Psychology, Health & Medicine
ISSN: 1354-8506 (Print) 1465-3966 (Online) Journal homepage: http://www.tandfonline.com/loi/cphm20
Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan Erika Tsukamoto, Takeru Abe & Michikazu Ono To cite this article: Erika Tsukamoto, Takeru Abe & Michikazu Ono (2015) Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan, Psychology, Health & Medicine, 20:7, 814-823, DOI: 10.1080/13548506.2014.963128 To link to this article: http://dx.doi.org/10.1080/13548506.2014.963128
Published online: 29 Sep 2014.
Submit your article to this journal
Article views: 128
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=cphm20 Download by: [McMaster University]
Date: 19 October 2015, At: 10:13
Psychology, Health & Medicine, 2015 Vol. 20, No. 7, 814–823, http://dx.doi.org/10.1080/13548506.2014.963128
Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan Erika Tsukamotoa, Takeru Abeb* and Michikazu Onob a Graduate School of Human Sciences, Waseda University, Tokorozawa, Japan; bFaculty of Human Sciences, Waseda University, Tokorozawa, Japan
Downloaded by [McMaster University] at 10:13 19 October 2015
(Received 15 May 2014; accepted 30 August 2014) Emotional labour increases among long-term care workers because providing care and services to impaired elders causes conflicting interpersonal emotions. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. We conducted a cross-sectional study among 132 established, private day care centres in Tokyo using a mail survey. The outcome variables included two health-related variables and four job satisfaction variables: physical and psychological health, satisfaction with wages, interpersonal relationships, work environment and job satisfaction. We performed multiple regression analyses to identify significant factors. Directors from 36 facilities agreed to participate. A total of 123 responses from long-term care workers were analysed. Greater emotional dissonance was associated with better physical and psychological health and worse work environment satisfaction (partial regression coefficient: −2.93, p = .0389; −3.32, p = .0299; −1.92, p = .0314, respectively). Fewer negative emotions were associated with more job satisfaction (partial regression coefficient: −1.87, p = .0163). We found that emotional labour was significantly inversely associated with health and job satisfaction. Our findings indicated that the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, and suggests that care quality and stable employment among longterm care workers might affect their emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and a self-care programme to educate workers regarding emotional labour would be beneficial. Keywords: long-term care workers; emotional labour; health; job satisfaction; quality of care
What is already known about this topic: Strain on long-term care workers has been increasing. Physical, cognitive and emotional labour is associated with health and job satisfaction among various workers, except for long-term care workers. Emotional labour needs to be evaluated in each work environment independently. What this paper adds: Emotional labour is positively associated with health and negatively associated with job satisfaction. *Corresponding author. Email: [email protected] © 2014 Taylor & Francis
Psychology, Health & Medicine
815
Downloaded by [McMaster University] at 10:13 19 October 2015
Emotional labour types were independently related to health and job satisfaction. Providing health communication programmes for workers and emotional labour assessment workshops for managers would be beneficial.
Introduction In long-term care facilities in Japan, the number of workers whose health deteriorates and who leave their job because of work-related stress continues to increase (Ministry of Health, Labour and Welfare, 2009a, 2009b). There are three types of labour (physical, cognitive and emotional labour) that cause work-related stress among long-term care workers, which are similar to other jobs, because the aging population has increased, and a greater work force is in demand for long-term care in developed countries. Previous research has focused on health and occupational outcomes among various workers influenced by physical and cognitive labour-related work stress (Mastracci, Newman, & Guy, 2010). Physical, cognitive and emotional labour were originally defined by the type of work performance that was required if employees interacted with clients, patients or customers (Hochschild, 2003). Emotional labour has been investigated among various working environments. Examples of such occupations include customer service, call centres, health insurance (Abraham, 1999, 2000; Cheung & Tang, 2010; Diestel & Schmidt, 2010; Pugh, Groth, & Hennig-Thurau, 2011; Wegge, Van Dick, & Von Bernstorff, 2010), teaching (Cheung & Cheung, 2013; Kinman, Wray, & Strange, 2011; Pugliesi, 1999) and nursing (Chou, Hecker, & Martin, 2012; Pisaniello, Winefield, & Delfabbro, 2012; Yanga & Chang, 2008). In many studies, emotional labour was categorized into four subscales (negative emotions, positive emotions, sensitivity requirements and emotional dissonance) based on the findings from Zapf (Zapf, 2002; Zapf, Seifert, Schmutte, Mertini, & Holz, 2001). However, the findings regarding the emotional labour required in different work environments were not consistent. Thus, one must evaluate the emotional labour in each work environment independently. The number of long-term care workers has been increasing, and emotional labour has been associated with various jobs and health outcomes among various service workers. However, the effect of emotional labour among long-term care workers remains unknown. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. The findings from this study could contribute to a better understanding of the long-term care work environment and subsequently help improve services to the elderly who are long-term care users. Methods Participants and procedures We conducted a cross-sectional study using a mail survey that was sent to all existing day care centres in Tokyo, which included a total of 132 facilities. We distributed 5 copies of the questionnaires to each facility, which totalled 660 copies. Out of the 132 facilities, the directors from 36 facilities agreed to participate (27.7% response rate), and a total of 134 questionnaires (20.3% response rate) were returned. The population in Tokyo was approximately 580,000 in 2012, and the proportion of persons >65 years old increased from 17 to 21% over the past several years (Hachioji-City, 2012). We sent copies of the self-administered questionnaire to the directors of each facility in June
