Predictors of Presenteeism among Nurses working at a tertiary care hospital in Karachi, Pakistan: A cross-sectional analytical study

Predictors of Presenteeism among Nurses working at a tertiary care hospital in Karachi, Pakistan: A cross-sectional analytical study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictors of Presenteeism among Nurses working at a tertiary care hospital in Karachi, Pakistan: A cross-sectional analytical study Farhan Shahzad, Salma Rattani, Rozmin Jiwani, Zulekha Saleem, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6625683/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: Nurses are considered the backbone of hospitals (healthcare institutions) who provide care for their patients despite being ill. This phenomenon of working while ill or suffering from a health condition is called presenteeism. Presenteeism is becoming a more prominent problem among healthcare providers, especially nurses. It has a variety of negative effects, including stress and burnout, decline in productivity and performance, and ultimately resulting in decreased quality of care. Therefore, the purpose of this study is to compute presenteeism score and predict its associated factors among nurses working at a tertiary care hospital. Methods: A cross-sectional analytical study design was utilized to assess presenteeism score and predict its associated factors among nurses. A total of 277 nurses were recruited for the study by using convenience sampling techniques. A socio-demographic questionnaire was used for participants’ characteristics and professional details, while a scale was used for assessing presenteeism score. Chi square test was used to analyze associated factors. Results: The overall mean presenteeism score obtained from the study was 18.28 with a standard deviation of ±2.70. Socio-demographic characteristics, including experience in years, and supervisor support, were found to have significant association with presenteeism. Regarding health-related problem, fatigue, digestive and respiratory issues, fever, headache, musculoskeletal complaints, cardiac issues, and menstrual pain in females, were found to be the predictors of presenteeism among nurses. Conclusions: This research suggests that presenteeism is linked to various health problems and has impacts on nurses and their quality of care. Understanding and addressing the underlying causes of presenteeism in the nursing profession is vital for promoting the overall health condition and productivity of healthcare staff and ensuring high-quality patient care. presenteeism nurses work productivity working while ill Background The nature of work, particularly in the environments in which it is performed, has been subject to a great deal of change recently. Employees output and well-being are affected by a wide range of influences, including but not limited to new managerial methods, scientific and technical advancements, mobility, and competition ( 1 ) ( 2 ). When compared to professionals working in other occupations, nurses frequently face job insecurity because of the precarious nature of their job, excessive workloads, physical fatigue, and psychological pressure as well ( 2 ). This issue has been investigated from different viewpoints, and is associated with higher medical expenses as well as breaching the safety of patients, both of which are linked to a low sense of well-being, and poor quality of patient care ( 3 ) ( 4 ) ( 5 ). Moreover, it is common for healthcare workers, and nurses in particular, to be subjected to high workloads, shift duties, and irreplaceable jobs, yet these individuals continue to perform their duties while being ill ( 6 ). Likewise, there is a potential for adverse outcomes to arise because of high work demands, treatment regimens, inadequate staffing, and staff turnover as well. These consequences include absenteeism and presenteeism, both of which can compromise nurses’ health, and the quality of care they provide to their patients ( 7 ). In addition, both absenteeism and presenteeism are closely linked together as they cover health problems that have varying personal, physiological, societal, familial, economical, or functional reasons. Presenteeism has more consequences as it raises health expenses, lowers efficiency, increases the number of work incidents, and also causes institutional losses ( 8 ). Additionally, it has been discovered that job-related attributes, such as shifting work, job demands and instability, unfavorable working environment, and relationship with co-workers, are linked to a greater incidence of presenteeism ( 9 ) ( 10 ) ( 11 ) ( 12 ). In healthcare, presenteeism is characterized as “the act of a healthcare professional who continues to work while sick or suffering from a health condition that results in their low performance at work” ( 13 ). Presenteeism has a variety of negative effects such as workplace burnout and depression ( 14 ), a decline in communication, productivity, and performance skills, which ultimately results in their decreased work quality towards patients depicted in their outcomes ( 15 ) ( 16 ). Additionally, it also has an effect on nurses when they provide basic nursing interventions like toileting, medication, health promotion, and assistance with diet ( 17 ). A rise in adverse events, such as errors in medication administration, transmission of diseases and infections, and increased risk of falls have been associated with presenteeism ( 18 ). Recent studies conducted in several countries showed that presenteeism is highly prevalent among nurses, including 52.6% among American nurses ( 19 ), 55% among Portuguese nurses ( 13 ), while in China, it is 82.1% and 94.25% among nurse managers and nurses respectively ( 6 ). A meta-analysis was done including 28 studies from 14 countries reported that presenteeism is a prevalent problem among nurses, expected to be around 49% ( 11 ). Presenteeism is caused by a “self-sacrifice culture” that encourages healthcare workers to remain at work despite being sick and expects the same from their co-workers to prevent understaffing, insufficient staff-patient ratios, or a lack of clinical skills ( 4 ). Based on the hospital’s viewpoint, it was discovered that presence in the workplace is a culture or based on a desire to be seen. In fact, this behavior is common and strong exist in the Asian healthcare industry, as well as in rural services where finding a substitute is a challenging task because of the shortage of workforce ( 21 ). Additionally, because of the profession’s caring behavior, emphasis on collaboration and teamwork, and an increased sense of devotion because of the nursing profession’s socialization process, presenteeism may unintentionally be encouraged because nurses, even when they are not feeling well, do not want to let their co-workers down ( 13 ) ( 19 ) ( 20 ). Thus, examining presenteeism in light of the experiences of nurses in various healthcare settings is necessary ( 22 ). In this context, it is important to comprehensively identify presenteeism and its associated factors among nurses. Therefore, the purpose of this study was to compute presenteeism score level and predict its associated factors among nurses working at the selected tertiary care hospital in Pakistan. Methods Study design and setting A cross-sectional analytical study was conducted between August and September 2023 in Karachi, Pakistan, at a tertiary care hospital named Aga Khan University Hospital. This hospital is accredited by Joint Commission International which provides the most advanced medical care according to the international standards. This study was approved by the Ethical Review Committee of the Aga Khan University Hospital (ERC: 2023-8689-25887), and permission was obtained from the hospital administration, chief medical and nursing officers, and the participating nurses. Participants and recruitment Nurses were recruited from all departments of the selected hospital. Convenience sampling was employed to ensure diversity across each department. Eligible participants were: ( 1 ) registered nurses with at least one year of clinical experience; ( 2 ) working in either inpatient or outpatient departments. However, trainee nurse interns and those nurses who did not meet these criteria or who failed to complete the questionnaire in full were excluded. Also, other healthcare professionals working in the selected setting were not included in the study. Recruitment was facilitated through departmental nursing managers and head nurses. Data collection tool Data collection was done using two instruments: socio-demographic questionnaire, and an adopted questionnaire called Stanford Presenteeism Scale (SPS-6). The socio-demographic questionnaire gathered participants’ data including age, gender, marital status, qualification, years of experience, etc. However, Stanford Presenteeism Scale (SPS-6) assessed presenteeism with 6 items using Likert-scale responses reflecting presenteeism over the past month. The SPS-6 has a score ranging from 6 to 30 points. Among the six items, 1, 3 and 4 pertain to the ability to ‘avoid distractions’ in their work. These items are worded negatively and are scored in reverse. On the other hand, items, 2, 5 and 6 examine the ability of people in completing their work and are worded positively. Moreover, the score is characterized as low (ranging from 6 to 18), and high (ranging from 19 to 30). Low score signifies a decline