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SOURCES OF STRESS AND STRESS MANAGEMENT PRACTICES OF HEALTHCARE PROFESSIONALS AT NATIONAL ORTHOPAEDIC HOSPITAL

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CHAPTER ONE

Introduction

 

Background to the Study                                           

Stress is one of the serious emotional and mental health problems spanning through the globe today because every human being has needs and wants and there is a deep hunger and enthusiasm in people to satisfy these demands. However, as effort is being made to satisfy these numerous needs one finds himself in a stressful situation. Stress is interwoven with life. The United Nation Organization -UNO (1992) reported stress to be the 20th century epidemic.  World Health Organization –WHO (1996) pointed out stress as a “World Wide Epidemic”. The American Institute of Stress (2005) also opined that the biggest threat to health today is stress. Hence, stress was rated as American number one health problem. United Kingdom Health and Safety Executives –HSE (2005) estimated that over 13 million working days are lost every year because of stress as it is believed to trigger 70 per cent of visits to doctors, and 85 per cent of serious illnesses occurring in the United Kingdom. The cost of stress in terms of human suffering, social and occupational impairment and illness are enormous.  In fact, there is nothing amazing about the statement that people today are being  assaulted by stress.

Nigeria is not left out in the struggle against stress. Studies have shown that oil spills and accidents can be major sources of stress (Ogundele; Ogunsola & Ogundele 2001). Nweze (2005) submitted that for two and half decades, stress has become a topical issue in management development, seminars and workshops in Nigeria. He further stated that the popularity of stress stems from a number of obvious reasons. Firstly, stress is inextricably interwoven with life and ceases only when the individual stops breathing. More so, nobody is immune to stress, the young, old, rich, poor, professionals, and lay men alike are potential victims of stress. Secondly, he further stated that our traditional mechanisms of handling the stresses and strains of living such as age grade activities, moonlight tales, watching and organizing cultural dances, swimming in village rivers are fast diminishing. This is being precipitated by the factor of rapid urban development, increasing corporate regimentation of work to life, breakdown of social supports, increasing personal and group conflicts, including security threats to life and property. The frustrations, disappointments and pressures of daily life constitute the genesis of stress. Stress has been conceptualized in many ways.

According to Sisk (1977) stress as a state of strain, tension, or pressure and it is a normal reaction resulting from interaction between the individual and the environment. Strain means to make great demand on something; tension is an anxious feeling, mental worry or emotional strain that makes natural relaxed behavior impossible; and pressure is a powerful demand on somebody’s time, attention or energy. Stress can also be viewed as a condition or situation in the body that makes people prone to anxiety, depression, anger, hostility, inadequacy and low frustration tolerance (Wai, 2003). Anxiety is a state of feeling nervous or worried; depression is a state of feeling very sad and without hope; anger is a strong feeling you have when something has happened that you think is bad or unfair; hostility is an unfriendly or aggressive feeling or behavior; inadequacy is a state of not being able to deal with a situation; and frustration arises when something is preventing somebody from succeeding (Hornby, 2005).

Beehr and Newman (1978) perceived stress in an occupational setting to mean a condition wherein job-related factors interact with workers, to change their psychological and physiological conditions such that the person’s mind and body are forced to deviate from normal functioning. Beehr (1995) further conceptualize job stress as a situation in which some characteristics in the work situation are thought to cause poor psychological or physical health, or to cause risk factors making poor health more likely. He further stated that these characteristics in the work situation liable to cause poor psychological and physical health are labeled stressors. However, stress in this study, will be refer to as a condition or situation where individual and job related stressors force the body and mind of the healthcare professional to deviate from normal functioning. Ezeilo (1995) asserted that these stressors are demanding life situation found in our homes, places of work, communities and in our interactions with people in the environment. These stressors found in the home and communities and our interactions with people in the environment will be considered personal stressors while those found in the place of work will be considered job stress in this study. More so, the healthcare professionals may be prone to stress via various sources due to the nature of their job which requires a high level of skill, team working in a variety of situations, provision of twenty four hour delivery of care, and input of what is often referred to as emotional labor (Coon, 1994).The stresses in the workplace are many.

Ahsan, Abdullah, Fie and Alam (2009) identified six workplace stressors that may impact on healthcare professionals and they include: workload pressure, relationship with others, role conflict, home-work interface, role ambiguity and performance pressure. Workload pressure is a situation where the amount of work assigned to a person places a high demand on ones time, attention or energy; relationship with others is the behavior or feeling toward somebody else; role conflict is the disagreement or clash between ideas or principles in practice among different health professionals; home-work interface is the overlap between work and home; role ambiguity is the lack of clear information about the requirements of the health  professional role; and performance pressure is the accomplishment of multiple task to keep abreast of changing technology (Ahsan, Abdullah, Fie & Alam, 2009).

