PSYCHOSOCIAL FACTORS AT WORK TRIGGERING GASTROINTESTINAL DISORDERS IN NURSES EMPLOYED BY SUPPORTIVE TREATMENT AND NURSING UNITS IN VILNIUS

PSYCHOSOCIAL FACTORS AT WORK TRIGGERING GASTROINTESTINAL DISORDERS IN NURSES EMPLOYED BY SUPPORTIVE TREATMENT AND NURSING UNITS IN VILNIUS SLAUGYTOJŲ, DIRBANČIŲ VILNIAUS MIESTO PALAIKOMOJO GYDYMO IR SLAUGOS SKYRIUOSE, PATIRIAMŲ PSICHOSOCIALINIŲ DARBO VEIKSNIŲ ĮTAKA VIRŠKINAMOJO TRAKTO SUTRIKIMAMS Vaida Jakubynaitė 1, Violeta Ožeraitienė 1,2 1 Vilniaus universiteto Medicinos fakulteto Slaugos ir vidaus ligų pagrindų katedra 2 Vilniaus miesto klinikinė ligoninė 1 Vilnius University, Faculty of Medicine, Department of Nursing and Fundamentals of Internal Medicine 2 Vilnius City Clinical Hospital ABSTRACT Key words: nurses, supportive treatment and nursing units, psychosocial factors at work, gastrointestinal disorders. Aim of the work. To assess the impact of psychosocial risk factors at work on gastrointestinal disorders of nurses working in supportive treatment and nursing units in Vilnius. Materials and methods. A cross-sectional study using an anonymous questionnaire was performed. 147 nurses aged 44.9 ± 10.1, employed by supportive treatment and nursing units in Vilnius filled out the questionnaires with questions concerning socio-demographic, psychosocial factors at work and gastrointestinal disorders. The odds ratios and 95 % confidence intervals were calculated. Results. The most common psychosocial risk factor which affected nurses was psychological (64 %) and psychological (32.6 %) violence at work. The respondents were dissatisfied with limited career opportunities (53 %) and salary (43.5 %). 51.1 % of nurses suffered from physical and mental strain at work. Other psychosocial risk factors which impacted nurses were a lack of support from colleagues and superiors, unfair distribution of work, inability to control the pace of work, rush, difficult periods and the risk of injury. The likelihood to feel heartburn for nurses unable to control the pace of work was 5 times higher and they were 3.8 times more likely to have regurgitation. A lack of support from a superior increased the likelihood of nausea by 8.5 times, a early satiation 14.4 times, a postprandial fullness 5 times. A lack of support from colleagues increased the probability to feel epigastric burning by 7.2 times, to develop chronic gastritis by 7 times to suffer from gastric or duodenal ulcer by 15.3 times. The accidental damage of equipment or performance outcomes increased the probability to develop gastric or duodenal ulcer by 11.4 times. Ignoring the nurses opinion on duties increased the chances to develop functional dyspepsia by 4.7 times. Conclusions. Psychosocial risk factors at work experienced by nurses significantly increase the risk of the symptoms of gastrointestinal disorders. The likelihood of the occurrence of the symptoms of functional dyspepsia was largely increased by the factors related to difficulties at work and bad relationship with superiors. The symptoms of gastroesophageal reflux are associated with the intensity and complexity of the performance, the responsibility for its outcomes. A lack of support from colleagues and responsibility for the performance outcomes increase the risk of the occurrence of chronic gastritis as well as gastric and duodenal ulcer. SANTRAUKA Reikšminiai žodžiai: slaugytojos, palaikomojo gydymo ir slaugos skyriai, psichosocialiniai darbo aplinkos veiksniai, virškinamojo trakto sutrikimai. Tyrimo tikslas. Įvertinti Vilniaus miesto slaugytojų, dirbančių palaikomojo gydymo ir slaugos skyriuose, patiriamų psichosocialinių darbo aplinkos rizikos veiksnių įtaką virškinamojo trakto sutrikimams. Violeta Ožeraitienė Vilniaus miesto klinikinė ligoninė Antakalnio g. 57, Vilnius violeta.ozeraitiene@mf.vu.lt 822 teorija ir praktika 2015 - T. 21 (Nr. 4.3), 822 828 p. doi:10.15591/mtp.2015.130

