Synopsis-M.Phil.docx

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A STUDY ON OCCUPATIONAL STRESS AMONG DOCTORS OFGOVERNMENT GENERAL HOSPITALS IN KRISHNA DISTRICT, A.P

A Synopsis submitted to the Acharya Nagarjuna University

(ANU), in partial fulfillment for the award of the degree ofMASTER OF PHILOSOPHY

SUBMITTED BYDAVID RAJU GOLLAPUDI

((Regd. No:C09MP016004)

Under the Guidance ofDr. NAGA RAJU BATTU

MBA, M.Phil., Ph.D

Department of Human Resources ManagementACHARYA NAGARJUNA UNIVERSITY

CENTRE FOR DISTANCE EDUCATION

ACHARYA NAGARJUNA UNIVERSITY

NAGARJUNA NAGAR

BACKGROUND OF THE RESEARCH

INTRODUCTION


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Change is an inevitable element in the history of human civilization.

Human beings have learnt their lessons of coping

with these multitude waves of changes to ensure

their future survival. Initially, these changes were

scarce, later they became more and fast at pace,

and along the way they posed problems for human

to cope with these changes. This condition of

inability to cope with the environmental changes,

have caused a new phenomenon called Stress.

Stress is simply a consequent of a disturbance to the equilibrium state that existed

previously. In the new millennium, stress has become a common and serious

problem faced by almost everyone at one point of time or the other. This problem

has become so common both in developed and developing countries that people

have called it the third wave plague (Sutherland and Cooper1, 1990)

Stress in our society is very prominent both in our personal as well as

professional lives. None of our occupation is free from stress. But the occupations

that we consider more stressful are medical, teaching, office work, labors and

police.

Internal and external factors have contributed to increase stress in almost

all occupations. Changing environment, new technologies, changing government

policies, downsizing in Hospitals, increase in shifts; they are all causing stress on

employees. So, I motivated to know the employee occupational stress at

workplace.

Stress in workplace, particularly, is reported to be on the rise in many

countries. It is the major issue that many labor unions are making big hue and

cry, so that respective authorities will take appropriate actions to safeguard the

workers welfare.

1. Sources of Work Stress in Hurrell, Murphy, Sauter and Cooper [eds ] Occupational Stress: Issues andDevelopments in Research, London, Taylor and Francis (1988)

Stress affects the quality of results and gives birth to job-dissatisfaction.

Health care industry being very sensitive in nature must manage the work related


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stress of doctors to achieve the objective of service to the society. Quality of

work and quality of work life is achieved when people have stress free life at

work place. It has been proved y some researchers such as a reference given like:

Job stress is a recognized problem in health care workers and doctors are

considered to be at particular risk of stress and stress related psychosocial

problems2

. Doctors have higher degree of psychological morbidity, suicidal

tendencies and alcohol dependence than controls of comparable social class3.

Caplan reported that about half of senior medical staff suffers from high level of

stress and a similar proportion suffers from anxiety4. Similarly, Firth-Cozens

5

found that half of the junior doctors in their pre-registration year were suffering

from emotional disturbance.

The delivery of high-quality medical care contributes to improved health

outcomes. Doctors job satisfaction affects quality of medical cares that they

provides, patientss satisfaction with the doctors, patients adherence to treatment

and decreases doctors turnover6. Stress is likely to create problems within the

organisation, which will have the direct or indirect effect on the bottom line.

The operating costs certainly rise because of lower productivity, incorrect

or random work and mistakes. The employer needs to pay attention on stress

factors at the work place (Yemn and Graham. 2007)7. When an employee of the

organisation experience depression both at home and office, it will affect the

human relationship with co-workers, work productivity and personal health

(William. 2007)8. Balancing of work and life through time management is highly

essential to reduce stress (Leslie, 2007)9.

2. Kapur N, Borrill C, Stride C. (1998). Psychological morbidity and job satisfaction in hospital consultants andjunior house officers: multicentre, cross sectional survey. BMJ 317: 511-12.

3. Caplan RP. (1994). Stress, anxiety, and depression in hospital consultants, general practitioners, and senior healthservice managers. BMJ 309: 1261-63.

4. Firth-Cozens J. (1987). Emotional distress in junior house officers. BMJ; 295: 533-36.5. Coyle YM, Aday LA, Battles JB, Hynan LS. (1999). Measuring and predicting academic Generalists

work satisfaction: implications for retaining faculty. Acad Med 74: 1021-27.6. Yemm and Graham (2007). Is your workplace suffering from contagious stress, Management

services, Winter, Vol. 51, No. 4, pp. 46-47.7. Williams Terrie M (2007). Public Relations Tactics, November, Vol. 14, No. 11, pp. 10-118. Leslie Delperdang (2007). Financial Executive, January/February, Vol. 23, No.1, p. 64.9. Hanna D R and Romana M (2007). Debrifing after a Crisis, Nursing Management, August, Vol.38,No. 8, pp. 38-47.

