i

The Relationship between Job Stress, Employee performance and job satisfaction
among the healthcare workers of South Waziristan tribal district Pakistan
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APPROVAL

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fully adequate, in quality and scope, for the fulfillment of the requirements for the

degree of Doctor of Philosophy

The student has been supervised by: [Name] and co-supervised by: [Name]

The thesis has been examined and endorsed by:

Professor Dr. AAA

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Professor Dr. AAA

Position

University

Examiner 1

Professor Dr. AAA

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This thesis was submitted to Asia e University and is accepted as fulfillment of the requirements for
the degree of Doctor of Philosophy.

Professor Dr. FFF

Asia e University

Chairman, Examination Committee

[Date]
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DECLARATION

I hereby declare that the thesis submitted in fulfillment of the PhD degree is my own work and that
all contributions from any other persons or sources are properly and duly cited. I further declare that
the material has not been submitted either in whole or in part, for a degree at this or any other
university. In making this declaration, I understand and acknowledge any breaches in this declaration
constitute academic misconduct, which may result in my expulsion from the program and/or
exclusion from the award of the degree.

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Signature of Candidate: Date: 9 May 2020

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Table of Contents
Chapter I.....................................................................................................................................1

Introduction................................................................................................................................1

1.1 Background......................................................................................................................2

1.2 Problem Statement...........................................................................................................9

1.3 Research Questions........................................................................................................15

1.4 Research Objectives.......................................................................................................18

1.4.1 General Objectives..................................................................................................18

1.4.2 Specific Objectives..................................................................................................19

1.5 Significance of the Study...............................................................................................21

1.5.1 Theoretical Significance..........................................................................................21

1.5.2 Practical Significance..............................................................................................22

1.7 Scope and Limitations....................................................................................................28

Chapter II.................................................................................................................................32

Literature Review.....................................................................................................................32

2.1 Introduction....................................................................................................................32

2.2 Job stress........................................................................................................................42

2.3 Employee Performance..................................................................................................62

2.4 Job Satisfaction..............................................................................................................74

2.5 Relationship between job Stress and job satisfaction……………………………………………………………..…75

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2.6 Relationship between job satisfaction and Employee performance…………………………………………..76

2.5 Underlying Theory.........................................................................................................93

2.5.1 Maslow’s Motivation Theory.................................................................................93

2.6 Gaps in the Literature...................................................................................................107

2.7 Hypotheses Development.............................................................................................111

2.8 Chapter Summary.........................................................................................................123

Chapter III..........................................................................................................................124

Introduction........................................................................................................................124

3.1 Population....................................................................................................................124

3.2 Sample size...................................................................................................................127

3.3 Research Design...........................................................................................................129

3.4 Research Instrument.....................................................................................................130

3.5 Data Analysis...............................................................................................................131

3.5 The Research Instrument..............................................................................................148

Chapter 4 Results ..............................................................................................................157

4.1 Descriptive Statistics................................................................................................159

4.2 Measurement Model ................................................................................................159

4.2.1 Relibilty.................................................................................................................160

4.2.2Convergent Validity...............................................................................................161

4.2.3 Discriminant Validity............................................................................................161

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4.3 Assessment of Structural Model..................................................................................162

4.3.1 Path coefficient inner Model.................................................................................163

4.3.2 Coefficient of Determinant...................................................................................164

4.3.3 The Predictive Relevence..........................................................................................165

4.3.4 Mean .........................................................................................................................168

4.7 Summary......................................................................................................................187

Chapter V...............................................................................................................................188

Discussion..............................................................................................................................188

5.1 Introduction..................................................................................................................188

5.2 Discussion....................................................................................................................189

Chapter 6 Conclusion.....................................................................................................189

Chapter 7 Limitations and Recommendations...............................................................192

References..........................................................................................................................220

Appendix A........................................................................................................................232

LIST OF TABLES
Table No. Title Page No
Table 4.2 Validity test……………………………………………………… 170
Table 4.3 Composite Reliability Demographics of Respondents 171
Table 4.4 Result of Sampling……………………………………………… 172
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Table 4.5 Respondents Profile……………………………………………… 173

Table 4.6.1 Questionnaire Result by Part…………………………………… 175
Table 4.6.1.1 Mean……………………………………………………………. 177
Table 4.6.1.2 Profession variables influence on the respondents Answers……… 179
Table 4.6.1.3 Correlation among items and its hypothesis………………………. 181
Table 4.6.1.4 Results of study depends on its hypothesis………………………... 183
..
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ABSTRACT

This study is to understand the true relationships among various latent variables such as Job

stress (Jst), job satisfaction (JS), and employee performance (EP) with Jst as independent

variable, EP as dependent variable and JS as mediating variable. The study is conducted in the

tribal area of Waziristan specifically in the health sector. Therefore data collected from the

respondents belong to health care sector such as hospital. The data collected from one hundred

and fifty one respondents via questionnaire developed from prior studies. The extracted data was

then transformed to arrange missing values and outliers. To observer the path analysis structural

equation model technique was utilized using smartPLS whereas descriptive statistics was

gathered via SPSS software. It was found that Jst has negative and significant impact on JS

whereas JS has significant positive impact on EP. JS is found to be the true mediator between Jst

and EP.

