The four questions explored in this study are the following:
1. What is the quality of work life of nurses working in the labour, delivery, recovery, and postpartum areas at Health Sciences North (e.g., in the study, this is the only hospital where nurses receive cross training), North Bay Regional Health Centre, Sault Area Hospital, and Timmins and District Hospital?
2. What are the factors of work ability among nurses working in selected labour, delivery, recovery, and postpartum areas at Health Sciences North, North Bay Regional Health Centre, Sault Area Hospital, and Timmins and District Hospital?
3. What are the factors of quality of work life among nurses working in selected labour, delivery, recovery, and postpartum areas at Health Sciences North, North Bay Regional Health Centre, Sault Area Hospital, and Timmins and District Hospital?
4. What is the quality of work life of nurses who are cross-trained compared to those with no cross-training for working in the labour, delivery, recovery, and postpartum areas at Health Sciences North, North Bay Regional Health Centre, Sault Area Hospital, and Timmins and District Hospital?
Study Framework
The study is grounded in the Job Demand-Control-Support Framework. This framework was used to determine the design of the study. It also informed aspects of the data analysis process in relation to both quantitative and qualitative findings.
The Job Demand-Control-Support (JDCS) is an expansion of the Job Demand-Control model[176] framework used to define the concepts of stress and quality of work life in the nursing work environment in northeastern Ontario. As noted above, the framework is an organizational model that is helpful in the process of data analysis and interpretation of findings. This model has dominated research on occupational stress in the last 20 years [17]. It focuses on two dimensions of the work environment: job demands and job control [176]. Job demands refer to work load and have been operationalized mainly in terms of time pressure and role conflict [171]. Job control, which is sometimes called decision latitude, refers to the person’s ability to control his or her work activities [171]. Decision latitude includes two components: skill discretion and decision authority[171].
The two dimensions of the JDCS represent a complex set of interactions among demand, control, and social factors that may impact health outcomes. According to the model, the highest strain occurs in a work environment when demands are high, control is low, and social support is low. Social support at work, was later added to the model; as a result, the demand-control- support model was defined. This revised model postulates that the highest risk of illness is expected in employers with high demand, low control, and low social support in the workplace [177]. This additional component of the model emphasizes the psychological and social factors people experience in the work environment are underpinned in social and interpersonal relations among participants in the work setting [178-182].
Figure 0_1. The Job Demand-Control-Support, where L=low and H=high. Adapted from de Jonge et al., 1996, p. 212 [183]
Use of the JDCS framework enables comprehensive understanding of stress that extends beyond traditional biomedical approaches to occupational stress. Furthermore, its two dimensions are factors associated with occupational stress among nurses [171, 184]. According to the JDCS model, jobs that utilize skills, provide control, and offer a supportive work environment contribute to better psychological and physical health than other jobs. Mentally demanding jobs with low levels of control and/or less supportive environments are found to be detrimental to health [184]. Several nursing studies have identified that diminished control over workplace decisions results in elevated occupational stress levels [62, 185].
Linkage of Framework to QWL, Occupational Stress and Cross-Training
The framework helps explain how occupational stress may be mitigated if nurses have greater job control and decision-making capacity. In nursing environments where this
opportunity is afforded, there are lower levels of occupational stress [125]. In terms of quality of work life, studies have reported that increased job autonomy and job control is linked to higher QWL among nurses and allied health professionals [186, 187]. It is hypothesized that cross- training will afford nurses with increased clinical competencies to work in all areas of the
birthing unit and permit for greater decision-making capacity in the delivery of obstetrical care to their patients.
Strengths And Limitations of The JDCS Model
Numerous studies have identified that a lack of autonomy or control in the work setting can lead to high levels of occupational stress and poor health outcomes [31, 37, 62, 159, 185]. According to the JDCS model, decision-making capacity within the work process reduces a worker’s stress and increases learning, whereas psychological demands increase learning as well as stress. Presently, the JDCS model has been systematically reviewed only in the context of physical health outcomes [188]. Both the model itself and inconsistent results based on empirical tests of the model have elicited considerable theoretical and methodological criticism [184].
One of the criticisms of this model is its reliance on “objective” measures of the work environment to the exclusion of other measures [189]. Workers will respond differently to the same group of control and demand conditions and thus experience varied biological outcomes. As a result, a measure of individual worker differences, specifically, various psychosocial coping styles, must be included in the JDCS [190].