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CHAPTER IV: DISCUSSION OF THE ARTICLES

The role of workplace health promotion in addressing job stress by Andrew Noblet and Anthony d. Lamontagne

This article addresses the issue of workplace health promotion. It has been pointed out that WHP focuses only on the individual and not relate it to the working conditions or organization. This paper purports to highlight the criticisms of the individual approach to job stress and examines evidence for developing strategies that combine both individual and organizational-directed interventions. It also provides a detailed description and develops initiatives that address both the sources and the symptoms of job stress (Nobel and Lamontage, 2006, p-1).

It is based on literature review of the WHP and a case study; a call centre located in Australia (p-2), where poor performance of employees as well as increased rate of customer complaints was found. Manager of the call centre hired services of a corporate Workplace Health Promotion company to overcome health related issues of the staff members. On analyzing the situation committee found that the employees were facing problems at workplace as they had to attend repetitive calls and callers sometime used abusive language and they had never been trained to handle such calls. Another major source of poor performance was mothers worrying about whether their children had got home from school safely. OAS employed a large number of mothers with dependent children. Realizing the problem, the company gave their operators a 10 min break around 4 p.m. so they could call home to make sure that the kids had arrived safely. This strategy alone resulted in a significant improvement in the service quality and morale.

Discussion Comments on “Occupational stress in nursing” by S. Jowett published in International Journal of Nursing in 2007

This article discusses an earlier article “Occupational Stress in nursing” by McGrath published in late 1980’s and relates it to the current situation. It is based on literature review based on the research from 1980 to 2003 and survey results from 171 nurses. The author confirmed the presence of workplace stress during late 1980’s “every day the nurse confronts stark suffering, grief and death’ end of the spectrum (Hingley, 1984)”. It confirms that ‘nursing is stressful and that some causes of stress are found in all specialties’. Their analysis reverberates with a definition of stress, “the reaction people have to excessive pressure or other types of demands placed upon them. It arises when they feel unable to cope” (HSE, 1999). The study indicates that nurses face considerable work-related stress. The main finding is that nurses are asked to concentrate on the physical objectives and avoid emotional demands of the patients. Other main points are powerlessness as they can’t make decisions in the workplace, as well as lack of acknowledgement of their work by practitioner. Other factors recognized were working relationships, communication difficulties and the high workload (Stehle, 1981). Nichols et al. (1981) identified concerns about inadequate support from senior nursing staff.Dissertation Abstracts

Analyzing these articles the author states the present situation which indicates “the findings are alarmingly familiar” (Worthington, 2001) as 71% of the nurses pointed out the effects of stress and overwork to be the major health and safety concern. 67% complained of working overtime every month. Literature reviewed in the article also indicates evidence of occupational stress among nursing staff; “Stressful situations at work have been seen to contribute to both anxiety and depression” (Weinberg and Creed, 2000)

Conflict and its resolution in the operating room by Jonathan D. Katz MD (Clinical Professor)* published in Journal of Clinical Anesthesia (2007)

This article focuses on operating room conflicts, their impact on the overall OR atmosphere and suggests solutions to resolve the conflicts. The study is based on review of literature regarding conflicts, sources of conflicts, consequences of unresolved conflicts, operating room conflicts, as well as relevant case studies to explain the interpersonal conflicts in operating room and its impact on the case.

The operating is a high-stress and explosive workplace where interpersonal conflict can be recurrent and at times severe “The potential for interpersonal conflict is especially heightened in the operating room (OR), where a broad range of professionals (physicians, nurses, technicians) have overlapping and, in many cases, poorly delineated areas of responsibility” (p-152). “the OR is the only location within a hospital where two coequal physicians regularly and simultaneously share responsibility for one patient. Decisions involving life and death are routine, and wrong decisions resulting in adverse outcomes are subjected to intense scrutiny and retrospective analysis”.

These conflicts sometimes result in cancellation or more accurately, postponement of a surgical procedure for additional evaluation – it is noted that conflicts over the method of treatment frequently occur between an anesthesiologist and a surgeon” (p-156).

In the OR, the surgeon is considered to be captain of ship and “At the root of many anesthesiologist-surgeon conflicts is the archaic doctrine of the captain of the ship. This concept held that the mere presence of the surgeon in the OR subjects him or her to legal liability for any negligent acts involving the patient in that room” (p-155).

Disagreement and aggression in the operating theatre By Richard Coe & Dinah Gould (2007)

This is a research study which was conducted to identify the reasons for increasing incidents of disagreement in OR among professional groups in operating departments and the incidence of seeming aggressive behavior shown by operating department personnel. The study was based on a survey conducted by National Health Service operating departments in England, of which 37 departments participated comprising 391 individuals including nurses, surgeons, and anesthetists and operating department practitioners of all grades.Dissertation Abstracts

The study results confirmed the presence of aggressiveness and disagreement among operating theatre personnel (p-616). 50% of the respondents confirmed occurrence of aggressive behavior from consultant surgeons while daily disagreements among nurses and consultants about list management were reported. It was also reported that there exists a lack of understanding of roles in patient care.

Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study by E. Arakelian, L. Gunningberg and J. Larsson (2008)

This article focuses on the perceptions of efficiency in operating room by supervisors, surgeons of the operating department - “Efficiency and productivity play a central role in managing an operating department” (p-1423).

The study was based on interviews of 21 members of operating department staff and supervisors in a Swedish hospital. The results show variation of efficiency perception among different categories of operation room staff. The major finding was that mostly nurses and assistant nurses defined efficiency as personal knowledge and experience, accentuating the importance of the work process, while the supervisors and physicians defined efficiency as completion of an assignment.

Incidence of Metabolic Syndrome among night-shift healthcare workers by A Pietroiusti, A Neri, G Somma, et al. published September 2009.

As healthcare is a 24 hour service so the medical staff has to perform night duty. Night-shift work is allied with ischemic cardiovascular disorders. Currently it is not confirmed whether it may be causally linked to metabolic syndrome (MS), which is a risk condition for ischemic cardiovascular disorders. This article is a research study to review whether there exist a connection between night-shift work and the development of MS. Methods: Male and female nurses performing nightshifts, free from any factor of Metabolic Syndrome were selected and reviewed annually for 4-years to know the development of the disorder. Male and female nurses doing day duty were also evaluated for the sake of comparison among both the groups during the same time period. The results indicated that incidence of MS and relative risk was higher among nigh-shift nurses as compared to nurses performing day time work. The study confirmed that there exists a risk of developing MS with night-shift work in nurses.

Occupational stress, job satisfaction, and working environment among Icelandic nurses: A cross-sectional questionnaire survey by Herdı´s Sveinsdo´ ttir_, Pa´ ll Biering, Alfons Ramel published 2006

This is a research study conducted to identify stress factors at workplace among Nurses working in Iceland. The study comprised of a survey which was posted to all registered nurses and results comprised of responses from 206 nurses both working inside and outside the hospital.

The survey results confirmed presence of workplace stress among nurses which was high among the nurses working in the Hospital as compared to those working outside the hospital. The reasons found are that the nurses working in the hospital have to work more hours per week, provide more direct patient care, have less opportunity to take lunch breaks at the appointed time and off the unit, and also there occur staff shortages. Nurses working in hospitals have also tolerated more unexpected changes in their work schedule.

The researcher has also referenced a report on women’s health from the Icelandic Ministry of Health and Social Security (2003) which concludes that working women also perform their household responsibilities for the welfare of family and thus they have to work extra hours. Another reason for overtime for Icelandic nurses is the shortage of nurses in Iceland.

Sources of Work-Stress Among Hospital-Staff at The Saudi MOH By Badran Abdulrahman Al-Omar (2003),

This article focuses on the factors causing work-stress as well as its impact amongst the MOH hospital staff working in Riyadh City, Saudi Arabia. Descriptive analytical research design was used in the study. The hospital staff including Doctors, nurses, technicians, administrators, and therapists working at five MOH hospitals was assessed by a questionnaire distributed among 700 members of the staff, of which 414 responded.Dissertation Abstracts

The results are indicated by, “It is clear that the first cause accounted for the variance in the dependent variable (work-stress level) was the insufficient technical facilities available to hospital staff” (p-10). The other factors lack of appreciation, long working hours, and short breaks also cause stress among the hospital staff. Results also indicated that Saudi participants showed drastically higher level of work-stress as compared to the non-Saudis.

The major impact of work related stress was the tendency to change the hospital, change the job and quitting the practice, however, no significant relation between the level of work stress and occurrence of health problems was found.

Occupational stress and its consequences In healthcare professionals: The role of type d personality by nina ogińska-bulik (2006)

This is a research study aiming at the consequences of occupational stress in healthcare professionals specifically focusing on Type-D personality. The study used personality evaluation of 79 healthcare professionals including physicians and nurses through work evaluation questionnaire, General health questionnaire and Maslach burnout inventory” The results confirmed that Type-D personality plays an important role to perceive job related stress and its effects on health, “There is a substantial evidence that stress can lead to various negative consequences for individuals, including somatic diseases, The study group of healthcare workers suffered from extensive job stress, which was more manifest among women than in men” (p-113).

It was also found that level of stress is higher in healthcare as compared to other professions, “The level of stress suffered in this occupation is higher than in other professions (measured with the same method), e.g., bank workers (M = 90.5), journalists (M = 98.6), and managers (M = 99.2) [41], mental health disorders or feeling” (p-113).

