisciplinary team, and cooperates with the patient and his relatives, often in situations of high emotional tension. Nurses are faced with a whole spectrum of challenges that go beyond the area of health, often of a psychological and social nature, and relate to the existential experiences of a human being, such as birth, suffering, and death [15, 17, 23, 24, 25]. The perceived stress of the professional role and the accompanying negative emotions, if they are sufficiently strong and prolonged in time, may lead to many permanent negative consequences, both in the physical and mental sphere, and may initially take the form of disease symptoms first, and then disease syndromes. The social effect of this phenomenon is the loss of personnel - members of the healthcare team, which affects the already observed crisis of nursing staff, and thus - the deterioration of the health of the world's population. [20].

The aim of the study was the analysis of behavior and experiences at work as determinants of the general mental health of nurses working in Hospital Emergency Departments.

The study involved 150 women (nurses) aged 22 to 60 (M = 41.34, SD = 8.82) employed in Hospital Emergency Departments in central Poland. The group was diversified in terms of socio-demographic and occupational variables. Due to their marital status, most of the respondents were "in relationships", the group was dominated by nurses with secondary education, and their professional experience was less than 20 years (M = 19.61; SD = 9.67). The vast majority of respondents worked in a 12-hour work system and held the position of a general nurse. Nurses employed in Hospital Emergency Departments were included in the study voluntarily. Data were collected from November 2015 to June 2016. Survey packages were made available to nurses at a designated location. Individuals willing to take part in the study, after completing the sets, could place them in a specially secured urn. The return of the questionnaires was tantamount to giving informed consent to participate in the study. The research was conducted in accordance with the principles set out in the World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human. The research was approved by the Bioethical Committee of the Nicolaus Copernicus University in Toruń. L. Rydygier in Bydgoszcz.

The following research tools were used in the work:

1. Author's sheet for collecting socio-demographic data concerning the description of the group in terms of socio-demographic variables and job characteristics.

2. The AVEM (Work-Related Behavior and Experience Patterns) questionnaire by Scharschmidt and Fischer in the Polish adaptation of the test developed by Rongińska and Gaida. The questionnaire consists of 66 items. The examined person assesses the accuracy of each of the statements in relation to their own feelings, experiences and experiences on a five-point scale. The area of behavior and experiences in task situations is described by 11 scales of the questionnaire (each of the scales corresponds to 6 tasks-statements). The purpose of the AVEM questionnaire is to determine the individual resources of an individual in the context of coping with the demands of professional situations. [7, 26]. Reliability measured by α-Cronbach for different scales assumes for the Polish version values from 0,71 to 0,84, and the Spearman-Brown correlation coefficient for different scales assumes values from 0,70 to 0,83 for the Polish version [27].
3. The General Health Questionnaire (GHQ-28) by Goldberg in the Polish adaptation by Makowska and Merecz is a screening tool used to assess the mental health of adults in the general population. GHQ-28 measures general mental health and its four dimensions, i.e.: somatic symptoms (GHQ 28 A), anxiety and insomnia (GHQ 28 B), social functioning disorders (GHQ 28 C), and symptoms of depression (GHQ 28 D). The internal consistency expressed in Cronbach's alpha index ranged from 0.91 to 0.93 [28].

The research was performed in a correlation model. The following statistical tests were used:

- to describe the variables in the groups, mean (M) and standard deviation (SD) as well as the number (f) and percentage (%);

- to determine the direction and strength of the relationship between the variables Pearson's linear correlation test when there was the linearity of the relationship between the variables or non-parametric R-Spearman's test when there was no linearity of the relationship between the variables or the variables were qualitative;

- to determine the significance of differences between two means by Student's t-test or Mann-Whitney U test;

- to determine the significance of differences between multiple means ANOVA or Kruskal-Willis analysis of variance.

The first stage was to present the average results of the analyzed variables. The surveyed nurses in terms of professional commitment were characterized by a high ability to distance themselves and very low professional ambitions, low subjective importance of work, which resulted in the fact that they were not perfect and not inclined to engage. In terms of mental resilience and strategies to combat problem situations, their behavior was of average intensity. In terms of emotional attitudes towards work, it was noted that nurses had a low sense of success in the profession. It was observed that the surveyed nurses most often behave according to type S - economical or B - burned out, and the least frequently according to type A - overloaded. The results are presented in Table 1.

