Applied Nursing Research xxx (2015) xxx–xxx

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Original Article

Stress as a mediator between work–family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence Jyoti Sharma, MBA ⁎, Rajib Lochan Dhar, PhD, Akansha Tyagi, MBA 1 Department of Management Studies, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, India, 247667

a r t i c l e

i n f o

Article history: Received 12 August 2014 Revised 31 December 2014 Accepted 7 January 2015 Available online xxxx Keywords: Work–family conflict Stress Psychological health Emotional intelligence Nurses

a b s t r a c t The study examined the extent to which work–family conflicts cause stress among nursing staff and its subsequent impact on their psychological health. It also examined if the emotional intelligence level of the nursing staff acted as a moderator between their level of stress and psychological health. A survey was carried out on 693 nursing staff associated with 33 healthcare institutions in Uttarakhand, India. A hierarchical multiple regression analysis was carried out to understand the relationships shared by independent (work–family conflicts) and dependent (psychological health) constructs with the mediator (stress) as well as the moderator (emotional intelligence). The results revealed that stress acted as a mediator between work–family conflict of the nursing staff and their psychological health. However, their emotional intelligence level acted as a moderator between their stress level and psychological health. To conclude, the crucial roles of emotional intelligence in controlling the impact of stress on psychological health along with the practical as well as theoretical implications are also discussed. © 2015 Elsevier Inc. All rights reserved.

1. Introduction Healthcare is a developing field, especially in India (CII-Healthcare, n.d.) where hospitals have a market share of 71% (IBEF, 2013; The Economic Times, 2013). This tremendous growth has enhanced the importance of healthcare workforce, especially nursing staff who constitute the largest group of frontline professionals in hospitals. Nurses play a significant direct role in delivering high quality health services to patients. Nursing is a complex profession that comprises both emotional and physical labor. A nurse acts as a communicator, an advocator, an educator and a caregiver to improve the health of patients in the best possible way. The complex process of providing vital health care services has a substantial impact on the health of nursing professionals themselves. Use of healthcare services has increased due to an increase in insurance penetration, government support, along with expansion of information and communication technology. As a result, the workload in hospitals has increased tremendously. According to reports on the About the authors: Ms. Jyoti Sharma is associated with the Department of Management of IIT Roorkee. Her area of research is Nursing Studies, Organizational Behavior and Human Resources. Ms. Akansha Tyagi is associated with the Department of Management of IIT Roorkee. Her area of research is Nursing Studies, Police stress, Organizational Behavior and Human Resources. Dr. Rajib Lochan Dhar is working as an Assistant Professor at Indian Institute of Technology Roorkee, Department of Management Studies. His area of expertise lies in Research Methods, Service quality management, Organizational Behavior and International HRM. ⁎ Corresponding author. Tel.: +91 7417210067. E-mail addresses: [email protected] (J. Sharma), [email protected] (R.L. Dhar), [email protected] (A. Tyagi). 1 Tel.: +91 9557975972.

availability of nurses, India is ranked 75th among 133 developing countries (PharmaTutor, n.d.).The high patient to nurse ratio tremendously increased the work pressure among nurses, which has resulted in negative outcomes such as stress, depression, and burnout. Nursing is a female dominated profession (Yildirim & Aycan, 2008) where females constitute 80% of the total workforce in the world. A high representation of women in the workforce is consistent with increased difficulty in balancing family and work roles. Past studies have focused on the extent that gender and cultural differences contribute to conflicts between work and family roles (Vogel, Wester, Heesacker, & Madon, 2003, Maxwell & McDougall, 2004). The gender role strain model (Pleck, 1981) suggests that psychological stress occurs when individuals try to attain culturally stereotyped gender role norms. In India, roles have traditionally been differentiated based on gender, where males were the primary income earners and females were expected to take care of children and the home (Vogel et al., 2003; Dhar, 2012). With modernization, Indian women have entered into the domain of a male dominated professional world, but Indian cultural values and social functioning have not changed. As a result, multiple role expectations for working women (Valk & Srinivasan, 2011) are evident. Both work and family are an indispensable part of their lives and to reconcile their roles in both spheres is challenging (Louw & Viviers, 2010), especially for those involved in the emotionally demanding and stressful profession of nursing. Irregular shift work, dealing with emergencies, incivility and work overload are integral challenges of the nursing profile. All these factors have contributed to incompatibility in work–family stress for the female nurses and consequent work–family conflict (Mesmer-Magnus & Viswesvaran, 2009). The literature suggests that

http://dx.doi.org/10.1016/j.apnr.2015.01.010 0897-1897/© 2015 Elsevier Inc. All rights reserved.

Please cite this article as: Sharma, J., et al., Stress as a mediator between work–family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence, Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.010

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J. Sharma et al. / Applied Nursing Research xxx (2015) xxx–xxx

work–family conflict is one of the most significant predictors of stress among nurses, which further impacts their psychological health (Bazana & Dodd, 2013). According to past studies, stress increases psychological strain, anxiety, depression, and mood disorders that will eventually adversely affect psychological health (Grzywacz & Bass, 2003). Researchers have examined the role of emotional intelligence in controlling stress and its impact on the psychological health in different populations. Studies revealed that the emotional aspect of a personality plays a vital role in determining the level of stress experienced by individuals (Austin, Saklofske, & Egan, 2005). This study is a novel effort to explore the impact of work–family conflict on the psychological health of female nursing staff, while considering the role of stress as a mediator between them and emotional intelligence as a moderator in managing the impact of stress and its repercussions on the psychological health of Indian nurses. The study also tests the applicability of stress and emotional intelligence theories, originally established in western countries, to developing countries like India.

(McGrawth, 1970). Later, a new theory called conservation of resource (COR) bridged the gap between environmental and cognitive aspects by introducing behavioral perspectives to analyze the situation and embraced different dimensions of various stress theories (Hobfoll, 2001). According to the Conservation of Resource model, people experience stress due to: (1) the threat of a net loss of resources, (2) the actual net loss of resources, or (3) a lack of resource gain following the investment of resources (Little, Nelson, Quade, & Ward, 2011). Resources are the individual features, situations or energy considered substantial to achieve either situational or personal characteristics. People strive to either acquire or maintain resources that have value for them. In addition, it described the consequences of both intra as well as inter-role stress (Morelli & Cunningham, 2012). The COR model is best suited for our study since COR model describes how the inter role conflict of moving between work and family roles causes stress due to the loss of resources in the process. This results in a degradation of psychological health evidenced by depression, tension and anxiety.

