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Research papers on employee morale

Furthermore, positive job morale is associated with greater retention and higher recruitment in healthcare staff [ 5 ]. A number of authors have tried to explore job morale as a single entity, but ended up assessing its predictors, consequences or explanatory variables, such as job motivation, job satisfaction, burnout, organizational commitment, work engagement and well-being [ 5 — 9 ].

Some terminological confusion seems to be linked to the history of the term. In some instances, job morale is synonymously used with other job-related concepts, such as job satisfaction, well-being or job motivation. Historically, this equation was supported by the fact that readers were referred to job satisfaction when searching for morale in the Index of Psychological Abstracts, a periodical of indexes and abstracts in psychology, the print version of the PsychInfo database, which was ceased in , between and [ 10 ].

In , the concept of morale was reintroduced to the Index of Psychological Abstracts after being delisted in [ 10 ] as equal to job satisfaction, causing a resurgence in the topic of morale in both job and non-job-related contexts. A recent systematic review and meta-analysis into the job morale of physicians and dentists in low- and middle-income countries LMIC [ 11 ] indicated a substantial methodological heterogeneity across studies measuring job morale.

This heterogeneity compromises attempts to justify its importance and to evaluate the impact of job morale on performance and make comparisons across different contexts and countries. There is very little unifying research on what job morale is and how it should be assessed, particularly in the field of healthcare [ 12 ].

Considering the heterogeneity of the scientific literature on job morale in the healthcare context, we aimed to conduct a scoping review of how the concept of job morale has developed over time and how it is used in healthcare research. In particular, we wanted to review which theoretical frameworks have been applied to job morale in healthcare, how job morale has been assessed, and the professional groups in which job morale has been studied. A scoping review was considered the most appropriate method to capture the concept of job morale, address the broad research question and inform future research [ 13 ].

In order to capture the evolution of job morale across contexts, the search was deliberately broad. Unpublished literature was searched using Google Scholar and OpenGrey, in an attempt to reduce publication bias, and backward and forward citation tracking was adopted. Furthermore, hand searches were performed in two special issues that were dedicated to the topic of morale, in the American Journal of Sociology Volume 47, Number 3, November and Journal of Educational Sociology Volume 15, Number 4, December Studies were excluded if: [1] they were published in a language other than English; [2] were non-research based articles such as commentaries, conference abstracts, editorials or book chapters ; [3] the abstract or full text was not available.

To best meet the aims of the review we adopted two sets of inclusion criteria depending on the year of publication, informed by the history of the concept. The year was chosen as the threshold for the beginning of the contemporary period of morale research. As reported in the introduction, the concept of morale was reintroduced to the Index of Psychological Abstracts, causing the resurgence of interest in the topic in both job-related and non-job-related contexts.

Considering the primary interest of the current review in job morale, the inclusion for the contemporary literature i. Studies were excluded if they were published prior to or were conducted in contexts other than healthcare. EndNote X8 Clarivate Analytics was used to screen the titles and abstracts of identified studies. Duplicate and irrelevant studies were excluded. Discrepancies were solved by consulting a third reviewer SP.

Data gathered included the study design, objectives, context, definition of morale if reported , outcome measures and main findings. A draft of the data charting form was created and piloted for fifteen of the included studies. Minor changes were made accordingly. The following categories were included in the final form and applied for all included studies: author s , year of publication, country, study design, study context, main objectives, the definition of morale if any , study population, methodology, outcome measures and main findings.

The identified literature was mapped according to the main development periods that the concept of job morale has undergone. Then the literature on job morale in the healthcare context was organised, highlighting the models and theoretical frameworks of job morale, the assessment methods and the professional groups studied. A total of articles were identified through database searches, and 15 through other sources.

Overall, articles were excluded as duplicates, and additional articles were excluded for not meeting the inclusion criteria. Two hundred and twenty-eight full texts were examined, of which 96 were included, representing 93 unique studies Fig. Further study characteristics can be seen in Additional File 1. The results of the current review will be presented in two parts. In the first part, the historical evolution of the concept of job morale will be introduced.

In the second part, contemporary job morale research in the healthcare context will be presented. WWI and the inter-war years marked the period where early research in morale began, as the shift from a limited number of professional soldiers to an expansion of armies recruited from civilians was required [ 14 ].

During the interwar years, interest in military morale lessened, and civilian morale became more of a concern [ 16 ]. The outbreak of WWII led to a resurgence of interest in military morale, but was also explored from a civilian perspective [ 18 — 22 ].

