First part: Summarize the research study: what is the background, hypothesis(es), methods (enough detail for me follow how the study was conducted a
First part:
Summarize the research study: what is the background, hypothesis(es), methods (enough detail for me follow how the study was conducted and main aspects of the methods related to the validity and generalizability of the research), and highlight the author(s) interpretation of the findings. This should all be in your own words and avoid your personal opinion in this section.
Second part:
Personal ideas or perceptions, based on your analysis and evaluation of the research methodology and conclusions. Focus on the main research problem and critique of the methods used in the study in addressing the question or address one or more of the specific ideas/points/findings and describe your opinion.
3-4 pages in APA format not including the cover page and references
Answer the following questions in your analysis:
• Do you agree with the conclusions the authors are stating? Is it free of bias? Does it make a meaningful contribution to our knowledge or to society in some way?
• What questions come to mind about the main ideas/points, methodology, research findings, and/or conclusions?
• Can you generalize the results to other populations or settings? How are subgroups addressed (or not), i.e., gender, race, culture, demographics, social or economic groups, etc.?
• How can the material relate to the modern world, to the society and to specific groups of individuals?
What are your conclusions about the information in the article and the author(s) position?
Ghanizadeh, Abotorabi-Zarchi, mohammadiet al
158 Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir
Environmental Psychology Effects on Mental Health Job Satisfaction and Personal Well Being of Nurses
Sodeh Tavakkoli, MSc
1
Mohammad Mahdy Asaadi, MD
2
Amir H Pakpour, PhD 3
Marzieh Hajiaghababaei, MSc 4
(add affiliation numbers 1 Landscape Architecht, Member
of IFLA ( International Federation of Landscape Architects) 2 Department of Psychology ,
University of Payam-e –Noor, Tehran, Iran 3 Social Determinants of Health
Research Center, Qazvin University of Medical Sciences,Qazvin, Iran. 4 Brain and Spinal Injury
Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran Corresponding author:
Marzieh Hajiaghababaei, MSc, Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Imam Hospital, Gharib street, Keshavarz boulevard, Tehran, Iran, P.O. Box: 14- 19733141 Tel: +98(21)66581560 Fax: +98(21)66938885 Email: m- [email protected]
Objective: Environmental psychology as a science could be useful in
understanding the dissociation between the man and the environment. The aim of this study was to compare mental health, job satisfaction and well-being of nurses who work in hospital environments with different designs. Material: This was a quasi-experimental study, in which 250 nurses filled
out the mental health, well-being and job satisfaction questionnaires. They were categorized into 3 groups randomly. Group1 included 63 nurses who worked in an environment without any natural elements; group 2 included 100 nurses who worked in an environment with natural elements and group 3 included 87 nurses who worked in an environment without any psychological and ergonomic design. The last group was only stimulated by demonstrating visual stimulus. Data were analyzed using the ANOVA and Tukey’s pursuit statistical method. Results: The nurses who were working in an environment without any
natural elements reported significantly lower scores on mental health, well-being and job satisfaction compared to those who were working in other groups, with the exception of social functioning . Moreover, depression and anxiety were more common in nurses who were working in environments without any natural elements compared to those in the other groups (p<0.05). Conclusions: We can increase job satisfaction, and mental health and
well-being of the nurses through the use of natural design and environmental psychology indexes in hospital buildings.
Keywords: Environmental Psychology, Mental Health, Job Satisfaction, Well- being, Nurses
Today, Urbanization and separation of humans from nature have caused enormous damages to
human beings. Influx to the cities and lack of space
caused the loss of natural spaces which is one of the
most important stressful factors for humans (1).
Researches have shown that lack of each person’s
control over the environment and existence of
problems in design-engineering system of the
buildings caused congestion and social isolation
which ultimately have led to some problems
regarding job and social features; and consequently,
these factors endanger the mental health of the
individuals (2).According to the World Health
Organization (WHO), the full ability to take social,
psychological and physical roles is called health.