Table 1

Descriptive statistics for types of behavior and experiences at work in the studied group (N = 150)
AVEM TEST SCALES		M	SD
Professional commitment	The subjective meaning of work	14,59	4,56
	Professional ambitions	18,00	4,23
	Willingness to get involved	18,65	4,11
	The pursuit of perfection	22,01	4,16
	The ability to distance oneself	22,10	4,89
Mental resilience and strategies to combat problematic situations	The tendency to give up in the event of failure	15,77	4,04
	Offensive problem-solving strategy	21,76	4,50
	Inner peace and balance	19,07	4,02
Emotional attitude towards work	Sense of success in the profession	18,81	3,80
	Life satisfaction	20,69	4,55
	A sense of social support	19,75	4,07
Types of behavior at work	G – healthy tyoe	0,21	0,31
	S – economical type	0,35	0,36
	A – overloaded type	0,15	0,23
	B – burned out type	0,29	0,35

In the next stage, the general mental health of the respondents was analyzed. The mean severity of abnormalities in health was average (4.72 sten). The surveyed nurses did not reveal depressive disorders (GHQ 28 D) M = 1.28, SD = 2.81, the most common were social functioning disorders (GHQ 28 C) M = 7.39, SD = 2.06 and complaints about symptoms somatic (GHQ 28 A) M = 6.81, SD = 3.42. (Table 2).

Table 2

Descriptive statistics for the general mental health of the surveyed nurses (N = 150)
General mental health	M	SD	Minimum	Maksimum
GHQ 28 A – somatic symptoms	6,81	3,42	0,00	18,00
GHQ 28 B – anxiety and insomnia	6,38	3,64	0,00	20,00
GHQ 28 C – social functioning disorders	7,39	2,06	1,00	16,00
GHQ 28 D – symptoms of depression	1,28	2,81	0,00	21,00
sum GHQ	21,93	9,11	7,00	70,00
GHQ sten	4,72	1,56	1,00	10,00

Nurses were divided into one of type of behavior and experiences at work. A given type was attributed on the condition that it was characterized by a significant degree, i.e., at least 80%. Five groups of nurses were selected. The most numerous were individuals functioning in a diversified manner, and the least numerous were nurses working, by far the most frequently overloaded. The results are presented in Table 3.

Table 3

The number of surveyed nurses depending on the dominant type of behavior and experiences at work
Dominant types of behavior and experiences at work	number	cumulative number	percentage	cumulative percentage
Type G – health	15	15	10,00	10,00
Type S – economical	33	48	22,00	32,00
Type A – overloaded	4	52	2,67	34,67
Type B – burned out	23	75	15,33	50,00
Type mixed	75	150	50,00	100,00

Due to large discrepancies in the numbers, further analyzes were not included in the group that operated in accordance with the savings type and the mixed group. The obtained results indicate that there were significant differences in health between nurses working according to type G - healthy, S - economical or B - burned out. Statistically significant differences were observed especially in the field of anxiety and insomnia GHQ 28 B and depression symptoms GHQ 28 D (Table 4).

Table 4

Results of the analysis of variance taking into account three subgroups of nurses functioning according to the healthy, economical, and burned-out types.
General mental health	F/H*	p
GHQ 28 A – somatic symptoms	0,939	0,396
GHQ 28 B – anxiety and insomnia	3,430	0,038
GHQ 28 C – social functioning disorders	0,097	0,907
GHQ 28 D – symptoms of depression	7,323*	0,026
Sum GHQ	5,586*	0,061
* were counted using a non-parametric test

The next stage concerned the analysis of the relationship between the general mental health of the surveyed nurses and the types of behavior and experiences at work. The analyzes showed a negative, statistically significant relationship between type G - healthy and complaints about general mental health, especially in terms of GHQ 28 A - somatic symptoms and GHQ 28 B - anxiety and insomnia. A statistically significant relationship was observed between functioning according to type A - overloaded and the occurrence of GHQ 28 A - somatic symptoms. The more often the examined person functioned at work in an excessively loaded manner, the more often they experienced disorders of the somatic state. A similar statistically significant relationship was found in nurses functioning in accordance with type B - burnout, they showed much more often disorders of social functioning (GHQ 28 C). Occupational ambitions negatively correlated at a statistically significant level with GHQ 28 A - somatic symptoms and GHQ 28 C - social functioning disorders. Occupational ambitions negatively correlated at a statistically significant level with GHQ 28 A - somatic symptoms and GHQ 28 C - social functioning disorders (Table 5).

