Nurses are one of the important pillars in health care systems and providing care to patients. Therefore, the quality of their professional life has a complex relationship with the characteristics of the work environment, personal life environment, and exposure to occupational accidents. Therefore, the present study was conducted to investigate the quality of professional life of nurses and the factors affecting it by reviewing past studies. For this purpose, using the keywords of health, public health, quality of professional life, and nurses, it was investigated in Pubmed, Proquest, Google Scholar, Scopus, and Web of Science databases. The results of various studies showed that the quality of professional life of nurses is average. In some studies, the quality of nurses' professional lives has been reported as optimal. In addition, the results of the studies showed that the quality of professional life in nurses is influenced by various factors such as salary fairness, justice, job satisfaction, desire to leave the profession, high workload, increased overtime, fatigue, inappropriate rules, decision-making power, Empathic communication, and occupational stress. Considering the average level of the quality of professional life of nurses, it is necessary to pay attention to the factors affecting the quality of professional life to maintain and improve the quality of nursing care.
Introduction
Nursing is one of the main fields of care and a healthy nurse is one of the main factors to improve the quality of care. There is a positive and strong relationship between healthy nursing and health promotion because nurses are potential role models for society [1-3]. The World Health Organization defines health as not only the absence of disease but also the integration and harmony of well-being between physical, mental, social, and spiritual factors [4, 5]. Health, which has different physical, mental, and social dimensions, is one of the necessary conditions for fulfilling individual and social roles, and people can be fully active if they feel healthy and their society feels healthy. Undoubtedly, someone with a health disorder cannot take on personal, family, and social obligations and requirements and he will be unable to do it properly [6-8]. People's jobs also affect their health. Some jobs threaten health more than other jobs by exposing a person to numerous and different physical, physical, psychological, and social stressors. Nursing is one of these jobs. Nursing has been proposed as one of the most dangerous and stressful jobs and one of the first four stressful professions in the world [9-11].
The World Health Organization, after studying stressful jobs, announced that out of 130 jobs surveyed, nurses ranked 27th in going to the doctor in terms of health-related problems [6, 12]. Long working hours, lack of support, heavy workload, violence from patients, insufficient personnel, insufficient resources, lack of respect, lack of involvement in decisions, and lack of adequate equipment are some of the things that affect the health of nurses [13, 14]. The results of studies show that nurses suffer from all kinds of diseases such as musculoskeletal, cardiovascular, respiratory, infectious, parasitic, contagious, mental, and behavioral disorders. These diseases are more common in female nurses than in males, which can be caused by the high proportion of female nurses compared to males. The results also show that moving, lifting, and transferring patients cause one-third of musculoskeletal diseases in nurses. Standing for a long time also causes other problems such as leg pain and varicose veins. High expectations from nurses cause psychological diseases such as stress, anxiety, and insufficient sleep in nurses, as a result, nurses' sensitivity to pain increases and they feel more pain [9]. nurses who do not have good general health; will not be able to provide good care such as physical and psychological support to the patients, and this increases the risk of mistakes and occupational accidents, the consequences of which will affect the patient and the nurse [15, 16]. In addition, health problems in nurses increase absenteeism; as a result, it affects both the quality of care and is costly for the organization [17].
As mentioned, general health is very important in nurses; because their health is at risk due to their profession and special conditions. In addition, the health level of nurses has a direct impact on how they perform. Therefore, any disorder in this group and their performance will have a significant impact on care and treatment [18].
Nurses are one of the important pillars in health care systems and providing care to patients. Therefore, the quality of their professional life has a complex relationship with the characteristics of the work environment, personal life environment, and exposure to occupational accidents. Therefore, the present study was conducted to investigate the quality of professional life of nurses and the factors affecting it by reviewing past studies.
Materials and Methods
This research was a review study that was conducted in 2023, during which the general health of nurses was examined. For this purpose, using the keywords of health, public health, quality of professional life, and nurses, it was investigated in Pubmed, Proquest, Google Scholar, Scopus, and Web of Science databases. MESH was also used to determine keywords. Two experts in the field of nursing determined keywords and these two experts did searching for phrases in databases. Then, one of the research colleagues checked and re-searched the sources and databases to ensure the adequacy of the search for information and articles. The criteria for entering the research included that the articles were published in the period from 2011 to 2023, the subject of the study was the general health of nurses working in medical centers, and the full text was easily available in reputable research and academic journals. Exclusion criteria included studies that only addressed nurses' health from one perspective, for example, only physical or mental health, studies that were unrelated to the topic, as well as articles that were only conducted on nursing students.