Patient’s environment can play a crucial role in
improving the therapeutic efficacy as well as patient-
reported outcomes (3). Environmental psychology as
a science could be useful in understanding the
dissociation between the
man and the environment (4), and it indicates that
how location specification affect behavior and helps
the behavior change and causes compatibility with
the environment (5). In broken window theory, Wilson et al. (1982)
showed that environment has powerful impacts on
human health and wellbeing (6). Personal wellbeing
shows individuals’ satisfaction and happiness about
their life quality and is a positive status of physical,
psychological and social welfare (7-8). One of the
Original Article
Iran J Psychiatry 2015; 10:3: 158-164
Environmental Effects on Mental Health Job Satisfaction
Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 159
aspects of environment that may affect human health
is Building Environment (BE). Conceptually,
Building Environment includes all of constructed
environments in which humans live and work (9),
and it also includes building design and interior
architecture and effects human’s emotions,
excitement and performance (10).
Nursing is one of the stressful professions. Working
pressure, by itself, is considered a source of
frustration for nurses. Nurses are the man power
inside the hospitals and are the main service
providers in the health care system and they
significantly affect the health and hygiene level of
the society by providing various health related
services to the patients (11). Nurses are always
exposed to the damages caused by stress, working
environment and activities related to their job (12).
Gelman and Turner in an article about nurses’ quality
of life have found that hospital environment directly
affects individual's quality of life (13).
One of the issues raised in nursing services
management is the low level or lack of job
satisfaction. Reduced attention quality, leaving work
and absence from work are some of the negative
effects of low job satisfaction. (14). Lack of job
satisfaction is one of the important factors in nurses
quitting their job (15). Job satisfaction is an
underlying attitude to create tendency, interest, talent
and preparation in order to give proper response to
the working environment in personal and social
features and includes the features and requirements
of a job with external environment and interpersonal
relations with working situation (16). Psychologists
also believe that environment ergonomics and design
may reduce physical and mental stressors and
pressures inside the working environment (17) . Using the environmental psychology principles in
location designs (especially due to the treatment of
environment which is discussed in the holistic
medicine) promotes mental health and wellbeing
(18). Watching the nature from a window increases
the sense of wellbeing (19); also, using natural
elements in the work environment results in the
following positive outcomes: Reducing the
environmental stress and increasing calmness (18),
less depression and more mental compatibility (20),
positive effects on happiness and quality of life (21),
acting as a buffer against the stressful events (22),
improving individual health (23), increasing the
compatibility, having a sense of safety, experiencing
positive emotion, reducing angriness and increasing
patience (24) . Therefore, this research compares mental health, job
satisfaction and wellbeing of nurses depending on
their working environment . The hypothesis of this research was that the indexes
of job satisfaction, wellbeing, mental health and their
subscales (somatic symptoms, anxiety and insomnia,
social dysfunction and severe depression) were
different in the three groups of the nurses who
worked in three different work environments: the
nurses who worked in an environment with no
interior design (1), nurses who worked in an
environment with natural beautiful perspective, (2)
and those nurses who worked in an environment with
no interior design, but with limited view of the
simulated garden (3).
Material and Methods
This was a quasi-experimental study. The sample
included 250 male and female nurses with the age
range of 23- 47 years who were randomly selected
from Khatamol-Al-Anbia hospital located in the third
district of Tehran municipality. This sample was substituted stochastically in 3 groups randomly. The first group of the nurses (n =
63) worked in the basement of the hospital where the
design was not in accordance with the psychological-
environmental principles, and the nurses who worked
there experienced an ordinary and cold environment
and they had no access to the designed environment;
the second group ( n = 100) worked in a small garden
simulated area which had been designed based on
psychological principles (25, 26) and the third group
( n= 87) worked in an area, from which they could
see the outside designed environment through a
distant window. The sampling has been done in two
shifts of morning and afternoon. All participants
were asked to complete the anxiety and depression
questionnaire at baseline . Job situation and working volume and salary were
equal in all the participants, and we tried to remove
all the interruptive factors . Sample size was calculated based on a previous study. A hypothesized mean which was considered
for this study was 4.96 for job satisfaction in the
control group (SD51.09). Power-calculations to
detect small effects (12%) on scores of job
satisfaction changes with a power of 0.80 (p < 0.05)
resulted in a target sample size of 50 for each group
(27)
This garden simulated location was designed based
on environmental psychology using known natural
elements in an environment covered by plants and
green elements with a combination of jungle outlook
and canebrake with a short waterfall and gentle
sound of the birds; also, there were some comfortable
chairs made of bamboo wood for the resting time of
the nurses below a canopy (Fig 1). The garden
simulated location could be seen from all parts of this
section; and when windows were opened, the nurses
could hear the sound of the waterfall and birds during
their work.
