Psychosocial work environment and cross-cultural competence among native and foreign-born registered nurses
Corresponding Author
Karolina Wesołowska PhD
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Correspondence Karolina Wesołowska, Department of Social and Health Systems Research, National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland.
Email: [email protected]
Search for more papers by this authorMarko Elovainio PhD
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
Search for more papers by this authorKia Gluschkoff PhD
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
Search for more papers by this authorLaura Hietapakka MSSc
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Search for more papers by this authorAnu-Marja Kaihlanen MNSc
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Search for more papers by this authorSalla Lehtoaro MPH
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Search for more papers by this authorTarja Heponiemi PhD
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Search for more papers by this authorCorresponding Author
Karolina Wesołowska PhD
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Correspondence Karolina Wesołowska, Department of Social and Health Systems Research, National Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland.
Email: [email protected]
Search for more papers by this authorMarko Elovainio PhD
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
Search for more papers by this authorKia Gluschkoff PhD
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
Search for more papers by this authorLaura Hietapakka MSSc
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Search for more papers by this authorAnu-Marja Kaihlanen MNSc
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Search for more papers by this authorSalla Lehtoaro MPH
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Search for more papers by this authorTarja Heponiemi PhD
Department of Social and Health Systems Research, National Institute for Health and Welfare, Helsinki, Finland
Search for more papers by this authorAbstract
Cross-cultural competence is an essential component of the nursing profession, but little is known about the specific psychosocial work characteristics that potentially promote or hinder such competence. In the present study, psychosocial work characteristics were based on Karasek's Job Demand—Control Model. The researchers examined whether Karasek's psychosocial work characteristics, such as high-strain jobs, high-strain isolated jobs, active jobs, and active collective jobs, are associated with cross-cultural competence (empathy, skills, positive attitudes, and motivation), and whether there are differences between native and foreign-born registered nurses (RN) in these potential associations. A random sample of 744 native RNs (91.0% women) and a total sample (n = 212) of foreign-born RNs (94.3% women) working in Finland were used. Data were collected using a questionnaire and analyzed with a series of multiple linear regression analyses. High-strain and high-strain isolated jobs were negatively associated with all four dimensions of cross-cultural competence. Active collective jobs, but not active jobs, were positively associated with cross-cultural skills. There were no differences between native and migrant nurses in these associations. The psychosocial work environment is associated with cross-cultural competence in both native and migrant nurses. Improvements in psychosocial working conditions, especially minimizing negative factors in the work environment, such as high-strain and high-strain isolated jobs, may need to be considered as a part of the efforts aimed to enhance cross-cultural competence among nursing personnel.
CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.
Supporting Information
Filename | Description |
---|---|
nur21970-sup-0001-Supplemental_material.docx20.8 KB | Supporting information |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- Aalto, A.-M., Heponiemi, T., Keskimaki, I., Kuusio, H., Hietapakka, L., Lamsa, R., … Elovainio, M. (2014). Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care. European Journal of Public Health, 24(3), 45–451. https://doi.org/10.1093/eurpub/cku021
- Aalto, A.-M., Heponiemi, T., Vaananen, A., Bergbom, B., Sinervo, T., & Elovainio, M. (2014). Is working in culturally diverse working environment associated with physicians’ work-related well-being? A cross-sectional survey study among Finnish physicians. Health Policy, 117(2), 187–194. https://doi.org/10.1016/j.healthpol.2014.02.006
- Ahrweiler, F., Neumann, M., Goldblatt, H., Hahn, E. G., & Scheffer, C. (2014). Determinants of physician empathy during medical education: Hypothetical conclusions from an exploratory qualitative survey of practicing physicians. BMC Medical Education, 14, 122. https://doi.org/10.1186/1472-6920-14-122
- Ailasmaa, R. (2015). Terveys-ja sosiaalipalveluiden henkiloston kansainvalinen liikkuvuus 2012 [International mobility of health care and social welfare personnel 2012]. Retrieved from http://urn.fi/URN:NBN:fi-fe2015060810052
- Amick, B. C., III, Kawachi, I., Coakley, E. H., Lerner, D., Levine, S., & Colditz, G. A. (1998). Relationship of job strain and iso-strain to health status in a cohort of women in the United States. Scandinavian Journal of Work, Environment and Health, 24(1), 54–61. https://doi.org/10.5271/sjweh.278
- Azur, M. J., Stuart, E. A., Frangakis, C., & Leaf, P. J. (2011). Multiple imputation by chained equations: What is it and how does it work? International Journal of Methods in Psychiatric Research, 20(1), 40–49. https://doi.org/10.1002/mpr.329
- Baumann, A. (2009). Positive practice environments: Quality workplaces = quality patient care. Information and action tool kit. Retrieved from https://www.twna.org.tw/frontend/un16_commission/webPages_4/IND/1.pdf
- Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of Royal Statistical Society, 57(1), 289–300.
