PERCEIVED PSYCHOSOCIAL WORK ENVIRONMENTAL 

FACTORS AND PERCEIVED STRESS OF PSYCHIATRIC 

NURSES IN AN IN-PATIENT CARE HOSPITAL 

 

 

 

TAKALANI JEFFREY 

MASHADZHA 

 

 

 

 

 

 

 

A research report submitted to the Faculty of Health Science 

University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements 

for the degree of 

 a Master of Science in Nursing. 

 

 

 

 

 

 

 

 

 

 

 

 

Johannesburg 2021



 
 

ii 
 

 

DECLARATION 

 

I, Takalani Jeffrey Mashadzha, declare that this research report is my own, unaided 

work. It is being submitted for the degree of Master of Science in Nursing at the 

University of the Witwatersrand, Johannesburg. It has not been submitted before for 

any degree or examination at any other University.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                07 July 2021 

Signature                                           Signed  

 

 

 

 

 

 



 
 

iii 
 

 

DEDICATION 

 

 

This research study is dedicated to the following: 

To my family: Phuluso Mashadzha Rhinah Mashadzha Eddie Mashadzha & Julia 

Maluleke. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 
 

iv 
 

 

 

ACKNOWLEDGEMENTS 

 

My appreciation and sincere thanks to the following people who supported me 

throughout: My family members: Phuluso, Rhinah, Evidence, Julia and Eddie. 

My supervisors, Dr. Nokuthula Nkosi-Mafutha and Ms. Agnes Huiskamp for their 

guidance and support. 

My friends: Mapaseka, Tsholofelo and Mhleli 

The TARA H. MOROSS CENTRE nursing team for their support and encouragement. 

Thank you very much. 

The hospital’s research committee and the Chief Executive Officer for granting me 

permission to do research. 

The nursing team of the identified hospital who took part in the study. 

The Human Research Ethics Committee of the University of the Witwatersrand for 

their support. 

Above all, I thank God for His blessings. 



 

v 

 

TABLE OF CONTENTS 

 

DECLARATION ......................................................................................................................................... ii 

DEDICATION .......................................................................................................................................... iii 

ACKNOWLEDGEMENTS ......................................................................................................................... iv 

TABLE OF CONTENTS .............................................................................................................................. v 

NOMENCLATURE ................................................................................................................................. viii 

LIST OF FIGURES .................................................................................................................................... ix 

LIST OF TABLES ....................................................................................................................................... x 

LIST OF ANNEXURES .............................................................................................................................. xi 

CHAPTER ONE ......................................................................................................................................... 1 

OVERVIEW OF THE STUDY ..................................................................................................................... 1 

1.1 INTRODUCTION ........................................................................................................................ 1 

1.2 BACKGROUND .......................................................................................................................... 1 

1.3 MOTIVATION AND RATIONALE FOR THE STUDY ............................................................ 5 

1.4 SIGNIFICANCE OF THE STUDY .............................................................................................. 5 

1.5 PROBLEM STATEMENT ........................................................................................................... 5 

1.6 RESEARCH QUESTION ............................................................................................................. 6 

1.7 PURPOSE OF THE STUDY ........................................................................................................ 6 

1.8 RESEARCH OBJECTIVES ......................................................................................................... 6 

1.9 RESEARCH DESIGN AND METHOD ...................................................................................... 6 

1.10 OPERATIONAL DEFINITIONS ............................................................................................... 7 

1.11 VARIABLES OF THE STUDY ................................................................................................. 8 

1.12 OUTLINE OF THE RESEARCH REPORT .............................................................................. 8 

1.13 SUMMARY ................................................................................................................................ 8 

CHAPTER TWO ........................................................................................................................................ 9 

LITERATURE REVIEW .............................................................................................................................. 9 

2.1 INTRODUCTION ........................................................................................................................ 9 

2.2 THE PSYCHOSOCIAL WORK ENVIRONMENT .................................................................... 9 

2.2.1 Individual’s relationship to his or her work ......................................................................... 10 

2.2.2 Organizational culture and climate ...................................................................................... 11 

2.2.3 Work demands and control .................................................................................................. 12 

2.2.4 Leadership, empowerment, and support .............................................................................. 13 

2.2.5 Core relationship and teamwork .......................................................................................... 14 



 
 

vi 
 

 

2.3 STRESSORS, PSYCHOSOCIAL HAZARDS AND RISKS IN THE PSYCHIATRIC WORK 

ENVIRONMENT ............................................................................................................................. 14 

2.3.1 Stress in the psychiatric work environment ............................................................................. 14 

2.3.2 Psychosocial risks and hazards in the psychiatric work environment ..................................... 15 

2.4 PSYCHIATRIC NURSING IN SOUTH AFRICA..................................................................... 17 

2.5 EFFECTS OF STRESS AMONGST THE PSYCHIATRIC NURSES ...................................... 19 

2.6 STRESS MANAGEMENT IN PSYCHIATRIC NURSING ..................................................... 20 

2.7 MANAGEMENT OF THE PSYCHOSOCIAL HAZARDS/ RISKS AND STRESS IN THE 

WORKPLACE .................................................................................................................................. 21 

2.8 MANAGEMENT AND CONTROL OF PSYCHOSOCIAL WORK ENVIRONMENT AS 

DESCRIBED BY BURTON (2010): ................................................................................................ 22 

2.9 SUMMARY ................................................................................................................................ 23 

CHAPTER THREE ................................................................................................................................... 24 

RESEARCH DESIGN AND METHOD ....................................................................................................... 24 

3.1 INTRODUCTION ...................................................................................................................... 24 

3.2.1 Research design.................................................................................................................... 24 

3.2.2 Advantages of the survey method ........................................................................................ 24 

3.2.3 Disadvantages of the survey method.................................................................................... 25 

3.3 RESEARCH SETTING .............................................................................................................. 25 

3.4 POPULATION ........................................................................................................................... 26 

3.5 SAMPLING AND SAMPLE SIZE ............................................................................................ 26 

3.5.1 Sampling method ................................................................................................................. 26 

3.5.2 Sampling size ....................................................................................................................... 26 

3.6 DATA COLLECTION ............................................................................................................... 26 

3.6.1 Data collection instruments .................................................................................................. 27 

3.6.2 Validity and reliability of the instruments ........................................................................... 30 

3.6.3 Data collection procedure .................................................................................................... 30 

3.7 DATA ANALYSIS ..................................................................................................................... 30 

3.7.1 QPS Nordic general questionnaire data analysis ................................................................. 31 

3.7.2 Perceived stress analysis ...................................................................................................... 32 

3.7.3 Statistical analysis ................................................................................................................ 32 

3.8 VALIDITY AND RELIABILITY OF THE STUDY ................................................................. 33 

3.9 ETHICAL INTEGRITY ............................................................................................................. 33 

3.10 SUMMARY .............................................................................................................................. 34 

CHAPTER FOUR ..................................................................................................................................... 35 



 
 

vii 
 

 

RESULTS AND DISCUSSION .................................................................................................................. 35 

4.1 INTRODUCTION ...................................................................................................................... 35 

4.2 RESULTS OF THE STUDY ...................................................................................................... 35 

4.2.1 The response rate.................................................................................................................. 35 

4.2.2 Socio-demographic profile of respondents.......................................................................... 35 

4.2.3 Psychosocial work environment .......................................................................................... 37 

4.2.4 PERCEIVED STRESS SCALE ........................................................................................... 48 

4.2.5 STATISTICAL CORRELATION ANALYSIS ................................................................... 49 

4.2.5.1 Pearson correlation ............................................................................................................ 49 

4.2.5.2 Correlation coefficient ...................................................................................................... 50 

4.2.5.2 Mann Whitney U-test ........................................................................................................ 51 

4.3   DISCUSSION OF THE MAIN RESULTS .............................................................................. 51 

4.3.1 Socio-demographic profile of respondents .......................................................................... 51 

4.3.2 Psychosocial work environment .......................................................................................... 52 

4.3.3. PERCEIVED STRESS SCALE .......................................................................................... 58 

4.3.4 LOGISTIC REGRESSION .................................................................................................. 59 

4.4 SUMMARY ................................................................................................................................ 60 

CHAPTER FIVE ....................................................................................................................................... 61 

SUMMARY, LIMITATIONS, RECOMMENDATIONS AND CONCLUSION .............................................. 61 

5.1 INTRODUCTION ...................................................................................................................... 61 

5.2 SUMMARY OF THE STUDY ................................................................................................... 61 

5.3 LIMITATIONS ........................................................................................................................... 63 

5.4 RECOMMENDATIONS ............................................................................................................ 64 

5.5 CONCLUSION ........................................................................................................................... 65 

REFERENCE LIST .................................................................................................................................... 67 

 

 

 

 

 

 



 
 

viii 
 

 

NOMENCLATURE 

 

CSN’s  Community service nurses 

EAP  Employee Assistant Programme 

EN’s  Enrolled nurses 

ENA’s  Enrolled nursing assistants 

ICN  International Council of Nurses 

ILO International Labor Organization 

OHN Occupational Health Nurse 

OHNP  Occupational Health Nurse Practitioner 

OHSA  Occupational Health and Safety Act (Act No 85 1993) 

PSS  Perceived stress scale 

QPSNORDIC   General Nordic Questionnaire for Psychological and Social factors at 

work 

 

RN’s  Registered Nurses 

RSA   Republic of South Africa 

SANC  South African Nursing Council 

SD   

  

Standard Deviation 

 

 

 

 

 

 

 

 

 

 

 

 



 
 

ix 
 

 

LIST OF FIGURES 

 

Figure 2.1: Diagram of depicting the consequences of unsafe and unhealthy 

workplace      

20    

Figure 4.1: 
  

Violence/threat exposure at work in the past two years  41 
 

Figure 4.2: Prevalence of errors at work that pose a risk of personal injuries 42 

Figure 4.3: Conflict between their job and their personal values   43 

Figure 4.4: Nurses’ perceptions of bullying or harassment of nurses 45 

Figure 4.5: 
 

Nurses’ experiences of bullying or harassment of nurses  45 

Figure 

4.6:
  

Nurses’ perceptions of immediate supervisor’s capability of problem 

solving 

46 

Figure 

4.7:
  

Management’s ability to look after the future of the organization 47 

Figure 4.8: Nurses’ perception regarding competitiveness of their work 

 

48 

Figure 

4.9:
  