Tyrimo medžiaga ir metodai. Buvo atliekamas skerspjūvio tipo tyrimas taikant anoniminę anketinę apklausą. Anketas užpildė 147 Vilniaus miesto slaugos ligoninėse ir bendro profilio ligoninių slaugos ir palaikomojo gydymo skyriuose dirbančios slaugytojos. Tirtų slaugytojų amžiaus vidurkis 44,9 ± 10,1 metų. Anketose pateikti klausimai apie sociodemografinius duomenis, psichosocialinius darbo aplinkos rizikos veiksnius bei klausimai apie gastroezofaginio refliukso, funkcinės dispepsijos simptomų dažnį, intensyvumą, lėtinį gastritą, skrandžio ir dvylikapirštės žarnos opą. Skaičiuoti šansų santykiai, lyginantys tikimybes turėti virškinamojo trakto sutrikimus slaugytojoms, reaguojančioms į įvairius psichosocialinius darbo aplinkos rizikos veiksnius, ir į juos nereaguojančioms. Santykis buvo laikomas statistiškai reikšmingas, jei p < 0,05. Rezultatai. Labiausiai slaugytojas veikiantys psichosocialiniai darbo aplinkos rizikos veiksniai buvo psichologinis (64 proc.) ir fizinis smurtas (32,6 proc.) darbe. Slaugytojos buvo nepatenkintos apribotomis karjeros galimybėmis (53 proc.), fizine įtampa (51,1 proc.), 43,5 proc. slaugytojų buvo nepatenkintos gaunamu atlyginimu. Kiti psichosocialiniai darbo aplinkos rizikos veiksniai buvo susiję su santykiais su bendradarbiais ir vadovu, su blogu darbo paskirstymu, dideliu darbo krūviu, skubotumu, nuolat darbe pasitaikančiais sužeidimo atvejais, dideliais darbo reikalavimais. Negalėjusioms reguliuoti darbo tempo tikimybė jausti rėmenį buvo 5 kartus didesnė ir 3,8 karto didesnė atpilti rūgščiu skrandžio turiniu. Vadovo paramos stoka ir vadovo nesutarimai su darbuotojais didino tikimybę atsirasti pykinimui 8,5 karto, anktyvam sotumo jausmui 14,4 karto, pilnumo jausmui po valgio 5 kartus. Netinkamai paskirstytas darbas didino anktyvaus sotumo jausmo tikimybę 6,4 karto. Bendradarbių paramos stoka didino tikimybę susirgti lėtiniu gastritu 7 kartus, skrandžio ar dvylikapirštės žarnos opa 15,3 karto, atsitiktiniai aparatūros ar darbo rezultatų sugadinimai didino tikimybę susirgti skrandžio ar dvylikapirštės žarnos opa 11,4 karto. Tikimybę susirgti funkcine dispepsija 4,7 karto didino nereagavimas į slaugytojų nuomonę, bendradarbių paramos stoka 7,2 karto didino tikimybę jausti funkcinį rėmenį, retrosterninį deginimą. Išvados. Slaugytojų patiriami psichosocialiniai darbo aplinkos rizikos veiksniai reikšmingai didina riziką patirti virškinimo sutrikimų simptomus. Funkcinės dispepsijos simptomų tikimybę ypač didino veiksniai, susiję su sunkumais darbe ir blogais santykiais su vadovais. Gastroezofaginio refliukso simptomai susiję su darbo intensyvumu, sudėtingumu, atsakomybe dėl rezultatų. Bendradarbių paramos stoka ir atsakomybė dėl darbo rezultatų didina riziką susirgti lėtiniu gastritu ir skrandžio bei dvylikapirštės opa. INTRODUCTION Psychosocial risk factors are defined as factors causing mental stress for employees and triggered by working conditions, requirements, job content, in-company relationships between the employees or between the employer and employees [1]. The main factors contributing to the nurses stress at work are high standard performance requirements, a lack of colleague support, a continuously changing work environment, a shortage of staff, being exposed to fatal or terminal patients, cases of violence [2]. Stress in nursing profession has been more explicitly explored for the last two decades [3, 4]. The major focus of scholars in Lithuania and abroad lay largely on stress and its consequences undergone by general practice nurses employed at hospital units of general profile (intensive care, emergency, psychiatry) and in primary health care centres [5 8]. However, psychosocial factors impacting nurses employed in hospices, supportive treatment and nursing units, involved in treating serious patients have not been widely analyzed. In Lithuania, only a few authors evaluated the effects of stress undergone when nursing terminal patients as well as stress management techniques [8, 9]. Scientific research shows that psychosocial risk factors at work have a negative impact on the employees physical and mental health [10]. A number of studies carried out in Lithuania involved the analysis of the impact of psychosocial risk factors on the occurrence of the diseases of the circulatory system [11], the development of depression [12], the association of nurses obesity, stress and other risk factors with the symptoms of gastroesophageal reflux disease (GERD) [13, 14]. In terms of the increasingly growing economy, the pace of work, the competition among employees, the impact of the working environment factors is accelerating on changes observed in relationships or the occurrence of functional bodily disorders. Anxiety caused by being responsible for the quality of work, strain, a burnout syndrome as well as a lack of rest provoke functional disorders which, under the influence of continuous stressogenic effects, may progress to psychosomatic symptoms [10]. The objective of the