Employee morale was examined across multiple industries [ 23 — 25 ]. It was measured using questionnaires and surveys, the validity and generalisability of which however was rarely assessed [ 26 , 27 ]. Since in the s, a clearer terminology emerged, as Payne et al. Job morale was proposed as the satisfaction of a group with the job itself, whereas organisational morale was the satisfaction of a group with the organisation [ 28 ].

McKnight et al. Job morale was associated with other factors, such as performance and productivity [ 30 , 31 ], work effort [ 30 ], intention to leave [ 6 ] and customer satisfaction [ 32 ]. Bedian and Armenakis [ 33 ] proposed one of the first models, proposing that conflict and ambiguity in job roles was associated with decreased job satisfaction, which was associated with a propensity to leave the organisation.

This model was utilised in a cross-sectional study on nurses and was used to explain changes in morale levels of healthcare staff during the integration of mental and social care services in England [ 8 ]. Alternatively, Warr [ 34 , 35 ] developed a framework around affective well-being, which outlines three dimensions of well-being: pleasure to displeasure, contentment to anxiety, and enthusiasm to depression [ 35 ].

This framework was used in a mixed-methods study conducted by Johnson et al. It aimed to explore the job morale of mental health staff in an inpatient setting [ 9 ], and concluded that employees need to be pleased, enthusiastic and comfortable with their job in order to have positive job morale, as opposed to displeasure, anxiety and depression [ 9 ]. A commonly applied theory is the Job Demand-Control JD-C Model [ 36 ], which considers the decision making capability and demand of employees to be determinants of job-related strain.

The model hypothesises that high levels of demand and decision capability leads to high job motivation, satisfaction and thus positive job morale [ 37 ]. Efforts relate to job demands and obligations, and the inherent motivation to meet them. Rewards include financial profit, benefits to esteem, job security and career opportunities [ 40 ].

The ER-I model hypothesises that an imbalance between reward and effort causes job strain, decreases employee well-being and provokes negative job morale [ 40 , 41 ]. This suggests that a balance between effort and reward is needed for positive employee well-being and job morale. The Job Demands-Resources JD-R Model [ 42 ] was proposed to encompass factors associated with job satisfaction [ 43 ], work related well-being [ 44 , 45 ] and burnout [ 46 ].

It incorporates the physical, social, psychological and organisational aspects of a job, and resources that can be used to address or reduce job demands. The model suggests that combining high demands and limited resources leads to job strain [ 42 ]. Single-item scales have been widely used for asking respondents to rate their job morale. One of the most extensive staff surveys in the world was conducted by the National Health Services in England [ 47 ].

Staff were asked to rate their job morale on a scale from 0 to Single item scales have also been adopted by several researchers to define job morale among medical students [ 48 ], nurses [ 48 , 49 ], working mothers in obstetrics and gynaecology [ 50 ] and GPs [ 51 — 53 ]. In this case, the definition of job morale can be interpreted by the respondent, who may have varying understandings of the term.

They were developed and refined using exploratory and confirmatory factor analyses [ 55 ] and principle components analysis [ 54 ] respectively. Despite this, the content validity of these scales is still problematic, which could be one of the reasons for why these measures have not been used more widely. As well as using direct measures, job morale can be assessed by inferring morale from its consequences and predictors.

For example, absenteeism, staff sickness, turnover and patient satisfaction are often taken to be consequences of low job morale [ 1 , 56 , 57 ]. Such variables are commonly accessible to employers, but they may also reflect changes in working conditions and industry fluctuations and not just job morale. Indicators that have been considered to be predictors of job morale varied across studies and often overlapped with those variables considered to be consequences, for example, staff turnover thus questioning the content validity of the quantitative scales.

In the light of the limitations of quantitative measures of job morale, several authors have applied qualitative methods to explore job morale [ 38 , 58 — 62 ]. Such methods, mostly in the form of interviews and focus groups, have been used flexibly and contributed to theory building, adopting an inductive approach without labelling predefined variables as job morale. Research on job morale in healthcare has focused on healthcare students, GPs, nurses and mental health professionals.

Job morale in students has been assessed in several studies without attempting to define the concept [ 48 , 63 , 64 ], and mostly adopted qualitative methods [ 59 , 65 ]. However, the morale of students is also likely to be influenced by their satisfaction with the educational component of being a student and cannot be considered as entirely job-related.