In the view of Aniza, Malini, and Khalib (2010), organizational factors that can expose the healthcare professional to stress include, job condition, interpersonal factors, career development. The authors further explained job condition as the workers ability or inability to cope with working condition such as work overload, shift work, technological problems, physical danger and decision making; interpersonal factors as a worker experiencing a situation such as poor work and social support, political rivalry, jealousy and anger between colleagues; career development as a situation where a worker experiences under or over promotion, job insecurity and frustrated ambition. Basically, this study will view sources of stress among the health care professionals to include the following; role conflict, role ambiguity, workload, performance pressure and home–work interface. Effects of stress are enormous.

Stress has effect both on the organization and individual by causing ill health on the individual and on the organization, causing economic loss via high absenteeism among staff, low productivity and a decrease in decision making ability (Aniza, Malini, & Khalib, 2010). Job condition, interpersonal relationship, career development, role in the organization, and home-work interface are known stressor for the HCPs, these listed stressors are demanding situation while the way each individual professional views the outcome becomes the perception. Brunero, Cowan, Grochulski and Garvey (2006) stated that the difference between the demanding situation and the HCPs perception of the situation is what determines the degree of the stress effect.

The effect of stress at work is undesirable, both on the health and safety of workers and on the health and effectiveness of their organization (International Labour Office-ILO, 1986). Brunero, Cowan, Grochulski and Garvey (2006) posited that the effect of stress ranges from minor symptoms like tiredness and disrupted sleep patterns to major crisis like hypertension and eventual heart attack, which emerges in the context of prolonged periods of exposure to intense stress. It is important, therefore, to be able to recognize and manage the early effects of stress, in order to avoid the more serious effects of stress on the health and wellbeing of the HCPs.  However, every health problem like stress that does not have a permanent cure can be managed.

Management can be defined in various ways. In the view of Esiekpe (2003) management simply implies the skill in dealing with something or to be in perfect control of a situation. According to Hornby (2005) management is the act or skill of dealing with people or situation in a successful way. When stress is linked with management, it becomes stress management. Stress management is the ability to maintain control when situation, people and events make excessive demands on us (Diener & Hokanson, 1998). According to Okafor and Okafor (1998) stress management entails setting up roadblocks so that the progression to the illness or disease level does not occur. They further explained that managing stress is an on going process. It is learning about whom we are as human beings, why we act and react to the world around us as we do, and having the ability to deal effectively with life’s insults and frustrations as well as its joys and pleasures. This may be why stress management is referred to as life management.  Encarta (2009) asserted that stress management is a means of dealing with stress which can be by physical and psychological techniques designed to enable people to cope with strain and anxiety. However, this study conceptualizes stress management as the ability the healthcare professional has to maintain control when a situation at workplace, communities and interaction with people in the environment becomes a stressor.  World Health Organization-WHO (2011) submitted that stress relating to work is the second most frequent health problem impacting one third of employed workers in the European Union today.  Hence this study will focus on stressors faced by healthcare professional at workplace, communities and interaction with people in the environment. Stress often projects a state of psychological and physiological disequilibrium; an equilibrium state can be re-established via stress management practices.

Practice basically connotes action. Webster (2000) defines practice as the act of doing something customarily, or habitually, or to do or perform something often. Practice also refers to doing something regularly (Hornby, 2005). Practice within the context of this study is the most common and regular technique used by the healthcare professional to manage stress. However, practice cannot be treated in isolation; there is a need that practice be linked with stress management. When practice is linked with stress management it becomes stress management practice. For Cooper (1986) stress management practices comprises of measures taken to  cope with trying periods, so that a state of psychological and physiological equilibrium is re-established. Olga and Terry (1994) stated that stress management practices are methods often employed to deal with stressful or disturbing situations. They further categorized these methods into effective and ineffective practices. Such ineffective practices are overreacting, drug abuse, aggression which may make us feel better shortly, while effective practices are positive thinking and relaxation. Akubue (2000) identified other management practices like exercise, discussion, relaxation and holiday. Stress management practice (SMP) is conceptualized in this study as all the methods or techniques often employed by the healthcare professional to deal with stressful or disturbing situation. In as much as the ineffective practices can expose the healthcare professional to ill health, the effective practices can energize the health care professional to render meaningful healthcare services.