816
E. Tsukamoto et al.
Downloaded by [McMaster University] at 10:13 19 October 2015
2012 and asked the directors to return the questionnaires within two months, which was by the end of August 2012. The Waseda University ethical committee approved this study. No personal identification information was obtained from the survey. Outcome variables In total, we used six outcome variables. Two of the health-related outcomes (i.e. physical health and psychological health) were measured using the Japanese standard version SF-8 (Fukuhara & Suzukamo, 2004, 2005). The other four outcome variables related to job satisfaction (i.e. wage satisfaction, interpersonal relationships, work environment and job content) were measured using the Japanese job-satisfaction scales (Adachi, 1998). The SF-8 consisted of eight subscales (i.e. physical functioning (PF), physical role (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), emotional role (RE) and mental health (MH)). The physical health score was the sum of PF, RP, BP and GH, while the psychological health score was the sum of VT, SF, RE and MH. The minimum and maximum physical health scores ranged from 4 to 22, and the psychological health scores ranged from 4 to 20. Higher scores indicated poorer health conditions. The job satisfaction scale consisted of 33 items measured using Likert scales across four categories. We used the following four composite scores as outcome variables related to job satisfaction: wages, interpersonal relationships, work environment and job content (Adachi, 1998). Higher scores indicated greater job satisfaction. We performed reliability tests for those four composite items. Cronbach’s α ranged from .68 to .83, which indicated reliability. Explanatory variables We used 12 explanatory variables from three sections of the survey (age, gender, marital status, the number of working days per week, the number of working years in the current facility, the number of working years as a long-term care worker, the type of job and the type of facility) and four emotional labour variables (positive emotions, negative emotions, sensitivity requirements and emotional dissonance) (Ogino, Takigasaki, & Inaki, 2004). Higher scores indicated the worker provided more emotional labour on the job. Statistical analysis First, we analysed descriptive statistics using all outcome and explanatory variables and calculated Pearson’s product correlation coefficients or Spearman’s rank correlation coefficients when appropriate. We then performed six separate multiple regression analyses to identify significant factors of the six outcome variables. We assessed the variance inflation factor (VIF) to avoid multicollinearity among explanatory variables in each multiple regression analysis. We considered variables with a VIF larger than 4 as violating multicollinearity to exclude the explanatory variable (Tabachnick, Fidell, & Osterlind, 2012). Data analysis was performed using the IBM SPSS ver. 19 (IBM, Tokyo, Japan). A p-value < .05 was considered to be statistically significant. Results After excluding any responses with missing values, we used 123 responses for the analysis. Table 1 lists the descriptive statistics for all of the study variables. Table 2 presents
Psychology, Health & Medicine Table 1.
Characteristics of the study variables among the survey responders (n = 123). Mean (SD)/ frequency (%)
Variables Explanatory variables Age Gender Marital status The number of working days per week The number of working years in the current facility
Downloaded by [McMaster University] at 10:13 19 October 2015
817
The number of working years as a long-term care worker The type of job The type of facility Emotional labour Positive emotions Negative emotions Sensitivity requirements Emotional dissonance Outcome variables Health Physical health Psychological health Job satisfaction Wages Interpersonal relationships Work environment Job content
(Min–Max)
Female Married Less than 5 years
47.54 93 95 4.53 75
(11.39) (75.6) (77.2) (.99) (61.0)
(22－83) (2－6)
5–10 years Longer than 10 years Less than 5 years
40 8
(32.5) (6.5)
30
(24.4)
47 46
(38.2) (37.4)
60 39 14 10 41
(48.8) (31.7) (11.4) (8.1) (33.3)
10
(8.1)
72
(58.5)
(.84) (.58) (.90) (.82)
(1.00－5.00) (1.00－4.17) (1.00－5.00) (.80－4.00)
5–10 years Longer than 10 years Care staff Consult staff Nursing staff Other Social welfare corporation Healthcare corporation Other
4.06 1.80 3.03 2.70
46.70 44.04
(7.45) (.58)
(20.98－61.98) (23.13－65.89)
13.33 30.32 20.63 27.13
(4.81) (5.88) (5.39) (4.23)
(6－24) (10－40) (8－32) (12－36)
the correlations among the study variables. Table 3 presents the results of two multiple regression analyses on physical and psychological health. Table 4 lists the results of four multiple regression analyses on the job satisfaction scale. Discussion We conducted a mail survey to investigate the associations between emotional labour, general health and job satisfaction outcomes in long-term care workers. First, greater emotional dissonance was the only significant predictor of both better physical and psychological health (Table 3). Fewer negative emotions were also associated with more job and interpersonal relationship satisfaction, and less emotional dissonance was associated with more work environment satisfaction (Table 4). To our
9 10 11 12 13 14 15 16 17 18
1 2 3 4 5 6 7 8
2
3
4
5
6
−.17* −.25** −.10 −.20* .00 .04 .01 −.11 −.05 .24** .03 .04 −.24** −.07 −.08 .01 −.01 −.01 −.11 .05 −.01 .11 .18* .03 .08 .02 −.03 .00 .09 .12
.04 .20* .09 .12 −.10 −.16* −.15* −.04 −.15* −.06
.11 −.07 .12 .07 −.04 .11 .16* .20* .21** .15*
.17* .06 .16* .19* −.03 −.08 −.11 −.16* −.10 −.09
.05 .35*** .10 −.15* −.14 −.20* .18* .12 .22** −.08 .17* −.06 .11 .10 .36*** −.15* .21** .03 −.23** −.03 −.30*** −.21** .08 −.23** .09 −.05 .05
1
Relationships among the study variables by correlation coefficients (n = 123).
Age Gender (0: Male, 1: Female) Marital status (0: Not married, 1: Married) The number of working days per week The number of working years in the current facility The number of working years as a long-term care worker The type of job (0: Other, 1: Care staff) The type of facility (0: Other, 1: Social welfare corporation) Positive emotions Negative emotions Sensitivity requirements Emotional dissonance Physical health Psychological health Wages Interpersonal relationships Work environment Job content
Table 2.
Downloaded by [McMaster University] at 10:13 19 October 2015
−.18* −.03 −.12 −.10 .06 .14 .02 .03 −.02 .07
.00
7
.02 −.08 −.06 .06 .12 −.15 .16* .05 .14 −.01
8
.26** .33*** −.19* −.15* −.14 −.30*** −.31*** −.36***
10
(Continued)
−.03 .38*** .45*** .06 −.19* −.07 .03 −.05 −.03
9
818 E. Tsukamoto et al.
Age Gender (0: Male, 1: Female) Marital status (0: Not married, 1: Married) The number of working days per week The number of working years in the current facility The number of working years as a long-term care worker The type of job (0: Other, 1: Care staff) The type of facility (0: Other, 1: Social welfare corporation) Positive emotions Negative emotions Sensitivity requirements Emotional dissonance Physical health Psychological health Wages Interpersonal relationships Work environment Job content
*p < .05; **p < .01; ***p < .001.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Table 2. (Continued).