It may be noted in addition to cost and benefit earnings, stress is an additional

burden for humanity. A good work life balance is important. The gap between


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work life balance leads to greater pressure and stress (Hanna and Romana,

2007)10

. Stresses therefore, is a dynamic condition in which an individual is

confronted with an opportunity, constraint or demand related to what the

individual desires and for which the outcome is perceived to be both uncertain

and important

STATEMENT OF THE PROBLEM

Several studies point out that the relationship between occupational stress

and job satisfaction & commitment has remained a topic of interest ever since it

was introduced. These studies point to that the continued interest is the result of

the belief that, if properly managed, employees organisational commitment can

lead to valuable consequences such as organisation success, reduced employee

turnover and non-attendance. This quest to harness the possible organisational

pay back has resulted in a number of researches that focus on the scenery and

relationship between occupational stress and job satisfaction

This study focuses on Occupational Stress (OS) and Job Satisfaction

among Expertise Medical Doctors of Andhra Pradesh Government Hospitals with

special reference to Krishna District, A.P. Various levels of stress and aspects of

job dissatisfaction are probed, to see how they are related to each other. The

relationship of these variables with demographic characteristics has also been

analyzed.

An extensive literature revealed that a great deal has been written about the

causes and adverse effects of occupational stress as well as the importance of

organisational commitment for the realization of organizational and professional

goals. However, very few studies were found which address this relationship in

the Medical Field of Krishna District, Andhra Pradesh. The review of the

literature also shows some reports on Occupational Stress, Job Satisfaction and

personnel management related problems.

10. Paul J Siracusa (2004). Financial Executive, January/February, Vol. 20, No. 1, p. 64.

The aim of this study is to identify the stressors issues that will influence

the government doctors job satisfaction. We selected Doctors because they havebeen consistently identified as a group experiencing high stress at work (Sigler


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and Wilson, 1988). More work and professional stress have been facing by the

government doctors. This study also aims at exploring the relationship between

stress factors and doctors performance in the context of Andhra Pradesh State

Health and Science Council with special reference to Krishna District.

The problem to be investigated is to, examine the relationship between

occupational stress and stress probing factors of M edical Doctors at their

workplace. Fur ther, th is study aims to explore the level, causes and dimensions

of occupational stress of doctors who are work ing in Government General

Hospitals, Kr ishna Di str ict, Andhra Pradesh

INTRODUCTION OF THE TOPIC

Stress in this society is not something that is invisible. Person whether a

child, adult, men, women, employed, unemployed everyone is facing stress in

his/her own way. Job life is one of the important parts of our daily lives which

cause a great deal of stress. Due to the competitive nature of the job environment

most of the people in the world are spending their time for job related work

purposes resulting ignore the stressor those are influencing their work and life.

Usually people are more worry about their outcome of their work that can even

affect the way they treat other people and how they communicate with their peers

and customers. For example, people with a higher percentage of occupational

stress may not be satisfied with their job and therefore they will not feel happy

working in the organization. They may feel frustrated or burned out when they

are having problems with peers or customers. This may leave a negative impact to

the organization itself. Therefore, it is very important for employer and employees

to realize the stress and the stressor that cause all the negative effects.

Stress at work is an increasingly common feature of modem life. A

survey11

of 28,000 workers in 215 organizations in the United States linked

stress at work to poor work performance, acute and chronic health problems,

and employee burnout. In the United Kingdom, researchers have estimated that


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360 million working days are lost through sickness each year at an estimated cost

of 8 billion ($12.8 billion; Sigman, 1992). The U.K12

health and Safety

Executive has estimated that at least half of these lost days are related to

workplace stress. Individuals and their organizations face a growing problem

of managing stress at work but are hampered by a lack of understanding of the

nature of occupational stress. When stress was first studied in the 1950s, the

term was used to denote both the causes and the experienced effects of pressures.

More recently, however, the word stressor has been used for the stimulus that

provokes a stress response. Currently, the disagreement among researchers

concerns the definition of stress in humans and their argument is based on the

following question: Is stress primarily and external response that can be measured

by changes in glandular secretions, skin reactions, and other physical functions, or

is it an internal interpretation of, or reaction to, a stressor; or is it both.

Every person has his own definition of stress. But according to Van Wyk13

(in Olivier & Venter, 2003), stress is derived from the Latin word Strictus that

translates into taut, meaning stiffly strung. Oliver and Venter (2003) rely on the

definition of Dr. Hans Seyle14

, who defined stress in physiological terms, as a

non-specific or generalized bodily response. The human body has a natural

chemical response to a threat or demand, commonly known as the flight or fight

reaction, which includes the release of adrenalin. Once the threat or demand is

over the body can return to its natural state.

11. Ivancevich, Matteson, Freedman, & Phillips, 1990; Kohler & Kamp, 199212. A survey conducted by European Foundation for the Improvement of Living and Working Conditions, 199613. Van Wyk, J. (1998). Stresbelewing by onderwysers. Ongepubliseerde DEd-proefskrif. Port Elizabeth:

Universiteit van Port Elizabet14. "A Syndrome Produced by Diverse Nocuous Agents" - 1936 article by Hans Selye from The Journal ofNeuropsychiatry and Clinical Neurosciences.The Stress of life. New York: McGraw-Hill, 1956.

A STRESSOR is an event or set of conditions that causes a Stress

response. STRESS is the bodys physiological response to the stressor, and

STRAIN is the bodys longer-term reaction to chronic stress.