2. Literature review

2.3. Work–family conflict and psychological health

2.1. Theoretical framework: emotional intelligence and stress

Stress has become an inevitable part of nurses’ lives; it is important to identify factors that can mediate and moderate the stress related to work and family conflict. Work–family conflict falls in the category of inter-role conflict, which arises due to excess demand at work that interferes in family roles (Judge, Ilies, & Scott, 2006). It occurs because of the incompatibility involved in the roles of two important domains of life, i.e., work and family (Greenhaus & Beutell, 1985, p. 77). Compared to men, women experience more work–family conflict (Eby, Casper, Lockwood, Bordeaux, & Brinley, 2005), in meeting family expectations. According to the gender role strain theory, females are held responsible for carrying out family responsibilities and not men (Vogel et al., 2003, Michel, Kotrba, Mitchelson, Clark, & Baltes, 2011), which is appropriate in the Indian culture and relevant in the context to the present study. A content analysis and review of literature targeting work–family conflict reported many antecedents (conflict, pressure, work variability, increased number of working hours, etc.) as well as consequences (lower job satisfaction, turnover intentions, stress, etc.), related to the construct (Eby et al., 2005). Studies revealed that work–family conflict has a significant negative impact on the physical and psychological health (Greenhaus, Allen, & Spector, 2006) of employees. In addition, Janzen and colleagues (Janzen, Muhajarine, & Kelly, 2007) have linked work–family conflict to greater psychological distress. Based on the literature reviewed we hypothesize that:

The concept of emotional intelligence (EI) has its roots in the theory of multiple intelligence given by Howard Gardner, in which two important forms of intelligence were identified: interpersonal intelligence and intrapersonal intelligence (Gardner, 1983). Even before Howard’s theory of multiple intelligence, Thorndike (1920) had explored the idea of “social intelligence” which also contributed to understanding the concept of emotional intelligence. Emotional intelligence could be classified into two main categories: trait emotional intelligence (TEI) and ability emotional intelligence (AEI). Being conceptually distinct concepts, TEI (or emotional self-efficacy) has been explained as “a constellation of behavioral dispositions and self-perceptions concerning one’s ability to recognize, process, and utilize emotion-laden information” whereas AEI (cognitive–emotional ability) has been described as “one’s actual ability to recognize, process, and utilize emotion-laden information” (Petrides, Frederickson, & Furnham, 2004, p. 278). In 1990, Peter Salovey and Dr. John Mayer conceptualized emotional intelligence and introduced the ability model of emotional intelligence (Salovey & Mayer, 1990). The present study used the ability model which defines EI as “the capacity to reason about emotions, and of emotions to enhance thinking. It includes the abilities to accurately perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions so as to promote emotional and intellectual growth” (Mayer, Salovey, & Caruso, 2004, p. 197). According to this model, EI comprises a set of four skills: a) ability to identify emotions in self and others, b) ability to use emotions to reason, c) ability to understand emotions, and d) ability to manage emotions in self and in emotional situations (Codier & Odell, 2014). In simple terms, EI can be understood as one’s capacity to execute abstract thought and the ability to learn and adapt to an environment (Cherniss, 2010). The theoretical basis of the current study is stress and emotional intelligence that gives better understanding of the inter-relationship shared by the two constructs moderated by emotional intelligence. 2.2. Stress and emotional intelligence Stress became part of scientific literature in 1930, in nursing literature in the 1950s (Lyon, 2000), and was defined as a “non-specific response of the body to noxious stimuli” (Selye, 1956, p.12). In other words, it is a state of acute mental or physical pressure that causes negative changes in the human body. Different models such as homeostatic and transactional models of stress have focused on perception and the importance of maintaining balance between demand and response capacity

H1. Work–family conflict has a negative relationship with psychological health. 2.4. Mediating role of stress Work–family conflict and stress have been linked in many past studies and it was found that work–family conflict increased the level of stress (Amstad, Meier, Fasel, Elfering, & Semmer, 2011). Previous studies have revealed stress as a strong consequence of work–family conflict specifically among women (Bolino & Turnley, 2005). Employees who experienced work–family conflict had higher levels of job stress due to an imbalance in performing work and family roles (Panatik et al., 2012). In the process of coping with this imbalance, the level of stress among employees increased (Esson, 2004) resulting in depression, strain, and anxiety (Sharma & Dhar, 2015) indicating lower psychological health. It was also found that stressed employees were less active and attentive in accomplishing the tasks and showed signs of nervousness (Steinisch et al., 2013). Thus, stress was found to have an inverse relationship with psychological health (Tyagi & Lochan Dhar, 2014). This study extends the role of stress as a mediator between work–family conflict and psychological health and proposes a hypothesis as:

Please cite this article as: Sharma, J., et al., Stress as a mediator between work–family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence, Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.010