To determine the compatibility of the articles with the research topic, first, the title and then the abstract of the articles were examined, and after the approval of the article, the topic was studied by one of the researchers for further examination of all the texts of the articles. The research subject, sample size and sampling method, statistical analysis, and study results were extracted from the selected articles by the responsible author, evaluated, and confirmed by other researchers, and disagreements were resolved through negotiation.
Results and Discussion
Lifestyle is one of the concerns of people in organizations. Nurses are not exempt from this as health defenders. The results show that less than 5% of nurses have a healthy lifestyle, which includes having a healthy diet, regular exercise, maintaining body weight, and not smoking [19]. Because exercise is one of the dimensions of lifestyle, the results of the studies show that nurses scored low in this dimension. In this regard, the results of a study conducted on American nurses showed that 72% of nurses did not participate in physical activities [19]. Among the factors affecting the lack of ideal physical activity in most nurses, chronic fatigue and reduced mobility resulting from shift work can be mentioned. Of course, the role of urbanization and car life cannot be ignored. Due to inactivity, we should also worry about overweight and obesity, which are prone to cardiovascular diseases and diabetes. Therefore, participating in physical activities is effective in preventing and reducing the risk of osteoporosis and can help manage risk factors such as high cholesterol, high blood pressure, and body weight [20, 21].
A healthy diet is another important aspect of lifestyle, as there are many challenges in eating habits. The results of Wang et al. study showed that shift work is related to abnormal eating behaviors. So sweet foods, snacks, and foods with low nutritional value are considered as options that are more available compared to healthy foods during working nights, and with the increase of more than four working nights per month, nutritional habits falsehood increases in nurses [22]. Of course, limited facilities for storing heating, and eating homemade food, time barriers, distance to buy food, and the variable quality of food were also other problems in this field [23]. The results of studies show that 61% of American nurses have an unhealthy diet [19].
In terms of smoking, in this study, nurses are at a favorable level, while smoking patterns among nurses are different between countries. The results of a study in New Zealand showed that 13% of female nurses (32.682 people) were smokers, which was the highest prevalence of smoking among nurses working in the psychiatric department [24]. In Turkey, 45% of nurses were smokers [25]. Due to the hard work conditions of working nurses the stress during work hours and the role of fatigue, nurses may use ineffective coping mechanisms such as excessive alcohol consumption and smoking [26].
Stress management is another dimension of lifestyle. The findings of studies show that nurses suffer a lot of stress due to the nature of their job, which is one of the major inevitable consequences of job stress, job burnout [27, 28]. The results of the Kurnat-Thoma et al. [29] study showed that burnout affects the lifestyle of nurses. On the other hand, stress management leads to an increase in the quality of life, which is confirmed by the results of Tal et al. research [30]. Therefore, it is necessary to use comprehensive approaches such as cognitive training, mindfulness, yoga, meditation, prayer, massage, and touch therapy that help manage stress and health [31]. Lifestyle has many effects on nurses' organizational citizenship behavior so the incompatibility between people's lifestyles and their interests and activities will lead to the occurrence of anti-organizational citizenship behaviors. When nurses conclude that the hospital fulfills its obligations, the incidence of organizational citizenship behaviors will increase [32]. The results of Nesai et al. study showed that e-learning was significant for strengthening health-promoting behaviors in nurses and the lifestyle score increased [33]. On the other hand, choosing a healthy lifestyle for nurses has positive effects on the care of the patient population [34]. Nurses, who practice a healthy lifestyle, including daily physical activity, healthy diet, and proper sleep, can better prevent workplace injuries and mistakes related to fatigue [35]. It also increases their ability to deal with job stress [36].
Based on the obtained results, most of the studies have reported the general health status of nurses as inappropriate or at risk. The most common health disorders of nurses were mental disorders high levels of depression and functional disorders. In addition, the results of the studies show that there is a relationship between factors such as job stress, job satisfaction, burnout, family life, emotional and spiritual intelligence, and religious beliefs with the general health of nurses. The investigated intervention studies show that compliance with things such as group therapy, stress management, communication skills training, and emotional intelligence training has improved public health and reduced anxiety and stress in nurses [37-39]. The results of a study also showed that the use of zinc food supplements improves the physical health of nurses [40].
