Level Of Job Stress Among Health Care Providers

Level of Job stress among Health Care Providers at ED of HUSM

during recent H1N1 Influenza Outbreak

Assoc. Prof. Dr. Rashidi AhmadDept. of Emergency Medicine

USM Health Campus

Introduction

In the 21st century, the world is being challenged by few contagious and life threat infection such avian influenza and SARS.

At current moment, no countries in the world are immune to an outbreak of a highly infectious disease.

Luckily, Malaysia did not encounter both SARS and avian flu outbreak.

We haven’t been challenged to the outbreak of deadly virus till now

Unfortunately, swine flu was disseminated rapidly throughout the world including Malaysia.

As a result, there was a sudden influx of patients with influenza like illness (ILI) to the ED including

HUSM. Longer shift hours, pressure to perform to meet

rising expectations from public and administrators and scared for being infected created a lot of tensions among the ED HCPs at HUSM

Cont…

Kathryn Wilkins. Work stress among health care providersHealth Reports, Vol. 18, No. 4, November 2007

135,573 respondents.

We are already in STRESS

Ping Wu, et al. The Psychological Impact of the SARS Epidemicon Hospital Employees in China:

Exposure, Risk Perception, and Altruistic Acceptance of Risk. The Canadian Journal of Psychiatry, Vol 54, No 5, May 2009

6-point Likert scale

Objectives

To determine the prevalence of job stress among HCPs in ED of HUSM during recent H1N1 influenza outbreak

To determine the significance of their level of job stress prior to and during the outbreak

To determine the association between the studied variables and stress level during the outbreak

Methodology

The sample size was determined using a single proportion (n = log β/log p’) for a population of about 100 people with an expected prevalence of job stress of 10% and a 95% confidence level with a precision of 5%.

The sample was obtained by non-probabilistic sampling.

The researcher approached the respected staff and explained the aim and how to score their stress level using VAS.

Cont..

The study was undertaken from 20 to 30 August 2009.

The considered variables were age, gender, race, co morbidities, marriage status and year of experiences.

Data were collected into single form and entered into a SPSS+ (12.0) statistical package and analyzed.

Visual analog Stress Scale

This scale consists of a 10 cm line drawn on a white paper that represents the variable to measure

The patient is informed that one end of the line represents the absence of the variable and the other symbolizes the most intense manifestation the subject can imagine or the worst stress experience.

The patient scores the intensity of the expression of the variable marking the point between both ends that more accurately represents the strength of the variable he/ she is experimenting.

VAS

The result is quantified measuring the distance from 0 to the point marked by the patient.

Stress scores obtained from the VAS were arbitrarily grouped in four degrees: I (0 to 2.5 cm scored on the VAS), II (2.6 to 5 cm), III (5.1 to 7.5) and IV (7.6 to 10 cm).

VAS > 7.5 cm was considered a high level of stress.

Results

Variables n(%)

Agemedian, range, IQR 31.0, 22 – 49, 5.5< 30 28 (45.2)30 and above 34 (54.8)

SexMale 29 (46.8)Female 33 (53.2)

Total respondents: 62 out of 110 staffs (56%)

Variables n (%)

RaceMalay 56 (90.3)Non-Malay 6 (9.7)

Marriage statusBachelor 23 (37.1)Married 39 (62.9)

Years of experience Median, range, IQR 6, 1 – 24, 7 <5 20 (32.3)5-9 25 (40.3)>10 years 16 (25.8)

Results

Variables n (%)

VAS before outbreakMedian, range, IQR 2.4, 0 – 6.6, 2.0Grade 1 35 (56.5)Grade 2 21 (33.9)Grade 3 6 (9.7)Grade 4 0

VAS during outbreakMedian, range, IQR 6.5, 0 - 10, 3.6Grade 1 4 (6.5)Grade 2 15 (24.5)

Grade 3 22 (35.5)Grade 4 21

(33.9)

Ranks

0a .00 .00

59b 30.00 1770.00

3c

62

Negative Ranks

Positive Ranks

Ties

Total

POST - VASN Mean Rank Sum of Ranks

POST < VASa.

POST > VASb.

POST = VASc.

