STRESS AMONG HOSPITAL STAFF

MANAGEMENT IN INDIAN HOSPITAL

Organizational Dynamics

BY: GROUP 1

SECTION A

ABHAYAKRISHNA V V -19001

ABHILASH R J - 19002

ABHISHEK R - 19003

ADARSH B S -19004

AKHILESH N V -19005

AKSHAY UDAY CHINCHANKAR -19006

AMIT ADWANI -19007

ANAND KRISHNA -19008

ANKIT KUMAR SHRIVASTAVA -19009

SUBMITTED TO: Dr. NILANJAN SENGUPTA

Table of Contents
Introduction...........................................................................................................................................2
Market Size........................................................................................................................................2
Health Care Workers.........................................................................................................................2
Causes of Stress in health workers....................................................................................................2
Unhealthy ways of coping with stress...............................................................................................3
Review of literature...............................................................................................................................3
Hospital – Bhabha Atomic Research Centre (BARC) Hospital................................................................4
Study in Mysore City..............................................................................................................................5
Ways to avoid stress..............................................................................................................................7
Conclusion.............................................................................................................................................8
REFERENCE............................................................................................................................................8
Introduction

Healthcare has become one of India’s largest sectors - both in terms of revenue and
employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing,
telemedicine, medical tourism, health insurance and medical equipment. The Indian
healthcare sector is growing at a brisk pace due to its strengthening coverage, services and
increasing expenditure by public as well private players. Indian healthcare delivery system is
categorised into two major components - public and private. The Government, i.e. public
healthcare system comprises limited secondary and tertiary care institutions in key cities and
focuses on providing basic healthcare facilities in the form of primary healthcare centres
(PHCs) in rural areas. The private sector provides majority of secondary, tertiary and
quaternary care institutions with a major concentration in metros, tier I and tier II cities.
India's competitive advantage lies in its large pool of well-trained medical professionals.
India is also cost competitive compared to its peers in Asia and Western countries. The cost
of surgery in India is about one-tenth of that in the US or Western Europe. India ranks 145th
among 195 countries in terms of quality and accessibility of healthcare.

Market Size

The healthcare market can increase three-fold to Rs 8.6 trillion (US$ 133.44 billion) by 2022.
Indian medical tourism market is growing at the rate of 18 per cent year on year and is
expected to reach US$ 9 billion by 2020. There is a significant scope for enhancing
healthcare services considering that healthcare spending as a percentage of Gross Domestic
Product (GDP) is rising. The government’s expenditure on the health sector has grown to 1.4
per cent in FY18E from 1.2 per cent in FY14. The Government of India is planning to
increase public health spending to 2.5 per cent of the country's GDP by 2025. The hospital
and diagnostic centres attracted Foreign Direct Investment (FDI) worth US$ 6.34 billion
between April 2000 and June 2019, according to data released by the Department of
Industrial Policy and Promotion (DIPP).

Health Care Workers

Healthcare workers suffer from work-related or occupational stress. Often this is because
healthcare workers face high expectations and they may not have enough time, skills and
social support at work. This can lead to severe distress, burnout or physical illness. In the end,
healthcare workers may be unable to provide high quality healthcare services. Stress and
burnout can also be costly because affected healthcare workers take sick leave and may even
change jobs. Health care workers have high rates of both work stress and on-the-job injury,
sometimes resulting in a long-term disability. Nurses, home health aids and other health care
workers can reduce the likelihood of on-the-job injury by understanding its typical causes.
Causes of Stress in health workers
 Health care professionals often work long shifts and in some cases overnights.
  They must deal with emotionally extreme situations such as death and bereavement.
 They frequently must interact with people suffering from a traumatic event or
grieving a loss.
 Many health care workers have trouble balancing their obligations at work with their
relationships outside work.
 Due to regulations requiring certain duties to be performed on a set schedule, health
care workers have a harder time pacing themselves than workers in many other jobs.
Unhealthy ways of coping with stress

These coping strategies may temporarily reduce stress, but they cause more damage in the
long run:

