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A fast-paced work environment with high demands, little chance of relief and limited control, characterize high-stress occupations. Recent studies reported work-related stress rates of 30 to 46 percent.1,2 In a study of 28,000 workers in 215 different organizations,3 Kohler and Kamp reported that stress at work was associated with employee burnout, acute and chronic health problems, and poor work performance.
In addition, a study of 130 occupations, conducted by the National Institute for Occupational Safety and Health, found that 40 occupations had a higher than expected incidence of stress-related disorders or stress responses.4 Seven of these occupations were in the health-care field.
Given the recent changes, health-care workers have identified occupational issues such as poor staffing, increased workload, patient death and dying, shift work, and conflicts with other health-care providers as leading to increased work stress.4,5 For health-care workers, stress can result in low morale, increased anxiety and depression, as well as other health-related concerns.6 For the employing organization, there are significant financial costs associated with job stress, including increased errors, absenteeism, and work-related injuries, in addition to decreased productivity as the result of poor job satisfaction. The primary purpose of this study was to systematically investigate selected psychological and organizational outcomes of a stress-reduction strategy, work-site acupressure and massage
(WSAM), for employees in high-stress health-care occupations.
Background
While a growing number of institutions, including the U.S. Department of Justice, offer massage in the workplace, limited data has been reported on the benefits of massage in high-stress work environments. Health-care environments have traditionally been associated with high occupational stress. Recent changes in their environment have resulted in increased job stress, so that health-care workers are at risk for significant physiological and psychological problems.
The development and investigation of work-site strategies to decrease stress are relevant and critical in the current health-care environment. Health-care organizations, in the face of frequent changes, widespread uncertainty, and increased competitiveness, need to consider the impact of these changes on employee work stress and foster the development of strategies to promote employee wellness.7,8,6 This study is of importance to both health-care employees and health-care organizations because it represents a potentially low-risk strategy for coping with the effects of job stress.
Literature Review
A variety of psychologically related measures such as anxiety, depression and coping skills have been associated with job stress.9,5,1,2,6 Fatigue also has been linked to job stress as the result of high demands or workload.10 In a study of more than 11,000 health-care workers in the United Kingdom,10 Hardy, et al (1997) found significantly higher levels of fatigue than expected, and found that work demands predicted additional general fatigue.
The use of alternative therapies, such as acupressure and massage, has reemerged in recent years as a strategy leading to multiple favorable health outcomes. In the late 1970s, George Engel introduced a biopsychosocial model of health and illness. This model states that health is an outcome with multiple integrated components such as genetics, lifestyle, attitude, environment and social relationships.
The stress response is one example of how the integration of biological, psychological and social factors affect health. When faced with an acute challenge or threatening situation, the body responds by initiating the fight-or-flight reaction that prepares the body to function at a higher level of efficiency.
Strategies to counter the negative effects of stress by promoting relaxation have been examined. A study of the physiological effects of various forms of relaxation demonstrated a pattern of changes known as the Relaxation Response, which provides a framework for examining the effect of various relaxation therapies on work-related
stress.11
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Although there are a wide variety of massage therapy techniques, each with their own cultural and theoretical perspectives, proponents suggest that beneficial outcomes in response to most, if not all, types of massage include: improved blood flow, release of muscle tension, improved musculoskeletal structure and function, and a reduction in the perception of stress12,13 While there are anecdotal reports of the aforementioned benefits, there are few systematic investigations to determine the effects of massage on psychological and organizational outcomes. One study of 50 healthy adults demonstrated that massage therapy leads to improved concentration and mood, lower anxiety and depression, increased alertness as measured by electroencephalogram, and decreased salivary cortisol
levels.14,5
Musculoskeletal injuries, one of the most frequent work-related category of injuries reported by nurses, may be caused by fatigue, lifting or work overload.4 Massage reduces muscle tension and tonic contraction, decreasing both postural and muscle imbalances that can lead to muscle fatigue and injury. Massage therapy is purported to affect both the structure and function of the musculoskeletal system by promoting the Relaxation Response and reducing muscle tension and fatigue while improving posture.12 The integration of these improvements in the musculoskeletal system, in turn, may lead to greater ease of body movement, wider range of motion, and greater flexibility, resulting in decreased musculoskeletal injuries.
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Given this theoretical framework, the research hypotheses of this study were:
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Employees who receive WSAM (work-site acupressure massage) will exhibit improved mood and general well-being, and decreased perceptions of anxiety, when compared with a control group.
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Employees who receive WSAM will exhibit decreased sleep disturbances and perceptions of fatigue, when compared with a control group.
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Employees who receive WSAM will have improved job satisfaction and decreased absenteeism and number of work-related injuries, when compared with a control group.
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