Introduction
Human health and the quality of life are the concepts of interdisciplinary features, constituting the subject of interest and research of individual from many fields of science. According to the WHO (World Health Organization) definition, health “is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. In turn, health-related quality of life is a functional state and a sense of satisfaction in relation to the ideal situation adopted by the individual. The most frequently mentioned components of it include: leading a normal life, social utility, happiness, life satisfaction, achieving personal goals and using personal potential. In addition, the issue of self-assessment of health and quality of life allows one to analyse many interesting aspects of the functioning of various social groups, including nurses [1–4].
The occupational group of nurses is particularly exposed to the negative effects of physical and mental stress at work. The patients’ huge demand for nursing care and work in conditions of particular stress are the main reasons for the observed health hazards among the indicated professional group. In addition, the constant experience of anxiety/fear and fatigue cause health, mental and emotional problems. A negative impact on the health of nurses is also caused by a sense of lower job satisfaction and emerging ethical and moral problems. Determining the most important causes and relationships between the factors that, in the opinion of nurses, determine the quality of life, may result in the future in the creation of preventive programmes and various forms of support [3, 4].
The aim of the study was to assess the quality of life of nurses, including the subjective sense of their own health.
Material and methods
The study was conducted in a group of 100 randomly selected nurses employed at the Ludwik Perzyna Provincial Hospital in Kalisz. The study used a standardized tool, i.e. the SF-36 questionnaire for assessing the quality of life (Polish version: Tylka J, Piotrowicz R), supplemented with custom questions. The survey contained a metric – 11 questions (SF-36) relating to eight indicators of quality of life, such as physical functioning, limitations due to physical health, pain perception, general sense of health, vitality, social, emotional and mental functioning, and 7 custom questions concerning the assessment of the health, social, economic and professional situation of the respondents. The statistical analysis was performed on the basis of the following tests from the chi-square family: Pearson’s c2, c2 with Yates’ correction and NW c2 (maximum likelihood). In addition, Spearman’s rank correlation coefficient significance test was used.
Results
The surveyed group of 100 nurses were women aged 24 to 60; the mean age was 43.1 ±10.8; 53% of respondents lived in a city, while 47% lived in the countryside. Among the respondents, 66% reported having a master’s degree in nursing. The work experience of nurses in the profession ranged from 1 to 38 years; the average seniority was 19.7 ±11.8 years. 79% of the respondents were married; having one child was reported by 33% of nurses; 31% of the respondents had two children. The economic situation of the respondents was at the average level in 45% and good in 35%. The vast majority of nurses (86%) worked in a twelve-hour system. Chronic diseases were the most common in the study group, including arterial hypertension in 25%; degenerative disease of the spine in 19% and hypothyroidism in 16%.
As the answer to the question: “How do you assess your current state of health?”, 33% of the respondents indicated a “satisfactory” state of health; 31% “good” and 24% “very good” (Fig. 1). The research revealed a statistically significant relationship between nurses’ marital status and self-assessment of their current health status (p = 0.0426). Among the respondents who rated their health as “very good”, a high percentage (47.6%) included single nurses and widows (Table 1).
