IJOH I NTERNATIONAL JOURNAL OF OCCUPATIONAL HYGIENE

Copyright © 2008 by Iranian Occupational Health Association (IOHA)

2008-5435/14/63-1-8

DOI: 10.18502/ijoh.v13i2.8370 ORIGINAL ARTICLE

A Survey of Shift Work and Work Ability Index among Nurses: A

Case Study in Educational Hospital, Ahvaz, Iran
LEILA IBRAHIMI GHAVAMABADI1, BEHZAD FOULADI DEHAGHI2, BEHNOUSH JAFARI*3

1
Department of Environment Management-HSE, Ahvaz branch, Islamic Azad University, Ahvaz, Iran
2
Department of Occupational Health Engineering, School of public Health, Ahvaz Jundishapur University of Medical
Sciences, Iran., Ahvaz, Iran
3
Department of Occupational Health Engineering, School of Health, Ahvaz Jundishapur University of Medical Sciences,
Ahvaz, Iran

Received March 26, 2021; Revised May 30, 2021; Accepted June 09, 2021

This paper is available on-line at http://ijoh.tums.ac.ir

ABSTRACT
Shift work is a social phenomenon with adverse effects on the lives and health of people in various aspects. This adverse
effect decreases shift workers’ ability over a time period. The aim of the present study was to survey disturbances due to
shift work and some disorders associated with work ability index among nurses in educational hospitals, Ahvaz, Iran. This
cross-sectional survey was conducted among 33 nurses at the Golestan Hospital, Ahvaz, Iran. The survey of shift workers
questionnaire (SOS) and the Work Ability Index (WAI) questionnaire was used as data collection tools. The related data
was analyzed based on the descriptive statistics, Pearson correlation test, and Spearman correlation test using IBM SPSS
software version 19. The results showed that 97% of problems related to the effects of shift work on the individuals’ lives,
families, and musculoskeletal disorders, 87.9% related to insomnia and social problems, and 75.8% related to mental
disorders. Although it showed a significant relationship between the workability index with the variable of experience and
mental disorders, it showed no significant relationship between the prevalence of insomnia and musculoskeletal disorders
variables. The results of this study showed that shift working disrupts mental, social, and physical health that ultimately
adversely affect the ability of shift workers. Therefore, it was recommended to adjust working hours and allocate the
appropriate shifts to improve the workability of individuals.

KEYWORDS: Shift Work; Work Ability Index; Nurses

INTRODUCTION
Shift work refers to a work schedule that is performed Economic pressures, requirements for industrial
outside of the working day framework (from 7 am to 6 processes, and the need for some services all 24 hours of
pm). Although this way of working is not new in the past the clock each day of the week (often abbreviated as 24/7)
few centuries, over the past decade along with the growth are some of the reasons that have led to work shifts [1].
of the industry has enjoyed a remarkable expansion. According to the results of previous studies, the
Corresponding author: Behnoush Jafari prevalence of shift work in European countries is
E-mail: [email protected] reported to be 15% to 20% percent and 20% in America
[2]. Regardless of

Copyright © 2021 The Authors. Published by Tehran University of Medical Sciences.

Shift Work and Work Ability Index among Nurses IJOH.tums.ac.ir | 166

this social phenomenon's effect on achievements of Workability is an important and complex concept in
technological progress, it can affect human life and occupational health research and practice that can be
their health in various aspects [3]. Shift work chronic evaluated using WAI index. This index is a set of
effects [4] are mainly identified by abnormalities in factors that enables a person to do job requirements in
physiological processes like a sleep-wake cycle, a best way in certain circumstances [17]. This
weakened physical and physiological health, problems assessment indicators in nursing as one of the main
of consciousness, function, safety, family, and social components of the healthcare system remain very
problems [5]. Chronic effects of shift work increase important and considered by researchers [18].
the risk of neuron-psychiatric, cardiovascular, and Numerous studies have focused on measuring these
gastrointestinal disease [6]. factors and the factors influencing its job [19]. For
example, the outcomes of a study conducted in 2012
Night shift causes disruption in biological rhythms to in Brazil concluded that the average index of 39.3% of
a large extent [7]. Based on the epidemiological nurses was at a good level and negatively correlated
studies, disruption of biological cycles associated with with age [20]. Another study in Croatia in 2009
night shift work causes various diseases such as showed that there was a negative relationship between
gastrointestinal disorders, cardiovascular, and the WAI and the organization of work and financial
musculoskeletal [8-9]. issues, low level of education, and nurses’ age [21].