10.1111/j.2517-6161.1995.tb02031.x Google Scholar
- Bernhard, G., Knibbe, R. A., von Wolff, A., Dingyan, D., Schulz, H., & Mosko, M. (2015). Development and psychometric evaluation of an instrument to assess cross-cultural competence of health care professionals (CCCHP). PLOS One, 10(12), e0144049. https://doi.org/10.1371/journal.pone.0144049
- Brunetto, Y., Xerri, M., Trinchero, E., Beattie, R., Shacklock, K., Farr-Wharton, R., & Borgonovi, E. (2017). Comparing the impact of management on public and private sector nurses in the UK, Italy, and Australia. Public Management Review, 20(4), 525–544. https://doi.org/10.1080/14719037.2017.1309100
- Brzoska, P. (2018). Disparities in health care outcomes between immigrants and the majority population in Germany: A trend analysis, 2006–2014. PLOS One, 13(1), e0191732. https://doi.org/10.1371/journal.pone.0191732
- Campbell, J., Dussault, G., Buchan, J., Pozo-Martin, F., Guerra Arias, M., Leone, C., … Cometto, G. (2013). A universal truth: No health without a workforce. Retrieved from https://www.who.int/workforcealliance/knowledge/resources/GHWA_AUniversalTruthReport.pdf
- Chen, P. G., Curry, L. A., Bernheim, S. M., Berg, D., Gozu, A., & Nunez-Smith, M. (2011). Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training. Academic Medicine, 86(11), 1383–1388. https://doi.org/10.1097/ACM.0b013e31823035e1
- Choi, S. Y., & Kim, K. S. (2014). The effects of work characteristics, supervision, and cultural competence on nurses’ burnout. International Journal of Bio-Science and Bio-Technology, 6(4), 187–200. https://doi.org/10.14257/ijbsbt.2014.6.4.18
- Crutcher, R. A., Szafran, O., Wolochuk, W., Chatur, F., & Hansen, C. (2011). Family medicine graduates’ perceptions of intimidation, harassment, and discrimination during residency training. BMC Medical Education, 11(8), https://doi.org/10.1186/1472-6920-11-88
- Cuellar, N. G., Brennan, A. M., Vito, K., & de Leon Siantz, M. L. (2008). Cultural competence in the undergraduate nursing curriculum. Journal of Professional Nursing, 24(3), 143–149. https://doi.org/10.1016/j.profnurs.2008.01.004
- De Witte, H., Verhofstadt, E., & Omey, E. (2007). Testing Karasek's learning and strain hypotheses on young workers in their first job. Work & Stress, 21(2), 131–141. https://doi.org/10.1080/02678370701405866
- Ding, L., Landon, B. E., Wilson, I. B., Wong, M. D., Shapiro, M. F., & Cleary, P. D. (2005). Predictors and consequences of negative physician attitudes towards HIV-infected injection drug users. Archives of Internal Medicine, 165(6), 618–823. https://doi.org/10.1001/archinte.165.6.618
- Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., … Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), 109–121. https://doi.org/10.1177/1043659614520998
- Eneroth, M., Gustafsson Senden, M., Schenck Gustafsson, K., Wall, M., & Fridner, A. (2017). Threats or violence rom patients was associated with turnover intention among foreign-born GPs—A comparison of four workplace factors associated with attitudes of wanting to quit one's job as GP. Scandinavian Journal of Primary Health Care, 35(2), 208–213. https://doi.org/10.1080/02813432.2017.1333319
- Fichman, M. (1999). Variance explained: Why size does not (always) matter. In R. I. Sutton, & B. M. Staw (Eds.), Research in organizational behavior ( 1st ed, pp. 295–331). Stamford, Connecticut: JAI Press.
