Study population
This study was conducted in five affiliated hospitals of Xinjiang medical university, China (i.e., the first affiliated hospital, the third affiliated hospital, the fourth affiliated hospital, the fifth affiliated hospital and the sixth affiliated hospital). Consent was obtained after communication with each hospital prior to the investigation. The survey was carried out from May 2019 to September 2019. All surgical nurses from the five affiliated hospitals were investigated in this study. Surgery mainly included cardiothoracic surgery, neurosurgery, hepatobiliary surgery, urology surgery, anorectal surgery, burn surgery, breast surgery, pediatric surgery, plastic surgery, orthopedics, and hand surgery, which amounted to a total of 11 departments, and each department employed an average of 10–15 nurses. Using the cluster random sampling method, 10 nurses were randomly selected from each department for investigation. A list of personnel from each department was obtained from the chief nurse of each department, and according to the list, the research objects were randomly selected. The inclusion criteria consisted in the following: (1) age: 18–60; (2) continuous working time ≥ 0.5 years; and (3) registered nurse of clinical practice. A total of 550 questionnaires were distributed, and 532 questionnaires were retrieved. Thereafter, 488 valid questionnaires were finally retrieved, with an effective recovery rate of 88.73%. The research design was approved by the ethics committee of Xinjiang medical university, and all respondents provided their voluntary written informed consent before the investigation.
Research methods
A questionnaire (detailed below) was used to investigate the status of occupational stress, job burnout and quality of life.
General investigation
This section discusses general demographic characteristics such as sex, age, working years, educational level, marital status, professional title, night shift frequency, smoking and dringking.
Occupational stress investigation
The Effort - Reward Imbalance questionnaire (ERI) was used to evaluate the level of occupational stress among the participants in this study. This questionnaire was formulated by German Siegrist in 1996[26,27]. It was developed under the model of imbalance between pay and remuneration, and consisted of three parts: effort, reward (including salary, respect, career stability and promotion prospect) and internal input, and consists in a total of 23 items. The Chinese version of the ERI scale was introduced by the domestic scholar Li Jian in 2004. The reliability and validity of the Chinese version of the ERI scale were tested with the staff from Zhengzhou hospital in China, as a sample cohort. After data analysis, the results showed that the alpha coefficient of the effort scale was 0.78, the alpha coefficient of the reward scale was 0.81, and the alpha coefficient of the internal input scale was 0.74, which showed good reliability[28]. Li Xiuyang et al[29]. also believe that the Chinese version of the ERI scale has better reliability and validity in China. The first six items in the ERI scale measure "effort", the middle 11 items measure "reward", and the last six items measure "internal input". The calculation formula of the ERI ratio was as follows: The score for "effort" /(score for "reward" × C), where C is the ratio of the number of "effort" items to the number of "reward" items, i.e., 6/11. If the ERI ratio was > 1, it was considered to be the winner with high effort and low reward (i.e., high occupational stress); if the ERI ratio was ≤ l, it was the winner without high effort and low reward(i.e., low occupational stress)[30].
Job burnout investigation
The Chinese Maslach Burnout Inventory General Survey (MBI-GS) was used to measure the burnout level among the respondents in this study. The MBI-GSwas revised by Maslach and Jackson in 1996 on the basis of the original MBI scale[]31. The Chinese version of the MBI-GS was translated and revised by domestic scholars, Li Yongxin et al., according to domestic language and cultural habits[32,33]. Li Fuye et al. showed that the reliability, validity and other measurement indicators of the questionnaire were good and satisfied the requirements of psychological measurement[34,35]. The Chinese version of the MBI-GS includes three factors, namely, “emotional exhaustion”, “depersonalization” and “lower personal satisfaction”, and consists in a total of 15 entries, i.e., five items for “emotional exhaustion”, four items for “depersonalization” and six items for “lower personal satisfaction”. The questionnaire was scored according to seven levels which ranged from 1–7, with "1" representing "completely consistent" and "7" representing "completely inconsistent". The study referred to the grading standard of Ye Zhihong et al[36]. on the critical value of job burnout (exhaustion score ≥ 25, depersonalization score ≥ 11, and lower personal satisfaction score ≥16) among nurses. The method Li Yongxin[33] was used to classify job burnout into four levels: Zero burnout (respondents scored below the critical value on three factors of the MBI-BS); mild burnout (respondents scored at or above a critical value on one factor of the MBI-GS); moderate burnout (the respondents' scores on two factors of the MBI-GS were equal to or above the critical value); and high burnout (the respondents' scores on three factors of the MBI-GS were equal to or above the critical value).
Quality of life investigation
The Chinese version of the 36-item Short Form Health Survey (SF-36) was adopted[37,38]. The Chinese version of sf-36 was translated and revised repeatedly by domestic scholars such as Li Lu[39], and its performance was tested. The study found that the alpha coefficients of the eight subscales in the Chinese version ranged from 0.78 (general health perceptions) to 0.94 (physical function), reflecting the acceptable internal stability of the Chinese version and suggesting that the Chinese version of SF-36 had good reliability and validity[40]. The scale included 36 items, divided into eight dimensions consisting in physical functioning (PF), role limitations due to physical health (RP), bodily pain (BP), general health perceptions (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), mental health (MH), where each dimension includes several problems. Among them, the first four dimensions were divided into physiological health, and those that followed were classified into four dimensions of psychological health. The conversion formula for the score of each dimension is: the conversion score = (actual score - the lowest possible score of this dimension)/(the highest possible score of this dimension - the lowest possible score of this dimension) ×100, the score of each dimension was 0–100 points. The mean of the sum of the scores of the eight dimensions was taken as the comprehensive score. The higher the score, the less the level of harm and the better the quality of life[37].
Quality Control
Before a formal investigation, a trial investigation should be organized to further modify and improve the questionnaire and accumulate experience in field investigation and organization. Make the investigator familiar with the investigation content through the preliminary investigation, and ensure that the investigated personnel can fill in the questionnaire accurately and completely. Survey implementation stage: The questionnaire was distributed to the nurses who participated in the survey by the trained investigator. The purpose and content of the study were explained to the participants, and the questionnaire was filled out with on-site guidance. The participants will be filled in anonymously to ensure that the questionnaire is only used for this study and to protect the participant privacy. Data recovery and entry: The collected questionnaires were reviewed, and questionnaires which failed to comply with the inclusion requirements were excluded. Questionnaires for which greater than 5% of items were missing were also excluded. The remaining completed questionnaires were coded and sorted, and the questionnaire results were entered into the database in pairs to ensure the accuracy of the data.
Statistical methods
SPSS for Windows v.22.0 software (SPSS Inc., Chicago, IL, USA) was used for data processing and statistical analysis. All measurement data were used for statistical description. The comparison between the two groups of means was conducted with the t-test of two independent samples. The comparison between the three groups and the means of more than three groups was conducted with one-way analysis of variance. Correlation analysis: Pearson correlation was used to analyze the correlation between occupational stress and job burnout of surgical nurses. Multivariate analysis: multiple linear regression analysis was used to analyze the impact of occupational stress and job burnout on the quality of life of surgical nurses, and the interaction between occupational stress and job burnout on the quality of life. The relationship between occupational stress, job burnout and quality of life of surgical nurses was analyzed by Amos 22.0 software, and the optimal structural equation model was fitted. The significance level was α = 0.05.