.75*** −.09 −.26** −.09 −.13 −.19* −.16*
11
−.17* −.37*** −.09 −.15* −.28*** −.24**
12
−.09 .18* .22** .27*** .15
13
14
.17* .25** .35*** .31***
Downloaded by [McMaster University] at 10:13 19 October 2015
.48*** .56*** .29***
15
.7*** .55***
16
.52***
17
Psychology, Health & Medicine 819
820
Downloaded by [McMaster University] at 10:13 19 October 2015
Table 3.
E. Tsukamoto et al. Associated characteristics and emotional labour with health outcomes (n = 123).
Age Gender Marital status The number of working days per week The number of working years in the current facility The number of working years as a long-term care worker The type of job (Reference: Care staff)
Female Married
The type of facility (Reference: Social welfare corporation) Positive emotions Negative emotions Sensitivity requirements Emotional dissonance R2 (Adjusted R2)
Physical health B
SE
β
.00 .07 .01 −2.74 1.70 −.16 1.18 1.80 .07 −.82 .75 −.11
Psychological health
P value
B
SE
β
P value
.9491 −.11 .08 −.16 .1102 −1.65 1.83 −.09 .5116 1.69 1.93 .09 .2775 −.41 .81 −.05
.1522 .3677 .3837 .6127
−.23
.60 −.04
.6970
1.08
.65
.17
.0979
−.05
.55 −.01
.9204
−.08
.59 −.01
.8898
Consult −.37 1.77 −.02 staff Nursing −3.42 2.51 −.15 staff Other −4.00 2.95 −.15 Healthcare −1.20 2.80 −.04 corporation
.8362
1.57 1.91
.09
.4124
.1755
1.57 2.70
.06
.5628
.1787 .6684
.50 3.18 .02 −.18 3.01 −.01
.8758 .9526
Other
−3.06 1.49 −1.72 .75 −2.93
1.59 −.20 .0564 2.62 1.71 .16 .1288 .95 .17 .1203 −.76 1.03 −.08 .4593 1.39 −.13 .2212 −1.41 1.50 −.10 .3499 1.17 .09 .5212 .26 1.26 .03 .8347 1.40 −.32 .0389 −3.32 1.51 −.33 .0299 .15 (.04) .22 (.11)
knowledge, these are novel findings regarding emotional labour among long-term care workers. Because long-term care workers are trying to provide-high quality care to users, they must pay attention to their own attitude, which might be different from their feelings if they are suffering from emotional labour. Nevertheless, these workers continue to provide care services despite facing negative emotions and emotional dissonance. It is necessary for facility managers to recognize that emotional labour might affect general health and job satisfaction among long-term care workers. To mitigate the negative effects of emotional labour, facility managers must recommend individual selfcontrol of emotional labour evaluations among care staff. It is necessary to consider a system that can assist with the psychological needs of long-term care workers. Second, we found that all emotional labour types were independently and significantly related to health and job satisfaction outcomes (Table 2). Mayeroff’s concept of caring might explain these findings, in which workers provide labour partly for their own selfactualization (Mayeroff, 1990). Emotional labour that has maintained healthy workplace satisfaction and health might aid in their own self-actualization and the provision of highquality care. This virtuous cycle suggests the possibility of encouraging further improvements in the quality of care. A greater number of working years at their current facility was independently associated with interpersonal relationships and work environment satisfaction (Table 4). This result might indicate that long-term care workers change their jobs more and do not tend to stay at the same facility. This result is partly explained by previous findings (Soo-kyung, 2013). To secure employment for long-term care workers, greater attention has to be paid to workers’
−.01 .05 −.02 1.48 1.08 .13 .57 1.14 .05 −.60 .47 −.12
Female Married
.3632 −1.96 1.58 −.12 −.87 1.86 −.04 3.26 1.76 .17
.3804 −1.72 1.88 −.09 −.36 2.21 −.02 1.82 2.1 .08
.09 .15 .04
1.87 1.77
.8716 .3870
1.01 −.23 .0299 −.74 1.19 −.06 .5329 .6 −.11 .3138 .18 .71 .03 .7990 .88 −.01 .9527 −2.69 1.04 −.26 .0112 .74 −.05 .7163 −.48 .87 −.07 .5851 .89 .04 .7836 −.58 1.05 −.08 .5821 .19 (.07) .24 −.13
.1716 .6869
.25
.6394 .0669
.2171
.1034
.0969
.0055
.3130 .3655 .8428 .0387
P value
β
.15
.97
.05
.30 −.14
.33
.04 .16 .93 −.01 .99 .04 .41 .07
SE
Job content
.8624 .9493
.5647
.6834
.1835
.1269
.1343 .9432 .6493 .4890
P value
.87 −.04 .6638 .52 .07 .5024 .76 −.26 .0163 .64 .02 .8940 .77 −.16 .2754 .21 (.10)
.28 1.62 .02 −.1 1.53 −.01
−.79 1.38 −.06
.4
−.4
.51
.06 −.07 .45 .29
B
−2.86 1.00 −.26 .0050 −.38 .02 .60 .00 .9708 .35 −1.6 .88 −.17 .0707 −1.87 −.11 .73 −.02 .8777 .09 −1.92 .88 −.29 .0314 −.84 .36 (.27)
.35 −.15
.38
1.59
−.58
1.07
.3381 −1.83 1.12 −.17
.0286
.0047
.8491 −1.28 1.33 −.11
.41 −.22
.28
1.12 −.02
−.91
.45
β
Consult −.21 staff Nursing 1.40 staff Other 2.57 Healthcare .72 The type of facility (Reference: Social welfare corporation corporation) Other −2.21 Positive emotions −.61 Negative emotions −05 Sensitivity requirements −.27 Emotional dissonance .24 R2 (Adjusted R2)
.1267
1.30
SE
−.05 .05 −.10 −.97 1.07 −.08 .22 1.13 .02 −.99 .47 −.18
B
.35 −.16
.0854
.0701 .9579 .6228 .9968
P value
−.54
.18
β
.38
SE
−.10 .06 −.20 .07 1.27 .00 .66 1.35 .05 .00 .56 .00
B
Work environment
.66
.8791 .1722 .6158 .2092
P value
Interpersonal relationships
β
Age Gender Marital status The number of working days per week The number of working years in the current facility The number of working years as a long-term care worker The type of job (Reference: Care staff)
SE
B
Wages
Associated characteristics and emotional labour with job-satisfaction outcomes (n = 123).
Table 4.
Downloaded by [McMaster University] at 10:13 19 October 2015
Psychology, Health & Medicine 821
Downloaded by [McMaster University] at 10:13 19 October 2015
822
E. Tsukamoto et al.
satisfaction with respect to their work environment and interpersonal relationships. We believe that the impact of emotional labour is closely related to workplace satisfaction. From these findings, the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, respectively, which suggests that care quality and stable employment among long-term care workers might have an effect on emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and self-care programmes to educate these workers regarding emotional labour would be beneficial. This study has several limitations. First, our study design was cross-sectional. Therefore, caution should be taken when inferring a causal relationship between general health and emotional labour or between job satisfaction and emotional labour. Second, we used a self-administered questionnaire for our data. This might have contributed to a lack of objectivity and an inability to make clinical diagnosis, especially for the general health measurement. Third, there are limitations with respect to generalizing the study findings. Therefore, we are planning to conduct a nationwide survey in Japan to remove this limitation. Acknowledgement We appreciate all responders to the survey for their voluntary participation.
References Abraham, R. (1999). Negative affectivity: Moderator or confound in emotional dissonanceoutcome relationships? The Journal of Psychology, 133, 61–72. Abraham, R. (2000). The role of job control as a moderator of emotional dissonance and emotional intelligence-outcome relationships. The Journal of Psychology, 134, 169–184. Adachi, T. (1998). Job satisfaction of sales people: A covariance structure analysis of the motivational process. The Japanese Journal of Psychology, 69, 223–228. [in Japanese] Cheung, F., & Tang, C. (2010). The influence of emotional dissonance on subjective health and job satisfaction: Testing the stress–strain–outcome model. Journal of Applied Social Psychology, 40, 3192–3217. Cheung, F.Y.L., & Cheung, R.Y.H. (2013). Effect of emotional dissonance on organizational citizenship behavior: Testing the stressor-strain-outcome model. The Journal of Psychology, 147, 89–103. Chou, H.Y., Hecker, R., & Martin, A. (2012). Predicting nurses well-being from job demands and resources: A cross-sectional study of emotional labour. Journal of Nursing Management, 20, 502–511. Diestel, S., & Schmidt, K.H. (2010). Interactive effects of emotional dissonance and self-control demands on burnout, anxiety, and absenteeism. Journal of Vocational Behavior, 77, 412–424. Fukuhara, S., & Suzukamo, Y. (2004). Manual of SF-36v2 Japanese version. Kyoto: Institute for Health Outcomes & Process Evaluation Research. Fukuhara, S., & Suzukamo, Y. (2005). Instruments for measuring health-related quality of life: SF-8 and SF-36. Journal of Clinical and Experimental Medicine, 213, 33–136. [in Japanese] Hachioji-City. (2012). Koreisha-keikaku [Plan for aging and long-term care at Hachioji-City]. Retrieved November 1, 2013, from http://www.city.hachioji.tokyo.jp/korei_shogai/032340.html Hochschild, A.R. (2003). The managed heart: Commercialization of human feeling, with a new afterword. Los Angeles, CA: University of California Press. Kinman, G., Wray, S., & Strange, C. (2011). Emotional labour, burnout and job satisfaction in UK teachers: The role of workplace social support. Educational Psychology, 31, 843–856. Mastracci, S.H., Newman, M.A., & Guy, M.E. (2010). Emotional labor: Why and how to teach it. Journal of Public Affairs Education, 12, 123–141. Mayeroff, M. (1990). On Caring Ri, Vol. 43. New York, NY: HarperCollins. Ministry of Health, Labour and Welfare. (2009a). Kaigobunya-niokeru-koyou-kanri-moderu-kentoukai [Reports for the commission of employment management model in long-term care]. Retrieved November 1, 2013, from http://www.mhlw.go.jp/houdou/2009/07/dl/h0731-2b.pdf
Downloaded by [McMaster University] at 10:13 19 October 2015
Psychology, Health & Medicine
823
Ministry of Health, Labour and Welfare. (2009b). Kaigo-shokuin-wo-meguru-genjo-to-jinzai-nokakuho-tou-no taisahku-nituite [Current concerns and countermeasures for securing human resources in long-term care]. Retrieved November 1, 2013, from http://www.mhlw.go.jp/stf/ shingi/2r9852000002ae5j-att/2r9852000002aej7.pdf Ogino, K., Takigasaki, T., & Inaki, K. (2004). Effects of emotion work on burnout and stress among human service professionals. The Japanese journal of psychology, 75, 371–377. [in Japanese] Pisaniello, S.L., Winefield, H.R., & Delfabbro, P.H. (2012). The influence of emotional labour and emotional work on the occupational health and wellbeing of South Australian hospital nurses. Journal of Vocational Behavior, 80, 579–591. Pugh, S.D., Groth, M., & Hennig-Thurau, T. (2011). Willing and able to fake emotions: A closer examination of the link between emotional dissonance and employee well-being. Journal of Applied Psychology, 96, 377–390. Pugliesi, K. (1999). The consequences of emotional labor: Effects on work stress, job satisfaction, and well-being. Motivation and Emotion, 23, 125–154. Soo-kyung, P. (2013). An analysis of emotional labor in the Japanese elder care profession. Women’s Studies, 84, 171–212. Tabachnick, B.G., Fidell, L.S., & Osterlind, S.J. (2012). Using multivariate statistics (International ed.). New York, NY: Pearson. Wegge, J., Van Dick, R., & Von Bernstorff, C. (2010). Emotional dissonance in call centre work. Journal of Managerial Psychology, 25, 596–619. Yang, F.H., & Chang, C.C. (2008). Emotional labour, job satisfaction and organizational commitment amongst clinical nurses: A questionnaire survey. International Journal of Nursing Studies, 45, 879–887. Zapf, D. (2002). Emotion work and psychological well-being: A review of the literature and some conceptual considerations. Human Resource Management Review, 12, 237–268. Zapf, D., Seifert, C., Schmutte, B., Mertini, H., & Holz, M. (2001). Emotion work and job stressors and their effects on burnout. Psychology & Health, 16, 527–545.