in work performance while high score indicates greater capacity for workers to concentrate and accomplish their tasks even in the presence of health problems ( 23 ). Study size Sample size estimation was done on the basis of 95% confidence level, a 5% margin of error, and an assumed variation across different departments. Using these parameters, a minimum required sample size of approximately 277 nurses was calculated using OpenEpi software for cross-sectional studies. To account for possible incomplete responses, the questionnaire was distributed to over 300 nurses, resulting in 278 valid responses which were included in the final analysis. Statistical analysis The data collected from nurses were coded into SPSS version 26 and Microsoft Excel Software. After completion of data entry, descriptive analysis was done for all independent and outcome variables. Moreover, mean and standard deviation were computed for quantitative variables. On the other hand, frequency and proportion were computed for categorical variables. Chi-square test was applied for determining the association between presenteeism with socio-demographic characteristics and health problems. P value of < 0.05 were interpreted as statistically significant for the study. The analysis was guided by research objectives and research questions and was done according to the literature reviewed. This complete analysis approach was used to maintain data integrity and reduce bias from imputation. Results Socio-demographic Characteristics of the Respondents Table 1 shows the socio-demographic characteristics of the respondents. The findings revealed a similar proportion of both male (50.2%) and female (49.8%) nurses in the study. The age was divided into four categories. The study indicated that the majority, 66.1%, were within the 21-30 age group. The age group, 31-40 years, accounted for 32.1% of the participants. Those in the 41-50 years age group made up 1.8%, while there were no participants above 50 years of age. In terms of marital status, more than half (58.5%) of them were married, and 41.5% were single. Besides, 88.1% of the respondents in the study hold bachelor’s degree as their educational level, followed by diploma which represented 11.2%. The participants having a master’s degree were 0.7%. Regarding their working areas, 46.2% were working in medical-surgical units, 48.7% in critical areas, and only 5.1% in outpatient areas. In terms of their duty schedule, majority of the nurses, 92.4% were working in shift duties. There were 89.2% participants who indicated that their job demands are high, while majority, 77.6%, stated their job as stressful. Majority of the respondents, 93.9%, perceived their supervisor as supportive. Of the total respondents, 40.8% of them reported having sleep problems. Moreover, most of the participants, 79.8%, stated while working they had experienced physical fatigue. Table 1. Socio-demographic characteristics of respondents (n=277) Characteristics Frequency Percent (%) Gender Male Female 139 138 50.2 49.8 Age in years 21-30 31-40 41-50 >50 183 89 5 0 66.1 32.1 1.8 0 Marital status Single Married 162 115 58.5 41.5 Education level Diploma Bachelors Masters 31 244 2 11.2 88.1 0.7 Working area Medical-surgical area Critical area Outpatient area 128 135 13 46.2 48.7 5.1 Work schedule One shift only Shift duty 21 256 7.6 92.4 Job demands High Low 247 30 89.2 10.8 Experience in years (Mean ± SD 4.78 (3.21) How would you rate your job? Stressful Not stressful 215 62 77.6 22.4 How would you rate your supervisor’s support? Supportive Not supportive 260 17 93.9 6.1 Do you usually have sleep problems? Yes No 113 164 40.8 59.2 Do you usually feel fatigued? Mentally Emotionally Physically 53 3 221 19.1 1.1 79.8 Prevalence of Presenteeism and Presenteeism Score This study revealed that all the participants admitted that they had experienced presenteeism while being at work. The study resulted that the presenteeism variable had an overall score of 18.28 ±2.70 with a relatively low standard deviation. (Table 2). Table 2. Overall presenteeism score and standard deviation of the study participants (n=277) Presenteeism Score Frequency Mean SD 277 18.28 ±2.70 Table 3: Frequency distribution and percentage of common health problems among nurses (n=277) Health Problems n (277) Percentage (%) Fatigue 260 93.8% Digestive 210 75.8% Stress 232 81.3% Respiratory 255 92.0% Eye 14 5.1% Fever 260 93.8% Menstrual pain (female only) (n = 138) 138 100% Headache 248 89.5% Musculoskeletal 248 89.5 Skin 15 5.4% Urinary 43 15.5% Ear 6 2.2% Migraine 52 18.8 Cardiac 13 4.7% Table 3 provides the information about the number of individuals who reported experiencing specific health problems or symptoms. Participants were not limited to select only one response as they could have more than one health problems. Fatigue was a common health problem among all nurses, with 260 (93.8%) out of 277. In addition, 210 (75.8%) experienced digestive issues, 232 (81.3%) were affected by stress, respiratory problems were reported by 255 (92%) nurses, and 260 (93.8%) of the nurses were affected by fever. In the present study, out of 277 nurses, 138 were females, who had worked while having menstrual pain. Furthermore, headache, musculoskeletal problems were another most common health problems faced by nurses while being at work. In addition, out of 277 nurses, 14 (5.1%) have faced eyes problems, 6 (2.2%) faced ear problems, 15 (5.4%) faced skin problems, and 13 (4.7%) of the nurses had cardiac problems while being at work. Table 4. Association of the two dimensions of SPS-6 with health problems, p-value 0.05 Variable ‘Avoiding Distraction’ Dimension ‘Completing Work’ Dimension Health Problems: c 2 Df p-value c 2 Df p-value Fatigue 43.462 12 .000** 23.510 12 .024* Digestive 36.327 12 .000** 42.552 12 .000** Stress 48.975 12 .000** 38.887 12 .000** Respiratory 60.026 12 .000** 35.502 12 .000** Eye 45.399 12 .000** 19.281 12 .082 Fever 74.162 12 .000** 45.971 12 .000** Headache 32.217 12 .001* 18.111 12 .112 Musculoskeletal 37.406 12 .000* 20.357 12 .061 Skin disorders 6.166 12 .908 38.791 12 .000** Urinary 12.788 12 .385 17.391 12 .135 Ear disorders 7.226 12 .842 62.301 12 .000** Migraine 15.483 12 .216 55.742 12 .000** Cardiac 30.314 12 .003* 27.355 12 .007* Table 4. Chi-square test was applied to find association between the two dimensions, ‘Avoiding Distraction’ and ‘Completing Work’, in relation to various health problems. Evidently, fatigue, digestive issues, stress, respiratory problems, fever, eye, headache, and musculoskeletal problems were the health problems having highly significant association with the two dimensions. Furthermore, cardiac-related issues also showed a significant association with both dimensions. In addition, other health problems showed include skin, urinary and ear disorders, and migraine. Table 5. Comparison of socio-demographic characteristics with presenteeism among nurses Presenteeism Variable c 2 Df p-value Gender 19.771 18 .346 Age in years 32.018 36 .659 Marital status 18.185 18 .444 Education level 40.682 36 .272 Working area 17.863 36 .995 Work schedule 7.014 18 .990 Job demands 15.032 18 .660 Experience in years 745.165 486 .000* How would you rate your job? 16.668 18 .546 How would you rate your supervisor’s support? 44.824 18 .000* Do you usually have sleep problems? 24.237 18 .147 Do you usually feel fatigued? 37.328 36 .408 Mean presenteeism score ± SD = 18.28 ± 2.70 Table 5 provides the results of the Chi-square test to find the association between socio-demographic characteristics and the variable ‘presenteeism’. This table aims to understand how various factors in the workplace are associated with presenteeism. The results indicated that most of the variables do not show a significant association with presenteeism, except for ‘experience in years’ and ‘supervisor support’, which showed highly significant association with presenteeism. Hence, it was suggested that years of experience and supervisor support are crucial factors in understanding presenteeism in this context. Table 6. Association of nurses’ health problems with presenteeism. Variable Presenteeism Health Problems c 2 Df p-value Fatigue 40.680 18 .002 Digestive 51.236 18 .000 Stress 46.505 18 .000 Respiratory 77.624 18 .000 Eye 19.248 18 .377 Fever 79.030 18 .000 Menstrual pain 19.771 18 .346 Headache 13.731 18 .746 Musculoskeletal 62.186 18 .000 Skin disorders 73.671 18 .000 Urinary 7.906 18 .980 Ear disorders 32.153 18 .021 Migraine 21.249 18 .267 Cardiac 109.743 18 .000 Table 6 provides results of Chi-square test of association between health problems and the variable ‘presenteeism’. Looking into the results given in Table 6, some of the health problems showed a highly significantly association with presenteeism. These health problems include fatigue, digestive issues, respiratory disorders, fever, musculoskeletal issues, skin disorders, and cardiac problems. In addition, ear issues also showed association with presenteeism. Moreover, regarding female nurses, menstrual pain showed highly significant association with presenteeism. Furthermore, other health problems, including eye disorders, headache, urinary issues, and migraine showed no significant association with presenteeism. Thus, these results suggest that fatigue, digestive issues, stress, respiratory disorders, fever, musculoskeletal issues, skin and ear disorders, and cardiac problems were found to be the predictors of presenteeism