title: Objectifying psychomental stress in the workplace--an example.
abstract: BACKGROUND
  Psychomental stress is a major source of illness and reduced productivity. Data objectifying physiological stress responses are scarce. We studied salivary cortisol levels in a highly stressful environment, the pediatric critical care unit. The aim was to identify targets for organizational changes, to implement these changes and to assess their impact on cortisol levels.
  
  
  METHODS
  Repeated measurements observational cohort study (before and after intervention).
  
  
  METHODS
  84 nurses working in two independent teams (A and B) in a 19 bed pediatric intensive care unit. Between study periods team A experienced a major exchange of experienced staff while the turnover rate in team B remained average.
  
  
  METHODS
  Salivary cortisol samples were collected every 2 h and after stressful events. Nurses in study period I showed elevated cortisol levels at the beginning of the late shift, interpreted as an anticipatory stress reaction. To ease conditions during the early part of the late shift (conflicting tasks, noise and crowding), we postponed the afternoon ward round, limited non-urgent procedures and introduced a change in visiting hours. The early shift, which was not affected by the intervention, served as control.
  
  
  RESULTS
  Both crude and adjusted analysis revealed a decrease of cortisol levels at the beginning of the late shift in team B (p = 0.0009), but not in team A (p = 0.464). The control situation showed no difference between teams and study periods.
  
  
  CONCLUSIONS
  We demonstrated reduced cortisol secretions in one team following organizational changes, which was probably overridden by the disruption of social coherence in the second team.
authors.affiliation: Department of Behavioral Sciences, Swiss Federal Institute of Technology, Zurich. fischer@ifv.huwi.unizh.ch
authors.forename: J E
authors.initials: JE
authors.lastname: Fischer
authors.forename: A
authors.initials: A
authors.lastname: Calame
authors.forename: A C
authors.initials: AC
authors.lastname: Dettling
authors.forename: H
authors.initials: H
authors.lastname: Zeier
authors.forename: S
authors.initials: S
authors.lastname: Fanconi
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D015278:Intensive Care Units, Pediatric; D016018:Least-Squares Analysis; D008297:Male; D009741:Nursing Staff, Hospital / Q000523:psychology*; D009784:Occupational Diseases / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D009936:Organizational Innovation; D010561:Personnel Staffing and Scheduling; D010563:Personnel Turnover; D011446:Prospective Studies; D012463:Saliva / Q000378:metabolism; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D013557:Switzerland / Q000453:epidemiology; D017132:Workplace / Q000523:psychology*
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone