Workplace interpersonal relationships and turnover intentions among care workers in older adult care facilities: a mediation analysis comparing direct and mediated effects via psychological distress

doi:10.21203/rs.3.rs-4649906/v1

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Workplace interpersonal relationships and turnover intentions among care workers in older adult care facilities: a mediation analysis comparing direct and mediated effects via psychological distress

https://doi.org/10.21203/rs.3.rs-4649906/v1

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Background

Methods

An anonymous online survey among 811 care workers in Tottori Prefecture, Japan, was conducted between November and December 2023. The data were collected using the Workplace Interpersonal Problems Scale for care workers (WIPS), the K6 scale, the Turnover Intention Scale and basic attributes. Responses were obtained from 254 participants with a response rate of 31.3%.

Results

The results of the mediation analysis for the WIPS subscale which was adjusted for basic attributes show that insufficient communication (direct effect, 0.319; mediated effect, 0.194), a sense of unfair workload (direct effect, β = 0.314; mediated effect, β = 0.190), and different attitudes to care work (direct effect, β = 0.278; mediated effect, β = 0.204) had stronger direct effect on turnover intention, whereas difficulty guiding subordinates/new staff (direct effect, β = 0.207; mediated effect, β = 0.219) and labeling (direct effect, β = 0.198; mediated effect, β = 0.211) had slightly stronger mediated effect on turnover intentions through psychological distress. For bullying (direct effect, β = 0.207; mediated effect, β = 0.204), the direct and mediated effects on turnover intention were nearly equal.

Conclusions

This study revealed that some workplace interpersonal problems have a stronger direct effect on turnover intentions, whereas others have a stronger mediating effect on turnover intentions through psychological distress. Workplace interpersonal problems are predictors of turnover intentions among care workers working in elderly care facilities, and different workplace interpersonal problems should be targeted for intervention to reduce turnover intentions.

The older population is growing rapidly globally, and this trend is expected to continue for some time [1]. As a result, the incidence of age-related diseases such as diabetes [2], neurodegenerative diseases [3], cardiovascular diseases[4], kidney disorders [5], and other age-related diseases are increasing. Age-related diseases increase the risk of older people needing long-term care. In Japan, 2.8% of individuals aged 65–69 years need long-term care insurance, compared with 5.8% of those aged 70–74, 12.1% of those aged 75–79, 25.8% of those aged 80–84, 48.5% of those aged 85–89, and 76.8% of those aged ≥ 90. This trend increases with age [6, 7]. This suggests that with the growing older population worldwide, the number of older people requiring care increases. Therefore, the role of care workers in caring for older people will also increase in the future.

The shortage of care workers is a global problem [8, 9], and the turnover rate of care workers is also high [10]. To address the shortage of care workers, it is important not only to increase the number of new care workers but also to stem the turnover of care workers in the workforce. Actual turnover is difficult to control because of factors unrelated to turn over intentions, such as organizational decisions, health problems, and work contract termination [11]. However, turnover intention refers to the attitude or perception of workers that can be changed through organizational intervention [12]. Because turnover intentions are closely related to turn over [13], organizational attempts to lower the turnover intentions of care workers should effectively compensate for the shortage of care workers.

Previous studies revealed that factors associated with care workers’ intentions to leave the workforce include support from supervisors and colleagues [14, 15]; interpersonal conflicts with supervisors, colleagues, and subordinates [16, 17]; perceptions of teamwork in the workplace [18]; affective organizational commitment [19]; employment status and other treatment [20]; job satisfaction [14]; and work burden [21]. In particular, many studies have reported on the relationship between workplace relationships and turnover intentions, and a review of studies of Japanese care workers revealed that workplace interpersonal problems were consistently associated with turnover intentions [22]. Conversely, turnover intentions among care workers are associated with high levels of job stress, including psychological distress [17, 23]. Care workers involved in older adult care are susceptible to psychological distress and burnout [24, 25]. In addition, peer and supervisor support is a predictor of burnout among older adult care workers [26], and workplace interpersonal problems are also associated with psychological distress among care workers [27].

