Ghanizadeh, Abotorabi-Zarchi, mohammadiet al

158 Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir

Environmental Psychology Effects on Mental Health Job Satisfaction and Personal Well Being of Nurses

Sodeh Tavakkoli, MSc

1

Mohammad Mahdy Asaadi, MD

2

Amir H Pakpour, PhD3

Marzieh Hajiaghababaei, MSc4

(add affiliation numbers 1 Landscape Architecht, Member

of IFLA ( International Federation of Landscape Architects) 2 Department of Psychology ,

University of Payam-e –Noor, Tehran, Iran 3 Social Determinants of Health

Research Center, Qazvin University of Medical Sciences,Qazvin, Iran. 4 Brain and Spinal Injury

Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Corresponding author:

Marzieh Hajiaghababaei, MSc, Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Imam Hospital, Gharib street, Keshavarz boulevard, Tehran, Iran, P.O. Box: 14-19733141 Tel: +98(21)66581560 Fax: +98(21)66938885 Email: [email protected]

Objective: Environmental psychology as a science could be useful in

understanding the dissociation between the man and the environment. The aim of this study was to compare mental health, job satisfaction and well-being of nurses who work in hospital environments with different designs. Material: This was a quasi-experimental study, in which 250 nurses filled

out the mental health, well-being and job satisfaction questionnaires. They were categorized into 3 groups randomly. Group1 included 63 nurses who worked in an environment without any natural elements; group 2 included 100 nurses who worked in an environment with natural elements and group 3 included 87 nurses who worked in an environment without any psychological and ergonomic design. The last group was only stimulated by demonstrating visual stimulus. Data were analyzed using the ANOVA and Tukey’s pursuit statistical method. Results: The nurses who were working in an environment without any

natural elements reported significantly lower scores on mental health, well-being and job satisfaction compared to those who were working in other groups, with the exception of social functioning . Moreover, depression and anxiety were more common in nurses who were working in environments without any natural elements compared to those in the other groups (p<0.05). Conclusions: We can increase job satisfaction, and mental health and

well-being of the nurses through the use of natural design and environmental psychology indexes in hospital buildings.

Keywords: Environmental Psychology, Mental Health, Job Satisfaction, Well-being, Nurses

Today, Urbanization and separation of humans from nature have caused enormous damages to

human beings. Influx to the cities and lack of space

caused the loss of natural spaces which is one of the

most important stressful factors for humans (1).

Researches have shown that lack of each person’s

control over the environment and existence of

problems in design-engineering system of the

buildings caused congestion and social isolation

which ultimately have led to some problems

regarding job and social features; and consequently,

these factors endanger the mental health of the

individuals (2).According to the World Health

Organization (WHO), the full ability to take social,

psychological and physical roles is called health.

Patient’s environment can play a crucial role in

improving the therapeutic efficacy as well as patient-

reported outcomes (3). Environmental psychology as

a science could be useful in understanding the

dissociation between the

man and the environment (4), and it indicates that

how location specification affect behavior and helps

the behavior change and causes compatibility with

the environment (5). In broken window theory, Wilson et al. (1982)

showed that environment has powerful impacts on

human health and wellbeing (6). Personal wellbeing

shows individuals’ satisfaction and happiness about

their life quality and is a positive status of physical,

psychological and social welfare (7-8). One of the

Original Article

Iran J Psychiatry 2015; 10:3: 158-164

Environmental Effects on Mental Health Job Satisfaction

Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 159

aspects of environment that may affect human health

is Building Environment (BE). Conceptually,

Building Environment includes all of constructed

environments in which humans live and work (9),

and it also includes building design and interior

architecture and effects human’s emotions,

excitement and performance (10).

Nursing is one of the stressful professions. Working

pressure, by itself, is considered a source of

frustration for nurses. Nurses are the man power

inside the hospitals and are the main service

providers in the health care system and they

significantly affect the health and hygiene level of

the society by providing various health related

services to the patients (11). Nurses are always

exposed to the damages caused by stress, working

environment and activities related to their job (12).

Gelman and Turner in an article about nurses’ quality

of life have found that hospital environment directly

affects individual's quality of life (13).