Importance of having a good pay      49 

Figure 4.10: Perceived stress scale of nursing staff 51 

Figure 4.11:  Illustration of relationship between variables   

 

 

51 

   

   

   

   

   

 

 

 

 

 

 



 
 
x 

 

 

 

 

LIST OF TABLES 

   

Table 1.1: Dependent and independent variables 8 

Table 3.1: Single items used and items’ number                                                28 

Table 3.2: Grouped (scales) items of the QPS Nordic questionnaire 29 

Table 4.1:

  

Results of socio-graphical profile of nurses who completed the 

questionnaires 

37 

Table 4.2:

  

Results of the single items and question numbers that were used in the 

QPS                                                                    

39 

Table 4.3: Results of the grouped items of the QPS Nordic questionnaire 40 

Table 4.4:            The results of the spearman’s correlation rank of the QPS Nordic 

subscales 

 

51 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 
 

xi 
 

 

 

 

LIST OF ANNEXURES 

 

Annexure 1: QPS Nordic general questionnaire  76 

Annexure 2: Perceived stress scale  89 

Annexure 3: Participants’ information leaflet & consent  90 

Annexure 4: Permission to conduct Research Study from the hospital  93 

Annexure 5: Ethical clearance certificate Human Research Ethics 

Committee at the University of the Witwatersrand 

95 

Annexure 6: Postgraduate approval of the study 96 

Annexure 7: Permission for use of the QPS Nordic general questionnaire 97 

Annexure 8: Permission for use of the Perceived Stress Scale questionnaire 98 

Annexure 9: Content areas and scales of the QPS Nordic questionnaire 99 

 

 

 

 

 

 



 
 
 

 

1 
 

CHAPTER ONE 

 

OVERVIEW OF THE STUDY 

 

1.1 INTRODUCTION 

 

This chapter outlines the overview of the study, with a discussion on the background, the 

problem statement, purpose, and objectives. The research methods and design, as well as the 

operational definitions are described. 

 

1.2 BACKGROUND 

 

The scarcity of scientific literature seems to be an indication that the psychosocial work 

environment of nurses in psychiatric hospitals has received less attention in research studies 

to date in South Africa. The psychosocial work environment plays a major role in predicting 

the nurses’ well-being and productivity in their workplaces (Abdalrahim, 2013). 

Furthermore, South African Nursing Council (SANC) states that nurses do work under 

heavy stress in their line of duty, and this can be the contributory factor to increased turnover 

in government institutions as well as the influx of nurses leaving the country to practice 

abroad (SANC, 2018). 

 

Psychiatric patients who are admitted in acute units can be aggressive and violent towards 

nurses, and thus many cases of nurses being assaulted have been reported (Maluleke & Van 

Wyk, 2017). The same authors are of the opinion that violence and assault cases compromise 

safety in the work environment, and it maybe be perceived as unsafe by psychiatric nurses 

(Maluleke & Van Wyk, 2017). Similarly, Elsayed, Hasan & Musleh (2017) conclude that 

psychosocial stressors in the psychiatric work environment may include dealing with 

aggressive patients, taking difficult decisions on behalf of the mentally ill patients, and staff 

shortages. 

 

A study by Stevensons, Jack-O’Mara and Legris (2015) suggests that violent behaviour in 

the psychiatric hospitals maybe perceived as normal, hence such behaviours are never 



 
 
 

 

2 
 

reported to the hospital management. These authors further state that nurses may not seek 

help but rather try to deal with situations on their own, leading to Post Traumatic Stress 

Disorder (PTSD) or worse, the nurse might resign from work (Stevensons, Jack-O’Mara 

& Legris, 2015). 

 

Management in psychiatric hospitals need to do all they can to retain their nurses, because 

the SANC pointed out that 115 advanced psychiatric nurses, according to their 2017 

register (psychiatric nursing specialty), graduate in South Africa per year, and of these only 

a few choose to work in the psychiatry specialized field (SANC, 2017). Psychiatric nursing 

has also been reported as unpopular, and not viewed as a favorable career choice because 

of its unpredictability, emotionally tiring job, fear of psychiatric patients and loss of learned 

skills from other disciplines in nursing (Jansen & Venter, 2015). 

 

The consequences of occupational stress in psychiatric nursing have also been studied both 

nationally and internationally. A study conducted by Chou, Li & Hu (2014), in Taiwan 

(regional hospital), amongst different medical professionals revealed that 66% of nurses 

presented with higher levels of burnout than any other group of medical professionals 

(Chou et.al, 2014). The same study further revealed that untreated burnout and stress could 

lead to psychological problems, such as low self-esteem, frustrations, depression and 

anxiety, and serious implications for physical health, such as injuries due assault from the 

patients and a decline in productivity at work and socially because of prolonged 

psychological problems (Chou et al, 2014). 

 

A study conducted in Greece, revealed that the majority of psychiatric nurses suffered from 

compassion fatigue due to their work environment (Mangoulia et al, 2015). However, 

burnout seems to be more prevalent amongst nurses in general in South Africa due to 

prolonged exposure to stressful environments, which have a negative impact on the 

wellbeing of the nurses and service delivery (Khamisa et al., 2015). Similarly, a study 

conducted in Letsholathebe II Memorial Hospital in Maun, Botswana, found that nurses 

suffered from fatigue, loss of sleep due to stress, anxiety and persistent tiredness 

(Keorekile, 2011). 

 

In Durban, South Africa, Mudaly and Nkosi (2013) conducted a study to establish the 

reasons for nurse absenteeism at a general hospital. The research findings indicated 



 
 
 

 

3 
 

numerous reasons for absenteeism, with poor work environment found as the contributing 

factor, this included lack of support from management, inadequate remuneration, job strain 

and unsatisfactory working conditions. The reasons further revealed that when the work 

environment is not empowering employees (nurses), the consequences might be high 

absenteeism rates and increased turnover (Mudaly & Nkosi, 2013).In Japan, a study aimed 

to identify the factors influencing job related stress among Japanese psychiatric nurses 

concluded that psychosocial challenges at work increases absenteeism due to ill health; this 

has been attributed to increased work pressure levels, work overload, attention to many 

patients’ needs, and ethical dilemmas (Yada et al., 2015). 

 

In Sweden, a study in 2011 by Tuvesson, Eklund and Wann-Hansson aimed to determine 

perceived stress among nursing staff in psychiatric inpatient care, the influence of 

perceptions of the ward atmosphere and the psychosocial work environment (Tuvesson, 

Eklunf & Wann-Hansson, 2011). The study included 93 nurses of different categories 

practicing the mental health institution. The research findings indicated low perceived stress 

levels; however, role clarity and ward atmosphere factor (involvement) were directly related 

to high-perceived stress levels. The same authors recommended that nursing management 

should find new possible ways of improving the nurses’ work environment in the psychiatric 

settings by explicitly stating what is expected of the nurses to prevent high levels of 

perceived stress (Tuvesson, Eklunf & Wann-Hansson, 2011). While facing work 

environment challenges such as violence, increased workload and staff shortages, a great 

deal of coping skills, alertness and vigilance are always required in the psychiatric 

environment to promote a therapeutic environment (Vierheller & Denton, 2013).  

 

To promote a safe and healthy working environment, the amended Occupational Health and 

Safety Act (OHS) governs the health and safety of persons at work in South Africa. The 

OHS Act states that employers are required to take steps in the assessment of risks and 

hazards in the workplace to take necessary precautions, minimise or eliminate those hazards 

to protect their workers always. According to Burton (2010), a healthy workplace or 

environment is the one in which the workers and managers continuously collaborate to 

improve the process of protecting and promoting health and safety wellbeing of all workers. 

This process includes identification and modification of the hazards in the physical 

environment, such as improving cleanliness and availing personal protective equipment to 

workers. Furthermore, the psychosocial hazards need to be identified and the risks assessed 



 
 
 

 

4 
 

(Burton, 2010). Health and safety concerning physical, psychosocial environment, work 

culture and personal health resources are all encompassed in the healthy work environment 

model (Burton, 2010). 

 

A safe and healthy work environment includes all the three levels of prevention to enhance, 

always protect employee’s health and wellbeing in that work environment (Burton, 2010). 

The primary prevention eliminates and minimizes the occurrence of incidences. Secondary 

prevention is where the occurrence of incidences has already taken place, therefore, means 

and resources are mobilized to reduce more harm through treatment and counselling sessions 

(Burton, 2010). Tertiary prevention is where the employer refers or offers rehabilitative 

measures to the affected employees due to occurred incidences; these may be done through 

debriefing or approving of reasonable sick leave days away from work to allow workers to 

recover fully (Burton, 2010). 

 

According to the ICN (2007), a positive working environment setting is one that supports 

excellence and decent work by striving to ensure health, safety, and wellbeing of nurses. A 

positive working environment supports rendering of quality nursing care by improving 

productivity and motivation to its staff. Occupational health, safety and wellness policies 

that address work environment hazards, security, work life balance, effective 

management/leadership, and decent pay and opportunities for career and professional 

development are all entailed in the elements of the positive working environment, as 

specified by the ICN (2010). A positive working environment ensures staff retention, 

effective teamwork within the multidisciplinary team and reduces absenteeism from work.  

 

Therefore, in this study the researcher aims to identify the perceived stress levels and 

describe the psychosocial work environment of the psychiatric nurses at a specific 

psychiatric hospital in Johannesburg. Management in psychiatric hospitals need to do all 

they can to retain their nurses, because the SANC pointed out that 115 advanced psychiatric 

nurses, according to their 2017 register (psychiatric nursing specialty), graduate in South 

Africa per year, and of these only a few choose to work in the psychiatry specialized field 

(SANC, 2017). Psychiatric nursing has also been reported as unpopular, and not viewed as 

a favorable career choice because of its unpredictability, emotionally tiring job, fear of 

psychiatric patients and loss of learned skills from other disciplines in nursing (Jansen & 

Venter, 2015). 



 
 
 

 

5 
 

1.3 MOTIVATION AND RATIONALE FOR THE STUDY 

 

The motivation for this study was that the researcher, as a psychiatric nurse practicing in a 

public psychiatric hospital and an occupational health-nursing student, became aware of the 

importance of stress as a psychosocial hazard and risk in workplace settings. Psychosocial 

hazards and risks need to be addressed and managed from an occupational health nursing 

perspective. Anecdotal evidence reveals a high absenteeism rate and increased nurses’ 

turnover in the psychiatric environment.  