From the above, workplace interpersonal relationships, psychological distress, and turnover intentions of older adult care workers are deemed interrelated. If this point is clarified, the mental health of care workers may be maintained, and maintaining good workplace interpersonal relationships may reduce turnover intentions. Deterioration of care workers’ mental health not only negatively affects the care workers themselves but also decreases the quality of care they provide [28]. In addition, high turnover among care workers not only increases the burden on care workers working in the field but also decreases the quality of care [29]. Therefore, the relationship between workplace interpersonal relationships, psychological distress, and turnover intentions must be examined to reduce the burden on care workers and maintain the quality of care. However, this point has not been adequately examined to date.

This study aimed to investigate the relationship between workplace interpersonal relationships, psychological distress, and turnover intentions among care workers working in older adult care facilities. We hypothesize that some workplace interpersonal problems among Japanese care workers directly influence turnover intentions, whereas others influence turnover intentions through the mediation of psychological distress (Fig. 1). This finding may have valuable implications in that we can distinguish between workplace interpersonal relationships that should be worked on directly to improve the turnover intentions of care workers and those that should be improved to maintain mental health. Thus, this finding may be useful for considering efficient organizational approaches to prevent turnover intentions among care workers.

Participants

An anonymous online survey among 811 care workers in Tottori Prefecture, Japan, was conducted between November and December 2023. Before the survey, the researchers requested cooperation from the Longevity and Social Affairs Division of Tottori Prefecture, which sent an e-mail to elderly care facilities in Tottori Prefecture through a mailing list requesting cooperation in the survey. The questionnaire request forms were distributed to elderly care facilities that agreed to cooperate in the survey. The online survey was conducted using Google Forms. Before entering the survey, the study participants were clearly informed that the information obtained would be kept strictly confidential, their personal information would be protected, and there would be no disadvantages for nonparticipation. Informed consent was also obtained online from all participants. Responses were obtained from 254 participants (83 men, 170 women, and 1 other) with a response rate of 31.3%. The mean age was 44.7 ± 12.1 years. This study was approved by the Institutional Review Board of the Tottori University Faculty of Medicine (No. 23A093).

Measures

Workplace Interpersonal Problems

The Workplace Interpersonal Problems Scale for care workers (WIPS) [30] was used to measure workplace interpersonal problems. This scale has shown good reliability and validity [30] and consists of a total of 23 questions. The subscale includes the following six items: insufficient communication, bullying, a sense of unfair workload, different attitudes to care work, difficulty in guiding subordinates/new staff, and labeling. The item on insufficient communication included: “I have not communicated well enough with my coworkers.” Similarly, the item on bullying included, “There have been times when I have been ignored by my coworkers”; a sense of unfair workload, “I have felt that I was treated unfairly because my workload differs from that of my coworkers”; different attitudes to care work, “I sometimes had trouble with staff at work because of differences in their ideas about nursing care and care”; difficulty in guiding subordinates/new staff, “I have had difficulties mentoring subordinates or new staff because of disagreements in opinions”; and labeling, “When a disagreement occurred with my coworkers, I have thought that it happened because of a person’s bad personality.” Respondents were asked to respond on a 4-point scale (0 = not at all applicable, 1 = not applicable enough, 2 = slightly applicable, 3 = very applicable), and the sum of each response was considered the scale score. Accordingly, the higher the scale score, the stronger the perception of workplace interpersonal problems.

Psychological distress

To assess psychological distress, the Japanese version of the K6 scale [31] was used. One of the items was as follows: “During the last 30 days, how often did you feel nervous?” Respondents answered on a five-point scale (0 = none of the time, 1 = a little of the time, 2 = some of the time, 3 = most of the time, 4 = all of the time). The sum of the responses was used as the scale score, with higher scores indicating higher levels of psychological distress.