The job morale of GPs has been explored in a number of UK based studies [ 1 , 38 , 51 , 52 , 61 , 62 , 66 , 67 ], most of which did not use a definition of the concept [ 1 , 38 , 51 , 61 , 62 , 66 , 67 ]. Grieve commented that one of the main job morale indicators is well-being [ 1 ], and Gilliland et al. A single-item Likert scale was adopted by studies using a cross-sectional design [ 51 , 52 ]. Low levels of job morale were reported by the majority of respondents [ 51 , 52 ], and several qualitative studies identified underlying causes of positive and negative job morale, including workload, changes to the work environment, decreased autonomy, increased work demand and fragmented teams [ 38 , 61 ].

In a review, Day et al. The authors went on to analyse personal and organisational job morale as separate entities, suggesting that there is a difference between group and individual morale [ 69 ]. The studies assessing job morale in nursing have adopted both single and multiple-item Likert scales, and from these it has been suggested that job morale in this group is associated with work environment [ 49 ], turnover [ 70 ], conflict resolution styles [ 71 ] and financial compensation [ 57 ].

Job morale has also been examined across mental health professions [ 72 ]. It was suggested that the term job morale is used as an umbrella term for a number of job-related variables, such as job satisfaction, burnout, occupational stress, psychological well-being, absenteeism, recruitment and retention issue and the incidence of psychiatric disorders [ 73 ]. This idea of job morale as an umbrella term was considered in some European studies [ 5 , 74 , 75 ].

It was suggested that job satisfaction, burnout and team identity are key indicators of morale, and that different levels of job morale depended on the professional group studied and the geographical area of the study [ 5 , 74 , 75 ]. Likewise, Johnson et al. Job morale was measured using a cluster of indicators, such as job motivation, satisfaction, well-being, burnout and overall psychological health [ 9 ]. Using these indicators, the authors concluded that staff job morale was good, but acknowledged that there were significant differences across service types [ 76 ].

Factors impacting on job morale were also explored qualitatively with both patients [ 58 ] and staff [ 7 ], with both groups expressing similar views. Both outlined the importance of a supportive working environment, clear organisational measures and close-knit teams [ 7 , 58 ]. The reports from 93 studies suggest that the concept of job morale originated from the military and gradually underwent four main periods of development up to the present day; [1] WWI and the interwar years; [2] WWII; [3] Aftermath of WWII; and [4] Contemporary period.

Although there is no universally accepted definition of job morale, several overlapping key elements appear across definitions, such as group cohesion and job satisfaction. In research in healthcare job morale is seen either as an umbrella term that encompasses job-related variables or a unifying variable.

Job morale in healthcare has been assessed using direct and indirect as well as quantitative and qualitative methods. Scales have questionable content validity and the generalisability of the results is problematic. Job morale research in healthcare focused on GPs, nurses and mental health professionals, and was mostly conducted in western countries such as the UK and USA. One of the important limitations of this scoping review is that the search strategy limited publications to the English language, covering articles published on health or health-related themes, which means that relevant studies conducted in other fields and languages were almost certainly missed.

Furthermore, the quality of the studies was not assessed, and the provided data may have been influenced by different sources of bias. Despite these limitations, the current scoping review is the first comprehensive review on the topic of job morale. It employed a clear, extensive search strategy, providing a base for anyone who conducts explorations into job morale in the future. The literature has used job morale as an individual and a group concept.

The majority of the studies suggested that job morale is shared by members of the group. However, group members may have differing feelings about job morale at any one time, and this may differ from individual to individual. Job morale is associated with personality traits such as altruism [ 39 ] or neuroticism [ 77 ] which emphasises the individual variation. Other authors proposed that job morale is simultaneously both an individual and group concept [ 59 , 65 ] which required complex multi-level analytic methods in order to understand the interaction between individual and group job morale.

In a study by Day et al. Job-related variables associated with individual and organisational job morale differed, supporting the view that it is useful to explore job morale both at group and individual levels [ 69 ]. The review identified significant gaps in the literature, specifically with respect to the origin of the studies and the assessment methods used. All of the studies included in the review except one [ 78 ] were conducted in high-income countries HIC , as defined by the World Bank criteria [ 79 ].

According to the JD-R model, having limited job resources can play an important role in diminishing job morale, and future research should include LMICs to explore this further. With respect to professional groups, very limited research has been conducted on the morale of a wide range of relevant professional groups such as specialists other than GPs, nurses and mental health professionals. It was not clear from the existing literature why research was focused on these professional groups; therefore, we can only speculate about the reasons.