Healthcare involves a multitude of services rendered to individuals, families, communities by health professionals for the purpose of protecting, promoting, maintaining or restoring health (Park, 2007). Wallace (2008) defined healthcare as all the activities rendered by the health care worker to ensure well being of individuals. He identified these activities to be preventive, for example immunization services; rehabilitative services, for example restoration of people who have had a severe, prolonged, debilitating illness; and keeping the public informed on health matters that is health education. Lucas and Gilles (2009) also included special services such as care of pregnant mothers and social welfare like caring for the handicapped as part of the services rendered by healthcare professionals.

A professional is a member of a professional association, somebody whose occupation requires extensive education or specialized training (Encarta, 2009). A healthcare professional (HCP) is a person trained and knowledgeable in medicine, nursing, or other allied health professions or public/community health (Wikipedia, 2012). For the purpose of this study, healthcare professionals – HCPs refer to a group of practitioners with specialized education and training, in their various fields of health who render curative, preventive, rehabilitative, and educational services to patients and public on matters relating to their health. They share common health goals and objectives and they include; medical doctors, nurses, pharmacist, medical laboratory scientist, physiotherapist, dieticians, radiotherapists, medical records officers, and social workers.

The Medical Job Description-MJD (2012) outlines the duties of these healthcare professionals as follows: medical doctors, diagnose, prescribe drugs for patients and perform surgeries; nurses, care for patients and help them attain, maintain, or recover optimal health; pharmacists, dispense safe and effective medication in the hospital/health facilities;  medical laboratory scientist, carries out investigations which are use in patient diagnosis and treatment; physiotherapist, treats patients with physical problems caused by illness, accidents or ageing with manual therapy, therapeutic exercise and application of electro- physical modalities. Furthermore, dieticians, supervise the preparation of food, develop modified diets for diabetics, obsessed, cancer patient, osteoporotic, pediatrics and kidney diseased patient, and educate patients, individuals and groups on good nutritional habits; radiotherapists, treats patients with radioactive substances and x-rays;  medical record officers, collate, organize, retrieve and archive the record of a patient or client for the purpose of recording and informing their care; and lastly, social worker, improve the quality of life and wellbeing of patient by intervening on behalf of those afflicted with poverty or any real or perceived social injustice and violation of their human rights. For optimum care of the patient/ public, these job specification listed above connotes that team working is required by each healthcare professional.

These healthcare professionals seem to undergo enormous stressors at work. These stressors may vary in severity and duration. No wonder, Onuzulike (2006) maintained that the uniqueness of human being in responding to pressure is not solely due to what happens to them but also the way they think. Nevertheless, the truth is that the HCPs have an emotionally demanding helping job type, that is, a type of job that leaves them with strong feelings for their patient condition of health, because they deal more directly with sick people, unlike any other profession and that makes them very much prone to stress. Amazingly, these set of professionals seem to be too emotionally attach to their job and patient that they seldom have time for leisure to ease off stress. Redmond (2009) maintained that helping professionals are more likely to be overstressed because their professional relationship tends to be one-sided, as opposed to reciprocal. Considering these facts, the researcher will be focusing on stress management practices adopted by HCPs at National Orthopaedic Hospital Enugu. However, there are some socio- demographic factors that may be associated with stress management practices among HCPs at national orthopaedic hospital, Enugu – NOHE. The factors include gender, job type and age.

Gender is a variable that has received consistent attention among researchers. Redmond (2009) opined that women suffer stress more than their male counterpart because they tend to have multiple roles in the society; they are more at risk of being over stressed than men. He further maintained that they juggle between being a spouse or partner, a parent, and an employee as a result, they have a tendency to take too much, either because they find it difficult to delegate responsibilities or because they are unable to get help with some of their duties. Also, Watson, Goh, Yong, Sarah, Wah, Sawang and Sukalenlaya (2011) posited that men and women differ in their stress coping processes, when subjected to stressful situation. However, Sukhadeepak (2006) had earlier stated that women are more adaptive to stress because of coping mechanisms, while men seem to be more stress prone because they are more likely to get into other things that add to stress such as alcoholism, smoking and so on. He added that while women are better equipped to deal with emotional issues, men find it difficult to express anxiety and sorrow.

Job type is another variable that needs adequate attention, since we are considering practice of stress management among health professionals who are care givers. Care giving among health professionals is also a high risk factor for stress. Adam (2000)  found that registered nurses with low job control, high job demands and low work related social support experienced very dramatic health declines, both physically and emotionally. Canadian Community Health Survey-CCHS (2003) reported that medical laboratory technologist was one of the health workers experiencing high job stress and the proportion ranged from 58- 64per cent.