J. Sharma et al. / Applied Nursing Research xxx (2015) xxx–xxx

H2. Stress mediates the relationship between work family conflict and psychological health. 2.5. Moderating role of emotional intelligence Emotional intelligence belongs to a class of intelligence that operates on social, personal, practical and emotional information (Mayer et al., 2004). The association of emotional intelligence with stress and health has been explored from multiple dimensions. Studies were conducted to test the relationship of stress with the two dimensions of emotional intelligence, trait emotional intelligence (TEI) and ability emotional intelligence (AEI) separately as well as jointly. Literature has focused on variations occurring in stress levels due to the influence of emotional intelligence, which supports the fact that a lower emotional intelligence results in a higher the stress level related to an inability to handle negative feelings caused by a lack of self-awareness (Nikolaou & Tsaousis, 2002, Sy, Tram, & O’Hara, 2006). It is evident from past literature that a few components of emotional intelligence such as emotion management skills (Ciarrochi, Chan, & Caputi, 2000) and managing other’s emotions (MOE) (Ciarrochi, Chan, & Bajgar, 2001) moderated the relation between stress and health to the extent that MOE reduces the adverse effects of stress on the health of employees. In contrast, several studies assessing the emotion perception and emotion management reported that people high on these two dimensions tended to be more sensitive toward the effects of stress due to the negative effect of stress on health outcomes such as depression, hopelessness and suicidal ideation (Ciarrochi, Deane, & Anderson, 2002). It was found that in conditions like economic deprivation, ability emotional intelligence (AEI) moderated outcomes by amplifying the depressive states. Similarly trait emotional intelligence (TEI) moderated the relationship between the stressor (effect of family dysfunction) by having a soothing effect on disruptive behavior (Davis & Humphrey, 2012a, 2012b). In one study focusing on nurses' health, those with a higher attention toward emotions experienced higher stress levels compared to those with a low level of EI (Landa, Lo, Martos, & Aguilar-luzo, 2008). Hence, based on the available literature, we propose our third hypothesis as: H3. Emotional intelligence moderates the relationship between stress and psychological health such that, the higher the emotional intelligence the more impact stress has on the psychological health of the employees (Fig. 1). 3. Research method 3.1. Sample selection and data collection A total of 40 private nursing homes in the region of Uttarakhand, India were approached out of which 33 agreed to cooperate in the study. A formal presentation to convey the significance of the study

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was given to the hospital management as well as female nurses, so they could participate with full cooperation and respond to the survey by understanding all the items. Questionnaires with a cover letter and return envelope were given to hospital managers who were requested to return the completed questionnaires as soon as possible. Informal communication through personal contacts helped to gain insight into factors related to nurses’ stress. With immense support from staff members and researcher’s informal contacts, the process of questionnaire collection was expedited. A total of 800 questionnaires were distributed in 33 private nursing homes and 752 female nurses returned the completed questionnaires, a response rate of 94%. Finally, 693 questionnaires were selected for analysis after removing 59 during the data cleaning process. Statement of review for protection of human subject: "Indian Institute of Technology, Roorkee" abides by the basic ethical principles underlying the conduct of research involving human subjects. Informed consent was obtained and maximum protection for the rights and privacy of the human subjects under study was ensured. 3.2. Measures Standardized scales that have been proved valid and reliable in past studies were considered for all four constructs used in this study. 3.2.1. Nurses stress Stress was measured using the nursing stress scale (NSS) consisting of 34 items developed by Gray-Toft and Anderson (1981) with possible answers ranging from 1 = Strongly Disagree to 5 = Strongly Agree. From this scale, only 22 questions were relevant for the present study. Sample questions include “not enough time to provide emotional support to the patients” and “not enough staff to adequately cover the unit”. Cronbach’s α reliability for this scale is 0.97. 3.2.2. Work–family conflict To measure work–family conflict, a 5-item scale developed by Netemeyer, Boles, and McMurrian (1996) was used with answers ranging from 1 = Strongly Disagree to 7 = Strongly Agree. Some of the questions are as follows: “The demands of my work interfere with my home and family life.” and “The amount of time my job takes up makes it difficult to fulfill family responsibilities.” Measure of reliability, Cronbach’s α was 0.903. 3.2.3. Emotional intelligence Emotional intelligence was measured using the customer emotional intelligence scale (CEIS) developed by Mok, Tsarenko, and Gabbott (2008) adapted from WEIP-3 which was developed by Jordan, Ashkanasy, Härtel, and Hooper (2002) for measuring the emotional intelligence of a work group. The CEIS is comprised of three constructs from the original ability emotional intelligence scale developed by

Fig. 1. Hypothesized model.

Please cite this article as: Sharma, J., et al., Stress as a mediator between work–family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence, Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.010

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Salovey and Mayer (1990): 1) ability to deal with your own emotions, 2) ability to deal with other’s emotions, and 3) ability to use emotions to assist in problem solving and decision making. The CEIS is a 7-point Likert scale where the answers ranged from 1 = Strongly disagree to 7 = Strongly agree and measure of reliability, Cronbach’s α = 0.97. Some of the sample questions are “I am aware of my emotional state when I engage in a service” and “When facing problems, I can adapt my emotional state to suit the task”.

other fitness indices such as: goodness-of-fit index (GFI), normed fit index (NFI), adjusted goodness-of-fit index (AGFI), and root mean square error of approximation (RMSEA). The acceptable limits of indices are as follows: for GFI, AGFI, and NFI 0.8–0.9 is acceptable. In case of RMSEA, a value below 0.05 reflects a very good model fit, whereas values between 0.06 and 0.09 indicate a good fit and is satisfactory. AMOS (20th version) and SPSS (20th version) software were used for the statistical analysis of the data. Each item is an indicator of the respective latent variable. In addition, we tested the hypothesized model using a hierarchical multiple regression analysis.

3.2.4. Psychological health Psychological health was measured using 14-items of mental health dimensions from an SF-36 scale (SF-36; Ware, Kosinski, & Keller, 1994) with possible answers ranging from 1 = All of the time to 5 = None of the time. Mental health is characterized by: (a) role emotional (limitations in usual role activities because of emotional problems, 3 items), (b) social functioning (limitations in social activities because of physical or emotional problems, 2 items), (c) mental health (psychological distress and well-being, 5 items) and (d) vitality (energy and fatigue, 4 items) with reliability of α = 0.94. Sample questions are “Have you been a very nervous person?” and “Have you felt so down in the dumps that nothing could cheer you up?” and “Have you felt calm and peaceful?”

CFA results indicate a good model fit, (χ2 = 3168.23, degrees of freedom [df] = 1964, p b 0.001, GFI = 0.880, AGFI = 0.869, NFI = 0.928, RMSEA = 0.030, CI [confidence interval] = 0.032–0.079). Further, the factor loadings of the constructs ranged from 0.62 to 0.91. For WFC the values ranged from 0.75 to 0.84, and for nurses’ stress the values ranged from 0.61 to 0.91; similarly for EI, factor loadings ranged from 0.62 to 0.91 and psychological health was 0.67–0.85. The correlation matrix obtained along with the standard deviation values is presented in Table 1.