The results of the current research show that most of the studies reviewed about the public health of nurses have described the current situation and related factors and have provided solutions to improve the public health of nurses. Nurses are in direct contact with society and touch people's problems closely. Therefore, it has a serious responsibility, and this causes an increase in job burnout among nurses and, as a result, a drop in their physical and mental health [41]. However, in the conducted studies, different results have been obtained regarding the health level of nurses. For example, in a study, Niazi et al. investigated the relationship between general health and emotional intelligence of nurses and reported the level of health of nurses as favorable [42]. Similarly, Farsi et al. reported the general health level of 68% of nurses in the normal range [43]. This is even though Dehghankar et al. have mentioned the general health status of nurses as inadequate in their study [18]. However, in the study of Barzideh et al. under the title of dimensions of occupational stress and its relationship with the general health status of nurses, the general health status of most nurses has been reported as doubtful [44]. In a similar study, Zanganeh et al. investigated the level of job burnout and its relationship with the general health of nurses, and the level of the general health of nurses was mentioned as average [41]. Finally, the results of the present study show that the general health status of nurses is inappropriately mentioned in more than 62% of articles.
In an extensive study conducted by Fernandes et al. [45] between 2010 and 2011 in Brazil in 18 hospitals with 3,229 nurses, the researchers examined the health and working hours of nurses by gender. In this study, the level of health is categorized into three groups: good, normal, and poor. The results of this research show that 6.85% of female nurses have good health, 1.27% have normal health, and only 1.7% have poor health. In addition, 65.5% of male nurses had good health, 6.6% had average health, and only 8.6% had poor health [42].
The results of studies show that the most focus on general health disorders in nurses are mental-psychological problems, depression, and anxiety rather than physical. For example, in a study, Haseli et al. investigated the general health status and related factors in nurses working in the teaching hospitals of Shiraz University of Medical Sciences. The findings of his study showed that 59.5% of nurses suspected mental disorders and 12.7% suspected physical disorders [46]. In their study, Dehghankar et al. showed that 1.6% of nurses have physical problems, 1.4% have anxiety and insomnia problems, 1.4% have functional disorders, and 1.6% have depression [18]. The results of the above and other studies show that nurses mentally, and psychologically, they are exposed to serious harm in their work environment. The evaluation of the studies also shows that several factors are related to the general health of nurses. For example, Haseli et al. [46] showed in their study that there is a significant relationship between mental health, job satisfaction, and satisfaction with the field of study. In addition, in their study, Mashak et al investigated the relationship between nurses' occupational stress and general health status. The results of his study show that stress can have adverse effects on nurses' performance and their general health by causing burnout. Therefore, there is a relationship between stress and the general health of nurses [47].
In a study conducted by Sauer and McCoy [48] in the United States of America on 345 nurses to investigate the effect of harassment on the health of nurses, the researchers concluded that nurses who are harassed in the workplace have less physical and mental health [48]. This study and similar studies show the importance of the work environment and its effect on nurses' health. Therefore, it can be said that the interaction of several work factors affects the health of nurses, although the relationship between the variables is debatable.
In connection with the promotion of public health, interventions have also been carried out in nurses and useful results have been presented. In a study conducted by McElligott et al. [49] in the USA on 149 nurses, the researchers examined the effect of behavioral methods on health promotion in nurses. The results of this study show that strategies such as holding training classes, performing activities such as massage reflexology, and simulation, and providing programs for stress management increase health in nurses.
The results also show that nurses suffer more psychologically, physically, and socially. The conducted studies also provide measures to improve the health of nurses. Actions such as group therapy, stress management, communication skills training, use of some nutritional supplements, and emotional intelligence training have made a significant contribution to increasing the health of nurses. This requires managers and officials to pay more attention to this issue and its importance in the health system. Therefore, it is recommended that the authorities pay more attention to the health of employees, especially nurses, and be diligent in improving it so that they can improve the quality of their services accordingly.
Conclusion
The results of various studies showed that the quality of professional life of nurses is average. In some studies, the quality of nurses' professional lives has been reported as optimal. In addition, the results of the studies showed that the quality of professional life in nurses is influenced by various factors such as salary fairness, justice, job satisfaction, desire to leave the profession, high workload, increased overtime, fatigue, inappropriate rules, decision-making power, Empathic communication, and occupational stress. Considering the average level of the quality of professional life of nurses, it is necessary to pay attention to the factors affecting the quality of professional life to maintain and improve the quality of nursing care.
Since the results of the study in some dimensions of the nurses' lifestyle, such as exercise, diet, and stress management, were reported at a low level, therefore, designing a comprehensive program to promote physical activity, integrating exercise into their daily life, teaching healthy diet daily consumption of fruits and vegetables and training to deal with stress seem necessary. Therefore, the researcher hopes that the results of this research can be useful in understanding the problems of nurses regarding the improvement of their lifestyle, and after that, they can take steps to solve their problems with proper planning.
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