A similar relationship was found between the respondents’ self-assessment of health and the place of residence (p = 0.0007). 38.3% of nurses living in rural areas reported a “very good” health condition (Table 2). The analysis of the results also showed a significant relationship between the self-assessment of the current health condition and the family situation of the respondents. The group of respondents with “good” and “satisfactory” health status was dominated by nurses with children (34.6% and 37.0%, respectively) (Table 3). Additionally, a correlation was found between nurses’ self-assessment of health and the occurrence of chronic diseases (p < 0.0001). Respondents who did not have chronic diseases rated their health as “very good” and “good” (35.4% and 47.9%, respectively) (Table 4). The analysis of the physical health of the respondents concerned the verification of the limitations and the ability of nurses to perform activities requiring various energy inputs. The obtained results revealed that in 35% of women, the current state of health “slightly” limited the performance of activities such as running, lifting weights and participating in sports that require a lot of engagement. On the other hand, in 21% of the respondents, the current state of health greatly limited their performance. The smallest difficulties were caused by bathing or dressing, and walking at a distance of approximately 100 m and 500 m (Table 5). The assessment of the impact of physical health on everyday functioning in the surveyed group of female respondents also included the question: “Did you have any problems with work or daily activity in the last month which resulted from your health and caused: the need to shorten working hours or other activities; feeling worse than expected; restriction in the type of work or other activities; occurrence of difficulties in the performance of work or other activities?” The results revealed that 44% of the respondents confirmed “worse well-being than expected”, in 36% of the respondents “there were difficulties in performing work or other activities”. Then, the study of the impact of emotional problems on the physical fitness of the respondents was analysed. As the answer to the question “During the last month, have you had problems related to your work or daily activities, resulting from emotional problems (e.g. feeling depressed, nervous)?” most of the respondents did not have the indicated problems; 34% of the respondents indicated less achievements/results in this area than expected. Analysing the impact of health and emotional problems on social functioning, the respondents answered the question: “During the last month, did your health or emotional problems affect your usual activities, contact with family, friends, neighbours or other groups?” Respondents could choose from 5 possible answers: “no”, “never”, “rarely”, “sometimes”, “very rarely”, “very much”. The obtained answers revealed that in 39% of nurses the above-mentioned problems did not affect their usual activities and contacts with family/other people, while in 18% of the respondents they had a “rare influence” on the above activities. The impact and role of rest on the health of the respondents was included in the question: “How often during the last month did you have time for yourself equal to or longer than 8 hours (excluding night rest)?” The provided answers revealed that 40% of the respondents reported “rare free time” and 20% of the respondents “very rarely” used free time. In addition, the aspect related to the mental functioning of nurses was assessed, included in the question: “How many times did the following condition occur in the last month?” The results revealed that nurses were most often: “tired” – 76% of the respondents; “happy” – 54% of the respondents; and “felt wasted” – 47% of the respondents (respondents answered “a lot of time”; “most of the time” and “all the time”) (Table 6). The research also evaluated the impact of the physical health or emotional state on the social contacts of the respondents. When asked: “How often in the last month did your physical health or emotional state affect your social contacts (meeting with family and friends)?”, 44% of nurses indicated that physical health or emotional state had such an effect “some of the time during the last month.”
In order to assess the subjective sense of health among nurses, the answers to two questions related to the perception of pain and its impact on professional and home activity were analysed. To the question “How many times have you felt pain in the last month?”, 26% of the respondents stated that they felt pain “rarely”, and 22% of the respondents “very rarely”. On the other hand, to the question “How often in the last month did pain interfere with your work (work and home)?”, 34% of respondents answered that pain “somewhat” interfered with their work; fewer, 32%, expressed the opinion that work was not disturbed by pain. In the remaining people, the pain interfered with work “very much” and “very” in 13% and 6% of the respondents respectively.
In addition, respondents expressed their opinion on how true or false statements about their health were, such as: “I believe that my health is better than that of other people I know”; “I am healthier than other people I know”; “I suppose my health will deteriorate” and “My health is excellent.” Most of the nurses had no opinion on the above statements. Most often, 88% of the respondents had no opinion on the statement “I suppose that my health will deteriorate”, choosing the answer “I don’t know”.
The analysis of the obtained results revealed statistically significant correlations between the self-assessment of the current state of health of the respondents and selected socio-demographic and health factors. Nurses, over the years of their lives, assessed their health to a lower degree (p < 0.0001); the longer the seniority in the profession, the lower the level of self-assessment of health (p < 0.0001). Among the nurses who rated their health as very good, the majority were single/widows, rural residents (p = 0.0007), without children (p < 0.0001) and without comorbidities (p < 0.0001). Furthermore, better financial situation of the respondents determined a higher level of self-assessment of health (p < 0.0001).
