Impact of Occupational Stress on Health Care Workers

Running head: DISSERTATION
A study on the impact of occupational stress on health care workers: A case study in a
hospital in Saudi Arabia
Name of the Student
Name of the University
Author Note

DISSERTATION
Executive Summary
The following research aim to prove the alternative hypothesis that is there is
significant relationship between occupational stress and health care workers. The research is
based on background of the healthcare setup of the KSA. The research is a case study based
on the healthcare setup of Kings Hospital KSA. The methodology of the review followed
quantitative research design. The quantitative primary research is based on the pragmatism as
the main research philosophy while the main research approach is inductive research. The
case study included research approach followed cross-sectional descriptive type analysis. The
main target population included 50 healthcare professionals and of them 25 were the nursing
professionals, 16 healthcare staffs and 9 doctors working in the Kings Hospital and who have
at least 5 years of working experience. The survey was conducted online with the help of the
survey monkey software and data was analysed both with the help of SPSS software in order
to obtain the statistical significance of the data and with the help of the survey monkey
software. Closed ended-questionnaire was used with a total of 30 questions. The analysis of
the survey results followed by the statistical analysis showed that there is a significant
relationship between the occupational stress and physical and psychological health or the
healthcare professionals (p-value: P-value of 0.000). The comparative analysis of the results
showed that nurses are the prime victims of the occupational stress in comparison to the
doctors and the healthcare staffs and this increase the tendency of developing stress, anxiety,
depression and suicidal tendencies. This negative psychological impact also forces them to
take up unhealthy lifestyle choices. The occupational stress also decreases the level of job
satisfaction and thereby increasing the turnover of the healthcare professionals mainly the
nurses. However, the study must be conducted with open-ended questionnaire with the
healthcare workers working in different healthcare organizations in order to get a generalized
result to get a detailed overview of the Saudi's healthcare setup.
1

DISSERTATION
Table of Contents
1. Hypothesis..............................................................................................................................5
2. Background............................................................................................................................5
2.1 Stress and its consequences..............................................................................................5
2.2 Occupational stress in healthcare.....................................................................................6
2.3 Occupational stress in Saudi Arabia................................................................................7
3.0 Problem Statement...............................................................................................................8
4.0 Literature Review...............................................................................................................10
4.1 Introduction........................................................................................................................10
4.2 Theme.................................................................................................................................10
Occupational Stress and its Association with the nurse turnover and employee satisfaction
..............................................................................................................................................10
Effect of occupational stress over the psychological health of the healthcare professionals
..............................................................................................................................................13
KSA healthcare professionals and their vulnerability of developing occupational stress...15
4.3 Gaps in the review..............................................................................................................18
4.4 Rational of the research......................................................................................................18
5.0 Methodology......................................................................................................................22
5.1 Introduction....................................................................................................................22
5.2 Research design..............................................................................................................22
5.2.1 Research philosophy...............................................................................................23
5.2.2 Research approach..................................................................................................24
5.2.3 Research Strategy and time horizons......................................................................24
5.2.4 Research method.....................................................................................................24
5.3 Target population...........................................................................................................25
5.4 Sampling and the sample size........................................................................................25
2

DISSERTATION
5.5 Data collection and data analysis...................................................................................26
5. 6 Reliability and validity of the survey instrument..........................................................27
5. 7 Ethical Consideration of the research...........................................................................27
6. Survey Results......................................................................................................................28
6.1 Introduction....................................................................................................................28
6.2 Survey responses obtained from nursing professionals.................................................28
6.2.1 Impact of work environment...................................................................................28
6.2.2 Impact of work load................................................................................................28
6.2.3 Career opportunity and growth...............................................................................29
6.2.4 Job satisfaction........................................................................................................29
6.2.5 Psychological impact of work load.........................................................................30
6.3 Survey responses obtained from doctors........................................................................32
6.3.1 Impact of work environment...................................................................................32
6.3.2 Impact of work load................................................................................................33
6.3.3 Career opportunity and growth...............................................................................33
6.3.4 Job satisfaction........................................................................................................34
6.3.5 Psychological impact of work load.........................................................................35
6.4 Survey responses obtained from Healthcare workers....................................................37
6.4.1 Impact of the work environment.............................................................................37
6.4.2 Impact of the work load..........................................................................................38
6.4.3 Career opportunity..................................................................................................39
6.4.4 Job satisfaction........................................................................................................39
6.4.5 Psychological impact of work load.........................................................................40
6.5 Comparison between the doctors, nurses and the healthcare staffs data........................42
6.6 Statistical analysis..........................................................................................................57
7. Intermediate Analysis and Conclusion.................................................................................59
7.1 Introduction....................................................................................................................59
3

DISSERTATION
7.2 Intermediate Analysis.....................................................................................................59
8. Overall Conclusion and Recommendation...........................................................................67
8.1 Conclusion......................................................................................................................67
8.2 Recommendations..........................................................................................................67
9. Lessons Learned...................................................................................................................68
10. Moral and Ethics................................................................................................................70
References................................................................................................................................71
Appendix..................................................................................................................................77
List of Questionnaire............................................................................................................77
4