During the break time, the nurses could use the
resting area inside the garden simulated area. At the
same floor of the hospital after leaving this section at
the end of opposite corridor, there was an area where the nurses could only look at the garden simulated
location from a far distance and there was no access
Tavakkoli, Asaadi, Pakpour, et al
Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 160
to the garden (Fig 2). At the same hospital, there
were some areas in the basement floor where there
were no environmental factors with a in a quiet dimly
lit room even there were no windows. In other words,
the hard and cold environment of the hospital cannot
be seen well enough.
General Health Questionnaire (GHQ): The
questionnaire of general health arbitrated to Goldberg&
Hillier for screening the non-psychotic mental
disorders has been designed with 28 questions on a 4-
point Likert- scale and 4 subscales about somatic
symptoms, anxiety and insomnia, social dysfunction
and severe depression (29,28). This tool has been
translated into Persian and was found to be highly valid
and reliable (30). Job Satisfaction Index (JSI): The Job Satisfaction Index
(JSI) which has been made by Smith and Kendal
(1996) is a scale with 20 items which is scored on a 5-
point Likert scale. Smith and Kendal believe that this
scale has high reliability and validity. They have
reported the reliability coefficient of the sub tests in the
first study from 59% to 93% and in the second study
from 62% to 93%. (31) Haghayegh Khorasani reported
the reliability coefficients of the subtests as 0.59-0.92
in the first study and 0.62-0.93 in the second study in
Iran (32). In the present study, reliability of JSI was
obtained 83% by Cronbach's α and content validity was
approved by the faculty . Personal wellbeing questionnaire: The personal
wellbeing questionnaire of adults named “Personal
Wellbeing Index” has been standardized in 2002. The
current scale has 8 items, each of which asks questions
about one field on a 7- point likert- scale. Aghayousefi
(2004) has found the reliability of the research to be
0.84 and in another research by using Cronbach's α;
also, he has found the reliability of the test equal to
0.87 (33). The current research has been performed three months
after designing the hospital environment. Then, some
nurses used that simulated garden, some looked at the
simulated garden from a far distance and the others
were located in the basement with no environmental
psychology. In this research, the indexes of mental
health, job satisfaction and wellbeing of the nurses
working in this hospital have been compared
considering the equality of all working situations and
only based on the differences between working
environment indexes. The findings were entered to
SPSS- 17 and have been analyzed by Variance
Analysis method and then by Tukey’s pursuit method.
Results
The study participants consist of were 250 nurses,
(62 men and 188 women); Of whom, 100 were
married and 150 were single. All participants had
tertiary education. There was not any significant
difference between the groups in terms of anxiety
and depression at baseline (P>0.05). We used variance analysis to The findings related to compare
and survey the differences among the means of the
three groups in the general health index, job
satisfaction and wellbeing.
As depicted in Table 1, significant differences
between the three groups were found. Nurses who
were working in an environment with interior design
reported significantly higher general health compared
than those working in an environment with no
interior design (Table 1). Considering the current
results, at significance level of p<0.05, the general
health of the nurses working in a garden simulated
area and the nurses who only viewed the
environment from the window was different from the
nurses working in an environment with no design.
Moreover, considering the results of the Tukey test,
it can be stated that at the same level of significance,
the general health of the nurses working in a garden
simulated environment and the nurses who looked at
the environment from a window was better than the
nurses who are worked in an area without any
designs . As demonstrated in Table 2, the comparison among
the sub scales of the general health shows that the
anxiety of those nurses working in the garden
simulated area and the nurses who looked at the
garden simulated area from a window were
significantly less than the nurses working in the area
without any designs (p<0.05). On the other hand,
depression of the nurses working in the garden
simulated setting and the nurses looking at the
garden simulated location from a window was less
than the first group. No significant difference was
found between the three groups in respect to the
social function subscale.