In search of relationships and dependencies between the respondents’ self-assessment of physical fitness and selected variables, the results of research in this area were analysed. It was revealed that age and marital status are very important factors determining the mobility and physical capacity of the respondents (p < 0.05). Among women who had no limitations in performing activities such as practising sports, lifting weights, or doing major chores, the largest percentage concerned younger women (aged up to 45) (Table 7), single and widows (Table 8) and female inhabitants of villages (Table 9). The occurrence of problems with work or daily activity resulting from the health condition of the respondents was related to their age and work experience. Significant relationships were found in women over 45 years of age (p < 0.001) and women with more than 20 years of work experience (p < 0.0001), who more often indicated “the need to shorten working time or other activities”, “worse well-being” and “occurrence of difficulties” (p < 0.0001).
By analysing the impact of selected variables on the vitality of the respondents, referring to such statements as: “You were full of spirit”, “You were full of energy”, “You were happy” and “You were tired”, significant correlations were obtained. The older the nurses were, the less often were they full of spirit (p = 0.0484) or energetic (p = 0.0208) and the more often were they tired (p = 0.0041). In addition, the longer their seniority, the less often were the respondents were full of spirit (Rs = –0.224) or energetic (Rs = –0.297) and the more often were they tired (Rs = 0.321). Furthermore, the better the economic situation of the nurses was, the more likely they were to be spirited (Rs = 0.467), “energetic” (Rs = 0.525), “happy” (Rs = 0.249) and “less tired” (Rs = –0.491).
The relationship between the perception of the current state of health and the mental functioning of the respondents, contained in the statements “You were very nervous”, “You felt unworthy and nothing was able to comfort you”, “You were quiet and calm”, “You were broken and sad”, and “You felt wasted”, showed correlations with selected statements. The better the health status of the nurses, the less often they felt worthless and nothing could comfort them (Rs = –0.253); and the less likely they were to be broken and sad (Rs = –0.306) or wasted (Rs = –0.574).
Discussion
The quality of life of nurses, as well as other social groups, is conditioned by many factors. These include, among others: age, place of residence, family and economic situation, lifestyle, nature of work and the presence of chronic diseases. Certain differences and characters of health problems occurring among this professional group result from the fact of particular exposure to physical and mental overload at the workplace and the risks associated with occupational exposure. In addition, comprehensive patient care and the growing demand for nursing care have a negative impact on all spheres of nurses’ functioning, often leading to depression and difficulties in performing professional activities [1, 4]. The analysis of the results of own research in a group of 100 nurses revealed many important aspects related to the quality of life and health functioning of the respondents. A significant impact of specific demographic, epidemiological and environmental factors on the level of health assessment of the respondents in particular areas of life was observed. 33% of nurses assessed their general current state of health as “satisfactory”, 31% as “good”, and 24% as “very good”. The results revealed that older respondents and those with longer work experience assessed their health at a lower level. The following factors had a positive impact on the above-mentioned assessment: being single, not having children, living in the countryside, higher level of material resources and lack of comorbidities. The vast majority of the respondents were unable to assess and compare their own health with the health of other people they knew. Interesting research results regarding the understanding and evaluation of health were obtained in the study by Deluga et al., which was conducted in a group of 191 nurses based on a standardized tool: the List of Health Criteria. The obtained results revealed that the nurses attributed the highest importance to health in the category of property and condition, defined by the statements: “do not feel any physical ailments”; “have all parts of your body in working order” and “feel happy most of the time”. In addition, respondents aged over 40, married and living in small towns significantly more often chose the health criterion “not feeling any physical ailments” (p = 0.03) compared to respondents from younger age groups, who more often indicated the criterion “be able to get along well with other people” (p = 0.01) [5].