study is to assess the psychosocial risk factors at work triggering gastrointestinal disorders in nurses employed by supportive treatment and nursing units in Vilnius. MATERIALS AND METHODS A cross-sectional study using an anonymous survey was performed. The questionnaires were completed by the nurses employed by hospices and supportive treatment and care units of the general profile hospitals in Vilnius city. Of all the 171 questionnaires filled out by the nurses, only 147 were selected having rejected spoilt questionnaires or those filled out by nurses employed for less than half a year (exclusion criteria). The age range of the surveyed nurses was 44.9 ± 10.1, almost 90 % of them have higher/non-university higher education. The length of the working experience the current health care institution was 10 ± 9.7 years, the total length of the working experience at health care institutions was twice longer 20.7 ± 11.9. More than half (52.3 %) of the nurses were full-time employees, while one third (37.5 %) of them had workload exceeding full-time. The questionnaire included questions about the nurses socio-demographic data (age, education), work experience (length of work experience the current health care institution and full time workload teorija ir praktika 2015 - T. 21 (Nr. 4.3) 823

in health care institutions). The second section of the questionnaire included questions on psychosocial risk factors at work taken from the Stress at work questionnaire [15]. The selection of questions prioritised the regulating factors (options of the impact of social relations), perceived environment (job requirements, rush and distribution of work, work strain (psychological and physical), limitations (inability to control the work pace), management, responsibility (accidental damage of equipment or an error in performance outcomes and a risk of injury or self-injury). Also, the questionnaire included six questions about career opportunities, bonuses, work family conflict (job responsibilities impact one s personal life), satisfaction with salary and cases of violence (psychological and physical). The frequency of risk factors was measured by Likert scale: 1 never, 2 rarely, 3 - sometimes, 4 often, 5 constantly/always. If nurses noted that they were frequently or constantly affected we considered them to have experienced a risk factor. A questionnaire on gastrointestinal symptoms was compiled of questions regarding the intensity of the upper digestive tract disorders [16], the range of the symptoms of the gastro-esophageal reflux disease (GERD) and dyspeptic (having the functional origin) symptoms and their frequency [17]. The criteria of the diagnostic functional gastrointestinal disorders (FGID) and their symptoms were based on modern classification according to Rome III criteria [18]. The frequency of symptoms was measured by Likert scale ranging from 0 (the symptom was never felt) to 4 (the symptom was constantly felt). The symptoms under evaluation were as follows: heartburn, regurgitation (expulsion or reflux of gastric content into esophagus), nausea, epigastric pain or burning, a feeling of early satiation, a feeling of fullness after a meal (postprandial fullness), a loss of appetite, abdominal bloating. Also, the nurses were requested to mark the gastrointestinal diseases (chronic gastritis, gastric and duodenal ulcers, GERD) or FGID (functional dyspepsia- FD) they were suffering from [19]. STATISTICAL ANALYSIS The nurses distribution by socio-demographic indices was estimated by calculating the percentage of data expression. The odds ratios (OR) were calculated to compare the probability of gastrointestinal diseases or disorders to be developed in nurses responding to a variety of psychosocial risk factors at work and in those who are not responding. The 95% confidence interval (CI) was applied for calculating the interval estimates. OR was regarded as statistically significant when the error probability value p < 0.05 and 95 % CI >1. RESULTS The most common psychosocial risk factor affecting all the nurses was violence at work experienced by 64 % of respondents. The second most frequent factor was a lack of incentives or a reward Even 55.8 % of the nurses complained about being rarely or never motivated by bonuses or incentives. The third most crucial factor affecting the nurses was limited career opportunities. Overall, 53 % of the respondents were rarely or never given an