ISSN: 1354-8506 (Print) 1465-3966 (Online) Journal homepage: http://www.tandfonline.com/loi/cphm20
Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan Erika Tsukamoto, Takeru Abe & Michikazu Ono To cite this article: Erika Tsukamoto, Takeru Abe & Michikazu Ono (2015) Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan, Psychology, Health & Medicine, 20:7, 814-823, DOI: 10.1080/13548506.2014.963128 To link to this article: http://dx.doi.org/10.1080/13548506.2014.963128
Published online: 29 Sep 2014.
Submit your article to this journal
Article views: 128
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=cphm20 Download by: [McMaster University]
Date: 19 October 2015, At: 10:13
Psychology, Health & Medicine, 2015 Vol. 20, No. 7, 814–823, http://dx.doi.org/10.1080/13548506.2014.963128
Inverse roles of emotional labour on health and job satisfaction among long-term care workers in Japan Erika Tsukamotoa, Takeru Abeb* and Michikazu Onob a Graduate School of Human Sciences, Waseda University, Tokorozawa, Japan; bFaculty of Human Sciences, Waseda University, Tokorozawa, Japan
Downloaded by [McMaster University] at 10:13 19 October 2015
(Received 15 May 2014; accepted 30 August 2014) Emotional labour increases among long-term care workers because providing care and services to impaired elders causes conflicting interpersonal emotions. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. We conducted a cross-sectional study among 132 established, private day care centres in Tokyo using a mail survey. The outcome variables included two health-related variables and four job satisfaction variables: physical and psychological health, satisfaction with wages, interpersonal relationships, work environment and job satisfaction. We performed multiple regression analyses to identify significant factors. Directors from 36 facilities agreed to participate. A total of 123 responses from long-term care workers were analysed. Greater emotional dissonance was associated with better physical and psychological health and worse work environment satisfaction (partial regression coefficient: −2.93, p = .0389; −3.32, p = .0299; −1.92, p = .0314, respectively). Fewer negative emotions were associated with more job satisfaction (partial regression coefficient: −1.87, p = .0163). We found that emotional labour was significantly inversely associated with health and job satisfaction. Our findings indicated that the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, and suggests that care quality and stable employment among longterm care workers might affect their emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and a self-care programme to educate workers regarding emotional labour would be beneficial. Keywords: long-term care workers; emotional labour; health; job satisfaction; quality of care
What is already known about this topic: Strain on long-term care workers has been increasing. Physical, cognitive and emotional labour is associated with health and job satisfaction among various workers, except for long-term care workers. Emotional labour needs to be evaluated in each work environment independently. What this paper adds: Emotional labour is positively associated with health and negatively associated with job satisfaction. *Corresponding author. Email: [email protected] © 2014 Taylor & Francis
Psychology, Health & Medicine
815
Downloaded by [McMaster University] at 10:13 19 October 2015
Emotional labour types were independently related to health and job satisfaction. Providing health communication programmes for workers and emotional labour assessment workshops for managers would be beneficial.
Introduction In long-term care facilities in Japan, the number of workers whose health deteriorates and who leave their job because of work-related stress continues to increase (Ministry of Health, Labour and Welfare, 2009a, 2009b). There are three types of labour (physical, cognitive and emotional labour) that cause work-related stress among long-term care workers, which are similar to other jobs, because the aging population has increased, and a greater work force is in demand for long-term care in developed countries. Previous research has focused on health and occupational outcomes among various workers influenced by physical and cognitive labour-related work stress (Mastracci, Newman, & Guy, 2010). Physical, cognitive and emotional labour were originally defined by the type of work performance that was required if employees interacted with clients, patients or customers (Hochschild, 2003). Emotional labour has been investigated among various working environments. Examples of such occupations include customer service, call centres, health insurance (Abraham, 1999, 2000; Cheung & Tang, 2010; Diestel & Schmidt, 2010; Pugh, Groth, & Hennig-Thurau, 2011; Wegge, Van Dick, & Von Bernstorff, 2010), teaching (Cheung & Cheung, 2013; Kinman, Wray, & Strange, 2011; Pugliesi, 1999) and nursing (Chou, Hecker, & Martin, 2012; Pisaniello, Winefield, & Delfabbro, 2012; Yanga & Chang, 2008). In many studies, emotional labour was categorized into four subscales (negative emotions, positive emotions, sensitivity requirements and emotional dissonance) based on the findings from Zapf (Zapf, 2002; Zapf, Seifert, Schmutte, Mertini, & Holz, 2001). However, the findings regarding the emotional labour required in different work environments were not consistent. Thus, one must evaluate the emotional labour in each work environment independently. The number of long-term care workers has been increasing, and emotional labour has been associated with various jobs and health outcomes among various service workers. However, the effect of emotional labour among long-term care workers remains unknown. Thus, we investigated the associations between emotional labour, general health and job satisfaction among long-term care workers. The findings from this study could contribute to a better understanding of the long-term care work environment and subsequently help improve services to the elderly who are long-term care users. Methods Participants and procedures We conducted a cross-sectional study using a mail survey that was sent to all existing day care centres in Tokyo, which included a total of 132 facilities. We distributed 5 copies of the questionnaires to each facility, which totalled 660 copies. Out of the 132 facilities, the directors from 36 facilities agreed to participate (27.7% response rate), and a total of 134 questionnaires (20.3% response rate) were returned. The population in Tokyo was approximately 580,000 in 2012, and the proportion of persons >65 years old increased from 17 to 21% over the past several years (Hachioji-City, 2012). We sent copies of the self-administered questionnaire to the directors of each facility in June