Turnover intentions

Turnover intentions were measured using the Turnover Intention Scale [32, 33], which includes one reversal item out of four items. However, Sakakibara et al. [34] showed that the inclusion of this reversal item significantly reduces Cronbach’s α coefficients. Therefore, the present study used the three items excluding the reversal item, similar to that in Sakakibara et al., with higher scores indicating higher turnover intentions. The questions included items such as, “I consider my decision to work for this employer as an obvious mistake,” and responses were given on a five-point scale: 1 = completely agree, 2 = somewhat agree, 3 = neither agree nor disagree, 4 = somewhat disagree, and 5 = completely disagree).

Basic attributes

The questionnaire included questions about age, sex, education, certified care worker qualifications, workplace status, employee status, duration of service in the current job, duration of care work experience, and managerial position.

Statistical analysis

Pearson’s correlation coefficient and McDonald’s ω coefficient for each variable were calculated. Then, to test a model in which workplace interpersonal problems influence turnover intentions through psychological distress, a mediation analysis was conducted using the bootstrap method with structural equation modeling. Scores on the WIPS, K6, and Turnover Intention Scale were standardized. Then, the direct effect of workplace interpersonal problems on turnover intentions, mediating effect of workplace interpersonal problems on turnover intentions through psychological distress, and total effect calculated by combining the direct and mediating effects were calculated. The sample size for the bootstrap method was set at 2000, and 95% confidence intervals (CIs) were calculated accordingly. If the 95% CI did not include zero, the association was significant. Results were calculated for both a model in which variables for basic attributes were not controlled (model 1) and a model in which all variables for basic attributes (age, sex, education, certified care worker qualifications, workplace status, employee status, duration of service in the current job, duration of care work experience, and managerial position) were controlled (model 2). This series of validations was performed for each WIPS total score and subscale. R version 4.3.2 was used for all statistical analyses.

Table 1 summarizes the basic attributes of the study participants. The most common final education was high school (43.7%), and 77.6% of all respondents were certified care workers. The majority of the care facilities where they worked were residential services (68.1%), 91.3% were employed full-time, and 70.1% were employees without a position. The means and standard deviations, Pearson’s correlation coefficients, and ω coefficients for the basic attributes (continuous variables only) and all scale scores are summarized in Table 2. All scales used in this study showed good reliability.

The results of the mediation analysis using total scores for the WIPS are presented in Table 3. In model 1, workplace interpersonal problems had a significant positive overall effect on turnover intentions (β = 0.520 [95% CI = 0.392–0.624]). Of these, the mediating effect of workplace interpersonal problems on turnover intentions through psychological distress was significantly positive (β = 0.227 [95% CI = 0.129–0.322]). workplace interpersonal problems also had a significant positive direct effect on turnover intentions (β = 0.293 [95% CI = 0.141–0.446]). Thus, psychological distress partially mediated workplace interpersonal problems. This was also noted in model 2, which was adjusted for basic attributes (Total effect: β = 0.528 [95% CI = 0.415–0.634]; Direct effect: β = 0.336 [95% CI = 0.194–0.469]; Mediation effect: β = 0.192 [95% CI = 0.104–0.281]), and the direct effect was more influential than the mediating effect in models 1 and 2.

The results of the mediation analysis for the WIPS subscale are shown in Table 4. In model 1, all subscales showed significant positive overall effects on turnover intentions. Of these, insufficient communication (direct effect, β = 0.284; mediated effect, β = 0.229) and a sense of unfair workload (direct effect, β = 0.318; mediated effect, β = 0.205) had stronger direct effects than the mediated effects. Bullying (direct effect, β = 0.121; mediated effect, β = 0.232), difficulty in guiding subordinates/new staff (direct effect, β = 0.179; mediated effect, β = 0.227), and labeling (direct effect, β = 0.184; mediated effect, β = 0.237) had stronger mediating effects than direct effects. Different attitudes to care work (direct effect, β = 0.235; mediated effect, β = 0.232) had about the same direct and mediating effects. Comparing the results of model 2 by subscales, the strongest overall effect was noted for insufficient communication (β = 0.514), followed by a sense of unfair workload (β = 0.505), different attitudes to care work (β = 0.481), difficulty guiding subordinates/new staff (β = 0.426), bullying (β = 0.411), and labeling (β = 0.409), in that order. Insufficient communication (direct effect, 0.319; mediated effect, 0.194), a sense of unfair workload (direct effect, β = 0.314; mediated effect, β = 0.190), and different attitudes to care work (direct effect, β = 0.278; mediated effect, β = 0.204) had stronger direct effect, whereas difficulty guiding subordinates/new staff (direct effect, β = 0.207; mediated effect, β = 0.219) and labeling (direct effect, β = 0.198; mediated effect, β = 0.211) had slightly stronger mediated effect. For bullying (direct effect, β = 0.207; mediated effect, β = 0.204), the direct and mediated effects were nearly equal.