Nurses should provide service in rotation all 24 hours Nurses’ physical and mental health has a great impact
of the clock each day of the week. For those who take on how to deliver effective health services. However,
turns in work, night shifts caused unfavourable irregular working shift hours adversely affect the
consequences on their natural life which most of them physical, mental, individual and social life
are uncontrollable [10-11]. performance and efficiency of nurses [22]. Hence, this
stress and its effects put nurses at risk of disability and
Night shift increases insomnia risk among nurses [5]. premature exit from the workplace over time.
These disordered patterns of sleep-wakefulness reduce Therefore, the current survey was aimed to evaluate
their job performance [12]. In a study conducted by some of these disorders and its association with shift
Gustafsson in 2002 on the quality of sleep and health work and workability index.
of 160 female nurses, 45% of the nurses suffered from
insufficient sleep, 30% suffered from digestive
problems, and 62% suffered from back pain and joint MATERIALS AND METHODS
pain [13]. Suwazono et al. investigated the impact of The present survey was a cross-sectional survey
night shift work in a steel factory during a period of 14 consisted of 33 nurses working at the Golestan
years on shift workers, they concluded that shift Hospital, Ahvaz, Iran. Inclusion criteria were at least
working is an independent cause for high blood one year working experience in relevant part,
pressure [14]. bachelor's degree or higher, and inclination for
research. The Survey of Shift Worker (SOS)
Thus, it can be concluded that shift work has adverse questionnaire and Work Ability Index (WAI)
consequences for the individual and lead to questionnaires were used for collecting the data.
dissatisfying them with their work. As a result,
absence from work and changing the job would be The effects of shift work data was collected via SOS
inevitable and could reduce the number of experienced questionnaire. This questionnaire assesses the effects
personnel in nursing systems [15]. Thus, the results of of shift working on nurses' health using questions
previous studies showed that about 7.4% of the nurses about demographic variables of nurses and personal,
would be absent every week due to exhaustion and social, and family life satisfaction among shift nurses.
mental problems which was 80% more than other jobs So, this questionnaire was designed to collect data on
[16]. Therefore, improving workability index has been musculoskeletal pain, health status, information about
proposed to be the most promising option to prevent a job, mental health status, sleep patterns of shift
work disability and work leaving in the recent years.

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workers, and work shift systems. The SOS researchers consists of seven sections (see Table 1).
questionnaire includes 49 questions for shift working The best possible estimate of the WAI index is 49 and
nurses. The questionnaire included 49 questions about the worst rating is 7. Finally, based on points obtained,
demographic characteristics and cardiovascular the ability to work can be classified into four levels of
symptoms, digestive symptoms, musculoskeletal pain, weak (27-7), medium (28-36), good (44-37) excellent
general health, chronic fatigue, social and domestic (49-45) [24]. This questionnaire has been widely used
disturbance, sleep disturbance, and neuroticism. The in various studies and it had a sufficient validity and
validity and reliability of the SOS questionnaire were reliability [25-27]. The collected data was analysed by
assessed in Iran [23]. The internal consistency descriptive statistics, Pearson, and Spearman
coefficients for the SOS questionnaire was equal to correlation tests using SPSS software version 19.
0.81[23].

The second survey is the work ability index (WAI)

qquestionnaire that has been developed by Finnish

Table 1. Options studied in the Work Ability Index questionnaire

Questionnaire of Work Ability Index Score Explanation

1-10 0=very poor 10= excellent

The current work ability compared with
the best time of life
2-10 2=Very Poor 10=Excellent
Ability in relation to the nature of the job
(physical, psychological)
1-10 1-5≤ illness, 2.4 disease, 3.3 disease, 4.2
Current diseases diagnosed by a physician
disease, 5-1 disease, 7. absence of disease

1= The maximum ability and disability, 6=

Individual estimates of disruptions in
1-6 no impact on job
work due to illness

1-100 days and more, from 2.99 to 25 days,

Sick leave during the past 12 months.
1-5 day 3-24-10, 4-9-1 days, 5-0 days

1-unlikely, 4-unsure, 7-almost sure

Prediction of the ability to work over next
1,4,7
two years

1-Very Poor, 4-High

Mental capabilities
1-4

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Shift Work and Work Ability Index among Nurses IJOH.tums.ac.ir | 168

RESULTS
mean of the participants was 35.06 ± 6.309 years old.
A total of 33 questionnaires were selected among 40 The duration of work and shift work mean was 1015 ±
distributed questionnaires. Due to inclusions criteria 5.34 hours. Marital status of the participants showed
such as a minimum of one year shift working that 60.6% of nurses were married and 39.4% of them
experience and incomplete questionnaire, 7 were single. Table 2 shows the frequency and the
questionnaires were excluded from the study. The age amount of disruption caused by shift working among
shift workers.