Occupational Stress can be defined as the harmful physical and emotionalresponse that occurs when the requirements of the job do not match the
http://neuro.psychiatryonline.org/cgi/content/full/10/2/230ahttp://neuro.psychiatryonline.org/http://neuro.psychiatryonline.org/http://neuro.psychiatryonline.org/http://neuro.psychiatryonline.org/http://neuro.psychiatryonline.org/cgi/content/full/10/2/230a


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capabilities, resources, or needs of the worker. Job stress can lead to poor health

and even injury. Long term exposure to job stress has been linked to an increased

risk of muscular skeletal disorders, depression and job burnout and may

contribute to a range of debilitating diseases, ranging from cardiovascular disease

to cancer. There are large number of occupational stressors of varying degree and

nature experienced by male and female employees.

At work place stressors can be poor physical condition at work place,

Downsizing, Privatization, Hiring freezes, Contingent work (e.g. part-time or

temporary), Shift work/Rotating schedules, Quality Programs/Worker

Participation schemes, little autonomy or control over ones Job, Non-

existent career ladders, Inadequate resources to do the job, High demands,

workload, time pressures, Lack of job security, Understaffing, Mandatory

overtime, Violence/Harassment.

Stress level changes according to Hierarchy. Lower level employees both male

and female experience stress in different way as compare to upper level and

middle level.

Consequences of StressStress produces a range of undesirable, expensive, and debilitating

consequences, which affect both individuals and organizations. In organizational

setting, stress is nowadays becoming a major contributor to health and

performance problems of individuals, and unwanted occurrences and costs for

organizations.

Stress can result in

Absenteeism

Turn over

Reduced job involvement

Job dissatisfaction

Its physical symptoms can be:

1. Headaches

2. Stomach problems

3. Eating disorders


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4. Sleep disturbances

5. Fatigue

6. Muscle aches & pains

7. Chronic mild illnesses

8. High Blood Pressure

9. Heart disease

10.StrokeIts psychological & Behavioral symptoms can be:

Anxiety

Irritability

Low morale

Depression

Burnout

Alcohol & drug

Feeling powerless

Isolation from co-workers

Musculoskeletal disorders

Effect of Job Stress on work outcomes

When person get stress on physic, emotion and behavior that person become

looser or he escapes from working. His behavior towards work changes and

ultimately the effect shows on different work outcomes. This workout comes are

as under:

Performance

Productivity

Job dissatisfaction

Reduce job involvement

Absenteeism

Turnover

Work ineffectiveness

Health


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STRESSES IN HEALTHCARE

Healthcare is widely perceived as one of the most inherently stressful

employment sectors (Anderson, Cooper, & Willmott15

, 1996; MacDonald,

Karasek, Punnett, & Scharf, 2001; McGrath, Reid, & Boore, 2003; Weinberg &

Creed, 2000), and so there has been extensive research into work stress in

healthcare. The majority of research deals with the identification of sources of

stress, that is, the stressors (Lambert & Lambert, 2001). One conclusion from the

research on stress is that there are a vast number of stressors in healthcare, and

most stressful events seem to involve multiple stressors. The factors identified as

stressors are complex, and some factors might not be stressful in isolation (Healy

& McKay, 1999; Hopkinson et al., 1998).

Furthermore, one reason for the diversity of stressors identified could be

the use of different concepts and measures.

Factors related to Patients seem to be the most critical Occupational Stress

Factors (OSF) in creating stress among doctors while work overload, role conflict,

and role ambiguity seem to cause less stress in Indian scenario.

This conclusion was reached over a decade ago by Tyler and Cushway

(1995), who implied that intrinsic, factors such as as death and dying were

receiving too much attention. Then again, according to other researchers (e.g.

Erlen & Sereika, 1997; McVicar, 2003), caring for the emotional needs of patients

is an important source of stress, and may even be the main one.

15. Anderson W., Cooper C. & Willmott M. (1996) Sources of stress of the Natiional Health Service: a comparisonof seven occupational groups. Work and Stress, 10(1), 88-95

Erlen and Sereika16

(1997) found, however, that stress levels increased with

the increase of other demands, for instance keeping up with new developments in

healthcare, having too much to do, having too many interruptions, and insufficient

numbers of staff. Another major source of stress is interpersonal relations at work,

such as being subject to group pressure and having opinions not accepted by the


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work group (MacDonald et al., 2001); or too many expectations from others

(Edwards, Burnard, Coyle, Fothergill, & Hannigan, 2000).

In some cases, the organisational structure is the direct source of stress,

creating stressors such as organisational injustice (Kivimki, Elovainio, Vahtera,

& Ferrie, 2003), a lack of organisational involvement (Kirkcaldy & Martin,

2000), and a misunderstanding by management of the needs of the department

(McGowan, 2001).

A major theme in stress research is the importance of being in control of

one's work situation; that is, being able to influence decisions or being given the

opportunity to be involved (Troup & Dewe, 2002). However, research in

healthcare regarding lack of control at work is contradictory. Mkinen, Kivimki,

Elovainio, and Virtanen (2003) emphasised that, for healthcare personnel,

increased responsibility and role expansion in primary nursing diminished the

potentially favourable effects of increased autonomy and control. Reid et al.

(1999) identified extensive responsibility as the most frequently reported stressor.

Nurses regarded their contact with patients as highly rewarding, but felt burdened

by a strong sense of being constantly responsible for their patients. Likewise,

Nordam17

, Srlie, and Forde (2003) concluded that physicians felt stressed by the

responsibility and loneliness involved in decision-making.