among nurses. Similarly, this study findings showed that socio-demographic variables, such as years of experience and supervisor support, were associated with presenteeism. Discussion This cross-sectional analytical study assessed presenteeism and the factors associated with it among nurses working at a tertiary care hospital in Karachi Pakistan. The results revealed that the mean score of presenteeism is 18.28 ± 2.70. The study further revealed that socio-demographic characteristics such as experience in years and supervisor support, and various health problems were the predictors of presenteeism among nurses. Socio-demographics and Presenteeism Regarding the socio-demographic characteristic sex, the study showed slightly different results than a previous study. For example, a cross-sectional study conducted in two hospitals in Turkey, they found that females were more susceptible to presenteeism resulting from health issues when compared to men ( 1 ). Moreover, regarding the socio-demographic characteristics, such as gender, marital status, educational level, working area, and work schedule, this study found no association with the level of presenteeism. This study’s findings are consistent with a cross-sectional study conducted among 309 nurses in Saudi Arabia at the university hospital. In this study, variables like gender, marital status, education, type of unit, type of shift, did not show any significant association with presenteeism ( 24 ). Concerning the socio-demographic characteristics, including gender, marital status, high job demands, and work schedule, this study found no association with presenteeism. In contrast, a study conducted in Egypt found different results. Their study revealed that higher presenteeism was found among nurses who were female and married, having high demanding jobs, and those worked in shifts ( 25 ). In addition, this study found no association between presenteeism and educational level. Similarly, a study conducted in China also reported that there was no statistically significant relation between presenteeism and educational level ( 6 ). However, a secondary analysis conducted in the United States showed slightly different results in which they found that presenteeism was highly influenced by the health of individuals with lower educational backgrounds compared to those with higher educational backgrounds ( 5 ). Prevalence of Presenteeism and SPS-6 Score Our findings showed that almost all of study participants experienced presenteeism. Similarly, studies conducted in other countries showed that presenteeism is highly prevalent among nurses, including 52.6% among American nurses ( 21 ), and 55% among Portuguese nurses ( 13 ). Similarly, in China, it is 82.1–94.25% among nurses’ managers and nurses ( 6 ). Our study findings indicated a low level of presenteeism. Low score indicates a decline in work performance. This means that the lower score obtained from this study shows a decline in performance which indicates that the participants’ work was more affected by the behavior ( 23 ). The SPS-6 score, 18.28 ± 2.70, obtained in our study, was lower than the overall mean score in another study was 21.6 ± 4.0 ( 26 ). However, our findings are consistent with a study conducted in Hafr Al-Batin, Saudi Arabia. In their study, the mean SPS-6 score was 18.25 ± 2.99 (30 = 27) . Besides, our study findings are different than a study conducted at Mansoura University Hospital. Their findings revealed that the overall SPS-6 score in both the groups (ICUs and comparison group) was 21.7 (SD 5.1) and 24.4 (SD 4.9) respectively ( 25 ). Health-Related Factors and Presenteeism The study findings, including fatigue and musculoskeletal problems, are in agreement with the findings of a research carried out previously. For example, in a cross-sectional study conducted in two hospitals in Turkey, they found that when it came to the most common health issues among employees, over half (55.9%) stated persistent fatigue and poor energy, followed by joint pain and musculoskeletal complaints (49.6%), and persistent lower back/neck pain (46.0%) ( 1 ). Furthermore, this study results showed that health problems, headache, fatigue, and musculoskeletal issues had significant association with presenteeism. Moreover, these findings are in agreement with a previous study conducted at the Mansoura University Hospital which revealed that presenteeism was considerably greater among those nurses who reported having headaches, fatigue, or musculoskeletal issues ( 25 ). Similarly, a study from Portugal reported that the reasons for presenteeism among nurses were lumbago, respiratory infections, migraine and stress ( 28 ). In line with previous studies, the most frequently reported health problems associated with presenteeism are back pain, stress and anxiety, probably because these health problems are strongly related with a profession that typically requires physical and psychological efforts ( 29 ). However, in another study, the health problems causing presenteeism for nurses and pharmacists were fatigue and low energy, back or neck pain, arm or leg arthralgia, sleep problems, headache, muscle pain, cough or sore throat, fever, cold, and constipation or diarrhea ( 30 ). Limitations The cross-sectional study design limits the ability to establish causation between variables. Thus, longitudinal studies could offer a more comprehensive insight into the dynamic nature of presenteeism and its determinants over time. Likewise, depending on the self-reported data raises the potential for response biasness and might not adequately account for its complexity of measuring presenteeism. Future studies could benefit from qualitative or mix-methods approach, combining self-reports with objective measures to get a deeper understanding of other factors that are associated with presenteeism. Furthermore, focusing solely on one tertiary care hospital in the research could limit the applicability of the results to different healthcare settings or geographic regions. Recommendations The results of this study are important to the healthcare sector and its institutions because presenteeism problem in this sector is an unexamined field especially in Pakistan. The presence of presenteeism among nurses is linked to negative outcomes both for the nursing staff as well as their patients, underscoring the need for further exploration in this area. Additional studies are required to elucidate the connection between presenteeism and various aspects of working conditions, including leadership styles, organizational environment, job satisfaction, job demands, and relationships with colleagues. Further research is essential to examine the causes and predictors of presenteeism. Introducing more flexible regulations can help prevent efficiency losses and enhance overall workforce productivity. Furthermore, the results of this study could help nurse administrators and policy makers in their understanding to the prevalence of presenteeism and formulate policies addressing this phenomenon among the nursing workforce. Conclusion This study has highlighted the issue of presenteeism among nurses at a tertiary care hospital in Karachi Pakistan. The findings of this research indicated that the mean presenteeism score was lower than studies conducted in other countries. The study results highlighted the phenomenon of presenteeism, its score, and the associated factors. Furthermore, the findings of the study also revealed that health-related problems were the most common factors causing presenteeism among nurses. Moreover, years of experience and supervisor support, also showed significant association among nurses. Data obtained from the study helped the researchers to address this important issue and suggest its implications for nursing practice. Moreover, the study also highlighted future implications for conducting further studies with a qualitative nature in multiple settings to gain better understanding of the phenomenon of presenteeism and the factors that contribute to it among nurses. Declarations Acknowledgment We thank all the registered nurses at Aga Khan University Hospital for taking part in the research and providing their data. Author contributions All the authors approved the final article. Funding details. This work was not supported by any funding agency and no grant was received for this research. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. The authors confirm that this research was reviewed and approved by the Aga Khan University Ethical Review Committee (ERC: 2023-8689-25887, Approval Date: August 1, 2023). The researchers also confirm that all methods were carried out in accordance with relevant guidelines and regulations. Ethics approval and consent to participate For participation in the study informed consent was obtained from all participants, and their confidentiality was maintained throughout the study. Consent for publication Authors grant consent to publish this article. Competing interests The authors declare no competing interests. References Aysun K, Bayram Ş. Determining the level and cost of sickness presenteeism among hospital staff in Turkey. 