- Fiscella, K., & Sanders, M. R. (2016). Racial and ethnic disparities in the quality of health care. Annual Review of Public Health, 37, 375–394. https://doi.org/10.1146/annurev-publhealth-032315-021439
- La Fleur, C. G., & Salthouse, T. A. (2017). Which aspects of social support are associated with which cognitive abilities for which people? Journal of Gerontology, 72(6), 1006–1016. https://doi.org/10.1093/geronb/gbv119
- Gluschkoff, K., Elovainio, M., Keltikangas-Jarvinen, L., Hintsanen, M., Mullola, S., & Hintsa, T. (2016). Stressful psychosocial work environment, poor sleep, and depressive symptoms among primary school teachers. Electronic Journal of Research in Educational Psychology, 14(3), 462–481. https://doi.org/10.14204/ejrep.40.16067
- Harris, P. (1989). The Nurse Stress Index. Work and Stress, 3(4), 335–346.
- Hausser, J. A., Schulz-Hardt, S., & Mojzisch, A. (2014). The active learning hypothesis of the job-demand-control model: An experimental examination. Ergonomics, 57(1), 23–33. https://doi.org/10.1080/00140139.2013.854929
- Hietapakka, L., Elovainio, M., Wesołowska, K., Aalto, A.-M., Kaihlanen, A.-M., Sinervo, T., & Heponiemi, T. (2019). Testing the psychometric properties of the Finnish version of the Cross-Cultural Competence instrument of Healthcare Professionals (CCCHP). BMC Health Services Research, 19(1), https://doi.org/10.1186/s12913-019-4105-2.
- Hintsanen, M., Kivimaki, M., Elovainio, M., Pulkki-Raback, L., Keskivaara, P., Juonana, M., … Keltikangas-Jarvinen, L. (2005). Job strain and early atherosclerosis: The cardiovascular risk in Young Finns study. Psychosomatic Medicine, 67(5), 740–747. https://doi.org/10.1097/01.psy.0000181271.04169.93
- Holman, D. J., & Wall, T. D. (2002). Work characteristics, learning-related outcomes, and strain: A test of competing direct effects, mediated, and moderated models. Journal of Occupational Health Psychology, 7(4), 283–301. https://doi.org/10.1037/1076-8998.7.4.283
- Jeung, D. Y., Kim, C., & Chang, S. J. (2018). Emotional labor and burnout: A review of the literature. Yonsei Medical Journal, 59(2), 187–193. https://doi.org/10.3349/ymj.2018.59.2.187
- Johnson, J. V., & Hall, E. M. (1988). Job strain, work place social support, and cardiovascular disease: A cross-sectional study of a random sample of the Swedish working population. American Journal of Public Health, 78(10), 1336–1342. https://doi.org/10.2105/AJPH.78.10.1336
- Kaihlanen, A.-M., Hietapakka, L., Aalto, A.-M., Lehtoaro, S., & Heponiemi, T. (2019). Sosiaali- ja terveydenhuollon ammattilaisten kulttuurinen kompetenssi ja siihen yhteydessä olevat tekijät [Cultural competence of health and social care professionals and associated factors]. Manuscript submitted for publication.
- Karasek, R. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24(2), 285–308. https://doi.org/10.2307/2392498
- Karasek, R. (1985). Job Content Instrument: Questionnaire and user's guide. Los Angeles, CA and Lowel, MA: Department of Industrial and Systems Engineering, University of Southern California.