-Table 1,2,3,4. Insert།

To the best of our knowledge, this was the first cross-sectional study that examined the relationship among workplace interpersonal problems, psychological distress, and turnover intentions in elderly care workers. The results showed that workplace interpersonal problems had a significant positive overall effect on turnover intentions. This finding is consistent with previous reports that workplace relationships are associated with turnover intentions [17, 35]. In particular, a study of healthcare workers showed a negative association between workplace social capital and turnover intentions, even after controlling for work-related factors [36]. Workplace social capital includes a vertical dimension (relationship between employees and their employer or supervisor) and a horizontal dimension (social contact, cooperation, and trust among coworkers) [37] and strongly reflects interpersonal relationships in the workplace. Thus, workplace interpersonal problems are an important predictor of care workers’ intentions to leave their jobs. Conversely, the results support our hypothesis by showing that some workplace interpersonal problems have a stronger direct effect on turnover intentions, whereas others have a stronger mediating effect on turnover intentions through psychological distress. These findings suggest that different workplace interpersonal problems should be targeted for intervention to reduce turnover intentions among care workers.

First, a sense of unfair workload, insufficient communication, and different attitudes to care work had large positive direct effects on turnover intentions in models 1 and 2. Of these, a sense of unfair workload and insufficient communication had the largest effects on turnover intentions. The sense of unfair workload suggests dissatisfaction because of differences in workload among care workers, which means that supervisors cannot manage the workload properly and care workers have difficulty cooperating [17]. Satisfaction with supervisors is negatively related to the turnover intentions of care workers [38]. In addition, better leadership increases the affective organizational commitment of care workers [39], and higher affective organizational commitment lowers the turnover intentions of elderly care workers [19]. Thus, the sense of unfair workload held by individual care workers, which is related to their supervisor’s management, appears to have a direct influence on turnover intentions. Conversely, differential attitudes to care, such as conflicting goals, hinder communication [40, 41]. The different attitudes to care work, which was found to have a direct effect on turnover intentions, would result in insufficient communication. A study of nurses showed that workplace communication is a protective factor for job retention intentions [42]. Insufficient communication lowers the perception of teamwork in the workplace; however, older adult care workers were found to have higher perceptions of workplace teamwork lower turnover intentions [18]. In summary, insufficient communication can be a direct factor that increases turnover intentions among care workers. These results suggest that improving the sense of unfair workload, insufficient communication, and different attitudes to care work among workplace interpersonal problems can reduce turnover intentions of care workers and may be an effective means of securing the caregiving workforce.