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Sick at work: presenteeism among nurses in a Portuguese public hospital. Stress Health, 28(4), 297-304. https://doi.org/10.1002/smi.1432 Skela-Savič B, Pesjak K, Hvalič-Touzery S. Low back pain among nurses in Slovenian hospitals: cross-sectional study. Int Nurs Rev. 2017 Dec;64(4):544-551. doi: 10.1111/inr.12376. Epub 2017 Apr 26. PMID: 28444732. Warren CL, White-Means SI, Wicks MN, Chang CF, Gourley D, Rice M. Cost burden of the presenteeism health outcome: diverse workforce of nurses and pharmacists. J Occup Environ Med. 2011 Jan;53(1):90-9. doi: 10.1097/JOM.0b013e3182028d38. PMID: 21187792. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6625683","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":494164491,"identity":"e69e236d-ddbd-4d29-9125-6b5ed81b85d8","order_by":0,"name":"Farhan Shahzad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYBAC9gYGNhCdwCABJHkqauRAvAMP8GjhOYCi5cwxY7CWBKK18LYwJzZAuHi0sJ999uDnjro8/tntDz+8bWBLnx92+CHQFjs53QYcWnjSzQ17zxwulrhzIFly7g6Z3I230wyAWpKNzQ5g12LPkMYmwdt2ILHhRsIBad4zbLkbZyeAtBxI3IZDCw//MzbJv211ifNvJDb/5m1jTjecnf4BvxaJNDZpoMrEDTeSwYwEeekcArZIPGOTlm07nLjxRhqb5Zwzxww3SOcUHEgwwO0XHv40Nsm3QIfNu5H++Mabihp5+dnpmz98qLCTw6UFExiAVRoQqxwE5BtIUT0KRsEoGAUjAQAAbAFk4gcuHzgAAAAASUVORK5CYII=","orcid":"","institution":"The Aga Khan University","correspondingAuthor":true,"prefix":"","firstName":"Farhan","middleName":"","lastName":"Shahzad","suffix":""},{"id":494164493,"identity":"e931f6a7-e703-492e-a40e-7c5c0ce109d4","order_by":1,"name":"Salma Rattani","email":"","orcid":"","institution":"The Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Salma","middleName":"","lastName":"Rattani","suffix":""},{"id":494164494,"identity":"ea1ac2ba-2631-4f3f-bde5-3cb5b94039f9","order_by":2,"name":"Rozmin Jiwani","email":"","orcid":"","institution":"UT Health San Antonio","correspondingAuthor":false,"prefix":"","firstName":"Rozmin","middleName":"","lastName":"Jiwani","suffix":""},{"id":494164495,"identity":"0025c912-e954-4c75-a5f1-0c75ebd991c6","order_by":3,"name":"Zulekha Saleem","email":"","orcid":"","institution":"The Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Zulekha","middleName":"","lastName":"Saleem","suffix":""},{"id":494164497,"identity":"6b5f289a-819f-40d6-a089-a779185b632a","order_by":4,"name":"Sumia Andleeb","email":"","orcid":"","institution":"The Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Sumia","middleName":"","lastName":"Andleeb","suffix":""},{"id":494164498,"identity":"87e57578-1a2a-4893-874f-de6532512a27","order_by":5,"name":"Khairunnissa Hooda","email":"","orcid":"","institution":"Aga Khan University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Khairunnissa","middleName":"","lastName":"Hooda","suffix":""}],"badges":[],"createdAt":"2025-05-09 06:38:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6625683/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6625683/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88232983,"identity":"fa8a2e2a-73e5-482f-88de-569539a087f4","added_by":"auto","created_at":"2025-08-04 09:46:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":981756,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6625683/v1/edcb32bf-30b1-45f8-8143-86103e8376cb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictors of Presenteeism among Nurses working at a tertiary care hospital in Karachi, Pakistan: A cross-sectional analytical study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe nature of work, particularly in the environments in which it is performed, has been subject to a great deal of change recently. Employees output and well-being are affected by a wide range of influences, including but not limited to new managerial methods, scientific and technical advancements, mobility, and competition (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). When compared to professionals working in other occupations, nurses frequently face job insecurity because of the precarious nature of their job, excessive workloads, physical fatigue, and psychological pressure as well (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This issue has been investigated from different viewpoints, and is associated with higher medical expenses as well as breaching the safety of patients, both of which are linked to a low sense of well-being, and poor quality of patient care (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMoreover, it is common for healthcare workers, and nurses in particular, to be subjected to high workloads, shift duties, and irreplaceable jobs, yet these individuals continue to perform their duties while being ill (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Likewise, there is a potential for adverse outcomes to arise because of high work demands, treatment regimens, inadequate staffing, and staff turnover as well. These consequences include absenteeism and presenteeism, both of which can compromise nurses\u0026rsquo; health, and the quality of care they provide to their patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In addition, both absenteeism and presenteeism are closely linked together as they cover health problems that have varying personal, physiological, societal, familial, economical, or functional reasons. Presenteeism has more consequences as it raises health expenses, lowers efficiency, increases the number of work incidents, and also causes institutional losses (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Additionally, it has been discovered that job-related attributes, such as shifting work, job demands and instability, unfavorable working environment, and relationship with co-workers, are linked to a greater incidence of presenteeism (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn healthcare, presenteeism is characterized as \u0026ldquo;the act of a healthcare professional who continues to work while sick or suffering from a health condition that results in their low performance at work\u0026rdquo; (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Presenteeism has a variety of negative effects such as workplace burnout and depression (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), a decline in communication, productivity, and performance skills, which ultimately results in their decreased work quality towards patients depicted in their outcomes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Additionally, it also has an effect on nurses when they provide basic nursing interventions like toileting, medication, health promotion, and assistance with diet (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). A rise in adverse events, such as errors in medication administration, transmission of diseases and infections, and increased risk of falls have been associated with presenteeism (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent studies conducted in several countries showed that presenteeism is highly prevalent among nurses, including 52.6% among American nurses (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), 55% among Portuguese nurses (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), while in China, it is 82.1% and 94.25% among nurse managers and nurses respectively (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). A meta-analysis was done including 28 studies from 14 countries reported that presenteeism is a prevalent problem among nurses, expected to be around 49% (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePresenteeism is caused by a \u0026ldquo;self-sacrifice culture\u0026rdquo; that encourages healthcare workers to remain at work despite being sick and expects the same from their co-workers to prevent understaffing, insufficient staff-patient ratios, or a lack of clinical skills (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Based on the hospital\u0026rsquo;s viewpoint, it was discovered that presence in the workplace is a culture or based on a desire to be seen. In fact, this behavior is common and strong exist in the Asian healthcare industry, as well as in rural services where finding a substitute is a challenging task because of the shortage of workforce (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Additionally, because of the profession\u0026rsquo;s caring behavior, emphasis on collaboration and teamwork, and an increased sense of devotion because of the nursing profession\u0026rsquo;s socialization process, presenteeism may unintentionally be encouraged because nurses, even when they are not feeling well, do not want to let their co-workers down (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThus, examining presenteeism in light of the experiences of nurses in various healthcare settings is necessary (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In this context, it is important to comprehensively identify presenteeism and its associated factors among nurses. Therefore, the purpose of this study was to compute presenteeism score level and predict its associated factors among nurses working at the selected tertiary care hospital in Pakistan.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003e A cross-sectional analytical study was conducted between August and September 2023 in Karachi, Pakistan, at a tertiary care hospital named Aga Khan University Hospital. This hospital is accredited by Joint Commission International which provides the most advanced medical care according to the international standards. This study was approved by the Ethical Review Committee of the Aga Khan University Hospital (ERC: 2023-8689-25887), and permission was obtained from the hospital administration, chief medical and nursing officers, and the participating nurses.