3.3. Control variables

5. Test of hypothesis

The literature supports that age, marital status and experience can influence the level of stress among nurses; they can have impact on psychological health (Gong, Huang, & Farh, 2009). In the present study, demographic variables like age, marital status and experience were controlled since these may potentially affect the dependent variable of psychological health.

Table 1 presents the mean, standard deviation and correlation among all study variable. Table 2 contains the results of the hierarchal regression analysis, performed to test proposed hypotheses 1 to 3. Hypothesis 1 proposed that work–family conflict negatively relates with nurses’ psychological health. As shown in Table 2, work–family conflict is negatively associated with psychological health (β = − 0.537, p b .001, Model 4), supporting hypothesis 1. Following Baron and Kenny’s (1986) method of mediation analysis, the results of testing hypothesis 1 provided support for Condition 1. Model 6 indicated that stress was negatively related with nurses’ psychological health (β = −0.554 p b .001, Model 6). Further, as presented in Table 2, work–family conflict also showed a significant positive association with stress (β = 0.657, p b .001, Model 2), satisfying Baron and Kenny’s 2nd condition., and the stress–health relationship provided the third condition necessary to prove the occurrence of mediation. Since all the necessary conditions were satisfied, we concluded that stress acts as a mediator between work–family conflict and the psychological health of the female nurses supporting hypothesis 2. Hypothesis 3 anticipated that emotional intelligence moderates the relationship of stress and psychological health. To assess this, an interaction term was introduced in the regression model and the results of Model 8 predicted that emotional intelligence had a significant moderating effect on the relationship between stress and psychological health (β = − 0.118, p b .001, Model 8), providing support for hypothesis 3.

3.4. Validity Anderson and Gerbing’s (1988) approach was used to test the convergent validity where the data are considered to be valid if the value of the estimated standardized factor loadings lies within the acceptable limits of above 0.6. A discriminant validity test was conducted following Fornell and Larcker’s (1981) approach, which says that the Average Variance Extracted (AVE) of any construct should be greater than its squared correlation to prove its validity (Table 1). Data biasness was checked using Harman’s single factor test. The first factor explained 48% of variance among the other variables, which is acceptable since it is less than 50% (Liu & Ipe, 2010). 3.5. Analytic approach A confirmatory factor analysis (CFA) was used to check the fitness of the items used in this particular model through the loading values and

4. Results

Table 1 Correlations, means, standard deviations and discriminant validity.

WFC Stress Mental Health Emotional Intelligence Age Marital status Experience

Mean

SD

WFC

Stress

Mental health

Emotional Intelligence

Age

Marital status

5.483 3.913 1.957 5.759 2.824 1.443 2.803

2.104 1.483 1.263 2.031 .962 .609 .973

0.807 .647⁎⁎ −.523⁎⁎ .469⁎⁎ .125⁎⁎ .077⁎⁎ .142⁎⁎

0.798 −.553⁎⁎ .670⁎⁎ .025⁎⁎ .015⁎⁎ .029⁎⁎

0.757 −.607⁎⁎ −.040⁎⁎ −.116⁎⁎ −.022⁎⁎

0.822 .040⁎⁎ .030⁎⁎ .030⁎⁎

.791⁎⁎ .883⁎⁎

.732⁎⁎

Experience

Note: N = 693. The bold numbers in the cells of diagonal line are the square root of AVE. Age: 1 = Below 20 Years (5.9%), 2 = 20 to 29 years (31.9%), 3 = 30 to 39 Years (42.96%), 4 = 40 to 49 Years (12.2%), 5 = 50 years and above (7.04%). Marital Status: 1 = Married (61.9%), 2 = Unmarried (31.9%), 3 = Divorcee (6.2%). Experience: 1 = Below 1 Year (11%), 2 = 1–5 years (26.1%), 3 = 6–10 Years (34.5%), 4 = 11 years and above (28.4%). ⁎⁎ denotes significance level of 0.01 (two-tailed).

Please cite this article as: Sharma, J., et al., Stress as a mediator between work–family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence, Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.010

J. Sharma et al. / Applied Nursing Research xxx (2015) xxx–xxx

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Table 2 Results of hierarchical regression analysis. Dependent Variable→

Stress

Control Variables Age Marital Status Experience Independent Variable Work–Family Conflict Mediator Stress Moderator Emotional Intelligence Interaction Stress × Emotional Intelligence F-value 2 R Adjusted R2 Change R2

Psychological Health

Model 1

Model 2

Model 3

Model 4

Model 5

Model 6

Model 7

Model 8

0.005 −0.024 0.037

−0.026 0.051 −0.067

0.065 −0.385*** 0.096

0.090 −0.447*** 0.181**

0.081 −0.429*** .157**

0.068 −0.399*** .117*

0.096 −0.394*** 0.095

0.099 −0.385*** .081

−0.537***

−0.301*** −0.554***

−0.269***

−0.278***

−0.426***

−0.521***

0.657***

−0.361***

0.215 .001 −0.003

126.08*** .423 .420 .023

5.340*** .023 .018

5.340*** .305 .301 .282

84.308*** .380 .376 0.075

84.419*** .329 .325 0.307

103.19*** .429 .425 .100

−.118* 87.107*** .432 .427 .003

Notes: ***p-value b 0.001, **p-value b 0.01, *p-value b 0.05.

Fig. 2 shows the nature of the interaction, which was obtained through plotting values ±1 standard deviation from the means of stress and emotional intelligence. Results reflected that when emotional intelligence is low, stress has less impact on nurses’ psychological health, signifying that nurses with higher emotional intelligence are more sensitive toward (identification of) stress that leads to a deterioration of their psychological health. This supports hypothesis 3, which indicates that EI behaves as a moderator between stress and psychological health. After analyzing the moderating effect of emotional intelligence between stress and psychological health, we tried to identify which component of emotional intelligence is responsible for strengthening the negative relationship between stress and psychological health by regressing the interaction effect of stress and emotional intelligence’s individual component on psychological health. The results indicate that the “ability to deal with other’s emotions” (−0.086) is one of the important factors that contribute the most in strengthening the negative relationship between stress and psychological health. A significant variance (35%) has been explained by this individual component of EI in psychological health variable supporting the above results indicating that while handling others’ emotions, the psychological health of the nurses get adversely affected.