Overload at work might lead to overload at home, as couples are usually

now both employed, and share family responsibilities (Majomi, Brown, &

Crawford, 2003). Cushway and Tyler (1996) found that the strongest and most

relevant sources of stress were not the ones leading to most psychological

distress.16. Erlen, J. A., & Sereika, S. M. (1997). Critical care nurses, ethical decision-making and stress.Journal of

Advanced Nursing, 26(5), 953-961.

17.Nordam, A., Sorlie, V., & Forde, R. (2003). Integrity in the care of elderly people, as narrated byfemale physicians. Nursing Ethics, 10, 388_403.

For instance, work-home conflicts were not a major source of stress, but they

were the main predictor of poor health. Wheeler (1998) has argued that stress

research has spent decades highlighting the determinants of stress in nurses, but

has offered few solutions for the problems. He has also stated that although the

studies highlight common sources of stress, a common source of stress does not


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necessarily represent the most important source of stress for any given individual

(p 40). Stress is to a large extent a matter of perception, as it always involves a

feeling self. The past decades radical changes in healthcare have generated

changes in the sources of stress. For instance, we now have the knowledge to do

more than we have resources for, raising new issues of standards, ethics, and

morality in healthcare.

MORAL DISTRESS IN HEALTHCARE

A concept somewhat similar to that of stress of conscience is moral

distress. Moral distress was first described in 1984 by Jameton (1993), and since

then the term has been used in several studies (e.g. Corley, Elswick, Gorman, &

Clor, 2001). In Sweden, Silfverberg (1996) has used the term ethical stress, as

has Raines18

(2000), while Ltzn et al. (2003) have used the term moral

stress for similar notions. Jameton19

(1993) defined moral distress as a negative

feeling occurring when institutional or other constraints make it difficult or even

impossible for nurses to act according to their moral conviction that is, their

values. Similar conceptualisation was given by Corley et al. (2001), who

developed the Moral Distress Scale (MDS) from research on the moral problems

that nurses are confronted with. Healthcare employees experience strain when

they are in situations of contradictory ethical demands and when they feel they

know what should be done but are prevented from acting in line with this insight.

The MDS assesses three factors; individual responsibility, not in the

patients best interests, and deception. According to Hanna (2004), the

conceptualisation of moral distress is unequivocal and not distinct.18. Raines ML. Ethical decision making in nurses. Relationships among moral reasoning, coping style, and ethics

stress.JONAS Healthcare Law Ethics Regulation. 2000;2:2941.

19. Jameton, A. (1993). Dilemmas of moral distress: moral responsibility and nursing practice. AWHONN's ClinicalIssues in erinatal and Women's Health Nursing, 4(4), 542-551.

For instance, moral distress seems to differ depending on whether the focus is on

norms or feelings. It lacks a clear and inclusive definition, and is problematic

since its definition is based on the way in which it arises.

Various sources of moral distress have been described. However, most

refer to injustices towards patients, failings in patient advocacy, and personnel not


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being able to work in accordance with their own values or provide adequate care

(Austin, Bergum, & Goldberg, 2003; Corley, 2002; Corley et al., 2001;

Georges & Grypdonck, 2002; vander Arend & Remmers-van den Hurk,

1999)20

. Most researchers have investigated moral distress in nurses; however,

Klvemark, Hglund, Hansson, Westerholm, and Arnetz (2004) showed that other

categories of healthcare personnel also experience moral distress. They concluded

that moral distress occurred when institutional constraints prevented staff from

acting according to their moral belief system, but also when staff did follow their

morals and in doing so were forced to clash with, for example, legal regulations.

Wilkinson21

(1987) argued that moral distress leads to feelings of

frustration, anger, and guilt, stemming from an inability to act according to ones

values. According to Kelly22

(1998), moral distress is a consequence of not

preserving one's moral integrity, that is, not being able to live up to ones moral

convictions. Moral integrity is connected to self and identity, and so, in the words

of Kelly, When moral integrity is threatened so are self and identity (p. 1137).

Consequently, moral distress is closely related to self-criticism and self-blame.

Kelly concludes that the degree of moral distress seems to be connected to the

degree of personal responsibility and accountability for patient care, and also to

moral ideals about nursing. Moral distress is primarily described in relation to

institutional obstacles, while stress of conscience can also cover stress due to, for

instance, self-selected actions or neglect, an aspect also addressed by some

research into moral distress. The concepts of morality and conscience are closely

related but not synonymous. Conscience can be in agreement with morals,

20. Austin, W., Bergum, V., & Goldberg, L. (2003). Unable to answer the call of our patients: mental health nurses' experience ofmoral distress.Nursing Inquiry, 10(3), 177-183.

21. Wilkinson, J. M. (1987). Moral distress in nursing practice: experience and effect.Nursing Forum, 23(1), 16-29.22. Kelly B(1998). Preserving moral integrity:a follow-up study with new graduate nurses.Journal of Advanced

Nursing,28(5)1134-1145.

or it can be opposed to and critical of them (cf. Ricoeur, 1992, pp. 342- 352). This

is evident, for instance, in Arendts (1963/1994, pp. 278-279; 1971) thoughts on

conscience and evil, and Eichmanns trial for war criminality in Nazi Germany.

The court ruled that even if Eichmann did nothing wrong in terms of the morals of

the culture he was living in, his conscience should have objected to those morals.