One of the issues raised in nursing services

management is the low level or lack of job

satisfaction. Reduced attention quality, leaving work

and absence from work are some of the negative

effects of low job satisfaction. (14). Lack of job

satisfaction is one of the important factors in nurses

quitting their job (15). Job satisfaction is an

underlying attitude to create tendency, interest, talent

and preparation in order to give proper response to

the working environment in personal and social

features and includes the features and requirements

of a job with external environment and interpersonal

relations with working situation (16). Psychologists

also believe that environment ergonomics and design

may reduce physical and mental stressors and

pressures inside the working environment (17) . Using the environmental psychology principles in

location designs (especially due to the treatment of

environment which is discussed in the holistic

medicine) promotes mental health and wellbeing

(18). Watching the nature from a window increases

the sense of wellbeing (19); also, using natural

elements in the work environment results in the

following positive outcomes: Reducing the

environmental stress and increasing calmness (18),

less depression and more mental compatibility (20),

positive effects on happiness and quality of life (21),

acting as a buffer against the stressful events (22),

improving individual health (23), increasing the

compatibility, having a sense of safety, experiencing

positive emotion, reducing angriness and increasing

patience (24) . Therefore, this research compares mental health, job

satisfaction and wellbeing of nurses depending on

their working environment . The hypothesis of this research was that the indexes

of job satisfaction, wellbeing, mental health and their

subscales (somatic symptoms, anxiety and insomnia,

social dysfunction and severe depression) were

different in the three groups of the nurses who

worked in three different work environments: the

nurses who worked in an environment with no

interior design (1), nurses who worked in an

environment with natural beautiful perspective, (2)

and those nurses who worked in an environment with

no interior design, but with limited view of the

simulated garden (3).

Material and Methods

This was a quasi-experimental study. The sample

included 250 male and female nurses with the age

range of 23- 47 years who were randomly selected

from Khatamol-Al-Anbia hospital located in the third

district of Tehran municipality. This sample was substituted stochastically in 3 groups randomly. The first group of the nurses (n =

63) worked in the basement of the hospital where the

design was not in accordance with the psychological-

environmental principles, and the nurses who worked

there experienced an ordinary and cold environment

and they had no access to the designed environment;

the second group ( n = 100) worked in a small garden

simulated area which had been designed based on

psychological principles (25, 26) and the third group

( n= 87) worked in an area, from which they could

see the outside designed environment through a

distant window. The sampling has been done in two

shifts of morning and afternoon. All participants

were asked to complete the anxiety and depression

questionnaire at baseline . Job situation and working volume and salary were

equal in all the participants, and we tried to remove

all the interruptive factors . Sample size was calculated based on a previous study. A hypothesized mean which was considered

for this study was 4.96 for job satisfaction in the

control group (SD51.09). Power-calculations to

detect small effects (12%) on scores of job

satisfaction changes with a power of 0.80 (p < 0.05)

resulted in a target sample size of 50 for each group

(27)

This garden simulated location was designed based

on environmental psychology using known natural

elements in an environment covered by plants and

green elements with a combination of jungle outlook

and canebrake with a short waterfall and gentle

sound of the birds; also, there were some comfortable

chairs made of bamboo wood for the resting time of

the nurses below a canopy (Fig 1). The garden

simulated location could be seen from all parts of this

section; and when windows were opened, the nurses

could hear the sound of the waterfall and birds during

their work.

During the break time, the nurses could use the

resting area inside the garden simulated area. At the

same floor of the hospital after leaving this section at

the end of opposite corridor, there was an area where the nurses could only look at the garden simulated

location from a far distance and there was no access

Tavakkoli, Asaadi, Pakpour, et al

Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 160

to the garden (Fig 2). At the same hospital, there

were some areas in the basement floor where there

were no environmental factors with a in a quiet dimly

lit room even there were no windows. In other words,

the hard and cold environment of the hospital cannot

be seen well enough.