816
E. Tsukamoto et al.
Downloaded by [McMaster University] at 10:13 19 October 2015
2012 and asked the directors to return the questionnaires within two months, which was by the end of August 2012. The Waseda University ethical committee approved this study. No personal identification information was obtained from the survey. Outcome variables In total, we used six outcome variables. Two of the health-related outcomes (i.e. physical health and psychological health) were measured using the Japanese standard version SF-8 (Fukuhara & Suzukamo, 2004, 2005). The other four outcome variables related to job satisfaction (i.e. wage satisfaction, interpersonal relationships, work environment and job content) were measured using the Japanese job-satisfaction scales (Adachi, 1998). The SF-8 consisted of eight subscales (i.e. physical functioning (PF), physical role (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), emotional role (RE) and mental health (MH)). The physical health score was the sum of PF, RP, BP and GH, while the psychological health score was the sum of VT, SF, RE and MH. The minimum and maximum physical health scores ranged from 4 to 22, and the psychological health scores ranged from 4 to 20. Higher scores indicated poorer health conditions. The job satisfaction scale consisted of 33 items measured using Likert scales across four categories. We used the following four composite scores as outcome variables related to job satisfaction: wages, interpersonal relationships, work environment and job content (Adachi, 1998). Higher scores indicated greater job satisfaction. We performed reliability tests for those four composite items. Cronbach’s α ranged from .68 to .83, which indicated reliability. Explanatory variables We used 12 explanatory variables from three sections of the survey (age, gender, marital status, the number of working days per week, the number of working years in the current facility, the number of working years as a long-term care worker, the type of job and the type of facility) and four emotional labour variables (positive emotions, negative emotions, sensitivity requirements and emotional dissonance) (Ogino, Takigasaki, & Inaki, 2004). Higher scores indicated the worker provided more emotional labour on the job. Statistical analysis First, we analysed descriptive statistics using all outcome and explanatory variables and calculated Pearson’s product correlation coefficients or Spearman’s rank correlation coefficients when appropriate. We then performed six separate multiple regression analyses to identify significant factors of the six outcome variables. We assessed the variance inflation factor (VIF) to avoid multicollinearity among explanatory variables in each multiple regression analysis. We considered variables with a VIF larger than 4 as violating multicollinearity to exclude the explanatory variable (Tabachnick, Fidell, & Osterlind, 2012). Data analysis was performed using the IBM SPSS ver. 19 (IBM, Tokyo, Japan). A p-value < .05 was considered to be statistically significant. Results After excluding any responses with missing values, we used 123 responses for the analysis. Table 1 lists the descriptive statistics for all of the study variables. Table 2 presents
Psychology, Health & Medicine Table 1.
Characteristics of the study variables among the survey responders (n = 123). Mean (SD)/ frequency (%)
Variables Explanatory variables Age Gender Marital status The number of working days per week The number of working years in the current facility
Downloaded by [McMaster University] at 10:13 19 October 2015
817
The number of working years as a long-term care worker The type of job The type of facility Emotional labour Positive emotions Negative emotions Sensitivity requirements Emotional dissonance Outcome variables Health Physical health Psychological health Job satisfaction Wages Interpersonal relationships Work environment Job content
(Min–Max)
Female Married Less than 5 years
47.54 93 95 4.53 75
(11.39) (75.6) (77.2) (.99) (61.0)
(22－83) (2－6)
5–10 years Longer than 10 years Less than 5 years
40 8
(32.5) (6.5)
30
(24.4)
47 46
(38.2) (37.4)
60 39 14 10 41
(48.8) (31.7) (11.4) (8.1) (33.3)
10
(8.1)
72
(58.5)
(.84) (.58) (.90) (.82)
(1.00－5.00) (1.00－4.17) (1.00－5.00) (.80－4.00)
5–10 years Longer than 10 years Care staff Consult staff Nursing staff Other Social welfare corporation Healthcare corporation Other
4.06 1.80 3.03 2.70
46.70 44.04
(7.45) (.58)
(20.98－61.98) (23.13－65.89)
13.33 30.32 20.63 27.13
(4.81) (5.88) (5.39) (4.23)
(6－24) (10－40) (8－32) (12－36)
the correlations among the study variables. Table 3 presents the results of two multiple regression analyses on physical and psychological health. Table 4 lists the results of four multiple regression analyses on the job satisfaction scale. Discussion We conducted a mail survey to investigate the associations between emotional labour, general health and job satisfaction outcomes in long-term care workers. First, greater emotional dissonance was the only significant predictor of both better physical and psychological health (Table 3). Fewer negative emotions were also associated with more job and interpersonal relationship satisfaction, and less emotional dissonance was associated with more work environment satisfaction (Table 4). To our
9 10 11 12 13 14 15 16 17 18
1 2 3 4 5 6 7 8
2
3
4
5
6
−.17* −.25** −.10 −.20* .00 .04 .01 −.11 −.05 .24** .03 .04 −.24** −.07 −.08 .01 −.01 −.01 −.11 .05 −.01 .11 .18* .03 .08 .02 −.03 .00 .09 .12
.04 .20* .09 .12 −.10 −.16* −.15* −.04 −.15* −.06
.11 −.07 .12 .07 −.04 .11 .16* .20* .21** .15*
.17* .06 .16* .19* −.03 −.08 −.11 −.16* −.10 −.09
.05 .35*** .10 −.15* −.14 −.20* .18* .12 .22** −.08 .17* −.06 .11 .10 .36*** −.15* .21** .03 −.23** −.03 −.30*** −.21** .08 −.23** .09 −.05 .05
1
Relationships among the study variables by correlation coefficients (n = 123).
Age Gender (0: Male, 1: Female) Marital status (0: Not married, 1: Married) The number of working days per week The number of working years in the current facility The number of working years as a long-term care worker The type of job (0: Other, 1: Care staff) The type of facility (0: Other, 1: Social welfare corporation) Positive emotions Negative emotions Sensitivity requirements Emotional dissonance Physical health Psychological health Wages Interpersonal relationships Work environment Job content
Table 2.
Downloaded by [McMaster University] at 10:13 19 October 2015
−.18* −.03 −.12 −.10 .06 .14 .02 .03 −.02 .07
.00
7
.02 −.08 −.06 .06 .12 −.15 .16* .05 .14 −.01
8
.26** .33*** −.19* −.15* −.14 −.30*** −.31*** −.36***
10
(Continued)
−.03 .38*** .45*** .06 −.19* −.07 .03 −.05 −.03
9
818 E. Tsukamoto et al.
Age Gender (0: Male, 1: Female) Marital status (0: Not married, 1: Married) The number of working days per week The number of working years in the current facility The number of working years as a long-term care worker The type of job (0: Other, 1: Care staff) The type of facility (0: Other, 1: Social welfare corporation) Positive emotions Negative emotions Sensitivity requirements Emotional dissonance Physical health Psychological health Wages Interpersonal relationships Work environment Job content
*p < .05; **p < .01; ***p < .001.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Table 2. (Continued).