According to Frankl (1959/2000, p. 32), conscience is a pre-moral value


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perception which emerges prior to any formulated moral. The study and it starts

from the identification of the problem to the final plans of for the data collection.

NEED AND SIGNIFICANCE OF THE STUDY

Occupational stress, job satisfaction and commitment have long been

worry for employees and employers, and it has been deliberate among varied

professional groups. In the available literature, the work of Doctors is portrayed

as challenging and intrinsically stressful, even a high degree of occupational

stress may be measured a part of their job.

Studies on occupational stress have been at length carried out by past

researchers mainly in the western countries. Due to lack of studies addressing the

issue of doctors occupational stress in Andhra Pradesh, India, it is questionable

whether western findings can be applied in the non-western context, like India.

For instance, people in the western countries have an individualistic direction

toward job where as people in the South Asian countries in general have a

collective direction. Therefore, more studies are needed to erase the doubton the

applicability of western studies in the Indian Context. The present study is uniqueas it is an attempt to describe the occupational stress among Government General

Hospital Doctors in the context of Krishna District, Andhra Pradesh, India.

In India, some studies have address the causes of occupational stress, but

its relationship with job satisfaction and commitment in the Medical field has not

been studied by the researchers so far. This research is significant because this

relationship is being studied for the first time in Krishna District, Andhra Pradesh,

India.

This study is significant because of the insights and contributions is

provides for the doctors to better understand the occupational stressors inherent in

the function of their workforce through the antecedents including age, experience,

job position, gender, qualification, income and marital status. Furthermore, this

study develops an understanding of the commitment and job satisfaction and

achievement their organization goals effectively. The Government General

Hospital which comes under Andhra Pradesh Vidhya Vidhana Parishat (APVVP)


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can utilize the research findings to formulate suitable strategies to address the

stress related problems of their employees. Exploration and understanding of this

relationship in the government hospital doctors is going to be a unique

contribution of this study.

In the context of the present study, little research has been conducted to

investigate the occupational stress experienced by doctors in a developing country

like India. India comprises of about 35% population who are below poverty line

and it is this part of the population who approach government hospitals for their

medical treatment because they cannot afford to get the expensive treatment done

in a private hospital.

The study involves one of the prominent government hospitals in Costal

Districts i.e. Machilipatnam District Health Center, Andhra Pradesh, India. A

typical day of a doctor in this hospital starts with attending patients in the OPD (in

case of physicians) or performing surgery in the operation theatre (in case of a

surgeon), then visiting the wards, taking lectures, guidance to doctoral students

and research, attending emergency cases and working for long hours. Besidesthese activities, he/she has administrative duties and family responsibilities to

perform as well. Moreover, this govt. job prohibits private practice which may

also be a cause of dissatisfaction among the doctors.

This proliferation of roles that the doctors have to undertake during their

everyday educational and clinical practice lead to stress which has become an

inherent feature of work life of the doctors and growing evidence suggest that it

may increase in severity. Medical knowledge is increasing exponentially, the

disease patterns are changing, the approach to health care delivery and medical

education is shifting and also professional roles and boundaries are being

modified.

Work-related stress has been implicated as a major contributing factor to

growing job dissatisfaction among doctors. It has been found that job stress

impacts not only on doctors health but also their abilities to cope with job


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demands. This will seriously impair the provision of quality care and the efficacy

of the health service delivery.

To the best of our knowledge there is a paucity of Indian work in this field

which is another reason to undertake this study.

HEALTH MEDICAL & FAMILY WELFARE DEPARTMENT

ANDHRA PRADESH VAIDYA VIDHANA PARISHAD

Established in the year 1986 under an act of legislation, Andhra Pradesh

Vaidya Vidhana Parishad deals exclusively with the middle level hospitals of bed

strengths ranging from 30 to 350. These secondary institutions also referred to as

first referral hospitals are 228 in number and are called District Hospitals, Area

Hospitals, Community Health Centres and Specialty Hospitals including 25 civil

dispensaries.

District Hospitals 20

Area Hospitals 56

Community Health Centres 117

Specialty Hospitals 10

Civil Dispensaries 25

TOTAL 228

HOSPITALS UNDER CONTROL OF APVVP

The District Hospitalhas ten service specialties i.e. General Medicine,

General Surgery, Obstetrics & Gynecology, Pediatrics, Ophthalmology,Orthopedics, ENT, Dental, Radiology and Anesthesiology. It has on its rolls, 11

Civil Surgeon Specialists along with 18-20 Civil Assistant Surgeons. In addition

to this, there are Para-Medical posts comprising 48 to 78 Staff Nurses, 3 Lab

Technicians, 3 Radiographers and other staff. In terms of equipment, district

hospital have all the major items such as 500 mA X-ray unit, Ultrasound Scanner,

Endoscopes, Boyles Apparatus, ECG, Defibrillator, Cardiac Monitor and similar

such items.


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The Area Hospitalwhich is in general a 100 bedded hospitals caters to

four specialties i.e. General Medicine, General Surgery, Obstetrics & Gynecology

and Pediatrics. As a result, each Area Hospital has 4 posts of Civil Surgeon

Specialists and a complement of 10-12 Civil Asst. Surgeons. In addition, there are

24 Staff Nurses, 3 Lab Technicians1 Radiographer and other technical staff and

supportive medical staff. In terms of equipment, Area Hospital have 300 mA X-

ray units, Ultra Sound Scanner, Boyles Apparatus, ECG and basic theatre

equipment.