Second, difficulty guiding subordinates/new staff, labeling, and bullying had large mediating effects on turnover intentions through psychological distress in model 1. In model 2, the direct and mediating effects of bullying on turnover intentions were similar; however, difficulty in guidance for subordinates/new staff and labeling exerted a significant mediating effect on turnover intentions through psychological distress. Because of the high turnover rates of care workers and the severe labor shortage in Japan [22, 43], new staff are expected to join older adult care facilities each year. In Japan, older adult care facilities allow people to enter the caregiving profession without having specialized knowledge or skills [22]. As a result, senior care workers already working there must provide fairly extensive guidance to new staff and subordinates. In addition to being busy with their daily duties, partly due to manpower shortage, care workers may feel quite overwhelmed in guiding new staff and subordinates. Labeling is a cognitive distortion in which people in the workplace are labeled negatively [17]. Cognitive distortions affect social adjustment through psychological distress such as depressive symptoms [44]. Based on these findings, negative views of workplace staff through labeling may mediate psychological distress, making workplace adjustment more difficult and increasing turnover intentions. In the model adjusted for basic attributes, bullying had equal direct and mediating effects on turnover intentions. This suggests that bullying can be a direct factor in increasing turnover intentions or a mediating factor in psychological distress leading to turn over intentions. To support this finding, a review of nursing staff reported that bullying causes psychological distress and increases the likelihood of isolation from colleagues [45]. Thus, improving workplace interpersonal problems such as difficulty guiding subordinates/new staff, labeling, and bullying is effective in preventing psychological distress among nursing staff and subsequently the intentions to leave the nursing profession. This will also help reduce turnover intentions of care workers in the long run.

This study had some limitations. First, owing to the cross-sectional design, we could not determine the causal relationship among workplace interpersonal problems, psychological distress, and turnover intentions. Second, the valid response rate was not high (31.3%), and selection bias may have affected the results of this study. Future studies should include a longitudinal investigation of a greater number of care workers in older adult care facilities.

WIPS

The Workplace Interpersonal Problems Scale for care workers

Ethics approval and consent to participate

This study was approved by the Institutional Review Board at the Tottori University Faculty of Medicine（No. 23A093). The authors confirmed that all methods were performed in accordance with the relevant guidelines. All procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments, and informed consent was also obtained online from all participants.

Consent for publication

Not applicable.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare no competing interests.

Funding

This work was supported by the Japan Society for the Promotion of Science under KAKENHI Grants 21K03106.

Authors’ contributions

ST designed the study, wrote the protocol, data collection and prepared the draft of the manuscript. Author TF conducted the statistical analysis and prepared the draft of the manuscript. All the authors read and approved the final manuscript.

Acknowledgements

We sincerely thank the research participants for taking time out to participate in this study.

Authors’ information

Department of Clinical Psychology, Tottori University Graduate School of Medical Sciences, Yonago, Japan

