Life Change Units (LCU) Rating as Stressors in Iranian Hospitals’ Nurses

  • Hossein Dargahi Mail Department of Health Care Management, Tehran University of Medical Sciences, Tehran, Iran.
  • Golsa Shaham Department of Health Care Management, Tehran University of Medical Sciences, Tehran, Iran.
Life Change Units, Nurses, Stressors, Hospitals, Iran


Healthcare workers suffer from work-related or occupational stress. This can lead to severe distress, burnout or physical illness, and finally to decrease quality of work life and services provision. Nurses must be aware of retential stressors, because they add to the cumulative effect of other stressful events. Holmes and Rahe both found a relationship between life change unit as stressors and health changes. This research reported here aims to measure the life change units as stressors among Iranian Hospitals Nurses by LCU rating. A cross - sectional, descriptive and analytical study was conducted among 389 nurses working in 15 teaching hospitals in Tehran, Iran. The respondents were asked to select each of 54 events that cause stress ranked in order of their life change units developed by Holmes and Rahe as stress scale. Before beginning the main study, the reliability and coincidental validity was performed. All data were analyzed using SPSS for windows version 18, t-test, Anova statistical methods. Approximately, half of the nurses associated major mortgage, foreclosure of mortgage or loan. More than 50% of the Iranian nurses had 150-300 and more than 300 LCU rating which had the chance to expose to extremely serious risk to health. Iranian hospitals nurses suffer from stress that caused by Life Change Units organizational factors such as change in the financial state, change in the work environment and major mortgage. We recommend to Iranian nursing policy-makers to choose strategies to help nurses' cope effectively with workplace stressors. Nursing managers and / or nursing management should develop strategies to address and improve the quality of working conditions for nurses in the hospitals. Providing educational and career prospects can contribute to decrease nurses' occupational stress level, the maintaining their work ability.


Patti Lucarelli, NP. ADVANCE for NPs & PAs. What does Stress have To Do With It? [online] 2010 Jul 15 [cited 2011 Oct 15]; Available from: URL:http://nursepractitioners- and-physicianassistants. whats-stressgot- to-do-with-it.aspx

Marine A, Ruotsalainen JH, Serra C, Verbeek JH. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev 2006;4:CD002892.

Venkatraman S. A Project Report On Quality of Work Life. What is QWL? University of Mumbai in Partial Fulfillment of Bachelor of Management Studies, Academic Year: 2004-2005, p. 11.

Nieto ML, Macmillan P. An Introduction to Human Resource Management. New York: Palgrave Macmillan; 2006.

AbuAlRub RF. Job stress, job performance, and social support among hospital nurses. J Nurse Scholars 2004; 36(1):73-8.

Guido Lde A, Linch GF, Andolhe R, Conegatto CC, and Tonini CC. Stressors in the nursing care delivered to potential organ donors. Rev Lat Am Enfermagem 2009; 17(6):1023-9.

Knezevic B, Milosevic M, Golubic R, Belosevic L, Russo A, Mustajbegovic J. Work-related stress and work ability among Croatian university hospital midwives. Midwifery 2011; 27(2):146-53.

Selye H. The Stress of Life. New York: McGraw-Hill; 1976.

Lambert VA, Lambert CE. Nurses workplace stressors and coping strategies. Indian J Palliative Care 2008; 14(1):38-44.

Chuanling F, Ruihua L, Cui W. Approach on related factors between nursing mistakes and accidents and behavior Science. Shanxi Nurse J 2002; three.

McVicar A. Workplace stress in nursing: a literature review. J Adv Nurse 2003; 44(6):633-42.

Brunero S, Cowan D, Grochulski A, Garvey A. Stress Management for Nurses. Sydney: New South WalesNurses Association, 2006.

Evans AM, Pereira DA, Parker JM. Occupational distress in nursing: a psychoanalytic reading of the literature.Nurse Philosophy 2008; 9(3):195-204.

Yang X, Wang Z, Lan Y, Wang M. Appraisal of occupational stress and work ability. Wei Sheng Yan Jiu 2004; 33(1):5-8.

Xiao Y, Fan G, Feng C, Li W, Wang Z, Wang M, Lan Y. Effect of occupational stressors on coping resources of nurses in Nanchang. Wei Sheng Yan Jiu 2010; 39(3):339-41.

Hojati H, Nazari R, Saat saz S, Hagh Doost AA, Ghorbani M, Ajihosseini F. The relationship of low back pain with psychological factors and psychological stress in nurses in Amol Hospitals. Knowledge Health J 2010; 4(4):27-33.

Mehrabi T, Parvin N, Yazdani M, Asemanrafat N. Investigation of some occupational stressors among nurses. Iran J Nurse Midwifery Res 2005; 10(2):24.

Apple Baum D, Fowler S, Fiedler N, Osinubi O, Robson M. The impact of environmental factors on nursing stress, job satisfaction, and turnover intention. J Nurse Adm 2010; 40(7-8):323-8.

Wang W, Wang P, Zhou X, Liu Y, Zhang H. Correlation analysis between fatigue and job stressors of nurses. Wei Sheng Yan Jiu 2010; 39(1):76-8.

Elovainio M, Kuusio H, Aalto AM, Sinervo T, Heponiemi T. Insecurity and shift work as characteristics of negative work environment: psychosocial and behavioral mediators.J Adv Nurs 2010; 66(5):1080-91.