The Community Health Centreprovides only general services without

involvement of any specialties there is a provision for 4-5 Civil Assistant

Surgeons and in many places one post of Deputy Civil Surgeon/Civil Surgeon are

available. The equipment is more basic and comprises 60 mA X-ray along with

basic surgical equipment.

Krishna1 D.H. Machilipatnam 350

2 CHC Avanigadda 50

3 CHC Nandigama 50

4 AH Nuziveedu 100

5 CHC Thiruvuru 506 AH Gudivada 100

7 CHC Mylavaram 30

8 Teaching Hospitals Vijayawada 410

Total Beds in Position 1140

OBJECTIVES OF THE STUDY

The objective of this empirical study was to examine the occupational

stress and job satisfaction among the doctors of government general hospitals,

Krishna District, Andhra Pradesh, India. The literature review failed to provide


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any viable data about the nature and level of occupational stress of doctors in

Krishna District. Therefore, this study attempts to help fill this vacuum by

providing additional information that might be of interest to the researchers,

Hospital Doctors. The specific objectives of this study are:

(i) To determine the factors causing occupational (role) stress among

doctors working in Government General Hospitals, Krishna District,

Andhra Pradesh, India.

(ii) To examine the stress levels at work place among doctors working in

the hospital.

In the present study the population consisted of doctors in all of the

units/wards/departments at Government General Hospital in

Machilipatnam (District Headquarter Hospital), Vijayawada

Government General Hospital, and Gudivawada Government Hospital.

The respondents were scattered in

all units/wards/departments already stated at Government GeneralHospitals. Because the nature of work of the doctors it made difficult

to conduct face interviews and a questionnaire was ideal as the

respondents used their own time and pace to complete the

questionnaire. Judgment sampling was used for the selection of the

doctors which was found to be a convenient and economical method.

RESEARCH METHODOLOGY

The methodology includes research design, population and sample, data

collection and data analysis process are outlined. For many systematic inquiry


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application of appropriate methods and a scientific bent of minds are a sine-qua-

non. This has an important bearing on the collection of the reliable information

The present study is to acquire an intensive opinion about the level of

occupational stress among the doctors of Government Hospitals in Krishna

District, Andhra Pradesh. For this purpose, a Descriptive Research method was

followed. The study in this content have utilized the available material about

various aspects of HRM, data collected through well-planned interview with the

Doctors, Nurses and other staff of the Hospitals of Krishna District.

RESEARCH DESIGN:A research design is an arrangement of conditions for collection and

analysis of data in a manner that aims to combine relevance to the research.

It is the conceptual structure within which research is conducted and it

constitutes the blueprint for the collection, measurement and analysis of data. It

includes an outline of what the researcher will do from within the hypothesis and

its operational implications to the final analysis of data.

The Descriptive & Analytical Research design was used for the study.

Descriptive research design was included extensive surveys by interviewing the

doctors and fact finding enquires of different kinds to know the level of stress

among them. The major purpose of descriptive research is to description of the

sources of stress at work place.

SOURCE OF DATA

The relevant data was collected both from the primary sources and

secondary sources. The primary data was collected from the Medical Doctors

working in Government General Hospitals at Machilipatnam, Vijayawada and

Gudivada of Krishna District, through a structured questionnaire. the structured

questionnaire was prepared with the consultation of the guide and hospital

Superintendent at Machilipatnam.


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The secondary data was collected through news papers, journals,

magazines, already submitted thesiss websites etc.

QUESTIONNAIRE ADMINISTRATION:

The Occupational Role Stress scale - ORS (Pareek,2002)14

was used as a

tool to measure 10 role stresses, i.e. self-role distance, inter-role distance, role

stagnation, role isolation, role ambiguity, role expectation conflict, role overload,

role erosion, resource inadequacy and personal inadequacy. ORS is a 5-point

scale (0 to 4), containing five items for each role stress and a total of 50

statements.

POPULATION SIZE:

Two hundred and fifty three (253) questionnaires were distributed to the

respondents and one hundred and fifty (150) questionnaires (duly completed)

were received back from the respondents. This means that about 59% of the

questionnaires (duly completed) were returned. The hospitals selected for this

study in Krishna district are shown in table-1. The academic rank of the faculty

members and their experience is shown in Table 1

23. Pareek u. 2002.training instruments in hrd and od. tata mcgraw hill publishing company ltd. new delhi

Table 1: Showing Hospital wise Response to the questionnaire

Sl. Place of Hospital No. of No. of % of


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No QuestionnairesDistributed

Questionnairesduly filled

Response

1 Machilipatnam General Hospital 100 50 19.76

2 Vijayawada General Hospital 100 80 31.62

3 Gudivada Health Center 53 20 7.91253 150 59.29

Table2: Showing the Academic ranks and experience of faculty members.