Age is also a variable of concern in this study. United Nations-UN (1995) identified age as one of the personal attributes which contributes to one’s reaction to stress. Segal, Hook and Crolidge (2001) found out that younger adults received higher scores on the dysfunctional management practices because they resulted more to using alcohol, smoking and drugs for venting their emotions, older adults by contrast, shared their problem with trusted spouses or friends and turn to their religion as their coping strategies. However, the United Kingdom Health and Safety Executives- UKHSE (2005) reported that older adults tend to suffer from workplace stress more than the younger adults because they are faced with greater responsibility in the workplace. The standard international age classifications outline ages as follows; young adulthood 15-24years; middle adulthood 25-44years; older adulthood 45-64years (United Nations International Economic and Social Affairs-UNIESA, 1982). Samuel (2006) also classified ages as follows; young adults 21-40 years, middle adulthood 41-46 years and older adults 65 years old and above. In the context of this study, the standard international age classification of middle adulthood 25-44years and older 45-64years adulthood will be adopted for this study. This study will be based on three theories.

The response based theory, the social cognitive theory, and self efficacy theory. The response based theory perceives stress as cluster of disturbing psychological and physiological responses to different situations. This cluster of response is known as syndrome. The basic assumption of this theory is that different environmental events known as stressors can produce the same stress response syndrome. It suggests that the same set of physiological reactions to stress occurs regardless of the particular cause of stress. The most popular response based theory was propounded by Selye in 1974 called general adaptation syndrome (GAS) (Obi & Obi, 2004).

Social cognitive theory posits that people learn by observing others, with the environment, behavior and cognition all are the factors influencing development (Bandura, 2001). According to Wikipedia (2010) these three factors are not static or independent rather they are reciprocal. For example, each behavior witnessed can change a person’s way of thinking (cognition). Similarly, the environment one is raised in may influence later behaviors. This directly implies that the stress management techniques observed and learnt can influence once practice.

Bandura (1988) defined self-efficacy as ones belief in ones ability to succeed in a specific situations. He further asserted that the belief that one has is able to control ones practice of a particular behavior. Schwarzer (1992) and Owie (2003) submitted that self efficacy refers to ones belief that one can successfully execute a particular action.  Therefore, the belief that the HCPs has that he/she can adequately execute the stress management practices, will help him/her effectively in carrying out the stress management practices at national orthopaedic hospital, Enugu.

National Orthopaedic Hospital, Enugu (NOHE) is located in Enugu urban along Enugu-Abakaliki express way, Abakpa-Nike in Enugu east Local government area of Enugu State. The hospital was established in 1972.The choice of the health facility for the investigation was made due to the following reasons; firstly, it is the only national orthopaedic hospital established to serve the south-east and south-south geopolitical zones of the country; secondly, it deals specifically with surgeries of orthopaedic, burns, plastic and trauma. According to Wikipedia (2012) surgery is the act of using instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury or to help improve bodily function and appearance. Orthpaedic is concerned with conditions involving the musculoskeletal system; burns is a type of injury to flesh caused by heat, electricity, chemicals, light, radiation and friction,  plastic is concerned with the correction or restoration of form or function while trauma involves injuries from road traffic and home accidents, or physical assault. Thirdly, long inpatient stay with different surgeries performed on them, for example a patient can be hospitalized for more than one year depending on the patient problem. About 121,144 patients pass through the outpatient clinic annually from 2005 till date (NOHE, 2007)

The day to day management and care of these huge number of patients is entrusted into the hands of the HCPs and they are about 437 in number (Planning, Research, Statistics, Computer-PRSC unit NOHE,2011)  and as such they are faced with the major task of ensuring the highest level of care alongside their personal and family burden. This of course may be quite burdensome and stressful since they are busy at all times. To study the sources of stress and the stress management practices which they adopt to reduce their stress level as HCPs seems necessary. This study therefore is an attempt to do so.

Statement of the Problem

           Stress is part of the normal fabric of human existence. It is an inevitable part of the challenges that prompt mastery of new skills and behavior patterns. In so far as man continues to live, he cannot be free from stress. Unpleasant situation produce stress oftentimes, but it is obvious that stress does not only arise just from unpleasant situations; stress can also be associated with physical challenges and the achievement of personal goals. It is important to note that modern society would be impossible without stress to which all creation is subjected, as it manifest in the harshness of the weather, diminishing returns of the land, diseases, as well as animal and human predators and so on. Modern technology such as use computers of assorted types, communication device like phones evolved from various attempts to curb all these and be free from stress.