opportunity to pursue a career. Also, a large part of the nurses experienced physical (51.1 %) and mental (46.9 %) strain at work. Slightly less than half of the respondents (44.9 %) were frequently and persistently forced to rush to do the job. 16.3 % of nurses were rarely or never able to control their pace of work. 43.5 % of the participants were dissatisfied with their salary. One-third (35.4 %) of the respondents claimed that they frequently or constantly experienced difficult periods at work and 32.6 % of them suffered from physical violence. Less than a third (27.2 %) of the nurses indicated that they frequently or constantly were exposed to risk of injury or self-injury. Ignoring the nurses opinion on duties received little was indicated by one-fifth of the respondents (16.3 %). High or extremely high standard requirements for performance had a negative effect on the nurses personal life (15.7 %). The superior provided little or very little support when it was needed (11.6 % of the respondents) while 10.9 % of the nurses noted that work was rarely or never distributed fairly, while 10.8 % indicated that the superiors rarely or never consulted the employees. Less than 10 % of nurses frequently damaged equipment or performance outcomes by accident or failed to perform some of the duties due to their large workload and 6.8 % of the surveyed respondents reported being dissatisfied with their work. Statistically significant ORs of gastrointestinal symptoms felt by nurses under the impact of a variety of psychosocial work factors are presented in Table 1. The probability to feel heartburn was 5 times and the chance to feel an acid reflux (regurgitation) was 3.8 times higher in nurses unable to control the pace of work. The fact that the nurses opinion was not taken into account increased the probability of acid reflux by 3.8 times, a feeling of early satiety 9.3 times. A lack of support from a superior increased the probability of nausea by 8.5 times, a early satiation 14.4 times, a postprandial fullness 4.4 times, abdominal bloating 3.8 times, while a superior s absence of consulting his employees increased the likelihood of the occurrence of nausea by 8.5 times, a postprandial fullness 5 times and abdominal bloating 3.9 times. Difficult periods at work increased the probability of epigastric pain or burning by 8.1 times and a postprandial fullness 2.6 times. Unfair distribution of work increased chances to feel a loss of appetite by 7.8 times, early satiation 6.4 times, abdominal bloating 3.4 times. The nurses who experienced mental strain more suffered from postprandial fullness 2.5 times, while those who 824 teorija ir praktika 2015 - T. 21 (Nr. 4.3)

experienced physical strain 2.6 times. Also, the experience of physical strain increased the probability of developing abdominal bloating by 2.7 times. Furthermore, the manifestation of some symptoms was higher in nurses who had experienced a lack of colleague support, were in a rush or accidentally damaged equipment or performance outcomes. Statistically significant psychosocial risk factors at work impacting the occurrence of gastrointestinal diseases are shown in Table 2. The probability to suffer from chronic gastritis was increased by 7 times in case of a lack of support from colleagues, 5 times in case of accidental damage of equipment or performance outcomes. The likelihood to develop a gastric or duodenal ulcer increased by 15.3 times due to a lack of support from colleagues, 8.2 times due to inability to control the pace of work, 11.4 times in case of accidental damage of equipment or performance outcomes. Statistically significant psychosocial risk factors influencing functional gastrointestinal disorders are presented in Table 3. In case of ignoring the nurses opinion the probability of developing FD increased by 4.7 times. The likelihood to feel functional heartburn (epigastric burning) increased by 7.2 times due to a lack of support from colleagues, 5.1 times due to unfair distribution of work and 4.5 times as a result of difficult periods at work. DISCUSSION The digestive tract being one of the most sensitive systems of the human body is reacting to stress. The most common gastrointestinal symptoms associated with stress are heartburn, epigastric pain, early satiation, nausea and vomiting, abdominal bloating, diarrhea, constipation and pain in the lower abdomen [20, 21]. Most commonly these symptoms tend