PDP-CASE STUDY

ON
WORKPLACE STRESS: AN OCCUPATIONAL HEALTH

SUBMITTED BY- SUBMITTED TO-

MD JEESHAN Ms. GARIMA MAM
PGDM 2 B
ABS/PGDM/19/081
Workplace stress: an occupational health case study

By Anne Donaldson And Anne Harriss on 6 Oct 2016 in Mental health and stress, Return to
work and rehabilitation, Occupational Health

Stress, anxiety or depression underpin much work-related ill health, accounting for 9.9
million days of sickness absence in 2014-15, with, on average, 23 days lost per person. It
resulted in 35% of all days missed from work due to ill health. Industries reporting the
highest prevalence of ill health from work-related stress included health and social care,
teaching, public administration and defence (HSE, 2015).
The Mental Health Foundation claims 12 million adults consult their GP each year due to
mental illness, much of it stress related; one in six of the population experiences anxiety
(MHF, 2014).
The main causes of work-related stress reported to GPs (THOR – GP) were workload
pressures, interpersonal relationships, including bullying, harassment and difficulty with
superiors, and work changes, including responsibilities and reduction of resources (HSE,
2014). A YouGov survey (2012) found 48% of the British workforce said they were stressed
most of the time and 47% cited performance issues as key reasons.
Impact of workplace stress on individuals and work colleagues
Stress wanes when stressors are reduced. Conversely, anxiety can persist without a clear
cause to the individual.
Anxiety and stress are closely linked with similar signs and symptoms; anxiety may be
associated with depression as the most common mood disorder seen in primary care (Kumar
and Clark, 2012). People with low psychosocial resources are more likely to succumb to
mood disturbance when stress levels increase despite experiencing few stressors (DeLongis et
al, 1988).
Colleagues often undertake the work responsibilities of absent staff. This may lead to
spiralling absences among co-workers, who are stressed because of the additional
responsibility (HSE, 2014). This case study presents the assessment of an employee, Norman,
in order to ensure his fitness to return to his role without impacting on his health (Palmer et
al, 2013).
The objectives of the consultation were two-fold:
evaluating whether work had adversely affected Norman’s health and whether it may
continue to do so; and
providing impartial advice to management regarding his sickness absence, suggesting
modifications for their consideration in order to support a successful return to work.
Norman’s referral by management was precipitated by a four-week absence related to stress
and anxiety. There had been four further single-day absences in the preceding six months
attributed to gastrointestinal upsets.
The consultation
Norman, a 22-year-old part-time receptionist and administrative assistant, had been employed
in this role for 10 months working 30 hours per week. He had been absent from work for a
month on the day of the consultation and was preparing to return to work. On entering the
department, his mobility difficulties and an obviously awkward gait and altered balance were
noted. He disclosed treatment by his GP for stress, anxiety and depression.
He described previous short-term absences resulting from nausea and vomiting, relating these
to his anxiety at attending work. In the previous five to six weeks, in addition to nausea he
also referred to difficulty sleeping, restlessness, loss of appetite, palpitations and rumination
on his low self-esteem. Rumination can be a negative effect of stress. Genet and Siemer
(2012) claim that rumination moderates the relation between unpleasant daily effects and
negative mood.
Although excessive rumination is maladaptive, McFarland et al (2007) agree that some
limited self-focus can be beneficial. Norman felt anxious about returning to the same
situation and was accessing counselling support to help anxiety management. Hunsley et al
(2014) suggest that psychological treatments are of at least equal benefit to medication for
common mental disorders.
He had been prescribed 75mg of Venlafaxine a day with good effect. Venlafaxine is a
serotonin and noradrenaline re-uptake inhibitor used to treat depression or generalised
anxiety disorder. His GP also prescribed 5mg of diazepam – a long-acting benzodiazepine
anxiolytic – to be taken as required. Recently he had not taken this as he felt better.