Key words: Job stress, job satisfaction, employee performance, SEM, PLS, SPSS.
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Chapter I

1. Introduction

Pakistani health practitioners are dealing with a significant amount of stress because of

the modern building in which they are working in South Waziristan Tribal District. In context of

legal and executive responses at either the worldwide, provincial, and federal governments and

also at the company level, it provided an outline of the frequency and effect of this form of stress

throughout various regions of the world. It also examines the probable circumstances and

variables that might lead to this form of risk prediction becoming more common. It is also hoped

that the findings of this research would serve as a guide for participants at the federal and

company sectors to act appropriately.

Since the 1990s, academics and regulators have paid increasing focus to the effect of strain on

medical practitioners, the repercussions of mental hazards, and the potential solutions to these

risks (Basit & Hassan, 2017). Thus, vocational rehab has broadened its scope to encompass

behavioral health; workplace health culture and organizational wellbeing in recognized the

importance of allowing individuals to lead successful lives at work and elsewhere in society.

Major developments in work organization and labor law have created challenges for employees

throughout the globe to satisfy the demands of professional years today. The barrier between

family and career is more and more blurry as the speed of work is pushed by the desire to keep

linked and the top rate of compete in global economy. Working conditions are becoming more

hostile as a result of rising rivalry, higher labor fuel economy standards, and long shifts.

Employees' mental state including well have been adversely affected by the present economic
 7

slump as a result of insecure work, diminishing job options, fear of loss of job and widespread

redundancies and unemployed. As a worldwide health issue, anxiety has become a major

concern for South Waziristan's staff nurses and their patients. Wellness care is a major cause of

mental hazards and an appropriate venue for resolving them via mass bargaining to preserve the

wellness and very well of personnel in tough circumstances.

Everybody has the right to comprehensive and unrestricted health care. Participation in

community and financial security are unattainable with adequate worker protections. Inadequate

working circumstances have a negative impact on both productivity and the broader societal

well-being of a whole population. It is more important than ever in the workplace to address the

issue of psychiatric condition because it has a massive effect on society's health, reduces work

opportunities and driving wages down, all of which have a negative effect on household earnings

and the efficiency of businesses, as well as generating greater expenses for the financial system.

1.1 Background

Nowadays, "stress" may refer to everything from a dull ache in the early to a depressive

state. It is a controversial term in the scientific community since it may mean both good and bad

things. We describe stress in a bad light in our study and only examine it when it comes to the

workplace. Anxiety is not always an indication of poor disease, but rather the beginning of a

distressing bodily and psychological response. Mental side and dangers have evolved throughout

time, as have the terms used to describe tension and the components that cause tension (Jalagat,

2017). "The brain's undifferentiated reaction to the desire for independence" was the first time

the word was used physiologically in 1936 by a scientist. His research led to the understanding

of stress as a cerebral cortex. "Variables anxiety" was also investigated as catalysts of the

psychophysiological reaction in order to distinguish stimuli from reaction. The physiological

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person, the surrounding conditions, and the external influence or event itself may all operate as

stressors in this context. Physically and mentally wellness and very well are impacted by stress,

which may be described as both a detrimental and a good response to a strain rate (Ramli, 2019).

When it comes to the concept of health, it is now understood to be a mix of physiological (the

body), mental, and sociological (the economy and the environment) components. Anxiety is an

unpleasant physical and mental response that occurs when there is a mismatch between what

individuals believe are their needs and what they have to satisfy those needs. The structure of

work, labor relations, and communication channels all contribute to stress if the owner's talents,

skills, or wants are not met, or if the expertise or capacities of the worker (or a group of workers)

are not in accordance with the standards of the company (Fonkeng, 2018).