Table 5

General mental health and types of behavior and experiences at work (Pearson's r correlation)
	A	B	C	D	GHQ 28
The subjective meaning of work	,1151	,0064	,0035	,0532	,0631
	p=,164	p=,939	p=,966	p=,521	p=,446
Sense of success in the profession	,0536	,0560	-,0172	,0136	,0429
	p=,518	p=,499	p=,836	p=,869	p=,605
Type G – health	-,1912	-,2412	-,1066	-,1426	-,2367
	p=,020	p=,003	p=,197	p=,084	p=,004
Type S – economical	-,0790	,0178	,0909	-,0599	-,0207
	p=,340	p=,830	p=,272	p=,469	p=,803
Type A – overloaded	,2474	,1082	-,0432	,0144	,1310
	p=,002	p=,190	p=,602	p=,863	p=,113
Type B - burned out	,0838	,1196	,0270	,1774	,1405
	p=,311	p=,148	p=,745	p=,031	p=,088
* The results were statistically significant p < 0.05

In the next stage, it was analyzed whether the components of the personality spheres correlate with the dimensions of general mental health. It was noticed that there was a negative statistically significant correlation between the pursuit of perfection and the sense of social support, and GHQ 28 D - symptoms of depression. The more nurses represented the pursuit of perfection and experienced a greater sense of social support, the less depressive symptoms they experienced. In the case of the tendency to quit in the event of failure, a statistically significant positive relationship with GHQ28B disorders - anxiety and insomnia, and the general state of mental health was revealed. The less the respondents had a tendency to resign in the event of failure, the less anxiety disorders and insomnia they experienced. The offensive problem-solving strategy revealed a negative statistically significant relationship with GHQ 28 D - symptoms of depression. Nurses who were more offensive about difficulties experienced fewer depressive symptoms. There was a statistically negative correlation between life satisfaction and general health dimensions - in particular with GHQ 28 A - somatic symptoms, GHQ 28 C - disorders of social functioning, and GHQ 28 D - symptoms of depression. The more satisfied the nurse was with life, the fewer negative symptoms they experienced. In the case of the ability to distance oneself, there were statistically significant negative correlations with complaints about the general state of mental health. This means that the less ability the nurse had to distance themselves from problems at work, the more negative mental health symptoms they experienced. The discussed results are presented in Table 6.

Table 6

Correlation of Spearman's rank order between the general state of mental health and types of behavior and experiences at work
Pairs of variables	N	r - Spearman	t(N-2)	p
Professional ambitions & GHQ 28 A	150	-0,168	-2,07	0,040
Professional ambitions & GHQ 28 B	149	-0,151	-1,85	0,066
Professional ambitions & GHQ 28 C	148	-0,220	-2,73	0,007
Professional ambitions & GHQ 28 D	150	-0,043	-0,52	0,605
Professional ambitions & GHQ 28	148	-0,204	-2,52	0,013
Getting involved & GHQ 28 A	150	0,099	1,21	0,227
Getting involved & GHQ 28 B	149	0,033	0,40	0,693
Getting involved & GHQ 28 C	148	-0,050	-0,60	0,546
Getting involved & GHQ 28 D	150	-0,087	-1,06	0,290
Getting involved & GHQ 28	148	0,072	0,88	0,383
The pursuit of perfection & GHQ 28 A	150	-0,004	-0,05	0,963
The pursuit of perfection & GHQ 28 B	149	-0,067	-0,81	0,420
The pursuit of perfection & GHQ 28 C	148	-0,104	-1,26	0,210
The pursuit of perfection & GHQ 28 D	150	-0,292	-3,72	0,000
The pursuit of perfection & GHQ 28	148	-0,055	-0,67	0,505
The ability to distance oneself & GHQ 28 A	150	-0,158	-1,95	0,053
The ability to distance oneself & GHQ 28 B	149	-0,151	-1,85	0,067
The ability to distance oneself & GHQ 28 C	148	-0,027	-0,32	0,746
The ability to distance oneself & GHQ 28 D	150	-0,099	-1,21	0,227
The ability to distance oneself & GHQ 28	148	-0,187	-2,30	0,023
The tendency to give up in the event of failure & GHQ 28 A	150	0,144	1,76	0,080
The tendency to give up in the event of failure & GHQ 28 B	149	0,266	3,35	0,001
The tendency to give up in the event of failure & GHQ 28 C	148	0,079	0,95	0,343
The tendency to give up in the event of failure & GHQ 28 D	150	0,052	0,63	0,531
The tendency to give up in the event of failure & GHQ 28	148	0,269	3,37	0,001
Offensive problem solving strategy & GHQ 28 A	150	-0,139	-1,70	0,091
Offensive problem-solving strategy & GHQ 28 B	149	-0,134	-1,64	0,104
Offensive problem-solving strategy & GHQ 28 C	148	-0,147	-1,79	0,075
Offensive problem-solving strategy & GHQ 28 D	150	-0,238	-2,98	0,003
Offensive problem-solving strategy & GHQ 28	148	-0,186	-2,29	0,023
Inner peace and balance & GHQ 28 A	150	-0,085	-1,04	0,299
Inner peace and balance & GHQ 28 B	149	-0,056	-0,68	0,497
Inner peace and balance & GHQ 28 C	148	-0,058	-0,70	0,482
Inner peace and balance & GHQ 28 D	150	-0,066	-0,81	0,419
Inner peace and balance & GHQ 28	148	-0,063	-0,76	0,446
Life satisfaction & GHQ 28 A	150	-0,205	-2,55	0,012
Life satisfaction & GHQ 28 B	149	-0,153	-1,88	0,062
Life satisfaction & GHQ 28 C	148	-0,275	-3,46	0,001
Life satisfaction & GHQ 28 D	150	-0,197	-2,45	0,016
Life satisfaction & GHQ 28	148	-0,244	-3,04	0,003
A sense of social support & GHQ 28 A	150	-0,032	-0,39	0,698
A sense of social support & GHQ 28 B	149	-0,144	-1,76	0,080
A sense of social support & GHQ 28 C	148	0,028	0,33	0,738
A sense of social support & GHQ 28 D	150	-0,203	-2,53	0,013
A sense of social support & GHQ 28	148	-0,101	-1,22	0,223