.75*** −.09 −.26** −.09 −.13 −.19* −.16*
11
−.17* −.37*** −.09 −.15* −.28*** −.24**
12
−.09 .18* .22** .27*** .15
13
14
.17* .25** .35*** .31***
Downloaded by [McMaster University] at 10:13 19 October 2015
.48*** .56*** .29***
15
.7*** .55***
16
.52***
17
Psychology, Health & Medicine 819
820
Downloaded by [McMaster University] at 10:13 19 October 2015
Table 3.
E. Tsukamoto et al. Associated characteristics and emotional labour with health outcomes (n = 123).
Age Gender Marital status The number of working days per week The number of working years in the current facility The number of working years as a long-term care worker The type of job (Reference: Care staff)
Female Married
The type of facility (Reference: Social welfare corporation) Positive emotions Negative emotions Sensitivity requirements Emotional dissonance R2 (Adjusted R2)
Physical health B
SE
β
.00 .07 .01 −2.74 1.70 −.16 1.18 1.80 .07 −.82 .75 −.11
Psychological health
P value
B
SE
β
P value
.9491 −.11 .08 −.16 .1102 −1.65 1.83 −.09 .5116 1.69 1.93 .09 .2775 −.41 .81 −.05
.1522 .3677 .3837 .6127
−.23
.60 −.04
.6970
1.08
.65
.17
.0979
−.05
.55 −.01
.9204
−.08
.59 −.01
.8898
Consult −.37 1.77 −.02 staff Nursing −3.42 2.51 −.15 staff Other −4.00 2.95 −.15 Healthcare −1.20 2.80 −.04 corporation
.8362
1.57 1.91
.09
.4124
.1755
1.57 2.70
.06
.5628
.1787 .6684
.50 3.18 .02 −.18 3.01 −.01
.8758 .9526
Other
−3.06 1.49 −1.72 .75 −2.93
1.59 −.20 .0564 2.62 1.71 .16 .1288 .95 .17 .1203 −.76 1.03 −.08 .4593 1.39 −.13 .2212 −1.41 1.50 −.10 .3499 1.17 .09 .5212 .26 1.26 .03 .8347 1.40 −.32 .0389 −3.32 1.51 −.33 .0299 .15 (.04) .22 (.11)
knowledge, these are novel findings regarding emotional labour among long-term care workers. Because long-term care workers are trying to provide-high quality care to users, they must pay attention to their own attitude, which might be different from their feelings if they are suffering from emotional labour. Nevertheless, these workers continue to provide care services despite facing negative emotions and emotional dissonance. It is necessary for facility managers to recognize that emotional labour might affect general health and job satisfaction among long-term care workers. To mitigate the negative effects of emotional labour, facility managers must recommend individual selfcontrol of emotional labour evaluations among care staff. It is necessary to consider a system that can assist with the psychological needs of long-term care workers. Second, we found that all emotional labour types were independently and significantly related to health and job satisfaction outcomes (Table 2). Mayeroff’s concept of caring might explain these findings, in which workers provide labour partly for their own selfactualization (Mayeroff, 1990). Emotional labour that has maintained healthy workplace satisfaction and health might aid in their own self-actualization and the provision of highquality care. This virtuous cycle suggests the possibility of encouraging further improvements in the quality of care. A greater number of working years at their current facility was independently associated with interpersonal relationships and work environment satisfaction (Table 4). This result might indicate that long-term care workers change their jobs more and do not tend to stay at the same facility. This result is partly explained by previous findings (Soo-kyung, 2013). To secure employment for long-term care workers, greater attention has to be paid to workers’
−.01 .05 −.02 1.48 1.08 .13 .57 1.14 .05 −.60 .47 −.12
Female Married
.3632 −1.96 1.58 −.12 −.87 1.86 −.04 3.26 1.76 .17
.3804 −1.72 1.88 −.09 −.36 2.21 −.02 1.82 2.1 .08
.09 .15 .04
1.87 1.77
.8716 .3870
1.01 −.23 .0299 −.74 1.19 −.06 .5329 .6 −.11 .3138 .18 .71 .03 .7990 .88 −.01 .9527 −2.69 1.04 −.26 .0112 .74 −.05 .7163 −.48 .87 −.07 .5851 .89 .04 .7836 −.58 1.05 −.08 .5821 .19 (.07) .24 −.13
.1716 .6869
.25
.6394 .0669
.2171
.1034
.0969
.0055
.3130 .3655 .8428 .0387
P value
β
.15
.97
.05
.30 −.14
.33
.04 .16 .93 −.01 .99 .04 .41 .07
SE
Job content
.8624 .9493
.5647
.6834
.1835
.1269
.1343 .9432 .6493 .4890
P value
.87 −.04 .6638 .52 .07 .5024 .76 −.26 .0163 .64 .02 .8940 .77 −.16 .2754 .21 (.10)
.28 1.62 .02 −.1 1.53 −.01
−.79 1.38 −.06
.4
−.4
.51
.06 −.07 .45 .29
B
−2.86 1.00 −.26 .0050 −.38 .02 .60 .00 .9708 .35 −1.6 .88 −.17 .0707 −1.87 −.11 .73 −.02 .8777 .09 −1.92 .88 −.29 .0314 −.84 .36 (.27)
.35 −.15
.38
1.59
−.58
1.07
.3381 −1.83 1.12 −.17
.0286
.0047
.8491 −1.28 1.33 −.11
.41 −.22
.28
1.12 −.02
−.91
.45
β
Consult −.21 staff Nursing 1.40 staff Other 2.57 Healthcare .72 The type of facility (Reference: Social welfare corporation corporation) Other −2.21 Positive emotions −.61 Negative emotions −05 Sensitivity requirements −.27 Emotional dissonance .24 R2 (Adjusted R2)
.1267
1.30
SE
−.05 .05 −.10 −.97 1.07 −.08 .22 1.13 .02 −.99 .47 −.18
B
.35 −.16
.0854
.0701 .9579 .6228 .9968
P value
−.54
.18
β
.38
SE
−.10 .06 −.20 .07 1.27 .00 .66 1.35 .05 .00 .56 .00
B
Work environment
.66
.8791 .1722 .6158 .2092
P value
Interpersonal relationships
β
Age Gender Marital status The number of working days per week The number of working years in the current facility The number of working years as a long-term care worker The type of job (Reference: Care staff)
SE
B
Wages
Associated characteristics and emotional labour with job-satisfaction outcomes (n = 123).