Test Statisticsb

-6.682a

.000

Z

Asymp. Sig. (2-tailed)

POST - VAS

Based on negative ranks.a.

Wilcoxon Signed Ranks Testb.

Significance mean differencebetween pre and during outbreak

kateg umur * postvas1 Crosstabulation

12 9 7 28

8.6 9.9 9.5 28.0

7 13 14 34

10.4 12.1 11.5 34.0

19 22 21 62

19.0 22.0 21.0 62.0

Count

Expected Count

Count

Expected Count

Count

Expected Count

20 - 30

> 30

kategumur

Total

gred 1 gred 2 gred 3

postvas1

Total

Chi-Square Tests

3.832a 2 .147

3.860 2 .145

3.739 1 .053

62

Pearson Chi-Square

Likelihood Ratio

Linear-by-LinearAssociation

N of Valid Cases

Value dfAsymp. Sig.

(2-sided)

0 cells (.0%) have expected count less than 5. Theminimum expected count is 8.58.

a.

Age and stress level during outbreak

SEX * postvas1 Crosstabulation

10 9 10 29

8.9 10.3 9.8 29.0

9 13 11 33

10.1 11.7 11.2 33.0

19 22 21 62

19.0 22.0 21.0 62.0

Count

Expected Count

Count

Expected Count

Count

Expected Count

Male

Female

SEX

Total

gred 1 gred 2 gred 3

postvas1

Total

Chi-Square Tests

.572a 2 .751

.573 2 .751

62

Pearson Chi-Square

Likelihood Ratio

N of Valid Cases

Value dfAsymp. Sig.

(2-sided)

0 cells (.0%) have expected count less than 5. Theminimum expected count is 8.89.

a.

Gender and stress level during outbreak

experience * postvas1 Crosstabulation

Count

13 3 4 20

3 14 8 25

3 5 8 16

19 22 20 61

junior

senior

very senior

experience

Total

gred 1 gred 2 gred 3

postvas1

Total

Chi-Square Tests

18.857a 4 .001

18.391 4 .001

9.640 1 .002

61

Pearson Chi-Square

Likelihood Ratio

Linear-by-LinearAssociation

N of Valid Cases

Value dfAsymp. Sig.

(2-sided)

1 cells (11.1%) have expected count less than 5. Theminimum expected count is 4.98.

a.

Experience and stress level during outbreak

Summary

The median VAS score prior to the outbreak is 2.4 (grade 1)

The median VAS score during the outbreak is 6.5 (grade 3)

Significance mean difference between pre and during outbreak

Significant association between years of experience in health services and the level of stress during the outbreak

Discussion

STRESS is a biological term which refers to the consequences of the failure of a human to respond appropriately to emotional or physical threats.

It includes a state of alarm and adrenaline production, short-term resistance as a coping mechanism, and exhaustion

The Stress of Life, Hans Selye, New York: McGraw-Hill, 1956

Job stress

is caused by conditions in the workplace that negatively affect an individual's performance and/or overall well-being of his body and mind.

One or more of a host of physical and

mental illnesses manifests job stress.

Signs of stress

May be cognitive, emotional, physical or behavioral.

Poor judgment A general negative outlook Excessive worrying Moodiness Irritability Agitation Inability to relax Feeling lonely or isolated Depressed Aches and pains

Diarrhea or constipation Nausea Dizziness Chest pain Rapid heartbeat Eating too much Sleeping too much Withdrawing from others Neglecting responsibilities Using alcohol, cigarettes,

or drugs to relax Nervous habits

Causes of work stress in government sectors

High Demand for Performance - Increased workload, long working hours for the same pay, excessive travel and too much time away from family

The expansion of technology Workplace Culture Personal or Family Problems Mental and physical harassment

Disadvantages of being ED HCW

Daily contact with ILI patients Risk of infection and & quarantine Risk of death and hospitalization Over work Over stress Under appreciated Community avoidance

Conclusion and recommendations

Infectious disease outbreak is a distressing event Preparedness and readiness are vital and it

reduce tension Buddy system enhances quality of care and

reduce stress level Involvement of occupational health experts,

appropriate communication system, token of appreciation and counseling and follow up reduce stresses among HCWs

shidee_ahmad@yahoo.com

Academic blog: www.drcd2009.wordpress.com