The last stage of the research was the analysis of behavior and experiences at work as determinants of the general mental health of nurses working in Hospital Emergency Departments. Progressive stepwise regression analysis was performed. The model includes all 11 areas of behavior and experience at work as well as socio-demographic variables: age, place of residence, work experience, and education level. In the course of the analysis, nine variables remained in the model, of which the following were statistically particularly significant: the level of education, the tendency to give up in the event of failure, and the pursuit of perfection at work. The analyzed variables together explained about 10% of the variability of reported complaints about general mental health (R = 0.399; R ^ 2 = 0.159; R2 = 0.103; F (9.135) = 2.832 p = 0.004). Therefore, it can be concluded that nurses with a lower level of education, as well as those who did not show any aspirations for perfectionism at work and were characterized by an increased tendency to resign in the event of failure, were exposed to the intensification of complaints about the general mental health condition. The results of the regression analysis are presented in Table 7.

Table 7

Work experiences as determinants of the general mental health of nurses
	b*	Bł. std. - z b*	b	Bł. std. - z b	t(135)	p
Age			21,23	9,017	2,35	0,020
Level of Education	-0,173	0,086	-1,29	0,644	-2,01	0,047
The ability to distance oneself	-0,113	0,102	-0,22	0,195	-1,11	0,270
The tendency to give up in the event of failure	0,175	0,088	0,41	0,203	2,00	0,047
Place of residents	0,130	0,081	1,11	0,691	1,61	0,109
The pursuit of perfection	-0,231	0,108	-0,51	0,241	-2,13	0,035
Sense of success in the profession	0,122	0,095	0,29	0,230	1,28	0,202
Professional ambitions	-0,208	0,113	-0,45	0,246	-1,84	0,068
Offensive problem solving strategy	0,164	0,120	0,34	0,247	1,37	0,173
Getting involved	0,139	0,126	0,31	0,279	1,10	0,272

Professional work takes up a significant part of human life and is the most common manifestation of human activity. Initially, it may be a passion, giving energy and fascination with new experiences, but over time they may give way to dissatisfaction with one's own achievements, exhaustion, and reluctance to contact people. In this case, the professional activity of a person may predispose to the occurrence of somatic and psychosomatic diseases or may be an important factor in ineffective functioning at work and lowering the quality of services provided [2].