to be severe, troublesome, long-term, affecting the quality of life and the ability to work. They are likely toward about the occurrence of the structural changes in the digestive tract typical to organic inflammatory, infections or cancerous diseases. If no structural changes that can explain these symptoms are detected, the FGID are suspected. The causes for such functional disorders can be related to physiological, psychological or sociocultural factors [22]. Modern pathoge- Table 1. Psychosocial risk factors at work, triggering the gastrointestinal symptoms Psychosocial risk factors OR 95 % CI p Heartburn The inability to control the pace of work 5.0 1.57 15.10 <0.001 Regurgitation Ignoring the nurses opinion on duties 3.8 1.00 14.39 <0.05 The inability to control the pace of work 3.8 1.00 14.39 <0.05 Nausea A lack of support from a superior 8.5 1.15 62.32 <0.05 8.5 1.16 62.81 <0.05 Epigastric pain or burning A lack of support from colleagues 4.8 1.16 20.04 <0.05 A rush 3.4 1.02 11.28 <0.05 Difficult periods at work 8.1 2.15 30.14 <0.001 A decrease or a loss of appetite Unfair distribution of work 7.8 1.62 37.70 <0.01 Accidental damage of equipment or performance outcomes 12.2 2.44 60.80 <0.001 Early satiation Ignoring the nurses opinion on duties 9.3 1.49 58.13 <0.01 A lack of support from a superior 14.4 2.27 91.51 <0.001 Unfair distribution of work 6.4 1.02 40.90 <0.05 Postprandial fullness A lack of support from a superior 4.4 1.37 14.43 <0.01 Difficult periods at work 2.6 1.18 5.71 <0.01 Psychological strain 2.5 1.16 5.55 <0.05 Physical strain 2.6 1.20 5.30 <0.01 A superior did notconsult his employees 5.0 1.53 17.48 <0.01 An accidental damage of equipment or performance outcomes 4.4 1.03 21.21 <0.05 The upper abdominal bloating A lack of support from a superior 3.8 1.08 12.55 <0.01 Unfair distribution of work 4.3 1.19 14.50 <0.01 Physical strain 2.7 1.01 7.58 <0.05 A superior did not consult his employees 3.9 1.09 12.66 <0.01 teorija ir praktika 2015 - T. 21 (Nr. 4.3) 825

nesis of functional diseases is based on the biopsychosocial concept which recognizes that FGID and symptoms can be not only physiologically multidetermined but also triggered by sociocultural and psychological factors. An increasingly growing number of scientific studies claim that disorders and diseases are caused by the impaired regulation of the ongoing processes between the brain and other bodily systems. Genetics, environmental factors (family, work, conflicts, stress, losses, harmful habits, a lack of sleep, violence), psychological state (depression, anxiety, panic attacks) can cause psychological distress which results in a gastrointestinal dysfunction. FGID involve abnormal motoric motility, abnormal mucosal immune system, abnormal gastric accommodation after meal, visceral hypersensitivity, abnormal flatulence, intestinal flora changes, low-grade mucosal inflammation. The existence of the so-called brain-gastrointestinal axis explains this concept. The gastrointestinal system has its enteric nervous system, thus it is also called the small brain. FGID can be defined as a clinical expression of the links between the psychosocial factors and the changes in the gastrointestinal tract with a reciprocal direction between these links [23, 24]. Recent studies have shown that in most cases there is a primary need to examine and amend the patient s psychological state. The treatment of FGID and gastrointestinal diseases has a favourable effect on the improvement of the psychoemotional state and the decrease of the degree of anxiety and depression [24]. The nursing job is full of psychogenic manifestations of stress. The Australian researchers, while studying the causes of psychogenic stress experienced by nurses, found that concern about the communication and behavior, violence at work, high workload, conflicts with colleagues and exposure to the death process were significantly related to the nurses health. The nurses terminated the employment contract Table 2. Psychosocial risk factors at work impacting the occurrence of organic gastrointestinal diseases Psychosocial work factors and organic gastrointestinal diseases A lack of support from colleagues and chronic gastritis Accidental damage of equipment or performance outcomes and chronic gastritis A lack of support from colleagues and gastric or duodenal ulcer The inability to control the pace of work and gastric or duodenal ulcer An accidental