DISSERTATION
1. Hypothesis
Hypothesis Statement (H0): There are no significant relationships between occupational
stress and health care workers
Alternative Statement (H1): There is significant relationship between occupational stress and
health care workers
2. Background
2.1 Stress and its consequences
Stress is a response generated by an organism against several stimuli. Stress can be
either positive or negative or can be perceived or real. The stimuli that lead to the generation
stress can be either short-term or long-term or recurring. However, irrespective of the nature
of the generation of stress, stress can lead to a significant change in the psychological and
physical functioning of the body (Trifunovic, Jatic and Kulenovic, 2017). The short-term
effects of the stressors have certain level of benefits however, the long-term exposure to the
stress results in the generation an in increased level of blood pressure or hypertension leading
to consequent heart failure or suppression of the immune response. There are different types
of stressors, the length of the overall exposure of the stressors and the personality stress are
the principal elements that influence the response generated in the hypothalamic-pituitary-
adrenal axis that is considered responsible for the significant development of several
healthcare complications caused by the effects of severe or chronic stress. High level of stress
can also lead to the development of health-related impairments like mental and behavioural
disorders along with other physical impairments (Woodhead et al., 2016). Stress resulting
from the work environmental factors are categorised in the domain of daily stress and due to
its outcomes, such factors demands special attention, evaluation and subsequent calls for the
identifications of the different in the trends of stress, and its effects on professional duties.
According to the definition, stress under the workplace settings mainly results from the
imbalance between the demands and the ability to satisfy those demands. This can be a
potential cause of illness along with increased levels of absenteeism at work due to illness,
professional issues or due to constant change in the personnel working within an institution
(Woodhead et al., 2016). According to the Karasek’s demand-control model of the
occupation health and safety, there are two dimensions under which the level of stress
5

DISSERTATION
increases along with increase in the professional demands in the workplace and this leads to
the reduction in the level of decision-making process. The factors that leads to the generation
of the occupational stress are mainly sub-divided into general factors and specific factors.
The general factors for stressors include those that are present among all or at least under
majority of the working environment. In few of the profession, along with the presence of the
general stressor elements, there are also few specific stressors that are environment specific
or profession specific (Tajvar et al., 2015). In summary of this paragraph, it can be said that
level of occupational stress has now become a growing problem among the healthcare
workers in the past few years and with this prevailing trends, the number of different tools
have been developed in order to identify the factors the leads to the stress development and
its subsequent outcomes in the overall healthcare service delivery approach (Trifunovic, Jatic
and Kulenovic, 2017).
2.2 Occupational stress in healthcare
Occupational stress is a crucial factor that influences the level of job satisfaction
among the employees and organisational commitment. Occupational stress mainly arises
when there is a disequilibrium between the demands prevailing in the professional
environment and the ability of the worker to cope up with stress. Healthcare is defined as
inherent stressful workplace where the organisation executes their work round the clock
under stringent work environment that deals with critically ill patients. This stressful yet
demanding workplace environment increases the level of occupational stress among the
healthcare professionals (Mosadeghrad, 2013). The working in the healthcare organization is
also associated with different levels of occupational health and safety hazards that further add
to the level of occupational stress. The nurses and the healthcare professionals (healthcare
staffs) play an important role in providing care to the patients and effective management of
the patients such that it is ascertained that the degree of occupational stress is higher among
the nurses in comparison to the doctors or other healthcare staffs (Mosadeghrad, 2013). The
study conducted by Trifunovic, Jatic and Kulenovic (2017) highlighted that the healthcare
professionals like the doctors, nursing professionals and the associated healthcare workers are
exposed to a wide range of occupational stress. The high level of occupation stress hampers
the mental and physical well-being of the healthcare professionals. The primary healthcare
professionals report a significant high level stress under the workplace settings and this cast a
significant mental health impact in comparison to other physicians who work under the
secondary healthcare settings. Apart from the nursing professionals, the physicians or the
6

DISSERTATION
doctors also become victims of the stressors elements under the healthcare settings. However,
during the past few decades, in comparison to the other healthcare professionals, the
physicians health and wellness has also decreased at a significant rate affecting the balance in
their professional life. Chronic level of stress affects the relationship of the doctors with their
patients and thus can lead to the generation of negative consequences in professional and
personal life. Healthcare physicians experience several types of stressors that have worsened
during the recent decades (Alosaimi et al., 2018). The main work-related stressors among the
physicians include but are not restricted to, less autonomy in the work-field due to increased
rate of adoption of the evidence-based practice under the healthcare settings of Saudi-Arabia
and working with the larger groups that is with the multidisciplinary team that creates gap
conflict of interest. Increased level of scrutiny done over the physicians in order to highlight
the errors increase the level of stress of performance and thereby hampering the overall
mental space in work and increasing the chances of the medication errors. Moreover, the
physicians are concerned about their increasing number of complains, judicialization of care
and costs of liability leading to increase in the level of stress (Alosaimi et al., 2018).
2.3 Occupational stress in Saudi Arabia
Work-related stress (WRS) is defined as a strenuous feeling that worse the overall job
experience of the employees. The prevalence of the WRS in the healthcare profession varies
by 20% to 40% and it negatively hamper the physical and psychological well-being of the
healthcare professionals (Rita et al., 2013). Cardiovascular disease, obesity, poor mental
health condition, musculoskeletal disorders, depression and emotional exhaustion are
inherently associated with WRS (Rawal and Pardeshi, 2014). The main circumstances of
persistent WRS among the healthcare professionals, especially the nursing professionals
include increase rate of employee turnover, frequent leaves, job dissatisfaction and high rate
of absenteeism (Rawal and Pardeshi, 2014). In the professional ground, WRS is linked with
decreased level of productivity, increased rate of healthcare costs and other legal
complications. These hamper in the well-being and other administrative work process impairs
the overall performance of the nursing professionals and the organisational activity (Cruz
2017).
Saudi Arabia delivers all diverse healthcare service including primary, secondary and
tertiary health-care services. The primary healthcare services are regarded as the prime front-
line for simple cases. On the other hand, the hospitals also provide either secondary or
tertiary healthcare services (Almalki, Fitzgerald and Clark, 2011). The kingdom of Saudi
7