Table 2. Distribution of disorders related to shift work

Digestive 57.6
27.3
Cardiovascular 97
75.8
Musculoskeletal 87.9

Mental 87.9

Suffering from insomnia 97

Adverse effect on social life 97

Adverse impact on family life

Adverse effect on an individual's life

Nurses’ work ability index distribution scores and the distribution with a score of 66.7% and 18.2%.
related classification has been presented in Table 3. As
can be seen, the highest percentage of distribution was The WAI index relationship with other variables was
calculated good in the category of medium-sized assessed by Pearson and Spearman correlation.

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Table 3. Work Ability Index (WAIT) in nurses

Weak 15.2
Average 66.7
Good 18.2
Excellent

• There was a significant relationship between the institution, problems caused by shift working also
work ability index and nurses’ work experience varied among the different organizations. It is due to
(P=0.000). On the other hand, the correlation this difference that the results of various studies
between the two variables was -0.798, therefore, conducted on the prevalence of nurses’ shift working
there was a significant inverse relationship problem showed different outcomes. For example,
between two WAI and work experience due to Alireza Khammar et al. investigated shift working
the negative rates. disorders among nurses, the results showed the most
 There was no significant relationship between frequent problems among the subjects were
WAI and suffering insomnia (p=0.094). psychological disorders (95%), digestive problems
 There was a significant relationship between the (85%) and social problems (80%) [28].
work ability index and mental disorders In another study by M. Kangavar et al. proved
(p=0.000). On the other hand, the correlation that the highest prevalence of problems was related to
between the two variables were -0.637. Thus, social life (86%), psychological disorder (74%), and
there was a significant inverse relationship sleeping problems (63%) [29]. Therefore, it can be
between two variables of WAI and psychological concluded that the shift working has a considerable
disorders due to the negative correlation between impact on nurses’ working and family life. These
two variables. results were similar to the results of an evidence-based
There was no significant relationship study conducted by Arlinghaus et al. to investigate the
between WAI and musculoskeletal pain (p=0.325). effects of shift work and non-standard working hours
on workers, family, and community [30]. The
difference in results of the studies would be due to
differences in environment, organization, culture, the
DISCUSSION
number of hours worked per week, employment status,
This study was aimed to determine problems and education level of the work environment in
caused by shift working and the relationship between communities [28].
disorders associated with the work ability index at the The results of the WAI showed that 18.2% of
Golestan hospital in Ahvaz, Iran. In the present study, nurses had a good WAI, 66.7% moderate and 15.2%
based on the objectives of the study and due to some weak.
limitations and the impossibility of further sampling, The relationship between the work ability
the current results were accessible. index and years of practice showed that increasing
The results of the analysis of the shift experience was correlated to the decline of the WAI
working questionnaires showed that problems caused index. Several studies also have proven the
by shift working were highly prevalent among nurses. relationship between the low ability to work and high
The highest prevalence were related to problems in experience [31-33]. However, there was a negative
personal life, family, and musculoskeletal disorders by correlation between the work ability index and
97%, social problems and suffering insomnia with psychological disorders. Kenneth J et al. showed that
87.9%, and mental and psychological problems with there was a significant inverse relationship between
75.8%. Due to the working system differences in each the work ability index with job stresses which was a

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Shift Work and Work Ability Index among Nurses IJOH.tums.ac.ir | 170

mental disorder and can lead to Burnout [25]. In the ETHICAL CONSIDERATIONS
present study, the work ability index and the
prevalence of insomnia and musculoskeletal disorders This study was approved by the Ethics
had no significant correlation. On the contrary, some Committee of Ahvaz Jundishapur University of
studies showed a significant correlation between this Medical Sciences (IR.AJUMS.REC.1399.719).
index, sleep, and musculoskeletal pain [34-35]. Obtaining informed consents, explaining the nature,
method, and purpose of the research to patients and
performing the study in accordance with the observing
the principle of secrecy and confidentiality of the data
CONCLUSIONS and freedom of the research participants to leave the
From the sample size point of view, our study were the ethical principles observed in this
cross-sectional study included a limited number of the research.
participants. Therefore, in the present study, only
nurses who were working during the study participated
in our research. So, it would be interesting to
investigate other hospitals with a larger sample size
and add more health statue index.
The results of WAI showed that 66.7% of
nurses were at intermediate level considering WAI.
Hence, extra efforts should be considered by managers
and the relevant authorities to improve these
indicators. In order to improve nurses’ sleep quality, to
prevent the work ability index decrease and the
incidence of complications and disorders, it is
recommended to adjust working hours and shift
working schedules.

ACKNOWLEDGMENTS
The authors are very thankful to the hospital
personnel who cooperated with researchers.
Moreover, we thank Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran.

FINANCIAL SUPPORT AND

SPONSORSHIP
This project was financially supported by the
grant number 330097976, Ahvaz Jundishapur
University of Medical Sciences.

CONFLICTING INTEREST
The authors declare that they have no
competing interest.

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