Academic Rank Number Percentage Years of Experience

Professors 32 12.8 Between 15-25 Years

Associate Professors 28 18.8 Between 10-15 Years

Assistant Professors 35 23.3 Between 5-10 YearsDoctors, H.S & others 55 33.3 Less than 5 Years

Table 3: Type of Respondents

Male Female

Respondents 92 58

Percentage of Respondents 61.30% 38.70%

SAMPLING AND SAMPLE SIZE:

The respondents comprised of 92 (61.3%) male doctors and 58 (38.7%)

female doctors. Total number of samples are 150 i.e. n=150. We have made an

attempt to form a representative sample which included all ranks of doctors

working in the hospital. Due care has been taken in giving representation to

female doctors as well.

The sample of doctors considered is from various departments of

Government Hospitals, Machilipatnam, Vijayawada and Gudiwada. It was

decided to consider at least 20% of the doctors of the various departments to

evaluate the amount of work-related stress. Statistically, it is desired to have the

standard error not more than 10%. 90% of the confidence level is considered to


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determine the sample size. The sample size for the survey is determined as

indicated below:-

N= Z2

{ (1-)}/E2

Where, N= Sample size to be determined

= The proportion of sample considered

Z= The confidence coefficient (1.64 for 90% confidence level)

Accordingly,

N= Z2{ (1-)}/E

2

= (1.64)2 {0.20.8}/(0.01)2 = 41.9904 (approximate to 50) Respondents

from each place of survey. However, to make the calculations easy the sample

size was increased to 150. A sample of 150 doctors working in different

departments in Government Hospitals, Machilipatnam, Vijayawada and

Gudiwada was selected on convenient random basis.

TEST OF ANALYSIS

After collection of data both from primary and secondary sources, it was

analysed by applying test statistics and analytical tools. The major analytical tool

was used in this research was weighted average method and factor analysis

method.

To rank the different sources of stress at work place, the tabulation and

classification techniques were used. In addition to this, key statistical tools like

the Kolmogorov-Smirnov (D-Test) and Fama Eigen (F-Test) were applied to

draw the inferences.

PERIOD OF STUDY:

The present study was undertaken during 2010-201, in which it was

divided into three stages as such. Stage I was of research problem and collection

the literature of the topic chosen. Stage II was of analysis and interpretations by

using different statistical tools and Stage III was findings and recommendations.


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LIMITATIONS

The present study has been suffered with serious limitations during the

study period.

1. The present study is only confined to only occupational stress among

doctors.

2. The present study on Occupational Stress among Doctors is only

confined to Government General Hospitals, Krishna District, Andhra

Pradesh but not applicable to other regions of the state and country.3. The study is confined to a 2009-2011.

4. Accuracy of the study was purely based on the information as given by the

respondents.

PLAN OF THE STUDY (CHAPTERISATION)

The whole study is divided in to 5 Chapters.

Chapter1 Introduction (Objectives, need and importance of the study)

Chapter2 Company Profile (APVVP)

Chapter3 Literature Survey & Theoretical Framework

(Employee Stress Management)

Chapter4 Data Analysis & Interpretation (Tables, diagrams, charts,

statistics etc.)

Chapter5 Findings & Suggestions

DATA ANALYSIS


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WEIGHTED AVERAGE OF SOURCES OF STRESS

SERIAL ORDER WISE

Sl.No: Sources of Stress Mean Rank

1 Emergency calls during surgery hours 2.77 152 coping with phone calls during night and early morning 4.23 4

3 Night Calls 2.52 17

4 Dealing with problem patients 3.85 6

5 Demands of job on family life 4.79 1

6 Interruption of family life by telephone 2.33 18

7 Fear of assault during night visits 1.64 31

8 Demands of job on social life 4.22 5

9 Dividing time between spouse and patients 4.29 3

10 24 hour responsibility for patients 3.83 7

11 Remaining alert when on calls 2.13 2212 Dealing with relatives as patients 2.23 21

13 Arranging admissions 1.70 29

14 Dealing with friends as patients 1.89 25

15 Adverse press publicity 3.75 9

16 Home visits 1.69 30

17 Worrying about patients' complaints 3.69 10

18 Increased demands for a second opinion from hospital specialists 1.82 28

19 Coping with journals and newsletters 2.91 13

20 Practice administration 4.32 2

21 Dealing with the terminally ill and their relatives 3.05 12

22 Hospital referrals and paper work 3.82 8

23 Lack of emotional support at home 2.59 16

24 taking work at home 2.27 20

25 conducting surgery 2.88 14

26 Daily contact with dying and chronically ill patients 3.64 11

27 No appreciation of your work by patients 1.89 26

28 Conflict with partners in a group practice 1.87 27

29 Driving 1.31 32

30 Taking several samples in a short time 2.06 2431 Examining patients of the opposite sex 2.13 23

32 Working environment 2.30 19

RANK WISE SOURCES OF STRESS


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Sl.No: Sources of Stress Mean Rank

5 emands of job on family life 4.79 1

20 ractice administration 4.32 2

9 ividing time between spouse and patients 4.29 32 coping with phone calls during night and early morning 4.23 4

8 emands of job on social life 4.22 5

4 ealing with problem patients 3.85 6

10 24 hour responsibility for patients 3.83 7

22 ospital referrals and paper work 3.82 8

15 dverse press publicity 3.75 9

17 orrying about patients' complaints 3.69 10

26 aily contact with dying and chronically ill patients 3.64 11

21 ealing with the terminally ill and their relatives 3.05 1219 Coping with journals and newsletters 2.91 13