6. Discussion The present study has explored the effect of work–family conflict on the psychological health of female nursing staff, while considering the

Fig. 2. Interaction effect of EI.

role played by stress between the two constructs. Further, the study also investigated the impact of emotional intelligence on the relationship shared by stress and health. According to the first hypothesis, it was found that work–family conflict had a direct negative relationship with the psychological health of female nurses, signifying that the lifestyle of female nurses is such that their work and family roles interfere with each other. This is consistent with the highly complex job demands and multiple roles that they are expected to play as an employee and at the same time as a member of their family. Past studies also support that females experience more work–family conflict as compared to men (Eby et al., 2005). This affects their mental health that can lead to psychological disorders. Empirical evidence supports that stress mediates the relationship between work–family conflict and psychological health. The relationship of work–family conflict with that of psychological health could be explained by the underlying stress that develops due to the prolonged exposure to such inter-role conflict. India has a collectivist culture with an attitude of “family comes first” either by choice or by family pressure, especially for female employees. Nursing is a female dominated and highly demanding profession, and it is impossible for nurses to neglect their family roles and responsibilities in lieu of their work or vice-versa. The inability to match the expectations of both family and work demands with limited emotional resources causes stress and its spillover effect is reflected in their services (Garg & Dhar, 2014) and repercussions are experienced on their psychological health. To improve the situation, hospital management could initiate counseling sessions to explain the severity of conflicts and adopt techniques like job rotation so all the nurses get enough time to satisfactorily fulfill their family roles. It has been seen that family role satisfaction will have a positive impact in fulfilling their work duties well, since it was found that females give priority to family roles. Therefore, they are not able to work with dedication for long periods by neglecting their family roles (Eby et al., 2005). An analysis of the third hypothesis brings forth some interesting results. It was found that EI moderated the relationship between stress and psychological health such that it strengthened the negative impact of stress on psychological health, which is aligned with previous studies (Davis & Humphrey, 2012a, 2012b). Stress is viewed as a continuum along which an individual may pass from a feeling of eustress to mild/ moderate distress, and then to severe distress. The identification of stressors that promote the transition from eustress to distress (McVicar, 2003) depends on an individual’s stress perception; and this is where emotional intelligence plays a vital role. The emotional intelligence of an individual is a resource that could be harnessed in

Please cite this article as: Sharma, J., et al., Stress as a mediator between work–family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence, Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.010

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structured situations. Whether emotional intelligence is an asset or liability depends on individual perceptions and its appropriate usage. If the ability of an individual to comprehend other’s emotions is high, then the stress perception will adversely affect the psychological health of employees (Tsaousis & Nikolaou, 2005). Nursing has been considered a noble profession because of the care and emotional support they extend to patients and their family members. It requires immense emotional stability and strength to handle stressful situations at the work place without displaying their actual emotions. Using emotional ability increases the stress level due to the emotional suppressions that affect psychological health in the long run (Davis & Humphrey, 2012a, 2012b). During work periods, informal relationships develop between patients and their regular attendants. Nurses; high on ability emotional intelligence would be more sensitive towards the emotions and would be able to identify with the patient and family's pain, causing psychological imbalance to themselves, further leading to depletion of their emotional resources. Thus, we can say that emotional intelligence moderates the relationship in such a way that it strengthens the negative effect of stress on psychological health, which is aligned with the past results (Davis & Humphrey, 2012a, 2012b). To overcome this situation, even a small positive step could bring a critical change in the system. Management should try to develop a support system Mittal and Dhar (2015), Jaiswal and Dhar (2015) for the nurses within the hospitals. Formal teams could be formed at work, through which staff members will have collegial support, and get a chance to share work difficulties, discuss emotional issues associated with work, seek solutions to problems, and build a healthy work environment in view of preventing the adverse effects of stress on psychological health. It was found that different dimensions of emotional intelligence moderated the relationship of stress and psychological health, such that EI strengthened the negative relationship between stress and psychological health. However, intelligently managed emotions could prove to be an asset for female nurses. Since the management of emotions (MOE) had a positive linkage with a few dimensions of the ability emotional intelligence (AEI) (Ciarrochi et al., 2002), the ability to comprehend the emotions and more importantly to use them to prevent stress instead of identifying with it could be learned through emotional intelligence training (Nelis, Quoidbach, Mikolajczak, & Hansenne, 2009). Hospital management must organize sessions on emotional intelligence training for nurses in order to maintain their psychological health. 6.1. Practical implications Some of the practical implications discussed above could be summarized as follows. First, management could organize counseling sessions to gain an insight on the severity of the work–family conflicts of its female staff and address them by re-designing roles, shifts timings and giving breaks in-between the working hours so that they do not affect family roles. This would be a beneficial step for the nurses exposed to highly stressful situations. Second, the hospital management could form teams that would provide collegial support and allow nurses to share their emotions and difficulties to overcome them and prevent the development of stress. Third, emotional intelligence training could be provided to enhance the ‘management of emotions’ aspect of emotional intelligence ability, so that emotions become an asset for staff members and helpful in overcoming the negative effects of stress rather than amplifying them. 6.2. Theoretical implications From a theoretical point of view, the present study tried to extend the theory of multiple intelligence by exploring the moderating effect instead of the direct impact of individual components of ability emotional intelligence between stress and psychological health. The study

