Journal of Modern Medical

Introduction
One of the basic problems that have put people at risk in the last few decades following the changes in societies and turning to modern life is the phenomenon of stress. The role of emotions in stress has been considered important due to the immediate reaction of people to stressful situations and also their motivation for physiological changes. In the last decade, occupational stress and its effects have received more attention and various experimental studies have investigated occupational stress from different aspects. Dealing with occupational stress is in response to annoying emotions that appear when the demands and requirements of the job do not match with the resources and needs of the individuals. Job pressure under the influence of the job position affects a person’s work and causes an adaptive response that is realized through personal characteristics or psychological processes. Occupational stress has devastating consequences for the healthcare system. Healthcare personnel experience a lot of stress during their work. The pressures and stresses in the nursing profession have accelerated the burnout of nurses compared to other professions. For this reason, more than one-third of nurses in England and Scotland and one-fifth of American nurses wanted to leave this profession. This study aims to design a stress management model to find occupational stressors in hospital staff.
Methods
This is a descriptive correlational study that was conducted in 2021 using Structural Equation Modeling (SEM). Participants were 384 personnel (with any type of employment) of teaching hospitals in Kashan, Iran. The stress management model was designed based on theoretical foundations and previous studies. Then the model was tested with a quantitative method. In this regard, a researcher-made questionnaire was used. The respondents indicated their level of agreement with each of the statements on a scale from 1 to 5 (5= very high, 4= high, 3= moderate, 2= low, and 1=very low). In checking the validity of the questionnaire, the opinions of three experts were used. In checking the reliability of the questionnaire, after collecting the questionnaires completed by the participants, Cronbach’s alpha coefficient was used. The acceptable value for Cronbach’s alpha should be ≥0.7. Accordingly, the reliability of the tool was confirmed. The structure of the proposed model was determined using exploratory factor analysis. Then, the confirmatory factor analysis of the designed model was carried out. SmartPLS software was used to perform SEM with partial least squares approach
Results
According to the results in Table 1, most of the participants were male and married aged 41-50 years.


Most of them had a bachelor’s degree (n=149), while minority of them had a high school diploma (n=14). Based on the results of SEM, individual factors (70.4%), organizational factors (66.6%), and extra-organizational factors (40.7%) had an effect on creating occupational stress in the hospital staff. The use of stress management strategies was effective in reducing occupational stress by 54.9%.
Discussion
The results of this study showed that organizational, extra-organizational and individual factors were effective in creating occupational stress in hospital staff. Individual factors of occupational stress had a total of 14 components in two genetic and acquired dimensions, each of which had seven components. In this respect, the results are consistent with Mansour’s study who reported that factors such as lack of self-confidence, lack of interpersonal relationships and lack of individual flexibility cause individual stress. Organizational factors of occupational stress had 27 components. Maleki listed the most important occupational stressors including high workload, unfair and inefficient reward and promotion system, problems caused due to lack of time. Extra-organizational factors of occupational stress had a total of 23 components in two dimensions of family-related and social. this respect, the results are consistent with Nazari’s study. He showed that the lack of meeting the emotional needs between the employees and their spouses, impossibility to see the family, and not paying attention to children’s activities and their upbringing were the most important extra-organizational occupational stressors. Stress management strategies had 36 components. Considering the multitude of occupational stressors and their effects in reducing productivity and waste of organizational resources and given the importance of reducing occupational stress in employees, the necessary conditions for prioritizing the stressors to eliminate them should be provided by the relevant officials.

Ethical Considerations
Compliance with ethical guidelines
This study obtained an ethical approval from Tehran Branch, Islamic Azad University (Code: IR.IAU.CTB.REC.1400.062)

Funding
This article is taken from the doctoral thesis of Abbas Ansaritabar, a doctoral student of Islamic Azad University, South Tehran Branch, and was done with the financial support of Islamic Azad University.

Authors' contributions
Drafting of the article: Abbas Ansaritabar; Data collection: Seyed Ahmad Hosseini Golafshani, Abbas Ansaritabar; Supervision and approval of the final version of the article: Seyed Ahmad Hosseini Golafshani; Statistical analysis: Seyed Ahmad Hosseini Golafshani, Parvaneh Golred; Editing of the article: Parvaneh Gelard.

Conflicts of interest
The authors declared no conflict of interest.


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