Shinya Takeda & Toshiki Fukuzaki

United Nations. World Population Prospects 2022: Summary of Results. 2022. https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf
Narasimhan A, Flores RR, Robbins PD, Niedernhofer LJ. Role of Cellular Senescence in Type II Diabetes. Endocrinology. 2021;162(10): bqab136.
Hou Y, Dan X, Babbar M, Wei Y, Hasselbalch SG, Croteau DL, Bohr VA. Ageing as a risk factor for neurodegenerative disease. Nat Rev Neurol. 2019;15(10):565-81.
Shakeri H, Lemmens K, Gevaert AB, De Meyer GRY, Segers VFM. Cellular senescence links aging and diabetes in cardiovascular disease. Am J Physiol Heart Circ Physiol. 2018. 315(3):H448-62.
Ortiz A, Mattace-Raso F, Soler MJ, Fouque D. Ageing meets kidney disease. Nephrol Dial Transplant. 2023. 38(3); 523-6.
Ministry of Health, Labour and Welfare. Monthly Report of Actual Statistics on Nursing Care Benefit Expenses. (Examinations in January 2023). 2023．https://www.mhlw.go.jp/toukei/saikin/hw/kaigo/kyufu/2023/01.html
Ministry of Internal Affairs and Communications. Population Estimates Monthly Report（Fixed value in January 2023）.2023. https://www.stat.go.jp/data/jinsui/2.html
OECD. Who cares? Attracting and retaining care workers for the elderly. OECED Health Policy Studies. Paris: OECD Publishing; 2020.
de Ruiter HP, Clisbee D, Houston R, Skärsäter I. Impacts resulting from introduction of digital communication and surveillance technologies in the home setting: Qualitative Inductive Study. JMIR Hum Factors. 2023;10:e47586.
Sköldunger A, Sandman PO, Backman A. Exploring person-centred care in relation to resource utilization, resident quality of lifeand staff job strain–findings from the SWENIS study. BMC Geriatr. 2020;20(1):465.
Bridger RS, Day AJ, Morton K. Occupational stress and employee turnover.Ergonomics. 2013;56(11):1629-39.
van der Heijden BIJM, van Dam K, Hasselhorn HM. Intention to leave nursing. Career Dev Int. 2009;7:616-35.
Firth L, Mellor DJ, Moore KA, Loquet C. How can managers reduce employee intentions to quit? Journal of Managerial Psychology. 2004; 19(2): 170-87.
Karantzas GC, Mellor D, McCabe MP, Davison TE, Beaton P, Mrkic D. Intentions to quit work among care staff working in the aged care sector. Gerontologist. 2012 ;52(4):506-16.
Masum AK, Azad MA, Hoque KE, Beh LS, Wanke P, Arslan Ö. Job satisfaction and intention to quit: an empirical analysis of nurses in Turkey. PeerJ. 2016 ;4:e1896.
Blackstock S, Harlos K, Macleod ML, Hardy CL. The impact of organisational factors on horizontal bullying and turnover intentions in the nursing workplace. J Nurs Manag. 2015; 23(8),1106-14.
Takeda S, Fukuzaki T. Relationship between turnover intention and workplace personal relations among care workers employed by elder care facilities. Psychogeriatrics. 2023; 23(1): 86-93.
Piers RD, Versluys K, Devoghel J, Vyt A, Van Den Noortgate N. Interprofessional teamwork, quality of care and turnover intention in geriatric care: A cross-sectional study in 55 acute geriatric units. Int J Nurs Stud. 2019; 91, 94-100.
Gaudenz C, Geest SD, Schwendimann R, Zúñiga F. Factors associated with care workers' intention to leave employment in nursing homes: A secondary data analysis of the Swiss Nursing Homes Human Resources Project. J Appl Gerontol. 2019; 38: 1537-63.
Zhang Z, Wang S, Miao C, Su M, Chen T, Yao N. Substantial Differences in Turnover Intention Between Direct Care Workers in Chinese Hospitals and Long-Term Care Facilities. J Am Med Dir Assoc. 2021; 22: 696-700.
Nei D, Snyder LA, Litwiller BJ.Promoting retention of nurses: A meta-analytic examination of causes of nurse turnover. Health Care Manage Rev. 2015;40(3):237-53.
Takeda S. Factors related to turnover and intention to leave the care working profession in Japan: A review. Yonago Acta Med. 2023; 66: 196-201.
Otto AK, Gutsch C, Bischoff LL, Wollesen B. Interventions to promote physical and mental health of nurses in elderly care: A systematic review. Prev Med. 2021;148:106591.
Baillon S, Scothern G, Neville PG, Boyle A. Factors that contribute to stress in care staff in residential homes for the elderly. Int J Geriatr Psychiatry. 1996; 11(3): 219-26.
Ayalon L. Subjective socioeconomic status as a predictor of long-term care staff burnout and positive caregiving experiences. Int Psychogeriatr. 2008; 20(3): 521-37
Low YS, Bhar S, Chen WS. Exploring the relationship between co-worker and supervisor support, self- confidence, coping skills and burnout in residential aged care staff. BMC Nurs. 2022; 21(1): 135.