Bratt MM, Broome M, Kelber S, Lostocco L. Influence ofstress and nursing leadership on job satisfaction ofpediatric intensive care unit nurses. Am J Crit Care 2000; 9(5):307-17.

Harwood L, Ridley J, Wilson B, Laschinger HK.Workplace empowerment and burnout in Canadiannephrology nurses. CANNT J 2010; 20(2):12-7.

Seyedfatemi N, Tafreshi M, Hagani H. Experienced stressors and coping strategies among Iranian nursing students. BMC Nurs 2007; 6:11.

Lin HS, Probst JC, Hsu YC. Depression among female psychiatric nurses in southern Taiwan: main and moderating effects of job stress, coping behavior and social support. J Clin Nurs 2010; 19(15-16):2342-54.

Stehle JL. Critical care nursing stress: the findings revisited. Nurs Res 1981; 30(3):182-6.

Dermody K, Bennett PN. Nurse stress in hospital and satellite haemodialysis units. J Res Care 2008; 34(1):28-32.

Admi H, Moshe-Eilon Y. Stress among charge nurses: tool development and stress measurement. Nurs Econ 2010; 28(3):151-8.

Perdikaris P, Kletsiou E, Gymnopoulou E, Matziou V. The relationship between workplace, job stress and nurses' tobacco use: a review of the literature. Int J Environ ResmPublic Health 2010; 7(5):2362-75.

Zeng Y. Review of work-related stress in mainland Chinese nurses. Nurs Health Sci 2009; 11(1):90-7.

Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res 1967; 11(2):213-8.

Masuda M, Holmes TH. The Social Readjustment Rating Scale: a cross-cultural study of Japanese and Americans. J Psychosom Res 1967; 11(2):227-37.

Humpel N, Caputi P. Exploring the relationship between work stress, years of experience and emotional competency using a sample of Australian mental health nurses. J Psychiatr Ment Health Nurs 2001; 8(5):399-403.

National Board of Health and Welfare. Yearbook of Health and Medical Care. Stockholm: SBU (Swedish Council on Technology Assessment in Health Care), 2001.

Burke TA, McKee JR, Wilson HC, Donahue RM, Batenhorst AS, Pathak DS. A comparison of time-andmotion and self-reporting methods of work measurement. J Nurs Adm 2000; 30(3):118-25.

Hinshaw AS, Atwood JR. Nursing staff turnover, stress, and satisfaction: models, measures, and management. Annu Rev Nurs Res 1983; 1:133-53.

Takase M, Kershaw E, Burt L. Nurse-environment misfit and nursing practice. J Adv Nurs 2001; 35(6):819-26.

Westman M, Eden D. The inverted-U relationship between stress and performance: A field study. Work Stress 1996; 10(2):165-73.

Lim J, Bogossian F, Ahern K. Stress and coping in Australian nurses: a systematic review. Int Nurs Rev 2010; 57(1):22-31.

Kane PP. Stress causing psychosomatic illness among nurses. Indian J Occup Environ Med 2009; 13(1):28-32.

Golubic R, Milosevic M, Knezevic B, Mustajbegovic J. Work-related stress, education and work ability among hospital nurses. J Adv Nurs 2009; 65(10):2056-66.

Kang Y, Hahm H, Yang S, Kim T. Application of the Life Change Unit model for the prevention of accident proneness among small to medium sized industries in Korea. Ind Health 2008; 46(5):470-6.

Williams S, Michie S, Pattani S. Improving the health of the NHS workforce. London: The Nuffield Trust; 1998.

Hillhouse JJ, Adler CM. Investigating stress effect patterns in hospital staff nurses: results of a cluster analysis. Soc Sci Med 1997; 45(12):1781-8.

Healy CM, McKay MF. Nursing stress: the effects of coping strategies and job satisfaction in a sample of Australian nurses. J Adv Nurs 2000; 31(3):681-8.

Ball J, Pike G, Cuff C. Royal College of Nursing (RCN). Working well? [online] 2002 Mar [cited 2011 Oct 15]; Available from: URL: 524/001572.pdf

McGowan B. Self-reported stress and its effects on nurses. Nurs Stand 2001; 15(42):33-8.

Demerouti E, Bakker AB, Nachreiner F, Schaufeli WB. A model of burnout and life satisfaction amongst nurses. J Adv Nurs 2000; 32(2):454-64.

Stordeur S, D'hoore W, Vandenberghe C. Leadership, organizational stress, and emotional exhaustion among hospital nursing staff. J Adv Nurs 2001; 35(4):533-42.

Huckabay LM, Jagla B. Nurses' stress factors in the intensive care unit. J Nurs Adm 1979; 9(2):21-6.

Dickinson T, Wright KM. Stress and burnout in forensic mental health nursing: a literature review. Br J Nurs 2008; 17(2):82-7.

Benner P, Hooper-Kyriakidis P, Stannard D. Clinical Wisdom and Interventions in Critical Care: A Thinking-in- Action Approach. Philadelphia, PA: WB Saunders; 1999.

How to Cite
Dargahi H, Shaham G. Life Change Units (LCU) Rating as Stressors in Iranian Hospitals’ Nurses. Acta Med Iran. 50(2):138-146.