explored key components of ability emotional intelligence that contributed in strengthening the negative relationship of stress with that of psychological health in the Indian context. Interestingly, the main component that was identified (“ability to deal with other’s emotions”) and strengthened the negative relation falls under the category of interpersonal intelligence. It is a significant contribution in the literature of ability emotional intelligence since most other studies have explored trait emotional intelligence in relation to stress and less attention has been paid on the ability aspect of emotional intelligence. The ability aspect of emotional intelligence is important since it is more closely related to cognitive ability (Lindebaum, 2013). Second, the study verified the applicability of the COR model in the Indian context since the model has been completely mapped in the present study. The factors involved in the study depicted the individual conditions of the COR model such that work–family conflict causes an actual loss of resources due to the multiple demands of work and family and the fear of resource loss creates stress. The present study focused on the day-to-day stressors of female nurses and its effect on their psychological health, because routine issues eventually cause stress, unlike past studies that only considered chronic stressors (Davis & Humphrey, 2012a, 2012b). Third, the findings highlighted the mediating role that stress plays between work–family conflict and psychological health, which implies that the effect of work–family conflict on psychological health is mediated by stress, which amplifies the negative impact and adversely affects psychological health. The present study has tried to bring forward the turmoil that is common for nurses, the irony of which is that being a part of healthcare sector, they themselves are unable to maintain their own psychological health due to ignorance of the underlying emotions that contribute to development of stress. This stress further percolates in their behavior and is reflected through their actions and the quality of service they provide to patients, which eventually affects their own psychological health. Also, the prevailing work conditions of our hospitals and the lack of resources add to the severity of the situation. The theory of conservation of resources advocates that psychological resources are exploited in the process of maintaining the work–family balance. Thus, hospital management is required to oversee the working conditions of their human resources who are expected to take care of patients. Good quality care is possible only when the caregivers are physically and mentally healthy. Therefore, it is imperative to frame policies that consider the welfare of their employees. Very few studies have tried to identify the critical areas of emotional intelligence with respect to Indian nurses, which could be better controlled to provide them with a healthy mind set. Therefore, several unexplored aspects of the stress–EI–psychological health relationship have been touched upon that can open new vistas of research.

7. Limitations and directions for future research This study has several limitations. First, the survey based findings of the study limit our interpretation of the relationships established between the different factors by only examining healthcare institutions. Thus, it is suggested that more experimental studies need to be performed to strengthen the established relationships identified in this study. Second, the private nursing homes surveyed in this study were small and medium sized situated in the Uttarakhand region, India. Thus, the findings of this study cannot be generalized in other industries. To generalize these findings, testing the relationships established in this study should be made in different service industries such as policing and call centers. Third, it can be seen that the majority of respondents in this study were females, which may be typical for small and medium sized nursing homes operating in India, but not necessarily in other fields such as policing and call centers. Further research is needed to generalize the results of the present study.

Please cite this article as: Sharma, J., et al., Stress as a mediator between work–family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence, Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.010

J. Sharma et al. / Applied Nursing Research xxx (2015) xxx–xxx

In conclusion, this study examined the impact of work–family conflict on the psychological health of nurses along with studying the mediating role of stress. A step ahead, it also explored the role of emotional intelligence in moderating the relationship between stress and the psychological health of nurses. The results reflected that in stressful situations, less AEI may have a protective effect on stress since a higher sensitivity toward stress degrades psychological health. Thus, hospital management must try to evaluate the stressors, provide appropriate support and training, and develop a quality work environment so the emotional intelligence of an individual can be directed toward improving their service quality and not increasing their stress perception. References Amstad, F. T., Meier, L. L., Fasel, U., Elfering, A., & Semmer, N. K. (2011). A meta-analysis of work–family conflict and various outcomes with a special emphasis on cross-domain versus matching-domain relations. Journal of Occupational Health Psychology, 16(2), 151–169, http://dx.doi.org/10.1037/a0022170. Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411–423, http://dx.doi.org/10.1037/0033-2909.103.3.411. Austin, E. J., Saklofske, D. H., & Egan, V. (2005). Personality, well-being and health correlates of trait emotional intelligence. Personality and Individual Differences, 38(3), 547–558. Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182, http://dx.doi.org/10.1037/00223514.51.6.1173. Bazana, S., & Dodd, N. (2013). Conscientiousness, work family conflict and stress amongst police officers in Alice, South Africa. The Journal of psychology, 4(1), 1–8. Bolino, M. C., & Turnley, W. H. (2005). The personal costs of citizenship behavior: The relationship between individual initiative and role overload, job stress, and work– family conflict. Journal of Applied Psychology, 90(4), 740–748, http://dx.doi.org/10. 1037/0021-9010.90.4.740. Cherniss, C. (2010). Emotional intelligence: Toward clarification of a concept. Industrial and Organizational Psychology, 3(2), 110–126, http://dx.doi.org/10.1111/j.17549434.2010.01231.x. Ciarrochi, J., Chan, A. Y., & Bajgar, J. (2001). Measuring emotional intelligence in adolescents. Personality and Individual Differences, 31(7), 1105–1119, http://dx.doi.org/10. 1016/S0191-8869(00)00207-5. Ciarrochi, J. V., Chan, A. Y., & Caputi, P. (2000). A critical evaluation of the emotional intelligence construct. Personality and Individual Differences, 28(3), 539–561, http://dx.doi. org/10.1016/S0191-8869(99)00119-1. Ciarrochi, J., Deane, F. P., & Anderson, S. (2002). Emotional intelligence moderates the relationship between stress and mental health. Personality and Individual Differences, 32(2), 197–209, http://dx.doi.org/10.1016/S0191-8869(01)00012-5. Codier, E., & Odell, E. (2014). Measured emotional intelligence ability and grade point average in nursing students. Nurse Education Today, 34(4), 608–612, http://dx.doi.org/ 10.1016/j.nedt.2013.06.007. Confederation of Indian Industry (d). Healthcare. Retrieved June 17, 2014 from http:// www.cii.in/Sectors.aspx?enc= prvePUj2bdMtgTmvPwvisYH+5EnGjyGXO9hLECvTuNu2yMtqEr4D408mSsgiIyM/. Davis, S. K., & Humphrey, N. (2012a). Emotional intelligence as a moderator of stressor–mental health relations in adolescence: Evidence for specificity. Personality and Individual Differences, 52(1), 100–105, http://dx.doi.org/10. 1016/j.paid.2011.09.006. Davis, S. K., & Humphrey, N. (2012b). The influence of emotional intelligence (EI) on coping and mental health in adolescence: Divergent roles for trait and ability EI. Journal of Adolescence, 35(5), 1369–1379, http://dx.doi.org/10.1016/j.adolescence. 2012.05.007. Dhar, R. L. (2012). Caregiving for elderly parents: A study from the Indian perspective. Home Health Care Management & Practice, 24(5), 242–254, http://dx.doi.org/10. 1177/1084822312439466. Eby, L. T., Casper, W. J., Lockwood, A., Bordeaux, C., & Brinley, A. (2005). Work and family research in IO/OB: Content analysis and review of the literature (1980–2002). Journal of Vocational Behavior, 66(1), 124–197, http://dx.doi.org/10.1016/j.jvb. 2003.11.003. Esson, P. L. (2004). Consequences of work–family conflict: Testing a new model of workrelated, non-work related and stress-related outcomes. Doctoral dissertation Virginia Polytechnic Institute and State University. Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50. Gardner, H. (1983). Frames of mind: The theory of multiple intelligences. New York: Basic Books, http://dx.doi.org/10.1002/pam.4050030422. Garg, S., & Dhar, R. L. (2014). Effects of stress, LMX and perceived organizational support on service quality: Mediating effects of organizational commitment. Journal of Hospitality and Tourism Management, 21, 64–75. Gong, Y., Huang, J. C., & Farh, J. L. (2009). Employee learning orientation, transformational leadership, and employee creativity: The mediating role of employee creative selfefficacy. Academy of Management Journal, 52(4), 765–778, http://dx.doi.org/10. 5465/AMJ.2009.43670890.