 

1.4 SIGNIFICANCE OF THE STUDY 

 

The findings of this study will potentially contribute to the literature on perceived stress and 

understanding the psychosocial work environment in psychiatric nursing. The findings will 

further bring more understanding the occupational challenges that psychiatric nurses are 

faced with which will assist eliminating potential hazards that are detrimental to their 

wellness and health at work. The findings will also create a basis for implementation of 

organizational developments and mediation regarding psychological and social aspects of 

the nurses in the psychiatric environment. 

 

1.5 PROBLEM STATEMENT 

 

Occupational stress has been recognised and researched among nurses in general and has 

been found to be more prominent amongst nurses working in psychiatric hospitals 

(Greenglass & Burke, 2016). However, at the specific psychiatric hospital where the study 

was conducted, a study had not been done and there was a scarcity of literature for the South 

African for this topic. The researcher has observed an increased absenteeism rate and high 

staff turnover among the nurses working at the psychiatric hospital and factors contributing 

to these problems have not been investigated. Therefore, the problem for this study is that 

the stress levels of psychiatric nurses and the aspects of the psychosocial work environment 

are not known. 

 



 
 
 

 

6 
 

1.6 RESEARCH QUESTION 

 

The study is guided by the following questions: 

 

• How do nurses in psychiatric hospitals perceive their psychosocial work 

environment? 

• How do nurses perceive their stress in their work environment? 

• What are the factors that contribute to perceived stress in their psychosocial 

environment? 

 

1.7 PURPOSE OF THE STUDY 

 

The purpose of the study was to investigate the psychosocial work environment and the 

perceived stressors of nurses in a psychiatric hospital to bring awareness to the hospital 

managers about the psychosocial work environment and perceived stressors as experienced 

by the nurses.   

 

1.8 RESEARCH OBJECTIVES 

 

The objectives of this study were to: 

• Describe how nurses in psychiatric hospitals perceived their psychosocial work 

environment. 

• Describe how the nurses perceived their stressors. 

• Identify the factors that are perceived to be contributing to psychosocial work 

environment and stress. 

 

1.9 RESEARCH DESIGN AND METHOD 

 

This study was a cross-sectional, following a quantitative approach using a survey method. 

A detailed description of the research design and methods is presented in Chapter 3. 

Research setting: the study was conducted in one of the academic psychiatric hospitals in 



 
 
 

 

7 
 

Gauteng, South Africa. The population included all (census sampling) nurses employed at 

the identified psychiatric hospital for a period of at least six months and above. Both day 

and night shifts were included in the study. The employee categories were professional and 

enrolled nurses, as well as enrolled nursing assistants. The study used two self-administered 

instruments for data collection, namely the QPS Nordic (general Nordic questionnaire for 

psychosocial and social factors and the perceived stress scale. Data was collected over three 

months between December 2018 and February 2019. 

 

1.10 OPERATIONAL DEFINITIONS 

 

Nurses: A nurse is a person who has completed a basic programme in generalized nursing 

and is authorized by the recognised regulatory body or authority to practice nursing in 

his/her own country (ICN, 1987). The basic nursing programme provides a broad and sound 

foundation in the behavioral, life and nursing science for the general practice of nursing, for 

leadership roles and post basic education for specialty. For this study, nurses meant all 

categories (registered, enrolled, and enrolled-nursing assistant) of nurses who were 

permanently employed in the identified psychiatric hospital and are registered with SANC. 

 

Psychiatric inpatient hospital: For the purpose of this study, a psychiatric inpatient hospital 

meant a hospital that caters for admission of patients diagnosed with serious psychiatric 

illnesses and conditions that requires management in the hospital settings for a short or long 

term in a specialized or controlled environment. 

Perceived stress: It is defined as the extent to which an individual perceives that their 

demands exceed their ability to cope. For this study, perceived stress meant extent to which 

nurses perceived their demands to exceed their ability to cope at work (Adams, Meyers & 

Beidas, 2016). This was a dependent variable in this study. 

 

Psychosocial work environment refers to the organization of work and organizational 

culture; the beliefs, values, attitudes, and work practices displayed on a day-to-day basis in 

the institution (hospital) affecting the physical and mental wellbeing of the employees 

(nurses) (Burton, 2010). This was an independent variable in this study. 

 



 
 
 

 

8 
 

1.11 VARIABLES OF THE STUDY 

 

The variables of the study are described in table 1.1 

TABLE 1.1 Dependent and independent variables 

Dependent variable Independent variable 

Perceived stress Psychosocial work environment 

Psychiatric nurses Psychiatric in-patient hospital 

 

1.12 OUTLINE OF THE RESEARCH REPORT 

 

The research report is divided in terms of Chapter as outlined below:  

 Chapter One: gave an overview of the study 

Chapter Two: has as focus the literature review  

Chapter Three: Research method and design 

Chapter Four: Results are presented and discussed 

Chapter Five: Summary, limitations, recommendations, and conclusion 

 

 

1.13 SUMMARY 

 

The psychiatric nurses’ experience multiple psychosocial hazards such as violence, 

aggression, and suicidality as they practice in their environment. These hazards (behaviours) 

are mainly presented by the mentally ill patients they treat; such behaviours may be aimed 

at the psychiatric nurses, other professionals, or fellow patients. The researcher who is 

practicing as a psychiatric nurse and an occupational health-nursing student saw the 

importance of conducting this study with the aim of describing a psychiatric work 

environment, and the perception of nurses’ stressors. The background, objectives, and 

operational definitions of this study were discussed. 

 

 



 
 
 

 

9 
 

CHAPTER TWO 

 

LITERATURE REVIEW 

 

2.1 INTRODUCTION 

 

This chapter contains a review of national and international literature on the psychosocial work 

environment and perceived stress factors of psychiatric nurses at an in-patient psychiatric 

hospital. Literature review is a process which includes critical evaluation of what already exist 

or published regarding a chosen topic by accredited scholars or research (Unisa, 2018). 

Therefore, an extensive literature review was undertaken to broaden the researchers’ 

knowledge and understanding of the topic. The literature review included an extensive 

electronic search using CINALH, MEDLINE, Science direct, Google scholar and PubMed that 

was done using a combination of keywords such as: psychosocial work environment, perceived 

stressors, psychiatric nursing, in-patient care psychiatric hospital (institution). Therefore, in this 

chapter the occupational (work related) stress, the psychosocial work environment, in-patient 

mental health institutions, factors associated with occupational stress, consequences of 

occupational stress and management are discussed. 

 

2.2 THE PSYCHOSOCIAL WORK ENVIRONMENT 

 

According to the Burton (2010) healthy workplace model, the psychosocial work environment 

encompasses work organizations, the culture of the organization, beliefs, values and attitudes 

demonstrated by the organization on a daily basis thus affecting the mental and physical 

wellbeing of the employees either positively or negatively. The psychosocial work environment 

can be affected by several hazards and risks factors. These are referred to as workplace stressors 

and that are found to be detrimental to emotional and mental health of the employees (Burton, 

2010). Work-related stress and psychosocial hazards in the workplace, as identified by Burton 

(2010), are: 

 

• Poor work organization that includes work demands, time pressure, and support from 



 
 
 

 

10 
 

supervisors, job training and clarity, poor channels of communication, reward and recognition. 

Organizational culture that entails lack of proper policies and practice related to dignity and 

respect for all workers, harassment and bullying, stigma related to illness such as HIV, 

discrimination against sexual. 

orientation, lack of support for healthy lifestyles. 

• Management style that entails lack of consultation, negotiations, and constructive feedback 

to its employees. 

• Inconsistency with applications of policies and rights of employees, including long and non-

negotiated hours of work, unfair hiring practices, and unfair leave practices. 

• Shift work issues. 

• Lack of support for work life balance. 

• Fear of job losses due to re-structuring and re-organization of the company or uncertainty of 

markets. 

• Lack of awareness of and competence in dealing with mental health and illness issues. 

The psychosocial work environment entails multiple factors, which focus on the individual’s 

relationship to his/work, and include organizational culture and climate, work demands and 

control, leadership empowerment and support, core relationship and teamwork (Tuvesson & 

Eklund, 2014). 

 

2.2.1 Individual’s relationship to his or her work 

 

A study conducted in Singapore’s largest psychiatric institutions revealed that psychiatric 

nurses had a higher job satisfaction rate, which was linked to the increase in experience of work 

in the same field or institution; this was measured by the number of years spent in psychiatry 

or an institution. The same study further reflected on a greater positive association between job 

satisfaction and resilience amongst nurses (Zheng et al., 2017). Newly employed nurses may 

experience challenges that relate to psychiatric inpatient role clarification; therefore, managers 

are encouraged to create an environment that clearly conveys what psychiatric nursing is all 

about, including individual’s expectation to inexperienced nurses (Tuvesson, Eklund & Eklund, 

2014).  

 

Kurjenluom et al., (2017) also revealed that most psychiatric nurses were satisfied with the 



 
 
 

 

11 
 

work environment, however, more experienced nurses (older) were more satisfied with their 

workplace culture compared to the less experienced (young). The literature suggests that 

experience in psychiatry was an important factor in predicting job satisfaction; the psychiatric 

hospital’s management were therefore required to make such environments conducive for 

nurses to retain them (Kurjenluom et al., 2017). Positive employee’s perception regarding his 

or her own work environment has been reported to be important in improving personnel 

outcome such as absenteeism, this also include positive perception with the immediate 

supervisors (Paquet et al., 2013). 

 

2.2.2 Organizational culture and climate 

 

The psychosocial work environment, according to Burton (2010), includes organizational 

culture, referred to as attitudes, beliefs, values, and practices, demonstrated by an institution 

daily and thus affects the mentality and wellbeing of its employees. The influence of 

organizational culture has also been studied. Kurjenliom et., (2017) explored organizational 

culture relating to workplace culture in psychiatric nursing and discovered that older nurses, 

the ones who have been in the profession for longer periods, were more likely to be satisfied 

with the work culture compared to the younger nurses, or the graduates who negatively 

perceived the work culture. The same study also revealed that experience also played a role in 

predicting job satisfaction, for example the older the nurses, the more satisfied they were with 

the work culture, while newly graduated nurses were less satisfied, this posed a threat as to how 

to attract and support young nurses to psychiatric work culture.  