damage of equipment or performance outcomes and gastric or duodenal ulcer OR 95 % CI p 7.0 1.79 27.47 <0.01 5.0 1.35 18.29 <0.05 15.3 2.98 79.30 <0.001 8.2 1.25 59.37 <0.01 11.4 1.38 78.46 <0.001 due to their excessive workload [2]. Lambert et al. (2008) carried out not only an explicit study on nurses exposed to stressogenic factors when working in palliative care units based in hospitals of China, Japan, South Korea, Thailand, the United States (Hawaii), Australia and New Zealand but also strategies to cope with those factors. Despite the intercultural differences, the biggest stressogenic factors at workplace as indicated by nurses were their big workload and exposure to the process of dying and death [25]. In one big study were surveyed 1,095 nurses employed by the primary health care units in Lithuania. It was found that stomach pain and a loss of appetite were related to conflicts with colleagues, insufficient preparedness for work, lack of support, large workload and concern for their condition [6]. Our study found that the psychosocial risk factors impacting nurses most in their work environment were as follows: psychological violence (experienced by 64 %) and physical violence (32.6 %), the factors related to the working process (strain, increasingly growing pace of work, high standards for performance, unfair job distribution, accidentally damaged equipment or performance outcomes, self-injuries, inability to regulate the pace of work), labour relations (a lack of support from colleagues and a superior, conflicts between superiors and subordinates), performance appraisal (limited career opportunities, absence of bonuses, incentives, a low salary). Psychosocial work environment risk factors have an impact on the physical and mental health as proved by scientific studies carried out by many researchers. Stressors at work trigger cognitive, physical and emotional health ailments. The most common gastrointestinal symptoms are diarrhea or constipation, nausea, a weight loss or growth, eating disorders. Long-term stress periods are likely to provoke ulcers, heartburn and eating disorders [26]. Chang et al. [27] found that emotional distress causes FGID, but their manifestation depends on gender. Women are more likely to frequently suffer from irritable bowel syndrome Table 3. Association between psychosocial risk factors at work and the occurrence of functional gastrointestinal disorders Psychosocial risk factors and functional gastrointestinal disorders Ignoring the nurses opinion on duties and functional dyspepsia A lack of support from colleagues and epigastric burning Unfair distribution of work and epigastric burning Difficult periods at work and epigastric burning OR 95 % CI p 4.7 1.17 18.60 <0.05 7.2 1.86 27.55 <0.01 5.1 1.53 17.21 <0.01 4.5 1.41 13.50 <0.01 826 teorija ir praktika 2015 - T. 21 (Nr. 4.3)

(IBS), bloating, constipation, chronic abdominal pain, pelvic muscle dysfunction, while functional esophageal and gastroduodenal disorders occur equally to both genders. Psychogenic stress impacting female irritable bowel symptoms is highly associated with depression and anxiety [28]. Previous scientific studies have found that gastrointestinal functional symptoms in females are associated with low activity of the parasympathetic nervous system and the malfunction of the autonomic nervous system [29]. However, A. Koloska and others [24] found that the patients with a higher degree of anxiety but not depression, over the period of 12 years, developed IBS significantly more frequently while FD was developed more frequently in those suffering from depression. Multidimensional relationships were identified between the patients with FD biopsychological malfunctions (anxiety, panic disorder, depression) and complaints of stomach hypersensitivity [30]. Our study shows that the symptoms of FGID (early satiety, postprandial fullness, abdominal bloating) characteristic of FD were mostly impacted by psychological distress factors provoked by relationship with a superior. A lack of support from a superior increased the probability of nausea by 8.5 times, early satiation 14.4 times, postprandial fullness 5 times. Ignoring the nurses opinion on duties increased the likelihood to feel the sense of early satiety by 9.3 times. Psychosocial working factors such as unfair distribution of work increased the probability of a loss of appetite by 7.8 times, a early satiety 6.4 