Research on Psycho neuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease? By Roger CM Ho,Li Fang Neo, Anna NC Chua, Alicia AC Cheak, and Anselm Mak,

This is a review of an article which is based on the importance of psycho neuro immunology (PNI) studies to understand the role of acute and chronic psychological stressors on the immune system and development of coronary artery disease (CAD). In this article the researcher proved that psychological stresses cause adverse effects on health and results in changes in cardiovascular function and development of CAD. It also indicates that, acute and chronic psychological stressors will increase haemostatic factors and acute phase proteins, possibly leading to thrombus formation and myocardial infarction. The evidence for the effects of acute and chronic psychological stress on the onset and progression of CAD is consistent and convincing. “Chronic stress and associated psychological responses can activate the hypothalamic-pituitary-adreno-cortical and sympathetic adreno-medullary systems”. This paper also points out possible research areas and insinuations of early detection of immunological changes and cardiovascular risk in people under high psychological stress.

Occupational stress and its effect on job performance A case study of medical house officers of district Abbottabad by Rubina kazmi, shehla amjad, delawar khan* (2008)

This article is a research study which was conducted to evaluate the impact of occupational stress on job performance. The area of research was Abbotabad District located in Pakistan. The research was in the form of a survey in which all the 55 house officers present at the time of research participated. The results of the study confirm the hypothesis “there is an inverse relationship between job stress and job performance indicating that there is high job stress in the house officers, resulting in low job performance”

The results also indicated high level stress for the physician and surgeons working in surgical and medical wards than those working in other wads (p-136). The factors causing stress include “job pressure, job description conflict, lack of communication and comfort with supervisor, job related health concerns, work overload and lack of resources and overall job performance, which all have negative relations”

Review Psychophysiological biomarkers of workplace stressors by Tarani Chandola *, Alexandros Heraclides, Meena Kumari (2009)

This article is based on literature review related to the Psychophysical biomarkers of workplace stressors. The researchers indicate the evidence of association of work stress with greater coronary heart disease risk. The author reviewed 04 studies on plasma catecholamines, 10 on heart rate variability, and 16 on post-morning cortisol. The results indicate that most of the studies conclude that work stress is associated with lower heart rate variability. The study concluded that work stress is related to high stress responses related to sympatho-adrenal and HPA axis biomarkers.

CHAPTER V: CONCLUSIONS

The purpose of this study was to examine the impact of stress on operating theatre personnel. Over the last few years, considerable amount of public concern and empirical research has been devoted to the issue of job-related stress, both within the United States and globally. There is concern that continually increasing global competition is creating more and more pressure on workers at every level, which can have significant deleterious consequences for the workers, their families and organizations. For these reasons, it is likely that operating theatre personnel will experience heightened levels of stress. Nonetheless, there has been little published research on stress among operating theatre personnel, either in the United States or apparently in other countries. The present research is an attempt to fill at least part of this gap and to pave the way for further research.

Present literature review suggests that the long working hours, lack of appreciations, interpersonal conflicts, are the primary factors which directly impact on the performance as well as health of operating theatre personnel. These factors directly affect the performance and health of the operating theatre personnel and consequently the patient is affected.

These results are entirely consistent with the claim that occupational stress is growing extensively and has impacts on the job performance as well as personal life and health of the individual. On the contrary, the three components that seem to be most important for operating theatre personnel are; belief or interest in the system, personal space, rational shifts and appreciation for the hard work. Dissertation Abstracts

As the risk of running and managing hospitals in the domestic market on commercial lines has been notably high, and the majority of the hospitals have not been able to recoup their investments, this research was conducted to explore the current working conditions of operating theatre personnel and the challenges commercial hospitals face in the United States. The analysis was based on a study of the earlier researches on the subject.

To conclude there is strong evidence of the presence of stress among operating theatre personnel and its following consequences among them:

· Reduced job satisfaction

· Increased negative feelings

· Symptoms of physical illness

· In many cases actual physical illness.

With commercialization of health care and the growing emphasis of the stake holders on the bottom line, it is important that the interests of the operating theatre personnel are not lost sight of and they get the deserved attention free of gender bias.

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Noblet, Anthony And Lamontagne (2006) The Role Of Workplace Health Promotion In Addressing Job Stress

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Dissertation Abstract

It is astonishing how a little piece of writing that the dissertation abstract is becomes an accurate difficulty still for knowledgeable writers. The problem is in particulars of this writing. The dissertation abstract, or managerial summary, how it is as well called, is a concise summary of the complete dissertation. It goes exact after all preliminary pages – Table of Contents, Copyright Page and Acknowledgments page. It is usually up to 300 words long, so you can figure out how hard it can be to squish a huge dissertation into a small dissertation abstract. If you ever read «The Lord of the Rings”, then you can realize the tragedy if you think of how to summarize the book in a couple paragraphs.