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants and recruitment\u003c/h3\u003e\n\u003cp\u003eNurses were recruited from all departments of the selected hospital. Convenience sampling was employed to ensure diversity across each department. Eligible participants were: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) registered nurses with at least one year of clinical experience; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) working in either inpatient or outpatient departments. However, trainee nurse interns and those nurses who did not meet these criteria or who failed to complete the questionnaire in full were excluded. Also, other healthcare professionals working in the selected setting were not included in the study. Recruitment was facilitated through departmental nursing managers and head nurses.\u003c/p\u003e\n\u003ch3\u003eData collection tool\u003c/h3\u003e\n\u003cp\u003eData collection was done using two instruments: socio-demographic questionnaire, and an adopted questionnaire called Stanford Presenteeism Scale (SPS-6). The socio-demographic questionnaire gathered participants\u0026rsquo; data including age, gender, marital status, qualification, years of experience, etc. However, Stanford Presenteeism Scale (SPS-6) assessed presenteeism with 6 items using Likert-scale responses reflecting presenteeism over the past month. The SPS-6 has a score ranging from 6 to 30 points. Among the six items, 1, 3 and 4 pertain to the ability to \u0026lsquo;avoid distractions\u0026rsquo; in their work. These items are worded negatively and are scored in reverse. On the other hand, items, 2, 5 and 6 examine the ability of people in completing their work and are worded positively. Moreover, the score is characterized as low (ranging from 6 to 18), and high (ranging from 19 to 30). Low score signifies a decline in work performance while high score indicates greater capacity for workers to concentrate and accomplish their tasks even in the presence of health problems (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eStudy size\u003c/h3\u003e\n\u003cp\u003eSample size estimation was done on the basis of 95% confidence level, a 5% margin of error, and an assumed variation across different departments. Using these parameters, a minimum required sample size of approximately 277 nurses was calculated using OpenEpi software for cross-sectional studies. To account for possible incomplete responses, the questionnaire was distributed to over 300 nurses, resulting in 278 valid responses which were included in the final analysis.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe data collected from nurses were coded into SPSS version 26 and Microsoft Excel Software. After completion of data entry, descriptive analysis was done for all independent and outcome variables. Moreover, mean and standard deviation were computed for quantitative variables. On the other hand, frequency and proportion were computed for categorical variables. Chi-square test was applied for determining the association between presenteeism with socio-demographic characteristics and health problems. P value of \u0026lt;\u0026thinsp;0.05 were interpreted as statistically significant for the study. The analysis was guided by research objectives and research questions and was done according to the literature reviewed. This complete analysis approach was used to maintain data integrity and reduce bias from imputation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic Characteristics of the Respondents\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eshows the socio-demographic characteristics of the respondents. The findings revealed a similar proportion of both male (50.2%) and female (49.8%) nurses in the study. The age was divided into four categories. The study indicated that the majority, 66.1%, were within the 21-30 age group. The age group, 31-40 years, accounted for 32.1% of the participants. Those in the 41-50 years age group made up 1.8%, while there were no participants above 50 years of age. In terms of marital status, more than half (58.5%) of them were married, and 41.5% were single. Besides, 88.1% of the respondents in the study hold bachelor\u0026rsquo;s degree as their educational level, followed by diploma which represented 11.2%. The participants having a master\u0026rsquo;s degree were 0.7%.\u003c/p\u003e\n\u003cp\u003eRegarding their working areas, 46.2% were working in medical-surgical units, 48.7% in critical areas, and only 5.1% in outpatient areas. In terms of their duty schedule, majority of the nurses, 92.4% were working in shift duties. There were 89.2% participants who indicated that their job demands are high, while majority, 77.6%, stated their job as stressful. Majority of the respondents, 93.9%, perceived their supervisor as supportive. Of the total respondents, 40.8% of them reported having sleep problems. Moreover, most of the participants, 79.8%, stated while working they had experienced physical fatigue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Socio-demographic characteristics of respondents (n=277)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50.2\u003c/p\u003e\n \u003cp\u003e49.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003cp\u003e31-40\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41-50\u003c/p\u003e\n \u003cp\u003e\u0026gt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003cp\u003e89\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e66.1\u003c/p\u003e\n \u003cp\u003e32.1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e58.5\u003c/p\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003cp\u003eBachelors\u003c/p\u003e\n \u003cp\u003eMasters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003cp\u003e244\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003cp\u003e88.1\u003c/p\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eWorking area\u003c/p\u003e\n \u003cp\u003eMedical-surgical area\u003c/p\u003e\n \u003cp\u003eCritical area\u003c/p\u003e\n \u003cp\u003eOutpatient area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003cp\u003e48.7\u003c/p\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eWork schedule\u003c/p\u003e\n \u003cp\u003eOne shift only\u003c/p\u003e\n \u003cp\u003eShift duty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003cp\u003e256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003cp\u003e92.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eJob demands\u003c/p\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e89.2\u003c/p\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eExperience in years (Mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e4.78 (3.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eHow would you rate your job?\u003c/p\u003e\n \u003cp\u003eStressful\u003c/p\u003e\n \u003cp\u003eNot stressful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e77.6\u003c/p\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eHow would you rate your supervisor\u0026rsquo;s support?\u003c/p\u003e\n \u003cp\u003eSupportive\u003c/p\u003e\n \u003cp\u003eNot supportive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e93.9\u003c/p\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eDo you usually have sleep problems?\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40.8\u003c/p\u003e\n \u003cp\u003e59.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eDo you usually feel fatigued?\u003c/p\u003e\n \u003cp\u003eMentally\u003c/p\u003e\n \u003cp\u003eEmotionally\u003c/p\u003e\n \u003cp\u003ePhysically\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003cp\u003e79.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of Presenteeism and Presenteeism Score\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study revealed that all the participants admitted that they had experienced presenteeism while being at work. The study resulted that the presenteeism variable had an overall score of 18.28 \u0026plusmn;2.70 with a relatively low standard deviation. \u003cstrong\u003e(Table 2).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eOverall presenteeism score and standard deviation of the study participants (n=277)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 616px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresenteeism Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e18.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u0026plusmn;2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eFrequency distribution and percentage of common health problems among nurses (n=277)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Problems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (277)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e93.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eDigestive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e75.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e81.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eRespiratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e92.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eEye\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e5.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e93.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eMenstrual pain (female only) (n = 138)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e89.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eMusculoskeletal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e89.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eSkin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e5.