 Smoking

 Drinking too much

 Overeating or under eating

 Zoning out for hours in front of the TV or computer

 Withdrawing from friends, family, and activities

 Using pills or drugs to relax

 Sleeping too much

 Filling up every minute of the day to avoid facing problems

 Taking out your stress on others (lashing out, angry outbursts, physical violence)

Review of literature
A study was done on 50 nurses working in government and 50 nurses from private hospitals
in Chandigarh and Punjab, India.  Four hospitals were randomly selected using lottery
method out of which two were government and were two private hospitals. Maslach Burnout
Inventory-Human Services Survey (MBI-HSS) was used to assess burnout among nurses. It
was found that in government hospitals majority (52%) of nurses experience high level of
emotional exhaustion, 44% of nurses experience moderate level of depersonalization and
62% of them experience low level of personal accomplishment. The study findings revealed
that nurses working in government hospitals experienced higher level of burnout than the
nurses working in the private hospitals. The researcher had attributed higher level of burnout
among nurses in government hospitals to possible factors such as heavy workload, poor work
environment, frequent night shifts and poor support from administration and superiors.
In another paper it was examined the factors responsible workplace stress and coping abilities
of nurses caring for the patients in intensive care units. A descriptive exploratory survey
design was used with sample size of 100 using non-probability purposive sampling method.
The sample consisted of nurses working in two hospitals under private trust in Maharashtra,
India. The tools used for data collection were Stress rating scale and coping questionnaire.
The study showed that majority (59 %) had good coping abilities and 41 % of nurses had
average coping abilities. There was no impact of demographic variables of nurses on their
stress or coping abilities. It revealed that there was no significant association between the
level of stress and coping abilities.
Abraham (2012) examined the relationship between self-efficacy and stress among nurses in
a private hospital and found that work overload, less control over job, underutilization of
skills and unrealistic deadlines were the most important causes of stress. Further, with regard
to working conditions related stress factors, nurses with high self-efficacy were able to
manage difficulties at the workplace.

Hospital – Bhabha Atomic Research Centre (BARC) Hospital

Aim of study – To determine the extent and causes of occupational stress among nurses at
Bhabha Atomic Research Centre (BARC) Hospital
Study sample – The pro forma along with the study instruments were distributed to 120
consenting nurses in a survey method. Convenience sampling was used. One hundred and
five questionnaires were returned but 8 were incompletely filled hence were excluded from
the study. Thus, 97 study pro forms were analysed. This gave the survey an overall response
rate of 80.8%.
Study Instrument
The response options are

Score Response
1 never stressful
2 occasionally stressful
3 frequently stressful
4 extremely stressful
the person has never faced such a
0
situation
The mean individual score was calculated by dividing the total score with the number of
items and the interpretation was done as follows:

Score Interpretation
None or minimal
0 - 1.5 stress
1.6 -
Mild stress
2.5
2.6 -
Moderate stress
3.5
>3.5 Severe stress
Results

1. Population demographics

Age Sex n Education n

General
Age group N Male 10 80
Nursing
1
20-30 Female 87 B.sc nursing 17
2
4
30-40
3
3
40-50
4
50-60 8

2. Prevalence and severity of stress

3. Causes of stress and the mean individual scores

% of nurses
Domain reporting
stress
Conflict with supervisors 68.1
Unreasonable demand from patient and their families 59.8
Workload 56.7
Limited experience with death and dying 32
Uncertainty regarding treatment 31
Conflict with others health-care officials 27.8
Inadequate preparation to deal with patients’ emotional
issues 19.6
Problems relating to peers 16.5
Discrimination 7.3
Study in Mysore City

Aim of study -

To assess the level of stress among staff nurses in Mysore city.

Sample size –

A list of hospitals in Mysore city was obtained from the district health office. Eight
hospitals were shortlisted for the study by simple random sampling method because of
logistics reasons and approached for permission to conduct the study. A data of 500 staff
were collected.

Study Instrument
The response options are

Score Response
1 never stressful
2 occasionally stressful
3 frequently stressful
4 extremely stressful
the person has never faced such a
5
situation

Result

1. Population demographics

A total of 500 nurses were included in the study among that 93% were females and 7%
were male staff nurses.