Piotrowski’s research, conducted among 813 nurses, assessed the quality of life of the respondents based on the following variables: experiencing physical ailments, health problems restricting daily activities and intensity of psychosomatic symptoms. It was found that over 90% of the respondents reported physical ailments and had health problems that restricted daily activities. The most common symptoms in the group of surveyed nurses were pain and tension in the muscles of the neck and shoulders (11.7%) and the feeling of fatigue not related to work (9.8%). In addition, the physical well-being of nurses was most strongly correlated with mental well-being and negatively correlated with life stress (the higher the physical well-being, the higher the level of mental well-being: the desire to live, satisfaction with the current/current life, no symptoms of depression and a lower level of life stress and self-destruction) [6]. On the other hand, in the study by Dugiel et al., moderate problems in at least one domain of quality of life were reported by 65.52% of respondents. Pain or discomfort was felt by 48.97% of respondents; anxiety or depressed mood by 50.3%; problems with performing usual activities by 10.34% and problems with walking by 6.2%. It is worth emphasizing that pain and anxiety were the most frequently reported problems in the group of younger women. In addition, the average assessment of the health status of the surveyed nurses, according to the VAS scale, was 78.85 points (SD 13.85). The mean health score decreased gradually according to the age of the respondents [7]. On the other hand, the results of research by Fidecki et al. on the assessment of the quality of life of 109 nurses working in neurological wards revealed that the respondents rated the overall quality of life and health at a similar level, respectively: 3.70 ±0.70 and 3.60 ±0.80. The highest score was given to the field of social relations (71.70 ±16.10), and the lowest to the psychological field (61.00 ±13.30) [8]. Subsequently, in a study by Kupcewicz et al. in a group of 253 nurses working in the operating block and intensive care units, the assessment of the impact of socio-demographic factors and factors related to the work environment on the quality of life was analysed. In addition, the aim of the study was to identify the relationship between stress coping strategies and the nurses’ quality of life. The relationship between education and the level of quality of life in the psychological domain was revealed, which differed depending on the level of education, in favour of nurses with higher education (second-cycle studies). The material situation of the respondents was significantly related to the quality of life in all domains; the strongest relationship was found between the material situation and the level of quality of life in the environmental domain [9]. In the study by Głowacka et al. conducted in a group of 100 professionally active nurses, the respondents reported an average level of assessment of the quality of their own lives. The level of education of nurses did not determine the quality of life, which was more influenced by the lack of time than by the perceived state of health [10]. Mendrycka et al., who examined a group of 701 nurses, found that the respondents were characterized by an internal sense of health control and a general low index of health behaviours (4.50 sten). It was found that the level of health behaviours of the respondents decreased with the increase in years of work; nurses with the longest work experience were characterized by a significantly lower index of health behaviours (p < 0.001) [11]. Research by Orszulak et al. on the quality of life of nurses conducted in a group of 312 respondents revealed that a higher quality of life had a significant impact on improving health behaviours [12].
Research by Lorek et al. conducted in a group of 155 nurses revealed that the sense of satisfaction with the work performed by the respondents was reflected in the general feeling of satisfaction with life and life orientation [13]. Additionally, research by Barmanpek et al. conducted on a group of 225 nurses confirmed that with the increase in professional satisfaction, both the quality of life and the quality of nursing care provided improved [14]. Cruz’s research conducted on a group of 163 nurses revealed that improving the quality of life of the respondents probably had an impact on the level of clinical competence [15]. In the study by Kupcewicz et al. conducted in a group of 110 nurses, the respondents’ sense of life satisfaction was analysed. The overall life satisfaction index was found to be 21 ±5; 35.45% of the respondents described the level of satisfaction with life as average, and the same percentage of respondents assessed it as high. In addition, a statistically significant impact on the level of life satisfaction was found for such factors as marital status (p < 0.02), education (p < 0.005), financial situation (p < 0.002), relationships with colleagues (p < 0.0001) and relationships with superiors (p < 0.009) [16].
In our present research, the analysis of the impact of health on the physical functioning of nurses confirmed that the majority of respondents (95%) had no restrictions in performing simple activities such as bathing or dressing and walking up to 100 m. Similarly, health and emotional problems did not affect normal activities and contacts with family, friends and neighbours. In addition, the results revealed that most often nurses reported the occurrence of “fatigue”, with an average value of 4.09 ±1. It is worth emphasizing that with the passage of successive years of life and longer work experience in the profession, nurses reported having more free time for themselves (p < 0.0001). In the group of respondents who “had no free time” (21.1%) and “rarely had time for themselves” (52%), women without children represented a higher percentage (p = 0.0212). In addition, the better the economic situation of nurses was, the less time they had for themselves (p = 0.0011). On the other hand, in Sygit-Kowalkowska’s study, conducted among psychiatric nurses, aimed at determining the degree of chronic fatigue, the occurrence of the indicated problem was found at a medium level and then at a high level (range of average scores up to 83 and high scores from 84) [17]. Dudek’s research conducted in a group of 100 nurses of hospital and primary care wards revealed that nearly half of the respondents had symptoms of chronic fatigue, and 36% had insomnia. It is worth emphasizing that seniority did not significantly affect the level of fatigue of the respondents [18]. In Franek’s research in a group of 379 nurses and midwives, 54.3% of the respondents stated that they often experienced mental fatigue [19].