 

In Finland, a study investigated workplace culture in psychiatric nursing and its findings were 

that a positive workplace culture is directly associated with quality nursing care, and it 

predicted that more nurses were likely to be retained if they were satisfied with the workplace 

culture (Kurjenluoma et al., 2017). A South African study concluded that a person working in 

a well-managed environment is less likely to be absent from work than a person working in a 

poorly managed work environment (Muday & Nkosi, 2015). While a study which sought to 

explore the organizational culture and resilience of nurses in a mental health institution 

described psychiatric organizations as a rigid, hierarchy dependent and power decentralized, 

therefore psychiatric nurses are required to have resilience to deal with such culture if daily 

demands of their work are to be met (Rocha et al., 2016).  



 
 
 

 

12 
 

Another study done in Sweden among 93 nursing staff working at a general psychiatric in-

patient ward with the aim of investigating different aspects of the ward atmosphere that were 

related to the psychosocial work environment, as perceived by nursing staff; they also 

discovered that organizational culture, role clarity and empowering leadership were the aspects 

that influenced nurses’ perceptions in the ward atmosphere (Tuvesson, Eklund & Wann-

Hansson 2011). Organizational culture should be taken into consideration when dealing with 

the psychosocial work environment of nurses working in psychiatric hospital, because it does 

influence how nurses perceive their workspace (Tuvesson, Eklund & Wann-Hansson, 2011). 

 

2.2.3 Work demands and control 

 

Psychiatric work environments have also been labelled as high demanding in terms of 

workload; nurses felt that the superiors had high expectations of them, or rather were 

uninformed about decision making, which also had an impact on how they related to their 

environment (Conradie et al., 2017). A study done in Brazil (2014) cited a wide range of 

challenges reported by the nurses; this included working conditions relating to the physical 

structure, human resources (nurse/patient ratio), shift work and lack of psychological support 

and motivation (Marques de Lima et al.,2014) 

 

The WHO (2012) depicted that certain job factors, which included high demands and low 

control over decision making, contributed to high levels of mental illness amongst employees 

that may not reach diagnosable stages. The stressors reported in the psychiatric work 

environment included inadequate resources in terms of material, lack of human resources and 

unhealthy working conditions due to work pressures. The nurses also reported conflicts relating 

to professional recognition, rewards, and the nature of the healthcare system (Marques de Lima 

et al., 2014). In Japan, the factor that contributed to job-related stress amongst psychiatric 

nurses who worked in the in-patient’s department of mental health institutions were primarily 

linked to work overload, including complex ethical dilemmas specific to this discipline (Yada 

et al., 2015). 

 

 



 
 
 

 

13 
 

2.2.4 Leadership, empowerment, and support 

 

A study conducted in Australia reported that the nurses who perceived themselves as competent 

and felt more supported were likely to engage more therapeutically with psychiatric patients 

(Roche, Duffield & White, 2011). Environmental factors that were associated with these 

perceptions mainly focused on the proper foundation of quality nursing care (Roche, Duffield 

& White, 2011). Roche, Duffield and White (2011) recommended that ongoing education and 

career development opportunities and clinical supervision were the factors found to have 

potentials to enhance these perceptions in the institutions. The study also recognised strong 

relationship between role clarity, role competence and therapeutic commitment (Roche, 

Duffield & White, 2011). Zheng et al. (2017) study also reported on the correlation between 

anger, stress, and low job satisfaction rate in an organization and how it affected individuals 

socially. 

 

A study conducted in Sweden, amongst psychiatric nurses, revealed that job satisfaction was 

positively related to experience in the same discipline; it further concluded that when one is 

less satisfied with their job, the more likely they would experience psychological distress 

relating to their work (Olatunde & Odusanya, 2015). In South Africa, Ngako, Van Rensburg 

and Mataboge (2012) reported that psychiatric nursing contributes to occupational stress among 

psychiatric nurses due to nurses describing such environments as unsafe. Nurses reported 

experiencing negative emotional reactions towards patients they have to care for, as such 

patients present with unpredictable, violent behaviour, which may be directed towards nurses 

or other patients who may also be admitted at that time (Ngako, Van Rensburg & Mataboge, 

2012). 

 

Tuvesson and Eklund (2014) concluded that clarity of nurses’ roles and programmes and 

encouragement of psychiatric nurses could improve their perception regarding their work 

atmosphere. The same study further indicated that developing activities and programmes that 

enhance practical and personal solving skills for both nurses and patients could further improve 

their work environment (Tuvesson & Eklund 2014). Malloy and Penprase (2010) suggested 

that implementation of transformational and reward leadership behaviours could the 

psychosocial work environment. In terms of leadership psychiatric nurses and patients seem to 

benefit from supportive leadership. 



 
 
 

 

14 
 

 

2.2.5 Core relationship and teamwork 

 

Nurses reported they need institutional support and positive relationships with the 

multidisciplinary teams (Fabri & Loyola, 2014). Coping with stress and job satisfaction is good 

for the both the individual and the organization (Abdalrahim, 2018). A similar study revealed 

that psychiatric nurses who were able to manage their anger amongst their patients, colleagues 

and family members were more likely to show job satisfaction and could deal well with 

stressful situations in their work environment (Kouchaki, Rezaei & Motagh, 2016). A study 

that was done in Canada amongst 315 mental health professionals with the aim of investigating 

variables associated with job satisfaction revealed that, job satisfaction was significantly 

associated with absence of team conflicts, stronger team supports, team collaboration, greater 

member involvement in decision making and affective commitment towards the team (Fleury 

et al., 2018). Weaver et al. (2017) found that frustrations and medical errors are increased in 

the work environment when there is a breakdown in communication and lack of teamwork. 

Core relationship and teamwork are critical as revealed by the literature here and it is evident 

that without teamwork not only the nurses are affected but the patient care as well, when there 

is absenteeism there is shortage of staff which negatively influence the quality of patient care 

provided. 

 

2.3 STRESSORS, PSYCHOSOCIAL HAZARDS AND RISKS IN 

THE PSYCHIATRIC WORK ENVIRONMENT 

 

2.3.1 Stress in the psychiatric work environment 

 

A psychiatric work environment is a specialized working environment that may be perceived 

as stressful due to the nature of patients the nurses care for daily (Maluleke & Van Wyk, 2017). 

Psychiatric nursing has been identified as a highly stressful specialty due the unpredictability 

and instability of patients; this is because most patients have an altered mental state especially 

those suffering from Schizophrenia and Bipolar Mood Disorder (Greenglass & Burke, 2016). 

Koukia and Zyga (2013) also revealed that psychiatric nurses were exposed to numerous 



 
 
 

 

15 
 

critical incidences at their workplace due to the mental state of the psychiatric patients. The 

critical incidences included agitation, acute anxiety, persistent insomnia, exacerbation of 

psychotic symptoms, verbal and physical violence towards others, violence to property, 

provocative attitude, and deliberate self-harmful suicidal behaviour (Koukia & Zyga, 2013). 

These behaviours have been reported to make the workplace environment unsafe and burdening 

to psychiatric nurses and found to be the contributory factors of occupational stress among 

psychiatric nurses (Ngako, Van Rensburg & Mataboge, 2012). 

 

Occupational stress is regarded as a serious threat to the safety of workers and such imbalance 

may lead to injustice in employees (psychiatric nurses), which may lead to feelings of anger 

that maybe directed towards supervisors, patients, and co-workers (WHO, 2012). According to 

the WHO (2018), one person in four globally will be affected by a mental disorder or 

neurological disorder by the year 2020, exacerbated by issues relating to unwillingness to seek 

treatment due to stigma, discrimination, and neglect. Psychiatric patients are reported to seek 

help after their conditions have deteriorated, increasing the burden of admissions of patients, 

which also revealed an element of frustration from patients to staff caring for them 

(Brännström, Strand & Sand, 2018). 

 

In Greece, a study conducted among mental health professionals and assistant nurses revealed 

that psychiatric nursing has shown that psychiatric nurses are exposed to numerous critical 

incidences at their workplace (Koukia & Zyga, 2013). These incidences included agitation, 

acute anxiety, persistent insomnia, exacerbation of psychotic symptoms, verbal violence to 

others, violence to property, physical violence to others, openly disturbed behavior, provocative 

attitude, and deliberate self-harmful suicidal behavior (Koukia & Zyga, 2013). Mcmullan 

(2017) discovered that the psychiatric in-patient care setting was described as challenging by 

the psychiatric nurses. Often, psychiatric nurses are required to care for the mentally ill with 

perceptual disturbances (hearing voices), patients that are hard to manage, which becomes 

distressing to both patients and nurses as they struggle with gaining control over those 

disturbances, contributing to feelings of powerlessness in nurses, making such a working 

environment unbearable (Mcmullan, 2017). 

 

2.3.2 Psychosocial risks and hazards in the psychiatric work environment 

 



 
 
 

 

16 
 

A study by Stevensons, Jack O’Mara and Legris (2015) revealed that psychiatric nurses 

experienced physical, verbal, and emotional violence during their line of duty; this study was 

conducted in Canada among 12 registered nurses with the aim of describing the nurses’ 

experience of violence on acute care psychiatric in-patient units. Also, Zeng et al. (2013) 

conducted a study in two mental psychiatric hospitals in China, with the aim of examining the 

frequency and risk factors of violence in the workplace amongst psychiatric nurses, including 

their impact of quality life. Their study revealed that 82.4% of the nursing population 

encountered some type of violence; this was attributed to overcrowding of the psychiatric 

wards, staff shortages (patient-nurse ratio) and lack of outpatients’ departments. In addition, 

the violent behaviour of patients in the psychiatric work environment may end up being 

perceived as normal, which may lead to such nurses dealing with such experiences on their 

own, without reporting or seeking help, because this is perceived as part of their occupation 

(Stevensons, Jack O’Mara & Legris, 2015).  

 

A study conducted in South Africa revealed that retaining nurses in the mental health 

institutions remained a challenge, as nurses left their work after violent encounters from 

patients, as they fear for such occurrences in the future (Nguluwe, Havenga & Sengane, 2014). 

Moreover, the World Health Organization (WHO) projects there will be a shortage of 12. 9 

million health workers by the year 2035 (WHO, 2013). A study conducted in South Africa, 

Gauteng Province, amongst 13 permanently employed nurses working in an acute psychiatric 

unit in 2014, revealed that most psychiatric nurses experienced violence in acute psychiatric 

wards despite their age, gender and years of experience (Nguluwe, Havenga & Sengane, 2014). 