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eUrinary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e15.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eEar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e2.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eMigraine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 270px;\"\u003e\n \u003cp\u003eCardiac\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e4.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e provides the information about the number of individuals who reported experiencing specific health problems or symptoms. Participants were not limited to select only one response as they could have more than one health problems. Fatigue was a common health problem among all nurses, with 260 (93.8%) out of 277. In addition, 210 (75.8%) experienced digestive issues,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e232 (81.3%) were affected by stress, respiratory problems were reported by 255 (92%) nurses, and 260 (93.8%) of the nurses were affected by fever. In the present study, out of 277 nurses, 138 were females, who had worked while having menstrual pain. Furthermore, headache, musculoskeletal problems were another most common health problems faced by nurses while being at work. In addition, out of 277 nurses, 14 (5.1%) have faced eyes problems, 6 (2.2%) faced ear problems, 15 (5.4%) faced skin problems, and 13 (4.7%) of the nurses had cardiac problems while being at work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Association of the two dimensions of SPS-6 with health problems, p-value 0.05\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026lsquo;Avoiding Distraction\u0026rsquo; Dimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026lsquo;Completing Work\u0026rsquo; Dimension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eHealth Problems:\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eDf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eDf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e43.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e23.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.024*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eDigestive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e36.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e42.552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e48.975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e38.887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eRespiratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e60.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e35.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eEye\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e45.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e19.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e74.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e45.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e32.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e18.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eMusculoskeletal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e37.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e20.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eSkin disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e38.791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eUrinary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e12.788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e17.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eEar disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e62.301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eMigraine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e15.483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e55.742\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.000**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eCardiac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e30.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e27.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Chi-square test was applied to find association between the two dimensions, \u0026lsquo;Avoiding Distraction\u0026rsquo; and \u0026lsquo;Completing Work\u0026rsquo;, in relation to various health problems. Evidently, fatigue, digestive issues, stress, respiratory problems, fever, eye, headache, and musculoskeletal problems were the health problems having highly significant association with the two dimensions. Furthermore, cardiac-related issues also showed a significant association with both dimensions. In addition, other health problems showed include skin, urinary and ear disorders, and migraine.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e Comparison of socio-demographic characteristics with presenteeism among nurses\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 316px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresenteeism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eDf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e19.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.346\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e32.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.444\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e40.682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.272\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eWorking area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17.863\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.995\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eWork schedule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e7.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.990\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eJob demands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e15.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.660\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eExperience in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e745.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eHow would you rate your job?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e16.668\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.546\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eHow would you rate your supervisor\u0026rsquo;s support?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e44.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eDo you usually have sleep problems?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24.237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 325px;\"\u003e\n \u003cp\u003eDo you usually feel fatigued?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e37.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.408\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 642px;\"\u003e\n \u003cp\u003eMean presenteeism score\u0026nbsp;\u0026plusmn;\u0026nbsp;SD = 18.28\u0026nbsp;\u0026plusmn;\u0026nbsp;2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e provides the results of the Chi-square test to find the association between socio-demographic characteristics and the variable \u0026lsquo;presenteeism\u0026rsquo;. This table aims to understand how various factors in the workplace are associated with presenteeism. The results indicated that most of the variables do not show a significant association with presenteeism, except for \u0026lsquo;experience in years\u0026rsquo; and \u0026lsquo;supervisor support\u0026rsquo;, which showed highly significant association with presenteeism. Hence, it was suggested that years of experience and supervisor support are crucial factors in understanding presenteeism in this context.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u003c/strong\u003e Association of nurses\u0026rsquo; health problems with presenteeism.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 426px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresenteeism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eHealth Problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eDf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e40.680\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eDigestive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e51.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e46.505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eRespiratory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e77.624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eEye\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e19.248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eFever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e79.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eMenstrual pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e19.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.346\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eHeadache\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eMusculoskeletal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e62.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eSkin disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e73.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eUrinary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e7.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.980\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eEar disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e32.