General Health Questionnaire (GHQ): The

questionnaire of general health arbitrated to Goldberg&

Hillier for screening the non-psychotic mental

disorders has been designed with 28 questions on a 4-

point Likert- scale and 4 subscales about somatic

symptoms, anxiety and insomnia, social dysfunction

and severe depression (29,28). This tool has been

translated into Persian and was found to be highly valid

and reliable (30). Job Satisfaction Index (JSI): The Job Satisfaction Index

(JSI) which has been made by Smith and Kendal

(1996) is a scale with 20 items which is scored on a 5-

point Likert scale. Smith and Kendal believe that this

scale has high reliability and validity. They have

reported the reliability coefficient of the sub tests in the

first study from 59% to 93% and in the second study

from 62% to 93%. (31) Haghayegh Khorasani reported

the reliability coefficients of the subtests as 0.59-0.92

in the first study and 0.62-0.93 in the second study in

Iran (32). In the present study, reliability of JSI was

obtained 83% by Cronbach's α and content validity was

approved by the faculty . Personal wellbeing questionnaire: The personal

wellbeing questionnaire of adults named “Personal

Wellbeing Index” has been standardized in 2002. The

current scale has 8 items, each of which asks questions

about one field on a 7- point likert- scale. Aghayousefi

(2004) has found the reliability of the research to be

0.84 and in another research by using Cronbach's α;

also, he has found the reliability of the test equal to

0.87 (33). The current research has been performed three months

after designing the hospital environment. Then, some

nurses used that simulated garden, some looked at the

simulated garden from a far distance and the others

were located in the basement with no environmental

psychology. In this research, the indexes of mental

health, job satisfaction and wellbeing of the nurses

working in this hospital have been compared

considering the equality of all working situations and

only based on the differences between working

environment indexes. The findings were entered to

SPSS- 17 and have been analyzed by Variance

Analysis method and then by Tukey’s pursuit method.

Results

The study participants consist of were 250 nurses,

(62 men and 188 women); Of whom, 100 were

married and 150 were single. All participants had

tertiary education. There was not any significant

difference between the groups in terms of anxiety

and depression at baseline (P>0.05). We used variance analysis to The findings related to compare

and survey the differences among the means of the

three groups in the general health index, job

satisfaction and wellbeing.

As depicted in Table 1, significant differences

between the three groups were found. Nurses who

were working in an environment with interior design

reported significantly higher general health compared

than those working in an environment with no

interior design (Table 1). Considering the current

results, at significance level of p<0.05, the general

health of the nurses working in a garden simulated

area and the nurses who only viewed the

environment from the window was different from the

nurses working in an environment with no design.

Moreover, considering the results of the Tukey test,

it can be stated that at the same level of significance,

the general health of the nurses working in a garden

simulated environment and the nurses who looked at

the environment from a window was better than the

nurses who are worked in an area without any

designs . As demonstrated in Table 2, the comparison among

the sub scales of the general health shows that the

anxiety of those nurses working in the garden

simulated area and the nurses who looked at the

garden simulated area from a window were

significantly less than the nurses working in the area

without any designs (p<0.05). On the other hand,

depression of the nurses working in the garden

simulated setting and the nurses looking at the

garden simulated location from a window was less

than the first group. No significant difference was

found between the three groups in respect to the

social function subscale.

As shown in table 3, the difference among the three

groups was statistically significant on job

satisfaction, and the mean of job satisfaction of the

second group is was higher than the third and the

first groups; also, the mean of job satisfaction of the

second group was higher than the third group.

Considering the results of variance analysis and Tukey pursuit test, it can be said that the job

satisfaction of in the second group (those working in

a simulated area) was higher than of the third group

(those who were working in an area having access to

the designed area via a window) at significance level

of 0.01. Furthermore, considering Tukey’s analysis,

it can be said that job satisfaction level of the nurses

working in a garden simulated area and nurses

working in the area with windows was significantly

more than those nurses working in the area with no

design. As shown in Table 4, the mean of wellbeing index on

the nurses working in a garden simulated area was

higher than the mean of wellbeing index of the

nurses working in the area without design with a

small difference comparing compared to the nurses

looking at the designed area from a window .