Takeda S, Fukuzaki T. Association between workplace interpersonal relationships and psychological distress among care workers at elder care facilities. Psychogeriatrics. 2024, DOI: 10.1111/psyg.13130
Maharaj S, Lees T, Lal S. Prevalence and risk factors of depression, anxiety, and stress in a cohort of Australian nurses. Int J Environ Res Public Health. 2018;16(1): 61.
Castle N, Engberg J, Anderson R, Men A. Job satisfaction of nurse aides in nursing homes: Intent to leave and turnover. The Gerontologist. 2007; 47(2):193-204.
Takeda S, Fukuzaki T. Development of the Workplace Interpersonal Problems Scale for Care Workers (WIPS) and examination of its reliability and validity. Heliyon. 2023; 9(9): e20156.
Furukawa TA, Kawakami N, Saitoh M, Ono Y, Nakane Y, Nakamura Y, Tachimori H, Iwata N, Uda H, Nakane H, Watanabe M, Naganuma Y, Hata Y, Kobayashi M, Miyake Y, Takeshima T, Kikkawa T. The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey Japan. Int J Methods Psychiatr Res. 2008; 17(3): 152-8.
Geurts S, Schaufeli W, De Jonge J. Burnout and intention to leave among mental health-care professionals: A social psychological approach. Journal of Social and Clinical Psychology. 1998; 17(3): 341-62.
Tsuno K, Kawachi I, Kawakami N, Miyashita K. Workplace bullying and psychological distress: a longitudinal multilevel analysis among Japanese employees. Journal of occupational and environmental medicine. 2018; 60(12): 1067-72.
Sakakibara K, Shimazu A, Toyama H, Schaufeli WB. Validation of the Japanese version of the burnout assessment tool. Front Psychol. 2020; 11: 1819.
Zhang H, Sun L, & Zhang Q. How workplace social capital affects turnover intention: The mediating role of job satisfaction and burnout. Int J Environ Res Public Health. 2022; 19(15): 9587.
Iida M, Watanabe K, Ando E, Tsuno K, Inoue A, Kurioka S, Kawakami N. The association between unit-level workplace social capital and intention to leave among employees in health care settings: A cross-sectional multilevel study. J Occup Environ Med. 2020; 62(5): e186-91.
Oksanen T, Kouvonen A, Vahtera J, Virtanen M, Kivimäki M. Prospective study of workplace social capital and depression: are vertical and horizontal components equally important? J Epidemiol Commun Health. 2010;64(8):684-9.
Elstad JI, Vabø M. Lack of recognition at the societal level heightens turnover considerations among Nordic eldercare workers: a quantitative analysis of survey data. BMC Health Serv Res. 2021;21(1):747.
Graf E, Cignacco E, Zimmermann K, Zúñiga F. Affective Organizational Commitment in Swiss Nursing Homes: A Cross-Sectional Study. Gerontologist. 2016; 56(6): 1124137.
Siddiqui S, Zhang WW, Platzbecker K, Douglas MJ, Rock LK, Eikermann M. Ethical, legal, and communication challenges in managing goals-of-care discussions in chronically critically ill patients. J Crit Care. 2021; 63: 231-7.
Sisk BA, Schulz G, Kaye EC, Baker JN, Mack JW, DuBois JM. Conflicting Goals and Obligations: Tensions Affecting Communication in Pediatric Oncology Patient Educ Couns. 2022 ;105(1):56-61.
Van Bogaert P, Peremans L, Van Heusden D, Verspuy M, Kureckova V, Van de Cruys Z, Franck E. Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study. BMC Nurs. 2017; 16: 5.
Hirata H, Harvath TA. The relationship between exposure to dementia-related aggressive behavior and occupational stress among Japanese care workers. J Gerontol Nurs. 2015; 41(4): 38-46.
Ota M, Takeda S, Pu S, Matsumura H, Araki T, Hosoda N, Yamamoto Y, Sakakihara A, Kaneko K. The relationship between cognitive distortion, depressive symptoms, and social adaptation: A survey in Japan. J Affect Disord. 2020; 265: 453-9.
Wilson JL. An exploration of bullying behaviours in nursing: a review of the literature. Br J Nurs. 2016;25(6):303-6.

Tables 1-4 are available in the Supplementary Files section.

No competing interests reported.

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Workplace interpersonal relationships and turnover intentions among care workers in older adult care facilities: a mediation analysis comparing direct and mediated effects via psychological distress

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Abstract

Background

Methods

Results

Conclusions

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Introduction

Methods

Participants

Measures

Workplace Interpersonal Problems

Psychological distress

Turnover intentions

Basic attributes

Statistical analysis

Results

Discussions

Conclusions

Abbreviations

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

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