times. Difficult periods at work increased the probability of epigastric pain or burning by 8.1 times. Physical and mental strain increased the chances to postprandial fullness up to 3 times. These data show that both psychological discomfort at work and large workload provoked FD symptoms associated with a gastric sensorimotor dysfunction (a postprandial distress syndrome). According to Rome III criteria, FD is a constant or recurrent epigastric pain or discomfort that occurs like burning, feeling of early satiety or/and fullness after a meal, nausea, abdominal bloating unless the investigation detects the presence of morphological organic pathology [31]. The disease pathogenesis involves the dominance of the relations between psychosocial and sensorimotor dysfunction of the stomach. The nurses under our investigation showed symptoms of visceral hypersensitivity of gastric distension (hyperalgesia) early satiety, a feeling of fullness after a meal, nausea, a loss of appetite. The factors related to work process increased the probability of the occurrence of GERD symptoms (heartburn, regurgitation). The inability to control the pace of work increased the likelihood of heartburn by 5 times, acid reflux episodes by 3.8 times. The study also showed that organic diseases with the occurrence of changes in the organ structure, mucosal integrity, and mucosal secretory function were impacted by the factors related to work intensity and complexity. A lack of support from colleagues increased the probability of chronic gastritis by 7 times, ulcers by even 15.3 times. The accidental damage of equipment or performance outcomes increased the likelihood of chronic gastritis by 5 times, of ulcers by 11.4 times. The inability to control the pace of work increased chances to develop gastric and duodenal ulcers by 8.2 times. The nurses suffering from FD more often emphasized the dissatisfaction of psychological content. Ignoring the nurses opinion on duties and a lack of support from colleagues increased the probability of FD 4.7 and 7.2 times, respectively. Barry et al. [32] found that FD is associated with psychosocial factors such as psychological distress, personality traits, social support, life events and stressful life events including losses. In Belgium, De Gucht et al. [33] conducted a scientific study the objective of which was to assess the association of psychosocial work factors (performance demands, performance control and social support), personality traits (neuroticism) and psychological distress (depression and anxiety) with somatic disorders in the population of nurses. This study showed that performance control being a factor of stress manifestation at work, was associated with IBS, however the workload, skills, social support from superiors and colleagues did not affect the IBS. Meanwhile, the dependency between FD and psychosocial work environment risk factors was not found, only psychological distress (anxiety) was associated with FD. Foreign scholarly data shows that psychosocial factors impacted the occurrence of GERD symptoms. In Norway, Jansson et al. [34] conducted a comparative study of 3,153 individuals suffering from severe GERD symptoms and 40,210 people not suffering from such symptoms. The population-based, cross-sectional, case-control model was used for the clarifying the relation between psychosocial factors and GERD. Positive associations were observed between high job demands, low job control and job strain and risk of GERD symptoms. The risk of severe GERD symptoms in individuals who are extremely dissatisfied with their job was recorded twice higher compared to those completely satisfied with their job. Also, positive relationships were determined between GERD symptoms and psychological pressure on oneself and time pressure. According to Johnston et al. [35], stress can have a dual mechanism on GERD. Due to stress, the irritants in esophageal mucosa are more susceptible but the individual s reaction and his ability to cope with stress play a very important role. Stress reduction can decrease the reflux effect on esophageal mucosa which repeatedly confirms the hypothesis that there is an interaction between the stomach and the CNS, thus the improvement of well-being has an effect on the reduction of somatic symptoms and visceral hypersensitivity [24]. teorija ir praktika 2015 - T. 21 (Nr. 4.3) 827

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