As shown in table 3, the difference among the three
groups was statistically significant on job
satisfaction, and the mean of job satisfaction of the
second group is was higher than the third and the
first groups; also, the mean of job satisfaction of the
second group was higher than the third group.
Considering the results of variance analysis and Tukey pursuit test, it can be said that the job
satisfaction of in the second group (those working in
a simulated area) was higher than of the third group
(those who were working in an area having access to
the designed area via a window) at significance level
of 0.01. Furthermore, considering Tukey’s analysis,
it can be said that job satisfaction level of the nurses
working in a garden simulated area and nurses
working in the area with windows was significantly
more than those nurses working in the area with no
design. As shown in Table 4, the mean of wellbeing index on
the nurses working in a garden simulated area was
higher than the mean of wellbeing index of the
nurses working in the area without design with a
small difference comparing compared to the nurses
looking at the designed area from a window .
Environmental Effects on Mental Health Job Satisfaction
Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 161
Table1: Descriptive Statistics and Analysis of Variance and the Tukey Test on the General Health of the Nurses in Different Working Environments
P – value SD error Mean Differences
(Tukey) F SD Mean n
General Health
0.011 1.02 (1&2) 4.408 4.4 4.94 21.21 63 Group1
0.019
1.06
(1&3)1.372
3.64
33.61
100
Group2
0.807 2.70 (2&3) 0.525
5.367
23.29
87
Group3
group1: Nurses working in an environment with no interior design group2: Nurses working in an environment with a natural beautiful outlook group3: Nurses working in an environment with no interior design, but with limited view of the simulated garden
Table 2: Descriptive Statistics and Analysis of variance and the Tukey test on the General Health Subscales of the Nurses in Different Working Environments
P – value SD error Mean Differences (Tukey)
F SD Mean n Group Subscales Of General Health
0/063 0.749 1&2 0.059 5.05 1.01 8.71 63 1
0.012 0.167 1&3 1.85
1.09 7.06 100 2 Somatic symptoms
0.568 0.596 2&3 0.406 0.30 7.97 87 3 0.013 0.706 (1&2) 1.152 4.023 2.63 7.57 63 1 0.011 0.917 (1&3) 1.272 3.68 6.43 100 2 Anxiety 0.875 0.628 (2&3) 0.128 3.03 6.31 87 3 0.014 0.509 (1&2) 0.123 5.343 2.09 3.08 63 1 0.011 0.781 (1&3) 0.128 2.85 2.17 100 2 Depression 0.875 0.564 (2&3) 0.175 1.39 1.93 87 3
group1: Nurses working in an environment with no interior design group2: Nurses working in an environment with a natural beautiful outlook group3: Nurses working in an environment with no interior design, but with limited view of the simulated garden
Table 3: Descriptive Statistics, Analysis of Variance and the Tukey Test on the Job Satisfaction of the Nurses in Different Working Environments
P – value SD error Mean Differences
(Tukey) F SD Mean n Job Satisfaction
0.01 1.12 (1&2) 4.91 3.565 1.01 21.6 63 Group 1 0.14 1.05 (1&3) 1.35 1.89 35.3 100 Group 2 0.05 2.13 )2&3) 3.13 1.01 28.13 87 Group 3
group1: Nurses working in an environment with no interior design group2: Nurses working in an environment with a natural beautiful outlook group3: Nurses working in an environment with no interior design, but with limited view of the simulated garden
Table 4: Descriptive Statistics and Analysis of Variance and the Tukey Test on the Wellbeing of Nurses in Different Working Environments
P – value
SD error Mean
Differences (Tukey)
F SD Mean n Wellbeing
0.014 3.57 (1&2) 8.07 5.097 10.17 59.01 63 Group1 0.032 2.19 (1&3) 6.05
6.69 68.98 100 Group 2
0.702 5.07 (2&3) 0.51
9.23 66.07 87 Group 3
group1: Nurses working in an environment with no interior design group2: Nurses working in an environment with a natural beautiful outlook group3: Nurses working in an environment with no interior design, but with limited view of the simulated garden
Tavakkoli, Asaadi, Pakpour, et al
Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 162
Fig1 Fig2
Considering the current results, the wellbeing of the
nurses working in a garden simulated area was
different from that of the nurses who looked at the
area from a window (p<0.05). Moreover, considering
Tukey’s pursuit test, it can be stated that at the same
significance level, the wellbeing of the nurses
working in the designed area was higher than that of
the nurses who worked in the area with no design
with a small difference compared to those looking at
the area from a window. There was no any
significant differences between nurses who were
working in the garden simulated area and those
looking at the area from a window.