- Karasek, R., & Theorell, T. (1990). Healthy work: Stress, productivity, and the reconstruction of working life. New York, NY: Basic Books.
- Kivimaki, M., & Lindstrom, K. (1992). Tyostressi ja hyvinvointi hoitoalalla: Kyselylomakkeen kehittely [Work stress in nursing: Development of a survey instrument]. Hoitotiede/Nursing Science, 4, 115–124.
- Kivimaki, M., Nyberg, S. T., Batty, G. D., Fransson, E. I., Heikkila, K., Alfredsson, L., … Theorell, T. (2012). Job strain as a risk factor for coronary heart disease: A collaborative meta-analysis of individual participant data. Lancet, 380(9852), 1491–1497. https://doi.org/10.1016/S0140-6736(12)60994-5
- Landsbergis, P. A., Schnall, P. L., Warren, K., Pickering, T. G., & Schwartz, J. E. (1994). Association between ambulatory blood pressure and alternative formulations of job strain. Scandinavian Journal of Work, Environment and Health, 20(5), 349–363. https://doi.org/10.5271/sjweh.1386
- Lindstrom, K., Elo, A.-L., Skogstad, A., Dallner, A., Gamberale, F., Hottinen, V., … Orhede, E. (2000). User's guide for the QPSNordic, General Nordic Questionnaire for Psychological and Social Factors at Work. Copenhagen, Denmark: Nordic Council of Ministers.
- MacCallum, R. C., Zhang, S., Preacher, K. J., & Rucker, D. D. (2002). On the practice of dichotomization of quantitative variables. Psychological Methods, 7(1), 19–40. https://doi.org/10.1037/1082-989X.7.1.19
- Martin, P., Salanova, M., & Peiro, J. M. (2007). Job demands, job resources and individual innovation at work: Going beyond Karasek's model? Psicothema, 19(4), 621–626.
- Mather, L., Bergstrom, G., Blom, V., & Svedberg, P. (2015). High job demands, job strain, and iso-strain are risk factors for sick leave due to mental disorders. Journal of Occupational and Environmental Medicine, 57(8), 858–865. https://doi.org/10.1097/JOM.0000000000000504
- Mick, S. S., Lee, S.-Y. D., & Wodchis, W. P. (2000). Variations in geographical distribution of foreign and domestically trained physicians in the United States: ‘Safety nets’ or ‘surplus exaerbation’. Social Science &. Medicine, 50(2), 185–202. https://doi.org/10.1016/S0277-9536(99)00183-5
- Mikkola, L., Suutala, E., & Parviainen, H. (2018). Social support in the workplace for physicians in specialization training. Medical Education Online, 23(1), 1435114. https://doi.org/10.1080/10872981.2018.1435114
- Montgomery, A., Spanu, F., Baban, A., & Panagopoulou, E. (2015). Job demands, burnout, and engagement among nurses: A multi-level analysis of ORCAB data investigating the moderating effect of teamwork. Burnout Research, 2(2–3), 71–79. https://doi.org/10.1016/j.burn.2015.06.001
- Niks, I., de Jonge, J., Gevers, J., & Houtman, I. (2018). Work stress interventions in hospital care: Effectiveness of the DISCovery method. International Journal of Environmental Research and Public Health, 15(2), 332. https://doi.org/10.3390/ijerph15020332
- Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2016). Communication barriers perceived by nurses and patients. Global Journal of Health Science, 8(6), 65–74. https://doi.org/10.5539/gjhs.v8n6p65
10.5539/gjhs.v8n6p65 Google Scholar
- Papathanasiou, I. V., Fradelos, E. C., Kleisiaris, C. F., Tsaras, K., Kalota, M. A., & Kourkouta, L. (2014). Motivation, leadership, empowerment and confidence: Their relation with nurses’ burnout. Materia Socio-Medica, 26(6), 405–410. https://doi.org/10.5455/msm.2014.26.405-410
- Penner, L. A., Blair, I. V., Albrecht, T. L., & Dovidio, J. F. (2014). Reducing racial health care disparities: A social psychological analysis. Policy Insights from the Behavioral and Brain Sciences, 1(1), 204–212. https://doi.org/10.1177/2372732214548430