A need to modify the psychiatric treating environments was recommended by Lozzino et al. 

(2015). A literature review was conducted to assess the prevalence and risk factors of violence 

in psychiatric inpatients; the results suggested that one out of five patients admitted in an acute 

unit had the potential of committing an act of violence (Lozzino et al., 2015). The same study 

described the risk factors as a diagnosis of schizophrenia, history of alcohol abuse, and mostly 

committed by male patients (Lozzino et al., 2015). 

 

The causative factors to such violence were directly linked to patients' intrinsic factors, which 

included history of substance abuse, habitual violence and altered mental status (Nguluwe, 

Havenga & Sengane, 2014). In this environment, the psychiatric nurses experienced physical, 



 
 
 

 

17 
 

emotional and psychological violence, and expressed the effects of such violence as physical 

pain and emotional distress, which further suggested that experiences of violence had negative 

effects on the mental health of nurses and influenced the quality of care provided in psychiatric 

hospitals (Nguluwe, Havenga & Sengane, 2014). Compared to other nursing disciplines nurses 

working in the mental health institutions encounter high levels of occupational stress, and 

complicated ethical dilemmas (Mangoula et al., 2015; Yada & Lu et al., 2015).  

 

Job satisfaction has proved to be positively related to psychological wellbeing of the nurses in 

the psychiatric inpatient care, i.e., psychiatric nurses who are reported to be satisfied with their 

jobs reported less psychological distress and this was found mainly in older nurses who had 

been in the institution for a longer period (Olatunde & Odusanya, 2015). The same study 

suggests that the more experienced nurses were in psychiatry therefore it was more likely for 

them to be satisfied with the psychiatric work environment (Olatunde & Odusanya, 2015). 

 

 A study that investigated the experience of anxiety amongst the nursing staff in public hospitals 

in Greece (2014), showed significant higher levels of stress and revealed a higher number of 

perceived anxieties amongst the female population. The same study further concluded that 

women were more unlikely to cope with the stress of anxiety compared to men; this therefore 

is an area of concern, as the nursing profession is dominated by female professionals (Mitrousi 

et al., 2014). The factors which lead to increased occupational perceived stress in the 

psychiatric work environment include high workload, lack of participation in decision making, 

inadequate remuneration, long hours of worked, high work expectations by the superiors, etc., 

thus all these factors in the long run have an impact on the health and wellbeing of psychiatric 

nurses (Conradie et al., 2017). 

 

2.4 PSYCHIATRIC NURSING IN SOUTH AFRICA 

 

Psychiatric nursing in South African is perceived as unpopular according to the study, which 

was conducted in the University of Free State, Bloemfontein, among undergraduate nursing 

students, who described mental health institutions as emotionally tiring due to violence, notable 

slow patients’ progress, and limited skills (Jansen & Venter, 2015). Uys and Middleton (2014) 

previously reported the same shortages for advanced psychiatric nurses to date in South Africa. 

Twelve professional nurses working with dual diagnosis patients in the North West Province, 



 
 
 

 

18 
 

South Africa, reported feeling unsafe to deliver care to patients who presented with 

uncooperativeness, physical aggression, and tendency to commit suicide in the wards (Dikobe, 

Manyedi & Sehluro, 2016). Psychiatric nurses working with intellectually disabled inpatients 

experienced unique stress that had an impact on their daily living, and these stressors included 

burnout, job dissatisfaction and understaffing (Conradie, Erwee et al., 2017).  

 

Nurses working in acute psychiatric settings felt unsafe due to fear of being assaulted by the 

patients and expressed feelings of disappointment towards the hospital’s management who did 

not care for them (Sobekwa & Arunachallam, 2015). However, a positive shift has been a 

reported in the delivery of mental healthcare service delivery in South Africa, which included 

provision of psychotropic drugs in primary health & tertiary health services (Petersen & Lund, 

2011). The establishment of 72 hours’ assessment of patients with mental illness in the regional 

and district hospital revealed that there has been a shortage of specialist human resources as 

well as infrastructure (Petersen & Lund, 2011). Moreover, bed shortages have been reported in 

the tertiary psychiatric institutions, which leads to premature discharge of patients, which in 

the long run leads to numerous re-admissions of the same patients (revolving door) (Petersen 

& Lund, 2011) There is a huge challenge of understaffing in the acute psychiatric units 

(Sobekwa & Arunachallam, 2015). 

 

Even though South Africa has challenges, the WHO (2019) reports describe the South African 

mental health standards as developed compared to that of other African countries. Furthermore, 

the amendment of the Mental Health Act number 17 of 2002 has positively placed the mental 

healthcare system of South Africa in compliance with the international standards, as it protects 

human rights (WHO, 2019). This is further supported by an audit using the Gauteng District 

Health Information System, which revealed that community mental health services were 

inadequate as they never met the standards as stipulated by the mental health policy for South 

Africa (Robertson & Szabo, 2017). Inadequate community mental health services lead to the 

readmission and overcrowding of psychiatric patients in the psychiatric hospital due to relapse 

and lack of medication, which in the long run increases the burden of work of the psychiatric 

nurses (Robertson & Szabo, 2017). 

 



 
 
 

 

19 
 

2.5 EFFECTS OF STRESS AMONGST THE PSYCHIATRIC 

NURSES 

 

The physical and psychosocial effects of stress are discussed interchangeably as they are 

dependent on one another. The impact of general stress on an individual’s performance in 

his/her functioning areas of life, is predicted to impair job functioning resulting in errors and 

injuries to the individual or core workers (Burton, 2010). According to the Healthy Workplace 

Model by Burton (2010), a stressful situation becomes a liability to an individual’s 

performance, which may lead to committing errors when one performs their duties. Such errors 

may lead to physical and emotional pains due to self-blame or lack of self-esteem on an 

individual, and when this is left untreated, a permanent physical or mental disability may occur 

in an employee.  

 

According to Dawood et al. (2017), perceived stress is defined as a level to which an individual 

assesses the value in which different life situations are perceived as stressors. The psychiatric 

work environment leads to secondary stress and has been reported to be prevalent amongst the 

psychiatric nurses due to caring for patients who are mentally ill or have encountered trauma 

(Mangoulia et al., 2015). Psychiatric nurses also experience compassion fatigue because of 

secondary stress at their work environment exposes them to extreme stressful situations; this 

was reported to be more prevalent amongst the females (Mangoulia & Koukia et. al, 2015). It 

is important to note that occupational stress if not well managed, can lead to emotional and 

psychological damage whereby psychiatric nurses will present with behaviours such as 

frustration and low self-esteem, which can have negative consequence on productivity (Chou, 

Li & Hu, 2014). 

 

A study conducted in South Africa, in the Free State Province by Conradie et al. (2017), 

revealed that stress factors such as loneliness, marriage conflict, and lack of emotional support 

also affected the psychiatric nurses’ negatively and the level of care to patients. This further 

confirmed that personal stress factors had an influence on the work performance (Conradie et 

al, 2017). Another study, which sought to compare the level of work-related stress between 

female nurses working in psychiatric and general hospitals in China, concluded that psychiatric 

nurses showed greater levels of occupational stress than those working in the medical units; 



 
 
 

 

20 
 

these factors related to discrepancies related to psychiatric work environment and recourses. 

This entailed working in a closed environment with isolation rooms that mainly accommodated 

acutely mentally ill patients who were potentially violent and aggressive; the study further 

revealed that workload was less in the psychiatric environment compared to the medical one in 

terms of work domains (Qi et al., 2014). This is echoed by Abdalrahim, who wrote that 

psychiatric nurses have been reported to experience occupational and interpersonal stress, 

which then interferes with how they interact with their patients and colleagues, which in the 

long-run lead to poor health and daily functioning of nurses. Nurses may therefore report 

dissatisfaction with their job or mchange careers (Abdalrahim, 2013). Figure 2.1 below is a 

flow diagram depicting the consequences of unsafe and unhealthy workplace (Burton, 2010) 

.

 

Figure 2.1 A flow diagram of depicting the consequences of unsafe and unhealthy workplace 

(Burton, 2010, p.6). 

 

2.6 STRESS MANAGEMENT IN PSYCHIATRIC NURSING 

 

A study conducted in Egypt, among psychiatric nurses, with the aim of evaluating the effect 



 
 
 

 

21 
 

of stress management on job related stress among nurses working with psychiatric patients 

revealed that stress management has a positive effect in stress reduction amongst psychiatric 

nurses (Zaki & Barakat, 2018). Interventions such as problem solving, assertiveness, skillful 

communication and responding appropriately to criticism have shown to benefit nurses in 

terms of reducing stress and burnout (Sailaxmi & Lalitha, 2015). Ward (2011) concluded that 

psychiatric nurses’ increased job satisfaction was directly influenced by their dedication and 

fulfilment to their profession; these significantly reduced stress and balanced maintenance. 

A study conducted in Jordan, amongst psychiatric nurses, with the aim exploring stress and 

coping among psychiatric nurses to gain more information about psychiatric nursing job 

stress, coping strategies, and the relationship between job stress and coping strategies, 

revealed that nurses perceived family support as an important component in coping with 

workplace related stress (Alsaraireh et al., 2014). 

 

2.7 MANAGEMENT OF THE PSYCHOSOCIAL HAZARDS/ 

RISKS AND STRESS IN THE WORKPLACE 

 

Burton (2010) defines a healthy workplace as one in which both the managers and employees 

collaborate to continuously enhance the processes that promote and protect the health and 

wellbeing of the workers through hazard identification and reducing risks that may occur. 

Implementation of a healthy workplace involves more than just knowing what the issues are, 

according to the four avenues as presented in Figure 2.2. The implementation process 

requires an institution to involve continuous improvement of managements systems through 

research, assessment, and incorporation of evidence-based practices through research 

(Burton, 2010). The process involves motivation of resources and stakeholders to assess, 

plan and evaluate for future improvement of the actions taken as depicted in Figure 2.2 

(Burton, 2010). 

 



 
 
 

 

22 
 

 

Figure 2.2: WHO Healthy Workplace Model (Burton, 2010:98) 

 

For this study, management and control of the psychosocial work environment 

hazards will be discussed. 

 

2.8 MANAGEMENT AND CONTROL OF PSYCHOSOCIAL 

WORK ENVIRONMENT AS DESCRIBED BY BURTON 

(2010):  

 

• Elimination or modification of the source will include reallocation of work or reduction 

in workload. Fair policy practices and respect towards nurses’ rights, both males and 

females. Implementation of smoke free policies and zero tolerance to bullying. Clear 

reporting procedures for bullying and routine workshops to address such issues. 