Past health and social history

Norman had cerebral palsy and experienced difficulty walking during his early years.
Achilles tendon surgery in childhood improved this, although surgery left him with residual
lower leg discomfort if he walked too far or stood for sustained periods without resting. The
orthopaedic team monitored him every 18 months.
Norman described excellent family support. A non-smoker and non-drinker of alcohol, he
took no formal exercise but walked as much as he felt able. Increasing physical activity
within his ability was advised as it is found to improve mental health (Crone & Guy, 2008;
McArdle et al, 2012).
Work issues
Norman generally enjoyed his role, shared with an able-bodied colleague with whom he
alternated his reception duties. He indicated the interface with the public could be challenging
and stressful. His workload had increased in the previous four months following the
resignation of a colleague who indicated that he too found this role stressful. Financial
constraints resulted in this position remaining unfilled, increasing Norman’s responsibilities.
Stress is recognised as contributing to high staff turnover and low morale (Wolever et al,
2012).
Although working primarily at the reception desk, Norman frequently got up from his chair
to deal with customers and to undertake photocopying duties. On one occasion he spent an
afternoon mostly standing, which resulted in leg discomfort. No workplace adjustments had
been effected to support his disability.
On recruitment, his manager had enquired whether he required any adjustments. Norman
declined this offer, not wanting to “make a fuss”. He had not disclosed his disability at pre-
employment screening (PES) as he did not consider himself disabled.
Many of Norman’s perceived stressors are normal daily occurrences of reception duties, but
his physical disability exacerbated this. As he had not requested adjustments, there was
nothing in place to support him in relation to his mobility difficulties.
Although his disability had not been disclosed at PES, under s.2 of the Health and Safety at
Work etc Act 1974, Norman’s employer has a duty of care to him. Withholding information
at PES that later comes to light could lead to disciplinary action but Norman considered that
declaring his disability may have precluded his employment.
Cerebral palsy describes a group of childhood syndromes, apparent from birth or early
childhood, characterised by abnormalities in motor function and muscle tone caused by
genetic, intrauterine or neonatal insults to brain development. Resulting disabilities, of
varying degrees, may be physical and mental.
A full functional capability assessment should have been performed at the start of his
employment, facilitating adjustments enabling him to function effectively (Palmer et al,
2013). This had not been undertaken.
Norman usually managed his leg discomforts but occasionally had been unable to rest them at
work. A study of workers with rheumatoid arthritis suggested that the workers reported
greater discomfort on the days when they experienced more undesirable work events or job
“strain” (Fifield et al, 2004).
Although this study looked at rheumatoid arthritis, issues concerning chronic pain and
discomfort are relevant in this case. Although ultimately a legal decision, Norman was likely
to be covered under the Equality Act 2010 as he had a long-term disability.
Withholding information at PES was fundamental to the case of Cheltenham Borough
Council v Laird (2009). The council accused Laird of lying on her PES questionnaire by not
disclosing her mental health history. She had been taking long-term antidepressants that kept
her depression under control, but after some work problems her health deteriorated and she
retired on health grounds. The judge confirmed there was no general duty of disclosure of
information that was not specifically requested.
Thus, if a PES form does not directly ask about cerebral palsy, disclosure was not required.
Kloss (2010) mentions these types of dilemmas are often only answered through the courts,
but unless the employer is given information regarding disability, he cannot reasonably put
adjustments in place. In the case of Hanlon v Kirklees Metropolitan Council and others, the
employee declined to consent to the disclosure of medical records, arguing this would
contravene his right to privacy, and subsequently lost his case of disability discrimination.

The Health and Safety Executive (HSE 2007) defines stress as: “The adverse reaction people
have to excessive pressures or other types of demand placed on them at work.”
The stress response
Stressors initiate physiological responses, evolved to protect and preserve the individual in
times of threat by ensuring a reaction (Alexander et al, 2006).
This response is triggered by the limbic system within the brain. This is a series of centres
controlling emotions, reproductive and survival behaviours (Blows, 2011). When survival is
threatened, the system is instantly triggered into action to protect the individual, regardless of
the threat magnitude.
A chain reaction occurs: the hypothalamus mediates the autonomic nervous system
(Alexander et al, 2006), resulting in a sequence of physiological changes. The initial reaction
is very fast, and only when the information reaches the cerebrum can the urgency of the
situation be determined and responses modified (Blows, 2011).
The initial flight-or-fight response acts on the sympathetic division of the autonomic nervous
system. Noradrenaline from the adrenal medulla immediately prepares the body for physical
activity, mobilising glucose and oxygen to the heart, brain and skeletal muscles, preparing for
flight or fight.
Non-essential functions, including digestion, are inhibited. Reduced bloodflow to the skin
and kidneys promote the release of rennin, triggering the angiotensin – aldosterone pathway
leading to fluid retention and hypertension. The resistance reaction results from corticotropin-
releasing factor from the hypothalamus, stimulating the release of adrenocorticotropic
hormone from the pituitary. This effects a release of cortisol from the adrenal cortex.
Cortisol effects are far-reaching, including lipolysis, gluconeogenesis and reducing
inflammation. (Tortora and Grabowski, 2003). The body compensates for the effects of stress
as long as possible. Three phases of stress are described as the general adaptation syndrome:
alarm phase, resistance and exhaustion (Blows, 2011). The resistance and exhaustion phases
may lead to immunosuppression and consequent disease (Tortora and Grabowski, 2003).
There is a reciprocal feedback link between the thalamus and amygdala. When the amygdala
becomes overactive, fear and anxiety result. While adrenaline keeps the stress response
active, endorphins protect the brain from the effects of fear (Blows, 2011). With so many
physiological responses, there are numerous symptoms of stress that vary with each
individual.
Significantly, stress causes muscle tension (HSE, 2007), exacerbating Norman’s discomfort,
influencing his quality of life. As Kumar and Clark (2012) note, this is associated with
depression.
The HSE (2007) management standards for work stress cover six main areas of primary work
design that can contribute to stress if not properly managed. These include:

Demands – including work patterns, workloads and work environment.