No matter what sort of work one do, statistical research has consistently shown a link

between personality characteristics and NODA. Overall, the incidence of NODA in the

workplace is linked to a feeling of excessive work load, little assistance from coworkers, a

restricted degree of flexibility, and repetition of work. NODA is also linked to a discrepancy

between work and outcome, trouble interacting with coworkers and supervisors, and aggression

in the workplace (including harassing, harassing, and intimidating). Anxiety and exhaustion may

lead to fatigue.

A continuous exposure to psychologically draining circumstances at work61 also

contributes to mental deterioration. Workplace significant psychological behavioral concerns

may cause long-term reactions like fatigue. Symptoms, pessimism (a hostile, callous, and

insensitive approach regarding patients), neuroticism, apathy to one's own accomplishments, and

inefficiencies are all symptoms of burnout in the workplace. Employees may experience fatigue

if they feel disconnected from their employer in key elements of the workplace, such as morals,
 9

fairness, solidarity, remuneration, authority, and responsibility. Several factors contribute to

worker exhaustion, include but are not limited to: an insufficient support from coworkers and

supervisors, elevated (anomalous) workloads (both quantitatively and emotionally demanding),

involvement ambiguity and strategic restructuring, a loss of job gratification and individual

success, a disconnect between family and career, and physical assaults, such as bullying.

Anxiety, impatience, mood swings, and social difficulties are all symptoms of stress that do not

have a clear cause. For example, diabetes and heart attack are linked to fatigue, decline,

difficulty sleeping, problems with the vague nerve, as well as other malfunctions of the body are

all possible symptoms. In latest days, there has been a considerable rise in the occurrence of the

illness as well as its identification. Numerous researches have been conducted in several nations

to determine its causes, the most prominent of which being stress.

According to a large body of studies, women are more vulnerable to burnout, which may

explain why this is the case. Several psychological stressors linked with emotional exhaustion

are more prevalent in women, which may be interpreted to mean that many of these variables

seem to be more prevalent in women. Per the findings of a pass research of patterns and

causation of cardiovascular disease (CVD) in Sweden, women in a challenging political and

social status are more likely to experience burnout. The higher frequency of this illness in

women as relative to men may be attributed to adverse working circumstances and elements in

the home.

Sadness is a prevalent kind of mental illness. 350 million individuals worldwide are

affected by this disease, which ranks first among all mental disabilities, irrespective of sex.

Sadness, a loss of enthusiasm in life, a loss of muscle, sense of shame or invisibility, sleep or

hunger difficulties, and poor focus are all symptoms of this condition. Once persistent, these
 10

issues may greatly impair an individual's ability to carry out their responsibilities. Sadness is

often associated with perceived stress as a result of emotions of stress and worry, as well as

physical implications in terms of hypertension. Over thinking or sentiments, as well as physical

issues such as perspiration, shaking, sleepiness, and fast pulse, are common among those suffer

from stress. Sadness is among the main causes of early mortality and lengthy impairment in the

international, according to the Health Organization.

At the very same time, the findings of a series of researches show that people who are

subjected to job stress have a four-fold increased risk of developing melancholy, according on

the metric used the ethnicity of the participants, and the job function in which they work.

Various researches have revealed that melancholy is accompanied by personality characteristics

and anxiety in the majority of cases. Given the severity of the condition, it is not unexpected that

the majority of the study on health stressors, anxiety, and poor health has concentrated on the

relationship between the three variables.

More than half of studies show that mental illnesses and anxiety are associated with high

course load (such as long shifts, physiological, mental, and sentimental strain), lower turnout in

judgment, insufficient benefits, incompatibility among exertion and outcome, a poor work

environment, and corporate change or reorganization. Aside from full resolution, other

psychological variables related with melancholy include job discontent, role ambiguity and

conflict, bad labor relations, excessive responsibilities, a generalized desire for professional

success, and workplace injustice. A series of researches have also shown that harassment and

cyber bullying raise the risk of developing mood and anxiety disorders. Several mental problems,

including melancholy, stress, and somatic ailments, are associated with gender differences, per
 11

the Health Organization (WHO). Among the risk variables for mental illnesses that are more

prevalent among women are female aggression, deprivation (including poor productivity and

wealth disparity), low or submissive social standing, and the continual need to provide for

someone else (including children).

According to the Globe Health Organization, more than 800,000 individual’s suicide is

the second leading each year around the world. More than 75% of deaths occur in low- and

middle-income nations, according to the World Health Organization. The majority of suicides

occur among persons in their working years. Suicidal conduct is connected with a depressive

state, and the association between suicide and mental diseases (including melancholy and

illnesses related with alcoholism) has long been established in the literature. Suicidal behavior is

often exacerbated by a mix of risk factors, which might include elements at the interpersonal

basis. Nevertheless, types of stress connected with a legal dilemma, prejudice, loneliness,

difficulty in partnerships, physically or psychologically abuse, academic or job challenges,

among other things, might result in this sort of proclivity.