• Lessen the impact on the worker by allowing flexibility when dealing with work life 

conflict situations. Proper supervision and support to given tasks, flexibility regarding 

shifts of choice where possible, with respect to location and timing of work. If there are 

changes in the company, the managers must be honest and consult their employees. 

Nurses should be informed in time if their shifts have to be changed from day to night 

duty. Changes of allocation of tasks or wards also need to be communicated in time to 

allow nurses to prepare themselves emotionally.  



 
 
 

 

23 
 

• Protection of the worker by training nurses on stress management techniques that include 

cognitive approaches. Conflict management programmes to be possibly run quarterly 

with nurses to raise awareness. In the case of a worker who reports to work after being 

on leave, assessments need to be made including readjustments where possible; for 

example, if a nurse has had a death in the family, it is important to at least be flexible 

with his/her shifts and workload, where necessary, to allow the grieving process to 

continue. 

 

2.9 SUMMARY 

 

This chapter reviewed the existing literature of the psychosocial work environment of 

psychiatric nurses both internationally and locally. The occupational (work-related) stress, 

the psychosocial work environment, in-patient mental health institutions, factors associated 

with occupational stress, consequences of occupational stress and management were 

discussed. According to Burton (2010), the psychosocial work environment encompasses 

the work organization, the culture of the organization, beliefs, values and attitudes 

demonstrated by the organization on a daily basis and thus affects the mental and physical 

wellbeing of the employees, either positively or negatively. The psychiatric work 

environment, from the literature, is perceived as a stressful environment for nurses as they 

encounter violence and aggressive behaviour from the mentally ill users (Koukia & Zyga, 

2013; Greenglass & Burke, 2016).  

 

Nurses reported experiencing negative emotional reactions towards patients they have to 

care for, because the patients present with unpredictable violent behaviour, which may be 

directed towards nurses or other patients who may also be admitted at that time (Ngako, Van 

Rensburg & Mataboge, 2012). The factors which lead to increased occupational perceived 

stress in psychiatric work environment included high workload, lack of participation in 

decision making, inadequate remuneration, long hours of worked, high work expectations 

by the superiors etc., therefore all these factors in the long run have an impact on the health 

and wellbeing of psychiatric nurses (Conradie et al., 2017).Furthermore, the psychosocial 

hazards need to be identified, minimized or eliminated in a way that minimizes emotional 

and physical harm to psychiatric nurses. 

 



 
 
 

 

24 
 

 

CHAPTER THREE 

 

RESEARCH DESIGN AND METHOD 

 

 

3.1 INTRODUCTION 

 

This chapter describes the research design, methods, setting, population, sample, sampling 

procedure, data collections, instruments, procedure for data collection analysis, and ethical 

integrity. 

 

3.2 RESEARCH DESIGN AND METHODS 

 

3.2.1 Research design 

 

Research design is a framework of research methods and techniques chosen by a researcher 

(Brink, van der Walt van Rensburg, 2017). This was a cross-sectional survey. A cross 

sectional design is a non-recurring study done at a specified time, at the same time and with 

the same participants (Brink, van der Walt & van Rensburg, 2017). This design was chosen 

because the researcher intended to describe how nurses in a psychiatric hospital perceived 

their stressors and psychosocial work environment. The advantages and disadvantages of the 

survey method, as discussed by Brink, van der Walt & van Rensburg (2017), are as follows: 

 

3.2.2 Advantages of the survey method 

 

Surveys can represent a large population. Surveys offer convenience in data collection as 

they can be administered to participants through a variety of ways without making direct 

contact, e.g., fax, online. The method is less costly as it can be administered at any given 

time and setting. The method limits the chances of bias due to researcher’s objectivity 

(Brink, van der Walt & van Rensburg, 2017). 

  



 
 
 

 

25 
 

3.2.3 Disadvantages of the survey method 

 

The questions in the surveys need to be standardized before administering to the participants 

to accommodate the general population.  Superficial or incomplete data, as the participants 

may only choose what they perceive as comfortable to them (Brink, van der Walt & van 

Rensburg, 2017). 

 

3.3 RESEARCH SETTING 

 

The study was conducted at a specialized tertiary psychiatric hospital in Gauteng Province, 

South Africa. This specialized psychiatric academic hospital admits short- and medium-term 

mental health patients, ranging from two weeks to 6 months of hospital stay. The hospital 

has six wards that accommodates only 136 inpatients, both male and female; three (3) 

biochemical units that admit 80 in-patients, the male semi-closed ward accommodates 30 

male patients, the female closed ward accommodates 18 mental healthcare users, and the 

male and female open ward that accommodates 32 patients. There is an eating disorder and 

adolescent unit with 23 beds. Out of this number, (thirteen)13 beds are reserved for the eating 

disorders and the adolescent unit accommodates only 10 in-patients (adolescents) with 

mental health conditions, six beds are reserved for females and four (4) for males between 

the age of 13 and 18. There is a psychotherapy unit providing 23 beds, for both males and 

females above 18 years of age. The last ward is the child unit that only admits 10 children, 

however only six (6) beds are currently in use. The total number of nurses across the hospital 

was 112, of which 71 are RN’s, 18 EN’s, 14 ENA’S and nine CSN’s who have just 

completed their undergraduate 4-year degree course. A maximum of two nurses work per 

ward during night shift as there are booked or expected admissions during their shift. The 

institution did not have part time nurses and does not subscribe to agency nurses. As an 

academic hospital, the hospital receives nursing students for work-integrated learning from 

nursing colleges and universities throughout the year. 

 

 

 



 
 
 

 

26 
 

3.4 POPULATION 

  

Population is a complete set of people or objects that represent homogenous characteristics 

of which the researcher is interested (Brink et al, 2017). In this study, the population 

consisted of all the nurses from all categories permanently employed at the selected hospital 

for at least 6 months. The total nursing population at the hospital was n=112 nurses of all 

categories, enrolled nurses, enrolled nursing assistants, professional nurses, and community 

services nursing, working both day and night shift. The target or accessible population was 

therefore the total number of n=112 nurses.  

 

3.5 SAMPLING AND SAMPLE SIZE 

 

3.5.1 Sampling method 

 

Sampling method is described as a method applied to select the participants in the study 

(Brink et al, 2017). A census sampling method was used in this study to select participants, 

therefore all the nurses (n=112) working day and night shift were selected for participation. 

Census sampling is described as the sampling method, which include involves everyone in 

a population who share common interest (Brink et al, 2017). 

 

3.5.2 Sampling size 

 

A sample size is described as the number of people/subjects included in a sample (Brink et 

al, 2017). Therefore, the sample size in this study was 112 (n=112) based on the total 

population of nurses currently employed at the identified hospital. 

 

3.6 DATA COLLECTION 

 

Data collection is process of obtaining the actual information by means of a selected relevant 

instrument that has been developed and tested in a pilot study (Jolley, 2013). The information 

may be acquired through questionnaires, interviews, or scales. Data collection will be further 



 
 
 

 

27 
 

discussed in terms of the instruments used, including their validity and reliability. Data 

collection procedures are also detailed. 

 

3.6.1 Data collection instruments 

 

A questionnaire is a written set of questions, which can be administered electronically or 

physically (Jolley, 2013), to respond to the objectives of this study, which were: 

 Describe how nurses in psychiatric hospital perceive their psychosocial work 

environment.  

 Describe how the nurses perceive their stressors. 

 Identify the factors that are perceived to be contributing to psychosocial work 

environment and stress. 

 

The researcher therefore used two questionnaires that were self-administered. The first 

instrument used in this study was called the QPS (QPS Nordic) The General Nordic 

Questionaire for Psychosocial and Social Factors (Annexure), which measured the 

psychosocial aspects of the work environment, job, and organization characteristics, as well 

as individual work-related attitudes. The questionnaire consists of 129 items; each item has 

five response alternatives, ranging from “very seldom to never” (1) “to often or always” 

(5). The QPS Nordic Questionaire for Psychosocial and Social Factors measures factors 

that pertain to most types of work and workplaces. The instrument consists of multiple-

choice questions relating to the following psychological and social factors at work: job 

demands and control, role expectations, predictability and mastery of work, social 

interaction with coworkers and clients, leadership, organizational climate, interaction 

between work and private life, work centrality, organizational commitment, and work 

motives (Dallner et al, 2000). This is a public instrument, the developer allows free use, 

without permission, for academic purposes (see Annexure 7). 

 

The second questionnaire, the Perceived Stress Scale (PSS) (Cohen et al., 1983), is a 10-

item scale used to measure the degree to which situations in one’s life are appraised as 

stressful. Items were designed to tap into how unpredictable, uncontrollable, and 

overloaded respondents find their lives. Each item has five response alternatives ranging 

from “never” (0) to “very often” (4); higher scores indicate a high amount of perceived 



 
 
 

 

28 
 

stress. The Perceived Stress Scale is for public use and no permission is required before 

use (Cohen et al., 1983) (Annexure 2). Please see annexure 8 for the permission to use this 

instrument. The two instruments were pre-tested on five undergraduate nursing students 

who were allocated for work-integrated learning at the identified hospital. No changes were 

made on both questionnaires. QPS Nordic general questionnaire guidelines allow for the 

items to be analyzed as single or grouped items (please see annexure 9). The single items 

which were used in this study are presented in table 3.1 

 

TABLE 3.1 Presents the single items of the QPS Nordic questionnaire included in study. 

Category Item 

number 

Details of the item 

Job demands Q31 Have you ever been exposed to 

threats or violence in the last two 

years? 

Job demands Q32 Are errors in your associated with a 

risk of personal injury? 

Role expectation Q44 Does your job entail tasks that 

conflict with your personal values? 

Social interactions Q81 Have you noticed anyone being 

subjected to harassment or bullying? 

Social interactions Q83 Have you been subjected to 

harassment or bullying? 

Leadership Q87 Does your immediate superior tackle 

the problems as soon as they surface? 

Leadership Q88 Do you trust the ability of the 

management to look after the future 

of the organisation in future? 

Organizational culture Q92 Is the climate of your work 

competitive? 

Work motives Q118 Is good pay and material benefits an 

important consideration in relation to 

your ideal job?  