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eMigraine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e21.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.267\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eCardiac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e109.743\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e provides results of Chi-square test of association between health problems and the variable \u0026lsquo;presenteeism\u0026rsquo;. Looking into the results given in Table 6, some of the health problems showed a highly significantly association with presenteeism. These health problems include fatigue, digestive issues, respiratory disorders, fever, musculoskeletal issues, skin disorders, and cardiac problems. In addition, ear issues also showed association with presenteeism. Moreover, regarding female nurses, menstrual pain showed highly significant association with presenteeism. Furthermore, other health problems, including eye disorders, headache, urinary issues, and migraine showed no significant association with presenteeism. Thus, these results suggest that fatigue, digestive issues, stress, respiratory disorders, fever, musculoskeletal issues, skin and ear disorders, and cardiac problems were found to be the predictors of presenteeism among nurses. Similarly, this study findings showed that socio-demographic variables, such as years of experience and supervisor support, were associated with presenteeism.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e This cross-sectional analytical study assessed presenteeism and the factors associated with it among nurses working at a tertiary care hospital in Karachi Pakistan. The results revealed that the mean score of presenteeism is 18.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70. The study further revealed that socio-demographic characteristics such as experience in years and supervisor support, and various health problems were the predictors of presenteeism among nurses.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographics and Presenteeism\u003c/h2\u003e\u003cp\u003eRegarding the socio-demographic characteristic sex, the study showed slightly different results than a previous study. For example, a cross-sectional study conducted in two hospitals in Turkey, they found that females were more susceptible to presenteeism resulting from health issues when compared to men (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Moreover, regarding the socio-demographic characteristics, such as gender, marital status, educational level, working area, and work schedule, this study found no association with the level of presenteeism. This study\u0026rsquo;s findings are consistent with a cross-sectional study conducted among 309 nurses in Saudi Arabia at the university hospital. In this study, variables like gender, marital status, education, type of unit, type of shift, did not show any significant association with presenteeism (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eConcerning the socio-demographic characteristics, including gender, marital status, high job demands, and work schedule, this study found no association with presenteeism. In contrast, a study conducted in Egypt found different results. Their study revealed that higher presenteeism was found among nurses who were female and married, having high demanding jobs, and those worked in shifts (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In addition, this study found no association between presenteeism and educational level. Similarly, a study conducted in China also reported that there was no statistically significant relation between presenteeism and educational level (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, a secondary analysis conducted in the United States showed slightly different results in which they found that presenteeism was highly influenced by the health of individuals with lower educational backgrounds compared to those with higher educational backgrounds (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of Presenteeism and SPS-6 Score\u003c/h2\u003e\u003cp\u003eOur findings showed that almost all of study participants experienced presenteeism. Similarly, studies conducted in other countries showed that presenteeism is highly prevalent among nurses, including 52.6% among American nurses (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), and 55% among Portuguese nurses (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Similarly, in China, it is 82.1\u0026ndash;94.25% among nurses\u0026rsquo; managers and nurses (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Our study findings indicated a low level of presenteeism. Low score indicates a decline in work performance. This means that the lower score obtained from this study shows a decline in performance which indicates that the participants\u0026rsquo; work was more affected by the behavior (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The SPS-6 score, 18.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70, obtained in our study, was lower than the overall mean score in another study was 21.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). However, our findings are consistent with a study conducted in Hafr Al-Batin, Saudi Arabia. In their study, the mean SPS-6 score was 18.25\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99 \u003cb\u003e(30\u0026thinsp;=\u0026thinsp;27)\u003c/b\u003e. Besides, our study findings are different than a study conducted at Mansoura University Hospital. Their findings revealed that the overall SPS-6 score in both the groups (ICUs and comparison group) was 21.7 (SD 5.1) and 24.4 (SD 4.9) respectively (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eHealth-Related Factors and Presenteeism\u003c/h2\u003e\u003cp\u003eThe study findings, including fatigue and musculoskeletal problems, are in agreement with the findings of a research carried out previously. For example, in a cross-sectional study conducted in two hospitals in Turkey, they found that when it came to the most common health issues among employees, over half (55.9%) stated persistent fatigue and poor energy, followed by joint pain and musculoskeletal complaints (49.6%), and persistent lower back/neck pain (46.0%) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Furthermore, this study results showed that health problems, headache, fatigue, and musculoskeletal issues had significant association with presenteeism. Moreover, these findings are in agreement with a previous study conducted at the Mansoura University Hospital which revealed that presenteeism was considerably greater among those nurses who reported having headaches, fatigue, or musculoskeletal issues (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Similarly, a study from Portugal reported that the reasons for presenteeism among nurses were lumbago, respiratory infections, migraine and stress (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn line with previous studies, the most frequently reported health problems associated with presenteeism are back pain, stress and anxiety, probably because these health problems are strongly related with a profession that typically requires physical and psychological efforts (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). However, in another study, the health problems causing presenteeism for nurses and pharmacists were fatigue and low energy, back or neck pain, arm or leg arthralgia, sleep problems, headache, muscle pain, cough or sore throat, fever, cold, and constipation or diarrhea (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe cross-sectional study design limits the ability to establish causation between variables. Thus, longitudinal studies could offer a more comprehensive insight into the dynamic nature of presenteeism and its determinants over time. Likewise, depending on the self-reported data raises the potential for response biasness and might not adequately account for its complexity of measuring presenteeism. Future studies could benefit from qualitative or mix-methods approach, combining self-reports with objective measures to get a deeper understanding of other factors that are associated with presenteeism. Furthermore, focusing solely on one tertiary care hospital in the research could limit the applicability of the results to different healthcare settings or geographic regions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations\u003c/h2\u003e\u003cp\u003eThe results of this study are important to the healthcare sector and its institutions because presenteeism problem in this sector is an unexamined field especially in Pakistan. The presence of presenteeism among nurses is linked to negative outcomes both for the nursing staff as well as their patients, underscoring the need for further exploration in this area. Additional studies are required to elucidate the connection between presenteeism and various aspects of working conditions, including leadership styles, organizational environment, job satisfaction, job demands, and relationships with colleagues. Further research is essential to examine the causes and predictors of presenteeism. Introducing more flexible regulations can help prevent efficiency losses and enhance overall workforce productivity. Furthermore, the results of this study could help nurse administrators and policy makers in their understanding to the prevalence of presenteeism and formulate policies addressing this phenomenon among the nursing workforce.