According to nation and area, there is a disparity in the volume and reliability of data on

the incidence of stressors and distress. In North America, as well as industrialized nations

generally, the majority of this sort of study is conducted; a lesser proportion is conducted in

particularly in the Asia region and Latin America, and a very tiny proportion is conducted in

Central Africa. Geographical data in Europe is mostly gathered and evaluated by institutions

affiliated with the European Union (EU).

As reported by the 4th EU Work Environment Survey (EWCS, 20071), over 40 million

persons suffer from stress at their place of employment. Per a survey published by a European
 12

Risks Center (2009), anxiety is responsible for between 50 and 60 percent of all missed working

time worldwide. According to the survey, on aggregate, 22 percent of employees are stressed,

with levels much greater in the newest Eu Countries (30 percent) than the old European Union

Member states (14 percent) (20 percent). The healthcare and development sectors, and also

farming, shooting, forest, and fisheries, are the most often cited as having high levels of stress

(28.5 percent). Professionals in wellbeing and school (12.7 percent), government and defense

(11.1 percent), farming, forest, sports, and angling (11.1 percent), and other industries are by far

the most common groups of patients who experience from panic disorder (9.4 percent). Although

workplace stress was identified as the most serious safety worry in the first questionnaire of

current and innovative dangers in EU businesses (ESENER) performed by the European Safety

And survive for a long time Organization (EU-OSHA) in 2009, only a minority of EU businesses

identified it as the most significant safety major worry in the second poll (Labor II).

Fifty percent of the businesses polled said that they educate their staff about health

stressors and their influence on safeguarding, with less than a third of the businesses stating that

they had processes in place to cope with stress. Administration and leaders of the workforce

came to an agreement at same time as the workers. According to a study on job stress in Europe,

their pervasiveness, and preventive care published in 2014, 25 percent of respondents feel

stressed all through all of their work time, and same number of staff thinks that their jobs have a

deleterious impact on their physical and mental health. Furthermore, psychological hazards are a

source of worry for the majority of enterprises in Europe. A significant number of managers

(almost 80 percent) said that stress was a significant issue, and that bullying was a major one.

Notwithstanding this, just a third of businesses have policies and processes in place to mitigate

such hazards. Working at a fast speed is verified by the 6th EU Work Environment Survey
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(EWCS, 2015), which found that 36 percent of employees labor "forever" or "nearly

continuously" owing to short timelines, with a further 33 percent functioning at an exponential

rate. Furthermore, nearly one in every six (16 percent) people suffers poor social conduct 

As reported by the 1st Central American Vocational Rehab and Circumstances

Questionnaire (2012), one out of every 10 participants in the United States is continuously

suffering serious strain or suspense (12–16 percent), unhappiness or depressed mood (9–13

percent), or sleeplessness (13–19 percent) as a result of their workplace conditions III. Per the 1st

Nationwide Survey of Jobs, Workplace Conditions, Workplace Culture, and Wellness (National

Survey of Full-time work, Workplace Environment, Organizational Climate, and Wellness,

2009), 26.7 % in Buenos Aires expertise mental trauma and take into account their work to be

tiring. Per the Accidents and Industrial Disorders Study conducted in Brazil, mental disorder was

the cause of 14 percent of all permanent social security payments received (9 percent for men

and 16.7 percent for women). According to the 3rd National Work-Life Balance Survey (2011)

conducted in Canada, 57 percent of respondents reported experiencing high levels of stress, up to

54 percent in 2001 and 44 percent in 1991. Additionally, a steady percentage of respondents

reported feelings of despair (36%), decreased sleep time (31%), and being physically ill (12%).

Since 1991, the proportion of individuals who are content with their lives has declined, from 45

percent in 1991 to just 23 percent in 2011. Finally, somewhat more than 75% of participants had

been away from the office in the six months before to the poll, with sickness (63 percent) and

mental, spiritual, and bodily exhaustion accounting for the majority of these absences (45

percent). A survey of EU Work Practices (EWCS) has been performed in Chile since 1990, per

the 7th Nationwide Survey of Work Environment (2011). The survey evaluates psychological

and social circumstances (such as the sense of the job, regular hours, heavy workload, and career
 14

opportunities) as well as the organization of work. In 2009, ESENER comprises approximately

28,000 enterprises from 31 countries, according to the organization III Central Rican, El

Salvador, Guatemalan, Honduran, Nicaraguan, and Nicaragua were among the countries that

participated in the poll. Apart from Nicaragua, the findings were identical across all nations.