Environmental Effects on Mental Health Job Satisfaction

Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 161

Table1: Descriptive Statistics and Analysis of Variance and the Tukey Test on the General Health of the Nurses in Different Working Environments

P – value SD error Mean Differences

(Tukey) F SD Mean n

General Health

0.011 1.02 (1&2) 4.408 4.4 4.94 21.21 63 Group1

0.019

1.06

(1&3)1.372

3.64

33.61

100

Group2

0.807 2.70 (2&3) 0.525

5.367

23.29

87

Group3

group1: Nurses working in an environment with no interior design group2: Nurses working in an environment with a natural beautiful outlook group3: Nurses working in an environment with no interior design, but with limited view of the simulated garden

Table 2: Descriptive Statistics and Analysis of variance and the Tukey test on the General Health Subscales of the Nurses in Different Working Environments

P – value SD error Mean Differences (Tukey)

F SD Mean n Group Subscales Of General Health

0/063 0.749 1&2 0.059 5.05 1.01 8.71 63 1

0.012 0.167 1&3 1.85

1.09 7.06 100 2 Somatic symptoms

0.568 0.596 2&3 0.406 0.30 7.97 87 3 0.013 0.706 (1&2) 1.152 4.023 2.63 7.57 63 1 0.011 0.917 (1&3) 1.272 3.68 6.43 100 2 Anxiety 0.875 0.628 (2&3) 0.128 3.03 6.31 87 3 0.014 0.509 (1&2) 0.123 5.343 2.09 3.08 63 1 0.011 0.781 (1&3) 0.128 2.85 2.17 100 2 Depression 0.875 0.564 (2&3) 0.175 1.39 1.93 87 3

group1: Nurses working in an environment with no interior design group2: Nurses working in an environment with a natural beautiful outlook group3: Nurses working in an environment with no interior design, but with limited view of the simulated garden

Table 3: Descriptive Statistics, Analysis of Variance and the Tukey Test on the Job Satisfaction of the Nurses in Different Working Environments

P – value SD error Mean Differences

(Tukey) F SD Mean n Job Satisfaction

0.01 1.12 (1&2) 4.91 3.565 1.01 21.6 63 Group 1 0.14 1.05 (1&3) 1.35 1.89 35.3 100 Group 2 0.05 2.13 )2&3) 3.13 1.01 28.13 87 Group 3

group1: Nurses working in an environment with no interior design group2: Nurses working in an environment with a natural beautiful outlook group3: Nurses working in an environment with no interior design, but with limited view of the simulated garden

Table 4: Descriptive Statistics and Analysis of Variance and the Tukey Test on the Wellbeing of Nurses in Different Working Environments

P – value

SD error Mean

Differences (Tukey)

F SD Mean n Wellbeing

0.014 3.57 (1&2) 8.07 5.097 10.17 59.01 63 Group1 0.032 2.19 (1&3) 6.05

6.69 68.98 100 Group 2

0.702 5.07 (2&3) 0.51

9.23 66.07 87 Group 3

group1: Nurses working in an environment with no interior design group2: Nurses working in an environment with a natural beautiful outlook group3: Nurses working in an environment with no interior design, but with limited view of the simulated garden

Tavakkoli, Asaadi, Pakpour, et al

Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 162

Fig1 Fig2

Considering the current results, the wellbeing of the

nurses working in a garden simulated area was

different from that of the nurses who looked at the

area from a window (p<0.05). Moreover, considering

Tukey’s pursuit test, it can be stated that at the same

significance level, the wellbeing of the nurses

working in the designed area was higher than that of

the nurses who worked in the area with no design

with a small difference compared to those looking at

the area from a window. There was no any

significant differences between nurses who were

working in the garden simulated area and those

looking at the area from a window.

Discussion

The analysis of this research data revealed that the

mental health of the nurses working in the garden

simulated area and those working in the area with a

window to a designed area was better than those

working in the area with no design. Also, the results

revealed a difference between the stress of the nurses

working in a no- design area and the nurses working in

the designed area and those looking at the designed

area from a window. This result is in accordance with

that of previous findings (20, 24).

We usually live in a place without realizing its effects

on ourselves. Development of the cities and their extra

ordinary growth had forced the architects to build the

buildings in a vertical direction instead of horizontal

and there is no exception about the hospitals; and this

has led to the vertical growth of the hospitals and also

caused a distance from the nature .