It is important to note that the findings of the current review apply only to the studies that explicitly used the term job morale. As it was shown in a recent systematic review and meta-analysis [ 11 ], there are a number of studies on physicians working in LMICs assessing job-related variables encompassed by the term job morale, including job motivation, job satisfaction and burnout. Whilst some of these are quantitative in nature, there are also some qualitative studies in this area [ 80 ].

As job morale is often used as an umbrella term with varying specific understandings, future research on job morale in healthcare should specify how exactly they understand job morale, preferably providing a theoretical justification or their use of the term. For quantitative assessments, the dominating dimensions of high versus low and positive versus negative job morale appear useful and provide the options to use cut-off points for categorising scores into high, moderate or low morale.

Such simplified categories may help using findings on job morale for policy makers, service development and on-going quality improvement processes. The concept of job morale has a long history and has been widely used. This may be due to its intuitive appeal, the applicability to different groups, its use as an umbrella term with varying components and its connotation that encompasses not only problems but also a positive meaning.

Despite the heterogeneity in ways of understandings of the concept, it has guided meaningful research in healthcare. Future research should specify which exact understanding of job morale is used, which may vary depending on the purpose of the given study. It should also advance the quality of the assessment methods, study all professional groups in healthcare and include professionals in LMICs.

If this can be achieved, job morale is likely to continue to play a role in both future research and development of policies and practice in healthcare. We would like to thank all members of the Unit for Social and Community Psychiatry for providing valuable feedback on the draft of this manuscript. AS designed the study. AS conducted the systematic scoping search, data extraction, performed the analysis and edited the manuscript. LMH contributed to analysis and drafting and editing of the manuscript.

SP provided supervision and contributed to the editing of the manuscript. All authors approved the final version of the manuscript. The funder had no input to the study design, analysis, interpretation of data, production of this manuscript nor decision to publish. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information accompanies this paper at National Center for Biotechnology Information , U.

BMC Public Health. Published online Jul Alina Sabitova , 1 Lauren M. Hickling , 1, 2 and Stefan Priebe 1. Lauren M. Author information Article notes Copyright and License information Disclaimer. Alina Sabitova, Email: ku. Corresponding author. Received Apr 28; Accepted Jul The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Associated Data Supplementary Materials Additional file 1. Study Characteristics. A table contain study characteristics of all included studies. Abstract Background The job morale of healthcare staff is widely seen as an important factor for the quality of care. Methods A scoping review was conducted to identify relevant literature. Results Ninety-three unique studies met eligibility criteria for the present review.

Conclusions Although the understandings of job morale in healthcare are heterogeneous and inconsistent, the concept appears to have been useful over longer periods of time and in different contexts. Methods Design A scoping review was considered the most appropriate method to capture the concept of job morale, address the broad research question and inform future research [ 13 ].

Review strategy EndNote X8 Clarivate Analytics was used to screen the titles and abstracts of identified studies. Data charting process A draft of the data charting form was created and piloted for fifteen of the included studies. Results A total of articles were identified through database searches, and 15 through other sources.

Open in a separate window. Job morale in healthcare research Theoretical frameworks and models Bedian and Armenakis [ 33 ] proposed one of the first models, proposing that conflict and ambiguity in job roles was associated with decreased job satisfaction, which was associated with a propensity to leave the organisation.

Assessment Single-item scales have been widely used for asking respondents to rate their job morale. Research focus Research on job morale in healthcare has focused on healthcare students, GPs, nurses and mental health professionals.

Discussion Summary of evidence The reports from 93 studies suggest that the concept of job morale originated from the military and gradually underwent four main periods of development up to the present day; [1] WWI and the interwar years; [2] WWII; [3] Aftermath of WWII; and [4] Contemporary period.

Strengths and limitations One of the important limitations of this scoping review is that the search strategy limited publications to the English language, covering articles published on health or health-related themes, which means that relevant studies conducted in other fields and languages were almost certainly missed. Differences of concepts and implications for research The literature has used job morale as an individual and a group concept.

Conclusions The concept of job morale has a long history and has been widely used. Supplementary information Additional file 1. Acknowledgements We would like to thank all members of the Unit for Social and Community Psychiatry for providing valuable feedback on the draft of this manuscript. Availability of data and materials Not applicable. Ethics approval and consent to participate Not applicable.

Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Supplementary information Supplementary information accompanies this paper at References 1. Grieve S. Br J Gen Pr. Linz et. A high morale means the employee is satisfied with the job, puts in effort, is creative, takes initiative, is… Expand. Save to Library. Create Alert. Launch Research Feed.

Share This Paper. Figures and Tables from this paper. Citation Type. Has PDF. Publication Type. More Filters. Effectiveness of employee morale and its impact on employee relation in manufacturing industry. Research Feed.

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Using these indicators, the authors concluded that staff job morale was good, but acknowledged that there were significant differences across service types [ 76 ]. Factors impacting on job morale were also explored qualitatively with both patients [ 58 ] and staff [ 7 ], with both groups expressing similar views.

Both outlined the importance of a supportive working environment, clear organisational measures and close-knit teams [ 7 , 58 ]. The reports from 93 studies suggest that the concept of job morale originated from the military and gradually underwent four main periods of development up to the present day; [1] WWI and the interwar years; [2] WWII; [3] Aftermath of WWII; and [4] Contemporary period. Although there is no universally accepted definition of job morale, several overlapping key elements appear across definitions, such as group cohesion and job satisfaction.

In research in healthcare job morale is seen either as an umbrella term that encompasses job-related variables or a unifying variable. Job morale in healthcare has been assessed using direct and indirect as well as quantitative and qualitative methods. Scales have questionable content validity and the generalisability of the results is problematic.

Job morale research in healthcare focused on GPs, nurses and mental health professionals, and was mostly conducted in western countries such as the UK and USA. One of the important limitations of this scoping review is that the search strategy limited publications to the English language, covering articles published on health or health-related themes, which means that relevant studies conducted in other fields and languages were almost certainly missed.

Furthermore, the quality of the studies was not assessed, and the provided data may have been influenced by different sources of bias. Despite these limitations, the current scoping review is the first comprehensive review on the topic of job morale.

It employed a clear, extensive search strategy, providing a base for anyone who conducts explorations into job morale in the future. The literature has used job morale as an individual and a group concept.

The majority of the studies suggested that job morale is shared by members of the group. However, group members may have differing feelings about job morale at any one time, and this may differ from individual to individual. Job morale is associated with personality traits such as altruism [ 39 ] or neuroticism [ 77 ] which emphasises the individual variation.

Other authors proposed that job morale is simultaneously both an individual and group concept [ 59 , 65 ] which required complex multi-level analytic methods in order to understand the interaction between individual and group job morale.

In a study by Day et al. Job-related variables associated with individual and organisational job morale differed, supporting the view that it is useful to explore job morale both at group and individual levels [ 69 ]. The review identified significant gaps in the literature, specifically with respect to the origin of the studies and the assessment methods used.

All of the studies included in the review except one [ 78 ] were conducted in high-income countries HIC , as defined by the World Bank criteria [ 79 ]. According to the JD-R model, having limited job resources can play an important role in diminishing job morale, and future research should include LMICs to explore this further. With respect to professional groups, very limited research has been conducted on the morale of a wide range of relevant professional groups such as specialists other than GPs, nurses and mental health professionals.

It was not clear from the existing literature why research was focused on these professional groups; therefore, we can only speculate about the reasons. It is important to note that the findings of the current review apply only to the studies that explicitly used the term job morale.

As it was shown in a recent systematic review and meta-analysis [ 11 ], there are a number of studies on physicians working in LMICs assessing job-related variables encompassed by the term job morale, including job motivation, job satisfaction and burnout. Whilst some of these are quantitative in nature, there are also some qualitative studies in this area [ 80 ]. As job morale is often used as an umbrella term with varying specific understandings, future research on job morale in healthcare should specify how exactly they understand job morale, preferably providing a theoretical justification or their use of the term.

For quantitative assessments, the dominating dimensions of high versus low and positive versus negative job morale appear useful and provide the options to use cut-off points for categorising scores into high, moderate or low morale. Such simplified categories may help using findings on job morale for policy makers, service development and on-going quality improvement processes. The concept of job morale has a long history and has been widely used. This may be due to its intuitive appeal, the applicability to different groups, its use as an umbrella term with varying components and its connotation that encompasses not only problems but also a positive meaning.

Despite the heterogeneity in ways of understandings of the concept, it has guided meaningful research in healthcare. Future research should specify which exact understanding of job morale is used, which may vary depending on the purpose of the given study. It should also advance the quality of the assessment methods, study all professional groups in healthcare and include professionals in LMICs.