7

Gray-Toft, P., & Anderson, J. G. (1981). The nursing stress scale: Development of an instrument. Journal of Behavioral Assessment, 3(1), 11–23, http://dx.doi.org/10.1007/ BF01321348. Greenhaus, J. H., Allen, T. D., & Spector, P. E. (2006). Health consequences of work–family conflict: The dark side of the work–family interface. Research in occupational stress and well-being, 5, 61–98, http://dx.doi.org/10.1016/S1479-3555(05)05002-X. Greenhaus, J. H., & Beutell, N. J. (1985). Sources of conflict between work and family roles. Academy of Management Review, 10(1), 76–88, http://dx.doi.org/10.5465/AMR.1985. 4277352. Grzywacz, J. G., & Bass, B. L. (2003). Work, family, and mental health: Testing different models of work–family fit. Journal of Marriage and Family, 65(1), 248–261, http:// dx.doi.org/10.1111/j.1741-3737.2003.00248.x. Hobfoll, S. E. (2001). The influence of culture, community, and the nested‐self in the stress process: Advancing conservation of resources theory. Applied Psychology, 50(3), 337–421, http://dx.doi.org/10.1111/1464-0597.00062. India Brand Equity Foundation (IBEF) (2013). Healthcare. Retrieved June 8, 2014 from http://www.ibef.org/download/Healthcare-March-220313.pdf Jaiswal, D., & Dhar, R. L. (2015). Impact of human resource practices on employee creativity in the hotel industry: Job autonomy as a moderator. Journal of Human Resources in Hospitality and Tourism (in press). Janzen, B. L., Muhajarine, N., & Kelly, I. W. (2007). Work–family conflict, and psychological distress in men and women among canadian police officers 1. Psychological Reports, 100(2), 556–562. Jordan, P. J., Ashkanasy, N. M., Härtel, C. E., & Hooper, G. S. (2002). Workgroup emotional intelligence: Scale development and relationship to team process effectiveness and goal focus. Human Resource Management Review, 12(2), 195–214, http://dx.doi.org/ 10.1016/S1053-4822(02)00046-3. Judge, T. A., Ilies, R., & Scott, B. A. (2006). Work–family conflict and emotions: Effects at work and at home. Personnel Psychology, 59(4), 779–814, http://dx.doi.org/10.1111/ j.1744-6570.2006.00054.x. Landa, A., Lo, E., Martos, M. P. B., & Aguilar-luzo, M. C. (2008). The relationship between emotional intelligence, occupational stress and health in nurses: A questionnaire survey. International Journal of Nursing Studies, 45, 888–901, http://dx.doi.org/10. 1016/j.ijnurstu.2007.03.005. Lindebaum, D. (2013). Does emotional intelligence moderate the relationship between mental health and job performance? An exploratory study. European Management Journal, 31(6). (pp. 538–548). Elsevier Ltd, http://dx.doi.org/10.1016/j.emj.2012.08.002. Little, L. M., Nelson, D. L., Quade, M. J., & Ward, A. (2011). Stressful demands or helpful guidance? The role of display rules in Indian call centers. Journal of Vocational Behavior, 79(3), 724–733, http://dx.doi.org/10.1016/j.jvb.2011.03.017. Liu, Y., & Ipe, M. (2010). The impact of organizational and leader–member support on expatriate commitment. The International Journal of Human Resource Management, 21(7), 1035–1048, http://dx.doi.org/10.1080/09585191003783496. Louw, G. J., & Viviers, A. (2010). A n evaluation of a psychosocial stress and coping model in the police work context. SA Journal of Industrial Psychology, 36(1), 1–11. Lyon, B. L. (2000). Stress, coping, and health. Handbook of stress, coping and health: Implications for nursing research, theory, and practice, 3–23. Maxwell, G. A., & McDougall, M. (2004). Work–life balance: Exploring the connections between levels of influence in the UK public sector. Public Management Review, 6(3), 377–393, http://dx.doi.org/10.1080/1471903042000256547. Mayer, J. D., Salovey, P., & Caruso, D. R. (2004). Emotional intelligence: Theory, findings, and implications. Psychological Inquiry, 15(3), 197–215, http://dx.doi.org/10.1207/ s15327965pli1503_02. McGrawth, J. E. (1970). A conceptual formation for research on stress. In J. E. McGrawth (Ed.), Social and psychological factors in stress (pp. 10–21). New York: Holt, Rinehart & Winston. McVicar, A. (2003). Workplace stress in nursing: A literature review. Journal of Advanced Nursing, 44(6), 633–642, http://dx.doi.org/10.1046/j.0309-2402.2003.02853.x. Mesmer-Magnus, J., & Viswesvaran, C. (2009). The role of the coworker in reducing work– family conflict: A review and directions for future research. Pratiques Psychologiques, 15(2), 213–224, http://dx.doi.org/10.1016/j.prps.2008.09.009. Michel, J. S., Kotrba, L. M., Mitchelson, J. K., Clark, M. A., & Baltes, B. B. (2011). Antecedents of work–family conflict: A meta‐analytic review. Journal of Organizational Behavior, 32(5), 689–725, http://dx.doi.org/10.1002/job.695. Mittal, S., & Dhar, R. L. (2015). Transformational leadership and employee creativity: Mediating role of creative self-efficacy and moderating role of knowledge sharing. Management Decision (in press). Mok, W. H., Tsarenko, Y., & Gabbott, M. (2008). A measurement of emotional intelligence in service encounters. Australasian Marketing Journal; AMJ, 16(1), 20–29, http://dx. doi.org/10.1016/S1441-3582(08)70002-8. Morelli, N. A., & Cunningham, C. J. (2012). Not all resources are created equal: COR theory, values, and stress. The Journal of Psychology, 146(4), 393–415, http://dx.doi.org/10. 1080/00223980.2011.650734. Nelis, D., Quoidbach, J., Mikolajczak, M., & Hansenne, M. (2009). Increasing emotional intelligence: (How) is it possible? Personality and Individual Differences, 47(1). (pp. 36–41). Elsevier Ltd, http://dx.doi.org/10.1016/j.paid.2009.01.046. Netemeyer, R. G., Boles, J. S., & McMurrian, R. (1996). Development and validation of work–family conflict and family–work conflict scales. Journal of Applied Psychology, 81(4), 400–410. Nikolaou, I., & Tsaousis, I. (2002). Emotional intelligence in the workplace: Exploring its effects on occupational stress and organizational commitment. International Journal of Organizational Analysis, 10(4), 327–342, http://dx.doi.org/10.1108/ eb028956. Panatik, S. A. B., Rajab, A., Shah, I. M., Rahman, H. A., Yusoff, R. M., & Badri, S. K. B. Z. (2012). Work–family conflict, stress and psychological strain in higher education. International Conference on Education and Management Innovation, 30.