25 conducting surgery 2.88 14

1 mergency calls during surgery hours 2.77 15

23 ack of emotional support at home 2.59 16

3 ight Calls 2.52 17

6 nterruption of family life by telephone 2.33 18

32 orking environment 2.30 19

24 aking work at home 2.27 20

12 ealing with relatives as patients 2.23 2111 emaining alert when on calls 2.13 22

31 xamining patients of the opposite sex 2.13 23

30 aking several samples in a short time 2.06 24

14 ealing with friends as patients 1.89 25

27 o appreciation of your work by patients 1.89 26

28 Conflict with partners in a group practice 1.87 27

18ncreased demands for a second opinion from hospital

specialists1.82 28

13 rranging admissions 1.70 2916 ome visits 1.69 30

7 ear of assault during night visits 1.64 31

29 riving 1.31 32

SOURCES OF STRESSFACTOR WISE


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Ranks

Factor 1: Interruptions 1 2 3 4 5

Weight (5) (4) (3) (2) (1)

11 Remaining alert when on call 12 12 15 56 55

2 coping with phone calls during night and early morning 95 20 15 15 56 Interruption of family life by telephone 15 20 10 60 45

1 Emergency calls during surgery hours 5 25 70 30 20

8 Demands of job on social life 81 45 10 4 10

3 Night Calls 15 36 15 30 54

5 Demands of job on family life 135 5 5 4 1

4 Dealing with problem patients 66 33 24 17 10

(Eigen value 7.42; Variance 23.2%)

Factor 2: Emotional Involvement

14 Dealing with friends as patients 2 13 13 60 62

17 Worrying about patients' complaints 46 49 30 12 1321 Dealing with the terminally ill and their relatives 22 15 65 45 3

15 Adverse press publicity 63 32 20 25 1027 No appreciation of your work by patients 4 19 22 16 89

18 Increased demands for a second opinion from hospital specialists 3 2 5 95 45

26 Daily contact with dying and chronically ill patients 36 44 54 12 4

31 Examining patients of the opposite sex 19 10 10 43 68

(Eigen value 2.97; variance 9.3%)

Factor 3: Administrative workload and work/home interface

22 Hospital referrals and paper work 62 25 45 10 8

9 Dividing time between spouse and patients 101 20 9 12 8

24 taking work home 12 14 8 84 32

20 Practice administration 94 33 10 3 10

23 Lack of emotional support at home 21 11 35 51 32

32 Working environment 13 11 30 50 46

19 Coping with journals and newsletters 25 26 47 15 3728 Conflict with partners in a group pracitce 2 12 16 54 66


Factor 4: Routine medical work

16 Home Visits 1 5 2 80 62

25 Conducting Surgery 27 49 8 11 55

13 Arranging admissions 1 2 23 49 7524 24 hour responsibility for patients 58 41 30 10 11

29 Driving 2 3 5 20 12030 Taking several samples in a short time 12 15 28 10 857 Fear of assault during night visits 5 6 9 40 90

12 Dealing with relatives as patients 10 5 25 80 30



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Results:

Factor analysis

Factor analysis was carried out on all 32 sources of stress. It is usual to

report factors whose eigenvalues exceed 1.0 and variables whose factor loadings

are greater than 0.3. Using this criterion for eigenvalues, 10 factors were

extracted.

However, because this was a pilot study only the four factors with eigenvalues

greater than 2.0 and items with loadings greater than 0.4 are reported (Table 3).

For factor 1 all the items are characterized by their unpredictable nature or

by a problem associated with such an event, with the exception of dealing with

problem patients (the item with the lowest loading). Explaining slightly less than

50%! of the variance, this is the most important factor in the present study.

Although factor 2 is the second most important factor, the proportion of

variance explained by this factor is well behind that explained by factor 1. The

variables with the highest loading for factor 2 concern emotional involvement and

the two items with the highest loading involve medical relationships where there

is also likely to be a strong affective attachment.

The variables loading heavily on factor 3 divide fairly evenly between

those of routine paperwork and reconciling the demands of home and patients.

For factor 4 the variables that load heavily are those medically related tasks that

general practitioners take for granted.

WiRitTotalWeighi

.

5

1

Where Ri = Rank of sources of stressWi = assigned weighted to the concerned ranksFor Rank 1 = weight 5

Rank 2 = Weight 4

Rank 3 = Weight 3

Rank 4 = Weight 2

Rank 5 = Weight 1

spondentsofNoTotalWeithMeanWeight Re./


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CONCLUSIONS

Stress is normal. Everyone feels stress related to work, family, decisions,

their future and more. Stress is both physical and mental it is caused by major life

events such as illness, the death of a loved one, a change in responsibilities or

expectations at work, job promotions, loss, or changes. Correct stress

management should start from improved health and good intrapersonal

relationships. As is evident from the mean ratings of various factors promoting

occupational stress across different professional categories of Government

Hospital employees Organisation ability to optimize human resources have found

highest mean score among physician. This calls due consideration in order tomeet the expectations of the future generation. The prevention and management

of workplace stress requires organizational level interventions because it is the

organization that creates the stress. Success in managing and preventing stress

will depend on the culture in the organization. A culture of openness and

understanding, rather than of criticism, is essential. Based on the major findings,

the following recommendations are provided. Lack of resources includes

inadequate staff, lack of equipment/machinery and medicines. So it must be

advocated by the head of the unit, not only for the benefit of doctors but their

patients as well.

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