If this can be achieved, job morale is likely to continue to play a role in both future research and development of policies and practice in healthcare. We would like to thank all members of the Unit for Social and Community Psychiatry for providing valuable feedback on the draft of this manuscript.

AS designed the study. AS conducted the systematic scoping search, data extraction, performed the analysis and edited the manuscript. LMH contributed to analysis and drafting and editing of the manuscript. SP provided supervision and contributed to the editing of the manuscript. All authors approved the final version of the manuscript. The funder had no input to the study design, analysis, interpretation of data, production of this manuscript nor decision to publish.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information accompanies this paper at National Center for Biotechnology Information , U. BMC Public Health. Published online Jul Alina Sabitova , 1 Lauren M.

Hickling , 1, 2 and Stefan Priebe 1. Lauren M. Author information Article notes Copyright and License information Disclaimer. Alina Sabitova, Email: ku. Corresponding author. Received Apr 28; Accepted Jul The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Associated Data Supplementary Materials Additional file 1. Study Characteristics. A table contain study characteristics of all included studies. Abstract Background The job morale of healthcare staff is widely seen as an important factor for the quality of care. Methods A scoping review was conducted to identify relevant literature. Results Ninety-three unique studies met eligibility criteria for the present review.

Conclusions Although the understandings of job morale in healthcare are heterogeneous and inconsistent, the concept appears to have been useful over longer periods of time and in different contexts. Methods Design A scoping review was considered the most appropriate method to capture the concept of job morale, address the broad research question and inform future research [ 13 ].

Review strategy EndNote X8 Clarivate Analytics was used to screen the titles and abstracts of identified studies. Data charting process A draft of the data charting form was created and piloted for fifteen of the included studies. Results A total of articles were identified through database searches, and 15 through other sources. Open in a separate window. Job morale in healthcare research Theoretical frameworks and models Bedian and Armenakis [ 33 ] proposed one of the first models, proposing that conflict and ambiguity in job roles was associated with decreased job satisfaction, which was associated with a propensity to leave the organisation.

Assessment Single-item scales have been widely used for asking respondents to rate their job morale. Research focus Research on job morale in healthcare has focused on healthcare students, GPs, nurses and mental health professionals. Discussion Summary of evidence The reports from 93 studies suggest that the concept of job morale originated from the military and gradually underwent four main periods of development up to the present day; [1] WWI and the interwar years; [2] WWII; [3] Aftermath of WWII; and [4] Contemporary period.

Strengths and limitations One of the important limitations of this scoping review is that the search strategy limited publications to the English language, covering articles published on health or health-related themes, which means that relevant studies conducted in other fields and languages were almost certainly missed.

Differences of concepts and implications for research The literature has used job morale as an individual and a group concept. Conclusions The concept of job morale has a long history and has been widely used. Supplementary information Additional file 1. Acknowledgements We would like to thank all members of the Unit for Social and Community Psychiatry for providing valuable feedback on the draft of this manuscript. Availability of data and materials Not applicable.

Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Supplementary information Supplementary information accompanies this paper at References 1. Grieve S. Br J Gen Pr. Department of Health. Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One. How can we achieve and maintain high-quality performance of health workers in low-resource settings?

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J Commun Manag. A path-analytic study of the consequences of role conflict and ambiguity. Acad Manag J. Warr P. Work, happiness and unhappiness. New York: Routledge; The measurement of well-being and other aspects of mental health. J Occup Psychol. Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign.

Adm Sci Q. A critical examination of the demand-control-support model from a work psychological perspective. Int J Stress Manag. Napier J, Clinch M. Job strain and retirement decisions in UK general practice. Occup Med. Exploring factors influencing the work-related morale for certified nursing assistants in hospice care: a structural equation modeling study.

Siegrist J. J Occup Health Psychol. Reviewing the effort-reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med. Bakker AB, Demerouti E. The job demands-resources model: state of the art. J Manag Psychol. McVicar A. Happy employees have high morale while dissatisfied and unhappy employees have low morale.

Linz et. A high morale means the employee is satisfied with the job, puts in effort, is creative, takes initiative, is… Expand. Save to Library. Create Alert. Launch Research Feed. Share This Paper. Figures and Tables from this paper.

Citation Type. Has PDF. Publication Type. More Filters. Effectiveness of employee morale and its impact on employee relation in manufacturing industry.

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