Please cite this article as: Sharma, J., et al., Stress as a mediator between work–family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence, Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.010

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J. Sharma et al. / Applied Nursing Research xxx (2015) xxx–xxx

Petrides, K. V., Frederickson, N., & Furnham, A. (2004). The role of trait emotional intelligence in academic performance and deviant behavior at school. Personality and Individual Differences, 36(2), 277–293, http://dx.doi.org/10. 1016/S0191-8869(03)00084-9. PharmaTutor (d). India ranks 67th among developing countries in doctor–population ratios. Retrieved June 12, 2014 from http://www.pharmatutor.org/pharma-news/ doctors-population-in-india Pleck, J. (1981). The myth of masculinity. Cambridge, Mass: The MIT Press. Salovey, P., & Mayer, J. D. (1990). Emotional intelligence. Imagination, cognition and personality, 9(3), 185–211, http://dx.doi.org/10.2190/DUGG-P24E-52WK-6CDG. Selye, H. (1956). The stress of life. New York, NY: McGraw-Hill. Sharma, J., & Dhar, R. L. (2015). Factors influencing job performance of nursing staff: Mediating role of affective commitment. Personnel Review (in press). Steinisch, M., Yusuf, R., Li, J., Rahman, O., Ashraf, H. M., Strümpell, C., et al. (2013). Work stress: Its components and its association with self-reported health outcomes in a garment factory in Bangladesh—Findings from a cross-sectional study. Health & Place, 24, 123–130, http://dx.doi.org/10.1016/j.healthplace. 2013.09.004. Sy, T., Tram, S., & O’Hara, L. A. (2006). Relation of nurse and manager emotional intelligence to job satisfaction and performance. Journal of Vocational Behaviour, 68(3), 461–473, http://dx.doi.org/10.1016/j.jvb.2005.10.003.

India’s healthcare sector to grow to $158.2bn in 2017. The Economic Times(2013). (Retrieved from http://articles.economictimes.indiatimes.com/2013-12-02/news/44657410_1_ healthcare-sector-healthcare-delivery-fortis). Thorndike, E. L. (1920). Intelligence and its use. Harper’s Magazine, 140, 227–235. Tsaousis, I., & Nikolaou, I. (2005). Exploring the relationship of emotional intelligence with physical and psychological health functioning. Stress and Health, 21(2), 77–86, http://dx.doi.org/10.1002/smi.1042. Tyagi, A., & Lochan Dhar, R. (2014). Factors affecting health of the police officials: Mediating role of job stress. Policing: An International Journal of Police Strategies & Management, 37(3), 649–664. Valk, R., & Srinivasan, V. (2011). Work–family balance of Indian women software professionals: A qualitative study. IIMB Management Review, 23(1), 39–50, http://dx.doi. org/10.1016/j.iimb.2011.01.006. Vogel, D. L., Wester, S. R., Heesacker, M., & Madon, S. (2003). Confirming gender stereotypes: A social role perspective. Sex Roles, 48(11–12), 519–528, http://dx.doi.org/10. 1023/A:1023575212526. Ware, J. E., Kosinski, M., & Keller, S. (1994). SF-36 physical and mental health summary scales: A user's manual. Health Assessment Lab. Yildirim, D., & Aycan, Z. (2008). Nurses’ work demands and work–family conflict: A questionnaire survey. International Journal of Nursing Studies, 45(9), 1366–1378, http://dx. doi.org/10.1016/j.ijnurstu.2007.10.010.

Please cite this article as: Sharma, J., et al., Stress as a mediator between work–family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence, Applied Nursing Research (2015), http://dx.doi.org/10.1016/j.apnr.2015.01.010

Stress as a mediator between work-family conflict and psychological health among the nursing staff: Moderating role of emotional intelligence.

The study examined the extent to which work-family conflicts cause stress among nursing staff and its subsequent impact on their psychological health...
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