Regrettably, stress still remains a global phenomenon.  The United Nation Organization-UNO (1992) reported that stress has become one of the most serious health issues of the 20th century; its presence in the workplace is palpable. Stress in life results from having to deal with daily hassles pertaining to jobs, personal relationship and everyday living circumstances. Obviously, many people experience the same hassles everyday. Instances of daily hassles include living in a noisy neighborhood, commuting to work in heavy traffic, disliking one’s fellow workers, worrying about owing money, waiting in long line, misplacing or loosing valuable things, job dissatisfaction, threat to life and property, inability to make ends meet among others. When taken individually, these hassles may feel like minor irritants, but cumulatively over time, they can cause significant stress which if not properly managed may degenerate to distress in some individuals.

HCPs are not free from stress as members of the society; they are burdened with triple responsibilities, involving the home, (example spouse/children problem), the environment, (example commuting in heavy traffic and dealing with nosy neighbours and the hospital work which involves dealing with the sick). Coon, (1994) asserted that the healthcare professionals work demands high level of skill and carefulness, a great deal of team working in a variety of situations, provision of twenty-four hour delivery of care, and input of what is often refer to as emotional labour. Coupled with the fact that NOHE is a specialist hospital with high influx of client/patient needing urgent and constant medical/surgical attention. Hence, this situation became burdensome to the researcher who wondered how the HCPs at National Orthopaedic Hospital, Enugu cope or manage work induced stress without breaking down. Therefore, conducting an investigation on the stress management practices of Health Care Professionals working at NOHE became a necessity.

Purpose of the Study

The purpose of this study is to find out the sources of stress and stress management practices of Health Care Professionals working at National Orthopaedic Hospital Enugu State, Nigeria. Specifically, the study will seek to;

  1. identify the sources of stress among HCPs in the workplace;
  2. find out the stress management practices among the HCPs;
  3. find out the job- related stress management practices among the HCPs;
  4. find out the differences in stress management practices according to gender;
  5. find out the differences in job related stress management practices according gender;
  6. find out the differences in stress management practices according to job type;
  7. find out the differences in job related stress management practices according to job type;
  8. find out the differences in stress management practices according to age, and
  9. find out the differences in job related stress management practices according to age.

Research Questions

To guide this present study, the following research questions are posed;

  1. What are the sources of stress among HCPs in the workplace?
  2. What are the stress management practices of the HCPs?
  3. What are the job-related stress management practices of the HCPs?
  4. What is the difference in stress management practice according to gender?
  5. What is the difference in job related stress management practice according to gender?
  6. What is the difference in stress management practice according to job type?
  7. What is the difference in job related stress management practice according to job type?
  8. What is the difference in stress management practice according to age?
  9. What is the difference in job related stress management practice according age?

Hypotheses

The following hypotheses were formulated and each was tested at .05level of significance;

  1. There is no significant difference in the stress management practice of male and female HCPs.
  2. There is no significant difference in the job related stress management practice of male and female HCPs.
  3. There is no significant difference in the stress management practice among various categories of HCPs.
  4. There is no significant difference in the job related stress management practice among various categories of HCPs.
  5. There is no significant difference in the stress management practice among middle adult and older adult HCPs.
  6. There is no significant difference in the job related stress management practice among middle adult and older adult HCPs.

Significance of the Study

           The information generated from the study will determine whether HCPs practice stress management judiciously. This will be of immense benefit to hospital administrator, health educators, members of the hospital management board, the federal ministry of health who can proffer solution,  if there is incessant breakdown of members of staff due to insufficient//lack of stress management practice, and who may need to encourage or enforce adherence to simple stress management techniques. These findings will also be beneficial to the HCPs, and the general public.

The result obtained from the sources of stress among HCPs in the workplace may reveal different types of stressors that the HCPs get exposed to at workplace. This will benefit the hospital administrators, the hospital management board members and the general public, hence, duty schedules will be revisited and emphasizes will be made on break period which oftentimes, tight work schedules does not permit.

The result from the stress management practices among the HCPs will reveal whether the HCPs on personal basis practice stress management to avoid them being broken down by stress. This will benefit hospital administrators, the hospital management, and heads of department, the HCPs and the general public. The HCPs who do not involve themselves with stress management techniques would be identified and encouraged to take stress management practices more seriously.

The results on job-related stress management practices among HCPs will show the stress management practices adopted by the HCPs in the workplace and how often they practice stress management to overcome stress effects. This will benefit the HCPs and the general public as adequate practice will boost

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