Own research showed that in terms of professional involvement, nurses were characterized by a high ability to distance themselves, very low professional ambitions, and low subjective importance of work, which resulted in low perfectionist and non-engaging tendencies. This can pose a risk to both the quality of the work performed and to patients who trust in the commitment and professionalism of the nursing staff. Research conducted in Poland by CBOS (Center for Public Opinion Research) in 2019 confirms that a nurse is a professional who enjoys the title of a profession of public trust in the opinion of 89% of society [29]. Distancing oneself from professional duties, a reduced need for perfectionism and low commitment to the work performed may result from the shortage of nursing staff in European countries, resulting in increased work requirements and the occurrence of chronic stress. In a study by Mróz (2014) on the importance of personal resources for work-related behaviors and experiences, it was found that nurses who had a high level of resources showed more adaptive behavior and work-related experiences than nurses who had a low intensity of the resources studied [4]. In terms of mental resilience and strategies to combat problem situations, the nurses' behavior was of average intensity. In terms of emotional attitudes to work, it was noted that nurses had a low sense of success in the profession. Numerous Polish studies have confirmed that the nursing staff is not satisfied with their professional role [30, 31, 32]. Dissatisfaction with the work of nurses was also reported by Dall'Ora et al. (2015) who, after researching 33,659 nurses in 12 European countries, concluded that more than one in five nurses was dissatisfied with their work [33]. As Li et. al., (2019) points out, nurses working in emergency departments in China also indicate low job satisfaction and consider changing the workplace [34]. Research by other authors shows that even 41% of nurses working in the USA, 38% working in Scotland, 36% in England, 33% in Canada, and 17% in Germany declare that they do not feel satisfied with their work [35]. On the other hand, a high level of job satisfaction occurs among Swedish nurses, which is confirmed by the research of Holmberg et al. (2016) [36]. The current situation of the lack of nursing staff and excessive workload may predispose to the occurrence of burnout syndrome. The World Health Organization has identified burnout as a serious health problem and has included it in the 11th edition of the International Classification of Diseases (ICD-11). Among healthcare professionals, especially nurses, the occurrence of burnout symptoms has serious consequences for patients, other workers, and healthcare organizations. [21]. The professional functioning of an employee can be considered in many respects. This is reflected in studies that, on the one hand, focus on positive aspects of work, such as job satisfaction, and on the other hand, analyze problematic areas, such as professional burnout. [37].

Nurses subjected to this study are at risk of burnout syndrome. The results of the conducted analyzes confirmed that nurses most often functioned in accordance with type B - burned out or S - economical, and least often in accordance with type A - overloaded. Individuals presenting the type of behavior B - burned out, are characterized by a low subjective meaning of work, low resistance to stress, and a low ability to distance oneself from problems at work. They may also show a tendency to give up in difficult situations and a very low sense of inner balance. Type S- economical characterizes people who do not expect professional success, and who see satisfaction with life in situations not related to work. This type, on the other hand, has a clear tendency to distance himself from work-related problems [4, 7, 11, 12]. The research of Polish authors confirmed the existence of occupational functioning in accordance with the types of risk to health. In a study by Haor et al. (2014) conducted on a group of 100 pediatric nurses, it was shown that 36% of the respondents showed functioning at work in accordance with type B - burned out [38]. Research by other authors - Mróz (2014) and Andruszkiewicz (2018) also confirmed that among the nurses surveyed, the style of functioning in accordance with type A – risky for health was dominant. [4, 7]. Similar results were obtained by Heuel et al. (2022) in a group of German nurses [12]. Long-term occupational functioning, according to the types unfavorable to health, may cause disturbances in the physical and mental spheres. Mental health is of great importance for the quality of life in society: in the family, and in the workplace. Mental well-being is part of the social, human, and economic capital of society. However, its poor condition may contribute to a reduction in the quality of life and may cause the inability to continue professional work. Mental health disorders are one of the three most common causes of absenteeism from work and one of the main reasons for early retirement or disability pension [39]. In the study group, the level of abnormalities in general mental health was average. Nurses did not reveal depressive disorders, the most common health problems were social functioning disorders and somatic symptoms. Polish studies assessing the health of nurses classify it similarly. In a study by Andruszkiewicz et al. (2011, 2014, 2018) on numerous groups of professionally active nurses, it was shown that the state of health, both physical and mental, can be assessed as average [7]. Most of the respondents did not show symptoms of depression, and the most commonly reported occurrence of somatic symptoms as well as anxiety and insomnia. Similar results were obtained by Kowalczuk et al. (2020) in a group of 558 nurses, the most common disorders were the disorders in general mental health, such as somatic symptoms, and the occurrence of anxiety and insomnia. An important correlation was also observed between the higher incidence of somatic symptoms and anxiety and insomnia in older nurses. This relationship deserves attention in the context of the aging professional group of nurses [40]. Our own results correspond to the results of Polish and international researchers. A Seabra study (2019) of 1,264 Portuguese nurses found that over 60% of respondents had a negative perception of their mental health. Of these, 22.2% reported symptoms of severe depression, 71.6% indicated significant somatic symptoms, and 76% showed significant anxiety and insomnia [39]. Surveys conducted among nurses in Iran have shown that the overall mental health of nurses can be assessed as average. The most common disorders reported by nurses are somatic symptoms, as well as restlessness and insomnia [41]. In turn, studies by Perry et al. (2015) among 381 Australian nurses who rated their overall health on a scale of 1–5, indicate that the mean group score was 3.8. Interpreted results show that Australian nurses rate their overall health as good (28.5%), very good (45.5%), and excellent (19.4%) [42]. Due to the need to educate new generations of nurses, it becomes important to monitor the general mental health of students. A study by Mohebbi (2019) among 130 nursing students at the University of Iran showed that more than half of the students presented disorders in general mental health. The respondents most often reported disorders in social functioning and somatic symptoms. This is a very disturbing phenomenon and obliges to take remedial actions [43].