Table 4.
Downloaded by [McMaster University] at 10:13 19 October 2015
Psychology, Health & Medicine 821
Downloaded by [McMaster University] at 10:13 19 October 2015
822
E. Tsukamoto et al.
satisfaction with respect to their work environment and interpersonal relationships. We believe that the impact of emotional labour is closely related to workplace satisfaction. From these findings, the emotional labour of long-term care workers has a negative and positive influence on health and workplace satisfaction, respectively, which suggests that care quality and stable employment among long-term care workers might have an effect on emotional labour. Therefore, we think a programme to support emotional labour among long-term care workers in an organized manner and self-care programmes to educate these workers regarding emotional labour would be beneficial. This study has several limitations. First, our study design was cross-sectional. Therefore, caution should be taken when inferring a causal relationship between general health and emotional labour or between job satisfaction and emotional labour. Second, we used a self-administered questionnaire for our data. This might have contributed to a lack of objectivity and an inability to make clinical diagnosis, especially for the general health measurement. Third, there are limitations with respect to generalizing the study findings. Therefore, we are planning to conduct a nationwide survey in Japan to remove this limitation. Acknowledgement We appreciate all responders to the survey for their voluntary participation.
References Abraham, R. (1999). Negative affectivity: Moderator or confound in emotional dissonanceoutcome relationships? The Journal of Psychology, 133, 61–72. Abraham, R. (2000). The role of job control as a moderator of emotional dissonance and emotional intelligence-outcome relationships. The Journal of Psychology, 134, 169–184. Adachi, T. (1998). Job satisfaction of sales people: A covariance structure analysis of the motivational process. The Japanese Journal of Psychology, 69, 223–228. [in Japanese] Cheung, F., & Tang, C. (2010). The influence of emotional dissonance on subjective health and job satisfaction: Testing the stress–strain–outcome model. Journal of Applied Social Psychology, 40, 3192–3217. Cheung, F.Y.L., & Cheung, R.Y.H. (2013). Effect of emotional dissonance on organizational citizenship behavior: Testing the stressor-strain-outcome model. The Journal of Psychology, 147, 89–103. Chou, H.Y., Hecker, R., & Martin, A. (2012). Predicting nurses well-being from job demands and resources: A cross-sectional study of emotional labour. Journal of Nursing Management, 20, 502–511. Diestel, S., & Schmidt, K.H. (2010). Interactive effects of emotional dissonance and self-control demands on burnout, anxiety, and absenteeism. Journal of Vocational Behavior, 77, 412–424. Fukuhara, S., & Suzukamo, Y. (2004). Manual of SF-36v2 Japanese version. Kyoto: Institute for Health Outcomes & Process Evaluation Research. Fukuhara, S., & Suzukamo, Y. (2005). Instruments for measuring health-related quality of life: SF-8 and SF-36. Journal of Clinical and Experimental Medicine, 213, 33–136. [in Japanese] Hachioji-City. (2012). Koreisha-keikaku [Plan for aging and long-term care at Hachioji-City]. Retrieved November 1, 2013, from http://www.city.hachioji.tokyo.jp/korei_shogai/032340.html Hochschild, A.R. (2003). The managed heart: Commercialization of human feeling, with a new afterword. Los Angeles, CA: University of California Press. Kinman, G., Wray, S., & Strange, C. (2011). Emotional labour, burnout and job satisfaction in UK teachers: The role of workplace social support. Educational Psychology, 31, 843–856. Mastracci, S.H., Newman, M.A., & Guy, M.E. (2010). Emotional labor: Why and how to teach it. Journal of Public Affairs Education, 12, 123–141. Mayeroff, M. (1990). On Caring Ri, Vol. 43. New York, NY: HarperCollins. Ministry of Health, Labour and Welfare. (2009a). Kaigobunya-niokeru-koyou-kanri-moderu-kentoukai [Reports for the commission of employment management model in long-term care]. Retrieved November 1, 2013, from http://www.mhlw.go.jp/houdou/2009/07/dl/h0731-2b.pdf
Downloaded by [McMaster University] at 10:13 19 October 2015
Psychology, Health & Medicine
823
Ministry of Health, Labour and Welfare. (2009b). Kaigo-shokuin-wo-meguru-genjo-to-jinzai-nokakuho-tou-no taisahku-nituite [Current concerns and countermeasures for securing human resources in long-term care]. Retrieved November 1, 2013, from http://www.mhlw.go.jp/stf/ shingi/2r9852000002ae5j-att/2r9852000002aej7.pdf Ogino, K., Takigasaki, T., & Inaki, K. (2004). Effects of emotion work on burnout and stress among human service professionals. The Japanese journal of psychology, 75, 371–377. [in Japanese] Pisaniello, S.L., Winefield, H.R., & Delfabbro, P.H. (2012). The influence of emotional labour and emotional work on the occupational health and wellbeing of South Australian hospital nurses. Journal of Vocational Behavior, 80, 579–591. Pugh, S.D., Groth, M., & Hennig-Thurau, T. (2011). Willing and able to fake emotions: A closer examination of the link between emotional dissonance and employee well-being. Journal of Applied Psychology, 96, 377–390. Pugliesi, K. (1999). The consequences of emotional labor: Effects on work stress, job satisfaction, and well-being. Motivation and Emotion, 23, 125–154. Soo-kyung, P. (2013). An analysis of emotional labor in the Japanese elder care profession. Women’s Studies, 84, 171–212. Tabachnick, B.G., Fidell, L.S., & Osterlind, S.J. (2012). Using multivariate statistics (International ed.). New York, NY: Pearson. Wegge, J., Van Dick, R., & Von Bernstorff, C. (2010). Emotional dissonance in call centre work. Journal of Managerial Psychology, 25, 596–619. Yang, F.H., & Chang, C.C. (2008). Emotional labour, job satisfaction and organizational commitment amongst clinical nurses: A questionnaire survey. International Journal of Nursing Studies, 45, 879–887. Zapf, D. (2002). Emotion work and psychological well-being: A review of the literature and some conceptual considerations. Human Resource Management Review, 12, 237–268. Zapf, D., Seifert, C., Schmutte, B., Mertini, H., & Holz, M. (2001). Emotion work and job stressors and their effects on burnout. Psychology & Health, 16, 527–545.