Control – the extent of the worker’s job control.
Support – provided by the organisation, management and colleagues.
Role – understanding of their role and avoiding role-conflict.
Change – management and communication of organisational change.
Conflict – avoiding conflict, unacceptable behaviour and promoting positive working.
Fitness to work
The fitness-for-work assessment was based on a phenomenological appraisal as the effects of
stress vary with each individual and their resilience (Alexander et al, 2006). A bio-
psychosocial model informed the assessment. Norman stated that his condition was
improving and he was ready to return to work. He no longer experienced symptoms that had
taken him to the GP, but he was concerned at ending up in the same situation as before.
A patient health questionnaire (PHQ-9), providing an indication of depression, could have
been used to assess Norman. Arroll et al (2010) found that the PHQ-9 is unreliable for
diagnosing depression, whereas Manea et al (2012) refutes this assertion. At the time it
seemed to be of limited value as he was making good progress.
Norman was advised to discuss his work concerns with his manager. With Norman’s consent,
his manager was contacted and advised to carry out a comprehensive stress risk assessment as
per the HSE management standards. It was suggested to Norman that he contact the
organisation’s employee assistance programme and Access to Work, which offers grants for
practical support for individuals with disabilities/health conditions to assist them with starting
and staying at work. A phased return to work was formulated assisting Norman back into
work and supporting him to stay at work. The following work regime was recommended:

Week 1: Four hours on two days.

Week 2: Four hours on four days.
Week 3: Six hours on four days.
Week 4: Full working week with the option of a review should Norman struggle.
Norman was to meet with his manager at the end of each week to review his progress, with
the option to delay the next stage if this programme proved ineffective. In general, Norman
had indicated that he had let his concerns take over without making any attempt to talk with
his managers. He realised he should have discussed his work issues with his managers at an
earlier stage. As Waddell and Burton (2006) note, early interventions are more effective at

Norman’s case illustrates how lack of control and apparent excessive demands and change
can influence stress at work to negatively affect health. It reached a successful conclusion,
but Norman’s case may have been prevented from requiring OH intervention had he been
able to discuss his concerns and feelings with his manager in the first instance and a proactive
approach, including the use of HSE stress management standards, been used at an earlier
stage.
Anne Donaldson is an occupational health adviser. Anne Harriss is associate professor and
course director, London South Bank University.
References
Alexander MF, Fawcett JN, and Runciman PJ (2006). Nursing Practice: Hospital and Home.
3rd edition. Edinburgh, Elsevier.
Arroll B, Goodyear-Smith F, Crengle S, Gunn J, Kerse N, Fishman T, Falloon K, and
Hatcher S (2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the
primary care population. Ann Fam Med. vol.8(4), pp.348-353. doi: 10.1370/afm.1139.
Blows W (2011). The biological basis of mental health nursing. 2nd edition. Abingdon,
Oxon. Routledge.
Crone D, and Guy H (2008). “I know it is only exercise, but to me it is something that keeps
me going: a qualitative approach to understanding mental health service users’ experiences of
sports therapy”. International Journal of Mental Health Nursing, vol.17(3), pp.197-207.
DeLongis A, Folkman S, and Lazarus Richard S (1988). “The impact of daily stress on health
and mood: psychological and social resources as mediators”. Journal of Personality and
Social Psychology, vol.54(3), pp.486-495. Available online. Accessed 19 April 2014.

TASK:
Examine, evaluate and prepare a report on the above case. Make sure the following
pointers are included:
1. The mechanism of Stress (Problem) & probable stressors.
2. The major role of Occupational Health Interventions
3. Any further suggestions, if any.
(Not more than 200 words)
Tips:
The report shall be written in passive voice only. Focus on vocabulary and sentence
formation. Each report will be evaluated and feedback will be shared. Prepare the
report in word document and attach it in your respective mail. Do not forget to mention
your
Full name, Batch, Course & Section.

SOLUTION-

Stress, anxiety or depression holds much work-related ill health. Even the data
claimed by the Mental Health Foundation proves the above fact. Workload
pressures, Interpersonal relationships, Bullying at workplace, Harassment and
difficulty with superiors, Change in work and financial stability were among the
main stressors for work-related stress as reported to GP.
The result of many biological reaction going inside our brain and body with
response to the outside environment is what led to Stress. Since stress is
associated with depression the quality of life can be greatly influenced by this.

The above situation explained by the real life example of an employee named
Norman, a 22-year-old part-time receptionist employed for 10 months working
30 hours per week. During his early years Norman had cerebral palsy and
experienced difficulty walking. Norman was generally enjoying his role but it
was a matter of stress because of financial constraint and his disability about
which Norman didn’t disclose to his employer

However after treatment, Norman condition was improving as he was no longer

experiencing earlier symptoms. He was suggested to contact the employee
assistance programme of his organisation that offers grants for practical support
for his comfort to assist him staying at work. Also he realizes that he should
have not hide his work concern to the organisation.

According to me, Norman should not have hide his disability from the
organisation which led him stressful life. On the other side organisation also
have a major responsibility to work on the feedback and provide happy and
transparent environment to its employees.