The subject of the research was also the analysis of behavior and experiences at work as determinants of the general mental health of nurses working in Hospital Emergency Departments. It was found that among nurses who worked most frequently according to type G - healthy, S – economical, or B - burned out, there were significant differences in health, especially in experiencing anxiety and insomnia, and in the occurrence of depressive symptoms. People functioning in accordance with type B - burned out significantly more often complained about perceived anxiety and sleep problems than people functioning in accordance with type G - healthy. In the own study, after performing a progressive stepwise regression analysis, it was shown that the severity of complaints about health may be inferred from lower education, low perfectionism in the performance of professional tasks, and an increased tendency to resign in the event of failure. These results have important practical implications. Nurses play a key role in health promotion, disease prevention, and the provision of primary health and community care. The World Health Organization estimates the world will need an additional 9 million nurses and midwives by 2030 [44]. All the more so for professionally active nurses, often experiencing disorders in the field of general mental and physical health, there is a need to develop and implement strategies to counteract health risks by developing professional competencies and personality resources. In designing the strategy, one should strive for individualized adaptation of educational programs taking into account behavior patterns and experiences at work in order to obtain the highest effectiveness of professional functioning. [11, 45].

Employers and decision-makers in the nursing area should conduct an individual analysis of the types of behavior and experiences at work in a group of nurses in order to eliminate factors contributing to the deterioration of their health condition.

Encouraging nurses to develop their professional skills and increase their professional qualifications may result in a significant improvement of staff qualifications, but also in better well-being and resistance to stressors in the workplace.

This study provides an impetus for interventional research and policy change to improve nurses' working conditions and the overall quality of healthcare.

Two limitations of the conducted study were identified. The first is a small research group. In the future, in order to obtain a greater generalization of results, we believe it would be worth repeating the research on a larger group of nurses. Secondly, there is a need to exclude two groups of nurses from the analysis. Due to large discrepancies in the numbers in the group of nurses operating according to the economical type - S and qualified to the mixed group, they were excluded from further analyzes.

Ethics approval and consent to participate

The research was conducted in accordance with the principles set out in the World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human. The research was approved by the Bioethical Committee of the Nicolaus Copernicus University in Toruń. L. Rydygier in Bydgoszcz.The individuals participating in the study on a voluntary basis were healthy and did not have a professional or other relationship with the researcher. All nurses were informed verbally and/or in text about topic, goals, expected benefits and possible risks of the study (informed consent) before participating in the study. Filling out the questionnaire after receiving information was interpreted as consent to participate. Informed consent was obtained from all the participants and/or legal guardians for the study.

Consent for publication

Not applicable

Availability of data and materials

The data generated and analysed during the current study are not publicly available due to the sensitivity of the data.

Data Availability

The data garnered during the current study and the final data set used for statistical analysis are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions

K.B. carried out the research and conception of the study in close cooperation with A.A.

K.B. contributed to the data collection. Interviews were transcribed, analysed and interpreted by K.A. and discussed with A.A.. All authors reviewed the drafts of the manuscript, gave comprehensive feedback, have read and approved the final manuscript.

Conflict of interest:

No conflict of interest has been declared by the author (s).

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No competing interests reported.

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Types of behaviors and experiences at work and health condition in the group of nurses at Accident and Emergency Units

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