Discussion
The analysis of this research data revealed that the
mental health of the nurses working in the garden
simulated area and those working in the area with a
window to a designed area was better than those
working in the area with no design. Also, the results
revealed a difference between the stress of the nurses
working in a no- design area and the nurses working in
the designed area and those looking at the designed
area from a window. This result is in accordance with
that of previous findings (20, 24).
We usually live in a place without realizing its effects
on ourselves. Development of the cities and their extra
ordinary growth had forced the architects to build the
buildings in a vertical direction instead of horizontal
and there is no exception about the hospitals; and this
has led to the vertical growth of the hospitals and also
caused a distance from the nature .
This research revealed a difference between
depressions of the nurses working in the area with no
design and those working in the designed area or those
looking at the area from a window; the findings were in
line with researches by Perrins et al. and Evans (21,
18). Also, there was no difference between the social
performances of the nurses working in the designed
area, those working in the area with a window to the
designed area and also those working in the area with
no design .
The findings of this research showed that this simulated
garden area improved the job satisfaction and the
marks of job satisfaction of the nurses working at the
designed area and those with a view to the designed
area. These findings are in accordance with the
findings by Walsh and Knott, Moos and Insel, Hoseini
and Mirzabeigi (16, 17, 14, 15) .
The other findings of this research showed that the
designed area for the resting time of the nurses affected
their wellbeing and that the marks of nurses’ wellbeing
were higher in the group working in the designed area
and those working in the area with a window in
comparison with those working in the area with no
natural environment. These findings are in accordance
with the previous findings that showed being at a
designed area reduces stress or mental fatigue
(psychologically), and improves physical health and
develops wellbeing (increasing social interactions and
reducing panic) (13, 17,11). Also, these findings
support Park’s research that showed principles of
environment design affect stress and well-being (34).
Green areas in cities have been rescued significantly.
On the other hands, the numbers of buildings have been
increased considerably in cities. Therefore, designers
and architects should closely follow the environmental
psychologists in order to improve the human
environment. Applying basic changes in the
environment based on environmental psychology
indexes, positively affects the health of the nurses. This
study revealed that wellbeing, job satisfaction and
mental health were significantly higher in the nurses
who were working in the area with no design but
watching the designed area from a window are not less
than those working in the area designed with natural
factors. This study indicated that places which were
designed by natural elements increase worker’s mental
health, job satisfaction as well as their wellbeing .
Environmental Effects on Mental Health Job Satisfaction
Iranian J Psychiatry 10:3, Jun 2015 ijps.tums.ac.ir 163
The studies conducted on the effects of different
environments on different psychological indexes are
rare and it is suggested that the survey on other
variables such as nurses’ quality of life with different
intervals after the design be conducted in the future
studies. The main limitation of this study was the lack
of a proper hospital design based on psychological
principles; consequently, we could not conduct an
experimental study.
Limitations
This study has a limitation as follow: the study sample
had been selected from only one hospital, thus, it
limited the generalizability of the study results.
Conclusion
By applying the environmental indexes in buildings,
we can reduce the coefficient of the hardness and
increase the environment psychological indexes.
Because nursing is one of the most important positions
in the society and the health of the nurses affects the
general health of the patients, we should improve their
mental health, job satisfaction and wellbeing through
the use of environmental psychology.
Acknowledgements
We would like to thank the authorities of Khatam-Al
Anbia hospital for their assistance and we also
sincerely thank all the participating nurses in this study.
Conflict of interest
None
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