 



 
 
 

 

29 
 

Below, the grouped data that were used in this study as per the QPS Nordic general 

questionnaire guideline are presented in Table 3.2. 

 

TABLE 3.2 Grouped items of the QPS Nordic 34 questionnaire 

SCALE SUBSCALES 

JOB DEMANDS 
Quantitative demands 

Decision demands 

Learning demands 

ROLE 

EXPECTATIONS 

Role clarity 

Role conflict 

CONTROL AT WORK 
Positive challenge at work 

Control of decision 

Control of work pacing 

PREDICTABILITY AT WORK Predictability during the next month 

Predictability of next two years 

Preference for challenge 

MASTERY OF WORK 
Perception of mastery 

SOCIAL INTERACTION 
Support from superiors 

Support from co-workers 

Support from friends and relatives 

LEADERSHIP 
Empowering leadership 

Fair leadership 

ORGANIZATIONAL CULTURE AND CLIMATE 
Social climate 

Innovative climate 

Inequality 

Human resource primacy 

WORK CENTRALITY 
Work centrality 

COMMITMENT TO ORGAMIZATION 
Commitment to organization 

PERCEPTION OF THE GROUP 
Perception of the group 

WORK MOTIVES 
Intrinsic motivation to work 

Extrinsic motivation to work 

 



 
 
 

 

30 
 

3.6.2 Validity and reliability of the instruments 

 

Validity of a test establishes if the instrument measures what it intends to measure (Polit & 

Beck, 2012). Reliability of a test is the degree of consistency with which the instrument 

measures an attribute (Polit & Beck, 2012). The two instruments have been used in a similar 

study in Sweden, in 2011, at the psychiatric in-patient hospitals (Tuvesson, Eklund & Wann-

Hanson, 2011). The QPS Nordic has been reported to be reliable with Cronbach’s alpha 

values ranging from 0.60 to 0.86 (Dallner et al., 2004). The perceived stress scale was found 

to be valid and reliable in a study conducted by Lee and Jeong (2019); the study reported a 

Cronbach’s alpha of 0.70. 

 

3.6.3 Data collection procedure 

 

The participant’s information leaflet (Annexure 3) and ethics clearance letter (Annexure 4) 

were distributed together with the two questionnaires in one unsealed envelope. The 

researcher distributed the questionnaires, information leaflets and ethics clearance letters to 

all the wards during the day shift. The information and envelopes were relayed to the night 

staff as they reported for their shift. After completion, they had access to ballot boxes. 

Instruction was given to the participants to put the completed questionnaires into the 

provided envelopes, seal them and place in the ballot box. For the sake of identification, all 

completed questionnaires were allocated with numbers for easy analysis purposes. Data 

collection was undertaken between December 2018 and February 2019. 

  

The questionnaires were distributed across all the wards in the hospital to all 112 (n=112) 

participants, but only 64 (n=64:57.1%) questionnaires were returned completed in the 

distributed boxes per ward, therefore, 64 (n=64) questionnaires were included in the 

analysis. The researcher collected the ballot boxes after every week from each ward from 

December 2018 to February 2019. 

 

3.7 DATA ANALYSIS 

 

Data analysis in research entails organizing the findings into meaningful terms; this involves 

summarizing, ordering and categorizing of data (Brink et al., 2017). Raw data (n=64) 



 
 
 

 

31 
 

participants were entered in an Excel spreadsheet. All statistical analysis was conducted 

using the STATA Windows programme (version 15). The researcher sought expertise from 

a statistician of the University of the Witwatersrand’s postgraduate research support 

services, who guided on the statistical analysis. Below is the description of the analysis done 

in the study specifically as per instrument used. 

 

 

3.7.1 QPS Nordic general questionnaire data analysis 

 

According to this questionnaire’s data analysis guidelines, the main analysis needed were 

the frequency distributions, means or medians computed on single items or on scales 

(Dallner et al, 2000). When single-item scores are used, it is common practice to calculate 

the percentage distributions of the responses of the target group (Dallner et al, 2000). Please 

refer to table 3.2 for the list of single items used. The questionnaire consists of grouped items 

for categories and subcategories for analysis which are presented through mean scores and 

standard deviation, additionally, each category has single items which are analyzed 

individually by presentation through the frequencies, percentages, and standard deviations. 

All the grouped items for categories and subcategories as they are analyzed individually, 

however single items per category were selected based on their significance regarding this 

study’s objectives. The raw data was captured into excel spreadsheet then exported into 

STATA (version 15) for analysis. In summary, analysis was presented through percentages 

and frequencies for single items only, and grouped items were analysed by means of 

standard deviation and mean value (Dallner et al, 2000).   

 

Single items were analysed by means of percentage and frequency distribution. Grouped items 

were analysed by grouping the scores of the items belonging to the subscales as per the 

guidelines of the questionnaire (Annexure 9), the overall mean score and standard deviations 

were used to interpret the results as follows: 

 Negative perception scores category 1: these were scales with a mean value of two (2) 

and below and the researcher perceived them as needing urgent intervention. This 

category indicates the negative perceptions of the participants regarding the concerned 

subscale. 

 Negative perceptions scores category 2: these scales with a mean value of 3 to 2, 



 
 
 

 

32 
 

requiring no immediate intervention. This represents a moderately perceived subscale 

by the participants. 

 Positive perception scores category 3: these were scales with a mean value score of 3.5 

and above, required no intervention. This category presents positively perceived areas 

or subscale by the participants. 

 

3.7.2 Perceived stress analysis 

 

The Perceived Stress Scale (PSS) results were obtained as stated by Cohen et al. (1983), 

which is by reversing responses to the four positively stated items, items 4, 5,7 and 8 and 

then summing across all scales (for example 0=4,1=3, 2=2, 3=1 and 4=0). Scores ranging 

from 0-13 are considered low perceived stress, 14-26 considered as moderate perceived 

stress and 27-to 40 as high-perceived stress (Cohen et al., 1983). In order to summaries the 

findings regarding the perceived stressed scale, data was analyzed using the frequencies, 

percentages and mean. The scoring guidelines of this questionnaire was not distributed to 

the participants during data collection to limit biasness.   

 

 

3.7.3 Statistical analysis 

 

3.7.3.1 Pearson correlation 

 

Pearson correlation measures statistical relationship or association of variables. In this study, 

this was applied to assess relationships among subscales (see Table 3.2), all the subscales of 

the QPS Nordic general questionnaire were placed into a rank to assess any correlation i.e., 

if there was any strong or negative correlation amongst each other in an order of a rank. A 

value of -1 to 1, where: +1=a positive correlation between the ranks; -1= a negative 

correlation between the ranks. 

 

3.7.3.1 Mann Whitney U-test 

 

This is a nonparametric statistical test which is used to compare the difference between two 

independent groups when the dependent variable is either ordinal or continuous (Divineet 



 
 
 

 

33 
 

al., 2018). In this study, Mann Whitney U-test was used to analyze any differences within 

the groups of respondents in relation to their perceived stress levels, i.e., gender, and 

experience in years. The perceived stress scale results were dichotomized as, all the scores 

between 0 and 26 were recoded as “no stress” and the scores between 27 and 40 were recoded 

as “stress. 

 

3.8 VALIDITY AND RELIABILITY OF THE STUDY 

 

Validity of an instrument establishes if the instrument measures what it is intended to 

measure (Polit & Beck, 2012). Reliability of a test is the degree of consistency with which 

the instrument measures an attribute (Polit & Beck, 2012). 

 

Validity and reliability of the study was ensured as the researcher based the research process 

on a proposal that was clearly defined after consultation with postgraduate research office 

of the Faculty of Health Sciences in the University of the Witwatersrand, and peer reviewed 

by experienced researchers in the department of nursing education. Both the supervisor and 

co-supervisor of this study are both experienced researchers. The items of the perceived 

stress scale were not modified, and certain items for the QPS Nordic general questionnaire 

were selected and used according to the objectives defined for this study. 

 

3.9 ETHICAL INTEGRITY 

 

Ethical consideration in research refers to the preliminary assessments, which need to be 

applied to protect those who will participate in the study; this is an obligation of a researcher 

and based on Human Rights (Brink et al, 2017). Therefore, the following ethical 

requirements were implemented: 

 Permission to conduct the study was granted by the hospital’s Ethics and Research 

Committee (annexure 4). 

 Ethical clearance to conduct research was granted by the Human Research Ethics 

Committee at the University of the Witwatersrand (M180859) (Annexure 5). 

 Postgraduate approval of the study (Annexure 6). 

 To ensure confidentiality and anonymity of the participants, no names appeared in 

the questionnaires, only code numbers for the study purpose. 



 
 
 

 

34 
 

 The information letter requesting participation from potential participants 

accompanied each set of questionnaires. Participation in the study was voluntary, and 

participants could withdraw from the study at any point without penalty, as stated in 

the information leaflets (Annexure 3). Completion of the questionnaires was 

considered as informed consent to participate in the study. This also allowed 

anonymity to those who decided to participate, as the researcher was also part of the 

staff at the selected hospital. In the information leaflet was the contact details of a 

professional person who was assigned to offer counselling (Ms. Rebecca Coetzee, 

Telephone: 0114884268) and further referrals, where necessary, were provided to 

ensure that participants’ emotional wellbeing was safeguarded. 

 

3.10 SUMMARY 

 

This was a cross-sectional survey in an identified psychiatric hospital in Gauteng Province. 

Data was collected by means of self-administered questionnaires, namely The QPS Nordic 

general and the Perceived Stress Scale (PSS). The study adopted census sampling and 

yielded a response rate of 57.1%. All statistical analysis was done using the STATA 

programme (version 15) as per the University of Witwatersrand’s recommendations. 

Descriptive statistics were analyzed by frequencies, means, standard deviations and 

percentages. The Mann Whitney U-test was performed to assess the differences between the 

groups, and Pearson correlation was performed to assess any correlation between the 

subscales of the QPS Nordic. Ethical clearance to conduct research was granted by the 

Human Research Ethics Committee at the University of the Witwatersrand. Permission to 

conduct the study was sought from the identified hospital’s CEO and participants’ 

confidentiality was maintained throughout, as their identities did not appear on either 

questionnaire. 

 

 

 

 

 

 

 



 
 
 

 

35 
 

CHAPTER FOUR 

 

RESULTS AND DISCUSSION 

 

4.1 INTRODUCTION 

 

Chapter Four focuses on the presentation and discussion of the results. This study 

attempted to answer the research question, “How do nurses in psychiatric hospitals 

describe their psychosocial work environment and perceive their stressors?” The 

presentation of the results will comprise of tables, graphs and charts illustrating the 

frequencies, percentages, means and standard deviations correlation coefficients. 