This research revealed a difference between

depressions of the nurses working in the area with no

design and those working in the designed area or those

looking at the area from a window; the findings were in

line with researches by Perrins et al. and Evans (21,

18). Also, there was no difference between the social

performances of the nurses working in the designed

area, those working in the area with a window to the

designed area and also those working in the area with

no design .

The findings of this research showed that this simulated

garden area improved the job satisfaction and the

marks of job satisfaction of the nurses working at the

designed area and those with a view to the designed

area. These findings are in accordance with the

findings by Walsh and Knott, Moos and Insel, Hoseini

and Mirzabeigi (16, 17, 14, 15) .

The other findings of this research showed that the

designed area for the resting time of the nurses affected

their wellbeing and that the marks of nurses’ wellbeing

were higher in the group working in the designed area

and those working in the area with a window in

comparison with those working in the area with no

natural environment. These findings are in accordance

with the previous findings that showed being at a

designed area reduces stress or mental fatigue

(psychologically), and improves physical health and

develops wellbeing (increasing social interactions and

reducing panic) (13, 17,11). Also, these findings

support Park’s research that showed principles of

environment design affect stress and well-being (34).

Green areas in cities have been rescued significantly.

On the other hands, the numbers of buildings have been

increased considerably in cities. Therefore, designers

and architects should closely follow the environmental

psychologists in order to improve the human

environment. Applying basic changes in the

environment based on environmental psychology

indexes, positively affects the health of the nurses. This

study revealed that wellbeing, job satisfaction and

mental health were significantly higher in the nurses

who were working in the area with no design but

watching the designed area from a window are not less

than those working in the area designed with natural

factors. This study indicated that places which were

designed by natural elements increase worker’s mental

health, job satisfaction as well as their wellbeing .

Environmental Effects on Mental Health Job Satisfaction

Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 163

The studies conducted on the effects of different

environments on different psychological indexes are

rare and it is suggested that the survey on other

variables such as nurses’ quality of life with different

intervals after the design be conducted in the future

studies. The main limitation of this study was the lack

of a proper hospital design based on psychological

principles; consequently, we could not conduct an

experimental study.

Limitations

This study has a limitation as follow: the study sample

had been selected from only one hospital, thus, it

limited the generalizability of the study results.

Conclusion

By applying the environmental indexes in buildings,

we can reduce the coefficient of the hardness and

increase the environment psychological indexes.

Because nursing is one of the most important positions

in the society and the health of the nurses affects the

general health of the patients, we should improve their

mental health, job satisfaction and wellbeing through

the use of environmental psychology.

Acknowledgements

We would like to thank the authorities of Khatam-Al

Anbia hospital for their assistance and we also

sincerely thank all the participating nurses in this study.

Conflict of interest

None

References

1. Brown T, Morgue B. Off the Couch and the Move: Global public health and the medication of nature. Social Science &Medicine 2007; 64: 1343-1354.

2. Gifford R. Environmental psychology and sustainable development: Expansion, maturation, and challenges. Journal of Social Issues 2007; 63: 199–212.

3. Gesler W, Bell M, Curtis S, Hubbard P, Francis S. Therapy by design: evaluating the UK hospital building program. Health & Place 2004; 10: 117–128 .

4. Levi D, Kocher S, Aboud R. Technological disasters in natural and built environments. Environment and Behavior 2001; 33: 78-92.

5. Moore DW. Energy crisis: Americans lean toward conservation over production. The Gallup Poll Monthly 2001; 428: 14-15.

6. Cohen DE, Brooks-Gunn J, Eventual T, Hertz man C. Neighborhood income and physical and social disorder in Canada: associations with young children’s competencies. Child Development 2002; 73: 1844–1860.

7. Ryff CD, Keyes CLM. The structure of psychological wellbeing revisited. Journal of personality and social psychology 2002: 69: 719-727 .

8. Keyes CLM, Shapiro AD. Social well being in the united states: A descriptive epidemiology. Forthcoming in Orville Brim, Midlife in united states, university of Chicago press; 2001.

9. Dreary A. Impact of our built environmental. Public Health Jubal of Environmental Health Perspectives 2004; 104.

10. Butter worth I. The Relationship Between the Built Environment and Well Being 2000.

11. Sudagar S. [Job satisfaction rate of employed nurses in hospitals of Hormozgan University of Medical Sciences in 2002]. Hormozgan Medical Journal 2003; 8.