Pain is an important health problem that reduces the quality of life of professionally active nurses. The results of our research did not confirm the high intensity of this problem. Pain was felt more often by older nurses with longer work experience in the profession
(p = 0.0094); (p = 0.0098); among the respondents who did not feel pain, the percentage of childless women was higher (p = 0.0027). Research by Sierakowska et al. confirmed the occurrence of pain in nurses from the musculoskeletal system in 57%, mostly affecting the lumbar spine (89.2%). Constantly occurring pain was characteristic of nurses whose average age was 49.5 years (p = 0.0001), with work experience of over 27 years (p = 0.0002) and with a body mass index (BMI) value ≥ 25 kg/m2 (p = 0.0038). In addition, the average quality of life results were significantly dependent on the intensity of pain, i.e. pain increasing with age and duration of professional activity was a significant factor lowering the quality of life of nurses. The self-assessment of the subjects’ own health showed a lower assessment of health with increasing frequency (p = 0.0009) and intensity of pain (p = 0.038) [20].
The results of our research also made it possible to assess the impact of health or emotional problems on the performance of ordinary activities and on social contacts of the respondents. The indicated problems more often disturbed functioning in the group of elderly people; with longer work experience; having children; with a worse economic situation; with chronic diseases and lower self-esteem of health (p < 0.05). Identical correlations were revealed in terms of the impact of emotional problems on work and daily activities, with the exception of the family situation. In addition, in the surveyed group of nurses, it was revealed that the existing limitations in physical fitness affected their worse mental and social functioning (p < 0.05). Mental well-being was better among women with a favourable economic situation (p < 0.05). There were restrictions on social contacts (p < 0.05) significantly more often among the elderly, with longer work experience, worse self-assessment of current health and with chronic diseases. The economic and family situation and the place of work of the respondents did not affect the above-mentioned aspect of functioning. In Rybka’s research conducted in a group of 100 nurses, the presence of depression symptoms was confirmed by over 1/3 of the respondents (34%); the severity of depressive symptoms was correlated with exposure to stress in the workplace and with the frequency of occurrence of stressors. In addition, the frequency of depressive symptoms was affected by the length of work experience, i.e. the greatest intensity of depressive episodes was reported in respondents with more than 30 years of work experience [21].
In our research, it was found that the respondents with a better economic situation and no chronic diseases were more often “full of spirit”, and “happy” (p < 0.05). The better the health of the nurses, the more often they were “full of spirit” and “full of energy”. In addition, worse mental functioning (they were “broken and sad” and “wasted”) was found in older respondents with longer work experience, in women with children and those working in conservative wards. Interesting results related to the presence of stress factors in the work environment of nurses and the associated entitlements were obtained in the study by Skorupska-Król et al. (mean 3.72, SEM 0.12) [22].
Conclusions
The surveyed group of nurses most often indicated a “satisfactory” degree of their general sense of health.
A “very good” degree of health functioning was most often reported by single/widowed people, without children, with a very good economic situation, and women living in rural areas.
The occurrence of limitations in the scope of physical functioning of the respondents and lower self-esteem of the perception of their general sense of health had a negative impact on the quality of their mental and social life.
Recommendations for nursing practice: Systematic assessment of the quality of life of professionally active nurses may be an indicator of the quality of care provided to the patient.
Disclosure
1. Institutional review board statement: Not applicable.
2. Assistance with the article: None.
3. Financial support and sponsorship: None.
4. Conflicts of interest: None
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