The effort on dissertation abstracts ought to commence only after finishing, editing and proofreading the whole dissertation. By this time something will surely stay in memory, and you will be competent to say, which parts of your educational paper are worth talking about in an executive summary.

The preliminary part of the dissertation abstract must present not only the main difficulty of your research, but its significance for the field of study, also. Through the way, now you can note – is your research appropriate for the intact branch of information, or is it definite.

Bring in the ways you solved the difficulty. Provide a brief impression of those methods that proved to be most helpful. Allocate your own academic structure in brief, and underscore the basic steps of some models of examination. After the methodology was described, proceed to stating the results of dissertation writing. Be logical. Instead of a vague language say clearly what was achieved while researching. Learn to operate with facts and numbers and make them work on you.

Conclude a dissertation abstract with a representative conclusion – propose how your research will impact knowledge.

A Guidelines for Writing Dissertation Abstracts

The dissertation abstracts is possibly the most significant part of writing in a student's academic career. Because such, the daunting assignment of writing and preparing a dissertation abstract is daunting to many academic scholars. Maybe this is since the dissertation abstracts is the conclusion of all the years of the student's learning. Perhaps this is because the dissertation abstracts will be finally available for all to see. Or possibly it is for the reason that the student does not have a firm grasp of how to go concerning prepare the dissertation abstract and all of its section parts. In spite of the reason, potential dissertation abstract writers are able to contain their feelings of anxiety by familiarizing themselves with the dissertation writing process. In this article, the dissertation abstract will be examined; allowing prospective writers to improve appreciate its task and how to start its groundwork.

The Dissertation Abstract - What It Is and What It Accomplishes

The dissertation abstract is simply a concise outline of the results of the dissertation research. By summarizing the outcome of the research, it allows others to acquire a plan of what was accomplished without having to read during the whole dissertation. Students or researchers are able to read a dissertation abstract to decide if looking at the full dissertation will be worthwhile. The dissertation abstract can often offer sufficient information concerning the results of research that examining the full dissertation is not required.

Dissertation Abstracts International (DAI)

Key Facts

Almost all qualified institutions in North America that honor doctoral degrees propose their dissertations abstract to ProQuest for publication or listing in DAI. The listing provides:

Bibliographic certification that comprise title, author name, degree- granting university, and year awarded, number of pages, and ProQuest order number. Since 1988, most DAI entries have also incorporated the name of the dissertation consultant, committee chair, etc. Titles published from 1980 ahead contain author dissertation abstract 350-word, written by the authors.

Monthly issues of DAI take in just about 5,000 new entries from North America, grouped by topic and printed in two separate sections: Section A, Humanities and Social Sciences Section B, Sciences and Engineering.

Infrequently a department or student might not present a dissertation abstract to ProQuest, so DAI is not 100% comprehensive. On the other hand we approximation that 95% to 98% of all U. S.doctoral dissertations abstract are incorporated. DAI is the mainly in progress of the printed sources for the ProQuest Dissertations abstract & Theses database. Published monthly and cumulated yearly, it is accessible both in soft cover and on microfiche.

Doctoral Dissertations Abstracts

These dissertation abstracts are submitted to the American Studies Association by American Studies graduate programs and by recent American studies Ph.D.s. These abstracts are added to the ASA website on a long-term basis. These pages have only abstracts of dissertations.

The ASA does not store full dissertations. University Microfilms (UMI) should have copies of most dissertations abstracts done in the United States available for purchase. Note: You may have to access the UMI web site through your institution’s library. For more information about American Studies programs, please discuss with the Guide to American Studies Resources and Directory of Graduate Programs in American Studies.

The third edition of The American Indian in Graduate Studies: A Bibliography of Theses and Dissertations is now available online. Members of the resident American community, scholars and other interested people are confident to use the database without charge.

We also perform an annual survey of American Studies and Ethnic Studies graduate programs to collect information about recent PhDs. Participating graduate programs submit names and dissertation titles of recent graduates to the ASA, and we invite these graduates to submit their dissertation abstracts to us. Only the author may send us the dissertation abstract for publication on these web pages.

If you are unable to find your dissertation listed on this site and have not sent it to us yet, you may do so at any time (see bottom of page).

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Guidelines for writing a dissertation abstract:

A dissertation abstract needs to give a reader a sense of your argument in a very short form, no more than 250-300 words. It should begin by introducing the general area of study in which your topic intervenes and then make clear the central argument of your work in the first two sentences. It should provide a sense of the methodological approach that you use in analyzing your topic and provide a compelling yet very brief description that lets readers know why your study is worthwhile and what is distinct about it. Avoid quoting other scholars in your abstracts, providing excessive detail, and listing topics chapter by chapter. It is most important to provide an overview in a succinct fashion.