12. Hemati Maslak Pak M. [Assessment of Anxiety Level of Employed Formal Nurses in Hospitals of Urmia University of Medical Sciences]. Journal of Urmia Nursing And Midwifery Faculty 2006, 3.

13. Gellman M, Turner JR. Introducing the Official Journal of the International Society for Quality-of-Life Studies: Applied Research in Quality of Life. Encyclopedia of Behavioral Medicine Journal; 2012.

14. Hoseini MA, Kakoii H, Shah Zeidi Sh. Dibaii M. [Effect of continuous quality improvement of education on knowledge, attitudes and job satisfaction]. Iranian Nursing 2006; 1.

15. Mirzabeigi Gh, Salemi S, Sanjari M, Shirazi F, Heidari Sh, Maleki S. Job Satisfaction among Iranian Nurses. Hayat 2009; 15: 49- 59.

16. Walsh M, Knott JC. Satisfaction with the emergency department environment decreases with length of stay. Emerge Med 2010; 27: 821-828.

17. Moos H, Insel PM. Increase work environment productivity and satisfaction, Work Environment Journal 2006; 22: 11-12.

18. Evans GW. The built environment and mental health. Journal of Urban Health, 2003; 80: 536-555.

19. Kaplan R. Environment and Behavior, eab.sagepub.com; 2001.

20. Davidson J. Fear and trembling in the mall: women, Agoraphobia, and body boundaries, In I. Dyck ND, Lewis SMc Lafferty, Eds, Geographies of women’s health, 2001; 3: 213–230.

21. Perrins-Margalis NM, Rugletic J, Schepis NM, Stepanski HR and Walsh MA. The immediate effects of a group-based horticulture experience on the quality of life of persons with chronic mental illness. Occupational Therapy in Mental Health 2000; 16: 15-31 .

22. Kuo, F., Fable, V., Taylor, A. Children with attention deficits concentrate better after walk in the park. J Atten Disord 2009; 12: 402-409.

23. Pillow, M. Ecological psychology, Environmental health; 1999.

24. Velarde MD, Fry G, tveit M. Health effects of viewing Landscapes- Landscape types in environmental Psychology. Urban Frosty & Urban Greening 2007; 6: 199-212.

Tavakkoli, Asaadi, Pakpour, et al

Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 164

25. Gifford R. Environmental Psychology: principles and practice. 1st Edn. Boston: Allyn and Bacon, Inc.1987.

26. McDowell, Christoper Forrest and Tricia Clark-McDowell. The Sanctuary Garden. Simon & Schuster. New York. 1998.

27. Fillion L, Tremblay I, Truchon M, Coˆte´ D, Struthers W, Dupuis R. Job satisfaction and emotional distress among nurses providing palliative care: empirical evidence for an integrative occupational stress-model. Int J Stress Manage 2007; 14:1–25.

28. Goldberg DP, Hillier VF. A scaled version of general health questionnaire. Psychol Med. 1979; 9:131.

29. Ganji H. Mental Health. Ed Tehran: Arasbaran publishers; 2000 .

30. Noorbala AA, Mohammad K, Bagheri Yazdi S. A, et al. Validation of GHQ–28 in Iran. Hakim Magazine. 1999; 5: 101– 110.

31. Saane N, Van M, Sluiter JK, Verbeek JHAM, Frings- Dresen MHW. Reliability and validity of instruments measuring job satisfaction-a systematic review. Occupational Medicine 2003; 53: 191-200.

32. Haghayegh Khorasani B. [The measurement of work stress and stress and examination of its effect on job satisfaction and mental health of employees and workers in a pharmaceutical company]. the thesis of M.A in Tehran University. 2008.

33. Aghayousefi A. [Comparison of stress and its consequences on families and martyr in Qom province]. Employer research project: The Foundation of Martyrs and Veterans Affairs in Qom. 2004.

34. Park S, Mattson RH Kim E. Pain tolerance effects of ornamental plants in a simulated hospital patient room. Acted Horticulture 2004; 639: 241-247.