Age n Sex n
<=24 179 Male 35
25 - 34 158 Female 465
35 - 44 125
45 - 54 21
>55 17

2. Perceived stress vs Moderate occupational stress

Majority of the participants (277 [55.4%]) had a moderate level of perceived stress and
249 (49.8%) had moderate occupational stress.
Ways to avoid stress
Dealing with Stressful Situations: The Four A’s

 Stress management strategy #1: Avoid unnecessary stress

Not all stress can be avoided, and it’s not healthy to avoid a situation that needs to be
addressed. You may be surprised, however, by the number of stressors in your life that you
can eliminate.
 Narrow down your to-do list – Analyse your schedule, responsibilities, and daily tasks. If
you’ve got too much on your plate, distinguish between the “should” and the “musts.”
Drop tasks that aren’t truly necessary to the bottom of the list or eliminate them entirely.
 Take control of your environment – If a TV show makes you anxious, turn the TV off. If
traffic’s got you tense, take a longer but less-travelled route.

 Stress management strategy #2: Alter the situation

If you can’t avoid a stressful situation, try to alter it. Figure out what you can do to change
things, so the problem doesn’t present itself in the future. Often, this involves changing the
way you communicate and operate in your daily life.
 Express your feelings instead of bottling them up. If something or someone is bothering
you, communicate your concerns in an open and respectful way. If you don’t voice your
feelings, resentment will build, and the situation will likely remain the same.
 Be willing to compromise. When you ask someone to change their behaviour, be willing
to do the same. If you both are willing to bend at least a little, you’ll have a good chance
of finding a happy middle ground.

 Stress management strategy #3: Adapt to the stressor

If you can’t change the stressor, change yourself. You can adapt to stressful situations and
regain your sense of control by changing your expectations and attitude.
 Reframe problems. Try to view stressful situations from a more positive perspective.
Rather than fuming about a traffic jam, look at it as an opportunity to pause and regroup,
listen to your favourite radio station, or enjoy some alone time.
 Adjust your standards. Perfectionism is a major source of avoidable stress. Stop setting
yourself up for failure by demanding perfection. Set reasonable goals for yourself and
others and learn to be okay with “good enough.”
 Focus on the positive. When stress is getting you down, take a moment to reflect on all
the things you appreciate in your life, including your own positive qualities and gifts. This
simple strategy can help you keep things in perspective.

 Stress management strategy #4: Accept the things you can’t change

Some sources of stress are unavoidable. You can’t prevent or change stressors such as the
death of a loved one, a serious illness, or a national recession. In such cases, the best way to
cope with stress is to accept things as they are. Acceptance may be difficult, but in the long
run, it’s easier than railing against a situation you can’t change.
 Don’t try to control the uncontrollable. Many things in life are beyond our control—
particularly the behaviour of other people. Rather than stressing out over them, focus on
the things you can control such as the way you choose to react to problems.
 Look for the upside. As the saying goes, “What doesn’t kill us makes us stronger.” When
facing major challenges, try to look at them as opportunities for personal growth. If your
own poor choices contributed to a stressful situation, reflect on them and learn from your
mistakes.
 Share your feelings. Talk to a trusted friend or make an appointment with a therapist.
Expressing what you’re going through can be very cathartic, even if there’s nothing you
can do to change the stressful situation.

Conclusion
Stress management studies has shown that the stress experience in the healthcare
environment negatively impacts healthcare professionals and commonly leads to so many
health-related problems particularly to decreased quality of life, physical and mental ill
health, and poor organizational performance. Healthcare professionals need support in
addressing the numerous stressors inherent in their work and it is suggested that stress
management interventions should be aimed at preventing or reducing stress among healthcare
professionals, this should focus on optimizing job demands through corresponding matching
type of job resource. Some of the relaxing techniques are slow breathing technique, Muscle
relaxation, keep things in perspective, prioritise the works, share your worries with family
and friends, set realistic goals, exercise regularly. The organisation can have Employee
Assistance programs and Anxiety and counselling services, Relaxation and stress
management courses.

Reference