- Priebe, S., Sandhu, S., Dias, S., Gaddini, A., Greacen, T., Ioannidis, E., … Bogin, M. (2011). Good practice in health care for migrants: Views and experiences of care professionals in 16 European countries. BMC Public Health, 11, 187. https://doi.org/10.1186/1471-2458-11-187
- Proost, K., De Witte, H., De Witte, K., & Evers, G. (2004). Burnout mong nurses: Extending the job demand-control-support model with work-home interference. Psychologica Belgica, 44(4), 269–288. https://doi.org/10.5334/pb-44-4-269
- Repo, H., Vahlberg, T., Salminen, L., Papadopoulos, I., & Leino-Kilpi, H. (2017). The cultural competence of graduating nursing students. Journal of Transcultural Nursing, 28(1), 98–107. https://doi.org/10.1177/1043659616632046
- Sargent, L. D., & Terry, D. J. (2010). The moderating role of social support in Karasek's job strain model. Work and Stress, 14(3), 245–261. https://doi.org/10.1080/02678370010025568
- Schilgen, B., Nienhaus, A., Handtke, O., Schulz, H., & Mosko, M. (2017). Health situation of migrant and minority nurses: A systematic review. PLOS One, 12(6), e0179183. https://doi.org/10.1371/journal.pone.0179183
- Stansfeld, S., & Candy, B. (2006). Psychosocial work environment and mental health—A meta-analytic review. Scandinavian Journal of Work, Environment and Health, 32(6), 443–462. https://doi.org/10.5271/sjweh.1050
- Taris, T. W., & Feij, J. A. (2004). Learning and strain among newcomers: A three-wave study on the effects of job demands and job control. Journal of Psychology, 138(6), 543–563. https://doi.org/10.3200/JRLP.138.6.543-563
- Taris, T. W., & Kompier, M. A. J. (2006). Job characteristics and learning behavior: Review and psychological mechanisms. In P. Perrewe, & D. Ganster (Eds.), Research in occupational stress and well-being: Vol. 4. Exploring interpersonal dynamics (pp. 127–166). US: Elsevier Science/JAI Press.
- Theorell, T. (2003). To be able to exert control over one's own situation: A necessary condition for coping with stressors. In J. C. Quick, & L. E. Tetrick (Eds.), Handbook of occupational health psychology (pp. 201–219). Washington, DC, US: American Psychological Association. https://doi.org/10.1037/10474-010
10.1037/10474-010 Google Scholar
- Theorell, T., Hammarstrom, A., Aronsson, G., Traskman Bendz, L., Grape, T., Hogstedt, C., … Hall, C. (2015). A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health, 15, 738. https://doi.org/10.1186/s12889-015-1954-4
- Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in health care: A systematic review of reviews. BMC Health Services Research, 14, 99. https://doi.org/10.1186/1472-6963-14-99
- United Nations. (2017). International migration report 2017: Highlights (ST/ESA/SER.A/404). Retrieved from http://www.un.org/en/development/desa/population/migration/publications/migrationreport/docs/MigrationReport2017_Highlights.pdf
- Wazqar, D. Y., Kerr, M., Regan, S., & Orchard, C. (2017). An integrative review of the influence of job strain and coping on nurses’ work performance: Understanding the gaps in oncology nursing research. International Journal of Nursing Sciences, 4(4), 418–429. https://doi.org/10.1016/j.ijnss.2017.09.003
- Wesołowska, K., Hietapakka, L., Elovainio, M., Aalto, A.-M., Kaihlanen, A.-M., & Heponiemi, T. (2018). The association between cross-cultural competence and well-being among registered native and foreign-born nurses in Finland. PLOS One, 13(12), e0208761. https://doi.org/10.1371/journal.pone.0208761