 

4.2 RESULTS OF THE STUDY 

 

The results will be reported in terms of response rate, demographic profile, perceived stress 

which objective number two of the study, followed by the first objective, the psychosocial 

work environment of the nurses and lastly, we described the factors that are perceived to be 

contributing to psychosocial work environmental factors and stressor. These will be followed 

by the discussion and summary of the results. 

 

4.2.1 The response rate 

 

The sample size was based on a population of 112 (n=112) nurses currently employed in 

the identified hospital, 64 questionnaires were returned completed: a response rate of 

57.1%. 

 

4.2.2 Socio-demographic profile of respondents 

 

The socio-demographical profile of all the respondents (n=64) is illustrated in Table 4.1.  

 

 



 
 
 

 

36 
 

Table 4.1 Socio-graphical profile of nurses (n=64) who completed the questionnaires 

 

Characteristics Frequency Percentage (%) 

Age(years) 

No response 5 7.81 

21-35 31 48.48 

36-46 17 26.56 

47-57 11 17.19 

Gender 

No response 1 1.56 

Male 17 26.56 

Female 46 71.88 

Experience (years) 

No response 1 1.56 

0-1 6 9.38 

1-5 25 39.06 

6-10 19 29.69 

11-15 7 10.94 

16-20 2 3.13 

21-25 3 4.69 

25 and above 1 1.59 

 

 

This entails the respondents’ age, gender, educational level, rank, their experience in years, 

and units where they are working Table 4.1 indicates that 48.48% (n=31) of the respondents 

were aged between 21-35 years, followed by respondents between the ages of 36-46 (26.56%: 

n=17), those between 47-57 years (17.19%: n=11), while five (7.81%: n=5:) did not indicate 

their age group when completing the questionnaire; the mean age was 32.5 years. Females 

(71.88%: n=46) dominated the entire nursing respondents, with males being 26.56% (n=17). 

Majority of the nurses (70.31%: n=45) were professional/registered nurses and either had a 

college diploma (46.88%: n=30) or a university degree (35.94%: n=23), whilst enrolled and 

nursing assistant nurses equaled only 10.94% (n=7). Most of the respondents had work 



 
 
 

 

37 
 

experience of 1-5 years in the institution, 39.06% (n=25), those between 6-10 years were 

29.69% (n=19), 4.69% (n=3) had between 21-25 years of work experience, 56 (87.50%) 

indicated that they worked 40 hours a week and a few respondents (10.94%: n=7) worked 

over 40 hours a week. Most of the respondents (37.50%: n=24) of the respondents worked in 

the biochemical wards. 

4.2.3 Psychosocial work environment  

 

This section responded to objective one of the study and will be presented in terms of job 

demands (decision demands, learning demands, repetition of tasks, and exposure to 

violence at work in past two years, risks/errors related or leading personal injury); role 

expectations (role clarity, role conflict and role expectation); control at work (positive 

challenge at work, control of decisions and control of work pacing); predictability at work 

(predictability at work during the next month, predictability at work in the next two years 

and preference for challenge); mastery of work, social interaction (social support from 

superiors, support from co-workers, and social support from friends and relatives); bullying 

and harassment (evidence of bullying, and individual experience of bullying in their 

workplace);  

Also, leadership (empowering leadership, fair leadership, and supervisor’s problem-

solving skills); organizational culture (social climate, innovative climate, inequality 

Human Resource primacy, competitiveness of the climate); commitment to the 

organization and group work, work motives (Intrinsic motivation and work, Extrinsic 

motivation to work); the Pearson correlation and logistic regression. The presentation of the 

results will refer to either table 4.2 (single items) and 4.3 (grouped item) of the QPS Nordic 

questionnaire as referred above. 

 

 

 

 

 

 

 

 

 



 
 
 

 

38 
 

TABLE 4.2 Results of the single items in frequencies and percentages 

 

JOB DEMANDS 

Q
3

1
 

Response Frequency (n) Percentage (%) 

No response 0 0 

Very seldom/never 23 35.94 

Rather seldom 13 20.31 

Sometimes 18 28.32 

Rather often 6 9.38 

Very often/always 4 6.25 

TOTAL 64 100 

Q
3

2
 

Response Frequency (n) Percentage (%) 

No answer 0 0 

Very seldom/never 15 23.44        

Rather seldom 14 21.88        

Sometimes 12 18.75        

Rather often 11 17.19        

Very often/always 12 18.75       

TOTAL 64 100 

ROLE EXPECTATIONS 

Q
4

4
 

Response Frequency (n) Percentage 

No response 0 0 

Very seldom/never 18 28.13        

Rather seldom 21 32.81        

Sometimes 17 26.56        

Rather often 8 12.50       

Very often/always 0 0 

Total 64 100 

SOCIAL INTERACTION (BULLYING AND HARRASSMENT) 

Q
8

1
 

Response Frequency (n) Percentage (%) 

No response 2 3.13 

No 29 45.31        

Yes 33 51.56        

Total 64 100 

Q
8

3
 

Response Frequency (n) Percentage (%) 

No response 3 4.69         

No 44 68.75        

Yes 17 26.56       

Total 64 100 

    

 

Table 4.2 presents the results of single items in terms of the percentage distributions and 

frequencies; these results are further presented in terms of figures arranged according to the 

scales they belong to. Below is table 4.3 which illustrates the results of grouped items. 

 

 

 

 

 



 
 
 

 

39 
 

Table 4.3 The results of the grouped items of the QPS Nordic questionnaire in terms 

of the standard deviation and the mean score for each category (n=64) 

 

D
o

m
a

in
 

Subscale Mean 
Standard 

deviation 

Mean score rounding  

J
O

B
 D

E
M

A
N

D
S

 

Quantitative 

demands 2,67 0,71 3 

Decision 

demands 3,82 0,76 4 

Learning 

demands 3,06 0,73 3 

R
O

L
E

 

E
X

P
E

C
T

A
T

IO
N

S
 Role clarity 4,19 1,07 4 

Role conflict 2,89 0,74 3 

C
O

N
T

R
O

L
 A

T
 W

O
R

K
 

Positive challenge 

at work 
 

4,13 
 

0,74 

 

4 

Control of 

decision 2,78 0,82 3 

Control of work 

pacing 2,48 0,71 2 

P
R

E
D

IC
T

A
B

IL
IT

Y
 A

T
 

W
O

R
K

 

Predictability during 

the next month 
 

3,04 
 

1,09 

 

3 

Predictability of next 

two years 
 

3,21 
 

1,02 

 

3 

Preference for 

challenge 3,24 0,97 3 

M
A

S
T

E
R

Y
 O

F
 

W
O

R
K

 

Perception of 

mastery 

 

3,72 

 

0,89 

 

4 

 

Table 4.3 above presented the overall the results of the grouped items in terms of the mean 

scores and standard deviations, below is a detailed presentation of the above results arranged 



 
 
 

 

40 
 

according to the scales and subscales they belong to. 

 

4.2.3.1 JOB DEMANDS 

 

As depicted in Table 4.3 in terms of quantitative demands, at a mean score of 2.67 SD=0.71, 

the nurses’ responses revealed that they perceived their workload as neither too big nor too 

little. Also, in terms of decision demands at a mean score of 3.82 SD=0.76, nurses expressed 

that their work required them to take complex decisions and at times such decisions had to be 

taken abruptly. While when exploring learning demands, this study discovered that (mean 3.06 

SD=0.73) nurses felt they possessed reasonable skills and training required of them to perform 

and successfully complete their task and duties for their nursing duties in the mental health 

institution. The results of perceptions regarding exposure to violence at work are in Figure 4.1 

indicating violence/threat exposure at work in the past two years.  

 

 

Figure 4.1. Violence/threat exposure at work in the past two years (n=64) 

 

Most of the nurses (56.24%: n=36) reported they never have been exposed to any kind of threat 

or violence in the last two years at work in this hospital, while 28% (n=18) reported they 

sometimes had been exposed to threats or violence in the same working environment. Only 

15.63% (n=10) of nurses reported they have often encountered violence or threats in the last 

two years at their workplace. Figure 4.2 presents results of nurses’ perceptions regarding the 

risks/errors related or leading personal injury as displayed below. 

 

0

23

13

18

6

4

0 5 10 15 20 25

NO RESPONSE

NEVER

RATHER SELDOM

SOMETIMES

RATHER OFTEN

ALWAYS

Frequency



 
 
 

 

41 
 

 

Figure 4.2 Prevalence of errors at work that pose a risk of personal injuries (n=64) 

 

Nurses’ responses indicated that almost half of them stated that the errors they commit in their 

duties never or rather seldom lead to a risk of personal injury (n=29:45.31%). The nurses 

described their workplace as less risky. A small margin of the difference was also observed in 

the results, where n=23 (35.94%) felt they were more likely to be injured due the errors. 

 

4.2.3.2 ROLE EXPECTATIONS 

 

When considering role expectation as displayed in Table 4.3, at a mean score of 4.19 and SD of 

1.07, the nurses revealed that they perceived their work environment to be clear in terms of 

their roles when it came to role expectation. The nurses were aware of their expectations in the 

workplace because they were well-defined objectives and goals.  For role conflict, the results 

revealed that nurses did not entirely understand their roles and perceived their work 

environment as conflictual in terms of individual roles and tasks. Moreover, nurses’ responses 

revealed that they received incompatible requests from other people or the multidisciplinary 

teams. Mean was 2.89 SD=0.74. 

 

In this study, 60.93% (n=39) SD=2.2 of nurses did not perceive their work to be a threat to their 

personal values, which is a positive attribute towards wellbeing during their line of duty, as well 

as outside the institution they are practicing at. Figure 4.3 presents nurses views regarding 

0

15

14

12

11

12

0 2 4 6 8 10 12 14 16

No
response

Never

Rather
seldom

Sometime
s

Rather
Often

Always

Frequency



 
 
 

 

42 
 

possibility of conflict between their job and personal values. 

 

Figure 4.3 Conflict between their job and their personal values (n=64) 

 

Concerning positive challenge at work (mean value of 4.13 and SD=0.74) as indicated in Table 

4.3, the results revealed that nurses strongly perceiv