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This study has highlighted the issue of presenteeism among nurses at a tertiary care hospital in Karachi Pakistan. The findings of this research indicated that the mean presenteeism score was lower than studies conducted in other countries. The study results highlighted the phenomenon of presenteeism, its score, and the associated factors. Furthermore, the findings of the study also revealed that health-related problems were the most common factors causing presenteeism among nurses. Moreover, years of experience and supervisor support, also showed significant association among nurses. Data obtained from the study helped the researchers to address this important issue and suggest its implications for nursing practice. Moreover, the study also highlighted future implications for conducting further studies with a qualitative nature in multiple settings to gain better understanding of the phenomenon of presenteeism and the factors that contribute to it among nurses.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the registered nurses at Aga Khan University Hospital for taking part in the research and providing their data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors approved the final article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding details.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was not supported by any funding agency and no grant was received for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eThe authors confirm that this research was reviewed and approved by the Aga Khan University Ethical Review Committee \u0026nbsp; (ERC: 2023-8689-25887, Approval Date: August 1, 2023). The researchers also confirm that all methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor participation in the study informed consent was obtained from all participants, and their confidentiality was maintained throughout the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors grant consent to publish this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAysun K, Bayram Ş. Determining the level and cost of sickness presenteeism among hospital staff in Turkey. 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International Journal of Nursing Studies. 2020 Sept;109:103659. doi:10.1016/j.ijnurstu.2020.103659\u003c/li\u003e\n \u003cli\u003eAndres EB, Lui JN, Song W, Johnston JM. Exploring Hong Kong nurses\u0026rsquo; decision-making processes around presenteeism. Occupational Medicine. 2021 May 8;71(4\u0026ndash;5):189\u0026ndash;95. doi:10.1093/occmed/kqab047\u003c/li\u003e\n \u003cli\u003eLui JN, Andres EB, Johnston JM. Presenteeism exposures and outcomes amongst hospital doctors and nurses: A systematic review. BMC Health Services Research. 2018 Dec;18(1). doi:10.1186/s12913-018-3789-z\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMoloney W, Fieldes J, Jacobs S. An integrative review of how healthcare organizations can support hospital nurses to thrive at work. International Journal of Environmental Research and Public Health. 2021 Apr;17(23):8757. doi:10.3390/ijerph17238757\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCho YS, Park JB, Lee KJ, Min KB, Baek CI. The association between Korean workers\u0026apos; presenteeism and psychosocial factors within workplaces. Ann Occup Environ Med. 2016 Sep 7;28(1):41. doi: 10.1186/s40557-016-0124-1. PMID: 27610235; PMCID: PMC5015345.\u003c/li\u003e\n \u003cli\u003eKoopman C, Pelletier KR, Murray JF, Sharda CE, Berger ML, Turpin RS, et al. Stanford Presenteeism Scale: Health status and employee productivity. Journal of Occupational and Environmental Medicine. 2002 Jan;44(1):14\u0026ndash;20. doi:10.1097/00043764-200201000-00004\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eH E, EA K, HS A-E, R S. Presenteeism among nursing staff of Intensive Care Units. Egyptian Journal of Occupational Medicine. 2022 May;46(2):101\u0026ndash;81. doi:10.21608/ejom.2022.237285\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSimonetti V, Della Pelle C, Cerratti F, Flacco ME, Cicolini G. Presenteeism levels among Italian nurses. A multicentric survey. Prof Inferm. 2021 Jul-Sep;74(2):119-125. English. doi: 10.7429/pi.2021.742119. PMID: 34418913.\u003c/li\u003e\n \u003cli\u003eAl-Mutairi AA, Al-Mutairi MM, Al-Sahli MS, almutairi KB, Almutairi AG, almutairi M saud. Prevalence of job stress and presenteeism among nurses in hospitals of Hafr Al-Batin City, Saudi Arabia. Saudi Journal of Nursing and Health Care. 2022 Sept 10;5(9):185\u0026ndash;99. doi:10.36348/sjnhc.2022.v05i09.003\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMartinez, L. F., \u0026amp; Ferreira, A. I. (2012). Sick at work: presenteeism among nurses in a Portuguese public hospital. Stress Health, 28(4), 297-304. https://doi.org/10.1002/smi.1432\u003c/li\u003e\n \u003cli\u003eSkela-Savič B, Pesjak K, Hvalič-Touzery S. Low back pain among nurses in Slovenian hospitals: cross-sectional study. Int Nurs Rev. 2017 Dec;64(4):544-551. doi: 10.1111/inr.12376. Epub 2017 Apr 26. PMID: 28444732.\u003c/li\u003e\n \u003cli\u003eWarren CL, White-Means SI, Wicks MN, Chang CF, Gourley D, Rice M. Cost burden of the presenteeism health outcome: diverse workforce of nurses and pharmacists. J Occup Environ Med. 2011 Jan;53(1):90-9. doi: 10.1097/JOM.0b013e3182028d38. PMID: 21187792.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"presenteeism, nurses, work productivity, working while ill","lastPublishedDoi":"10.21203/rs.3.rs-6625683/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6625683/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Nurses are considered the backbone of hospitals (healthcare institutions) who provide care for their patients despite being ill. This phenomenon of working while ill or suffering from a health condition is called presenteeism. Presenteeism is becoming a more prominent problem among healthcare providers, especially nurses. It has a variety of negative effects, including stress and burnout, decline in productivity and performance, and ultimately resulting in decreased quality of care. Therefore, the purpose of this study is to compute presenteeism score and predict its associated factors among nurses working at a tertiary care hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional analytical study design was utilized to assess presenteeism score and predict its associated factors among nurses. A total of 277 nurses were recruited for the study by using convenience sampling techniques. A socio-demographic questionnaire was used for participants’ characteristics and professional details, while a scale was used for assessing presenteeism score. Chi square test was used to analyze associated factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe overall mean presenteeism score obtained from the study was 18.28 with a standard deviation of ±2.70. Socio-demographic characteristics, including experience in years, and supervisor support, were found to have significant association with presenteeism. Regarding health-related problem, fatigue, digestive and respiratory issues, fever, headache, musculoskeletal complaints, cardiac issues, and menstrual pain in females, were found to be the predictors of presenteeism among nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis research suggests that presenteeism is linked to various health problems and has impacts on nurses and their quality of care. Understanding and addressing the underlying causes of presenteeism in the nursing profession is vital for promoting the overall health condition and productivity of healthcare staff and ensuring high-quality patient care.\u003c/p\u003e","manuscriptTitle":"Predictors of Presenteeism among Nurses working at a tertiary care hospital in Karachi, Pakistan: A cross-sectional analytical study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 09:30:44","doi":"10.21203/rs.3.rs-6625683/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-24T15:41:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-01T08:21:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-01T05:33:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"20278880626939109565328271559909079245","date":"2025-08-01T04:16:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-30T11:07:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227399558565273488796646286994965152293","date":"2025-07-30T11:03:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16323879576640525200504138493485019916","date":"2025-07-30T04:17:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315247324247124312917512448886064156676","date":"2025-07-30T04:09:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-30T02:03:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-15T10:21:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-15T05:31:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-15T05:29:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-05-09T06:31:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"89bf00ca-d10d-439b-b98a-4e5117e26c78","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T18:08:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-04 09:30:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6625683","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6625683","identity":"rs-6625683","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}