Anxiety and melancholy were identified as a concern by 27.9 percent of workers and 13.8

percent of managers in the case of companies only 8.9 percent of firms and 7 percent of workers,

on the other hand, said that they had taken preventative actions regarding these issues in the

previous months. Furthermore, per the Chilean Council for Health And safety at work (ACHS),

mental problems were shown to be connected with 21 percent of the 4059 workplace ailments

reported in Chile in 2012.

1.2 Problem Statement

Psychosocial hazards are variables at work that contribute to stress and other negative

emotions. As defined by the International Labor Union (ILO) in 1984, they are "the interplay, on

the one side, here between work situation, the information of job, and its organizational structure,

and, on either side, here between skills, requires, heritage, and individual quasi factors of

employees, which can get through perspectives and attitudes affect the body, efficiency, and

work performance." This concept stresses the fluid interplay here between work climate and

ecological variables in a work environment setting. Workplace stressors and human variables

may combine in a negative way to generate psychological stress, behavioral issues, physiological

and central nervous system alterations, which in turn increases the likelihood of developing

mentally or physically disease (Ajayi, 2018). On the other, if workplace environment and the

human component are in harmony, labor creates a feeling of excellence and identity, encourages

motivation, and boosts productivity.

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Over history, the nomenclature has evolved: tensions have started to take the place of stressors or

psychological hazards in certain circles. In the scientific literature, the phrases "psychological

theories" and "behavioral hazards" are occasionally used commonly used in reference to the

same thing. Psychology elements, per a range of staff, are those features of the structure of

organized labor of output, as well as its individual and institutional circumstances, that may

cause bodily or mental harm. There is now a considerable agreement in academic circles

concerned with the nature of psychosocial elements; nevertheless, since new forms of labor and

alterations in the work situation create new dangers, the description of these variables cannot be

regarded definitive6. To this end, Koch categorizes potentially hazardous work conditions into

ten different categories (psychosocial variables), which he divides into two organizations: "lab

our substance" and "labor environment."

Since the 1960s, there has been evidence for the effectiveness of workplace structure and

practices on the psychological health of employees. However, it has only lately that managerial

and labor safety practices have begun to shift in response to the need to assure not just work

efficiency, but also the health of the individuals who comprise a work group. Wellness strategies

that are based on traditional principles of behavior such as behavioral medicine and group

dynamics have not been successful in identifying new elements of organization commitment that

promote real work and well-being in the face of changing cultural circumstances (Yunita &

Saputra, 2019). Study on healthcare including well inside the twentieth century changed focus

away from examining the processes through which post mental diseases impair organization

effectiveness and toward investigating the repercussions of work, both good and bad, on one's

psychological well-being.
 16

The findings revealed that ambiguity and contradiction of responsibilities, overloading

(both descriptive and inferential statistical), personality, poor self, discontent and job - related

stress all had a positive relationship with stress. Interactions and social protection, and other

individual qualities, might help to lessen the severity of their consequences. As a result of

academic evidence into the preventative measures of sexually transmissible chronic illnesses,

lawmakers are now considering them as an origin not only of personal habits and attitudes, but

also of social class disparities, wellness and workplace circumstances, and the requirements of a

specific job.

As a consequence of these investigations, a load paradigm as well as a hard work

mismatch paradigm has been constructed. Even a tiny degree of independence has been shown to

have a positive long-term influence on one's mental health in order to be productive. An

increasing ethnic variety and technology advances are affecting scientists to pay increasing

amounts of attention to areas such as environmental and career progression, performance

appraisal, organizational efficiency, joblessness and underemployment, "reduced absenteeism"

(participation at job while sick) and absences (lack from job without excellent purpose), among

other things (Elshaer et al., 2018). There is also a greater emphasis placed on mental health, the

positive elements of wellbeing and very well, and the organizational variables that may help to

enhance these parts of life. The relevance of the social context in forming and evaluating

corporate behavior has been shown in many studies, and the value of rules and policies in

establishing labor relations built on trust, integrity, and collaboration has also been demonstrated.

According to the International Labor Organization, the success of psychiatric treatment at work

is dependent on preventive. Women and men may benefit from health & safety measures that

enhance their psychological health and very well while also reducing their chance of developing
 17

mental illnesses (Basu et al., 2017). This implies that the findings of psychological prevention

and mitigation should be used to inform the design of the workplace safety & health network,

with the goal of preventing work-related strain and industrial mental disease.

Growth and technology advancements have fundamentally altered the nature of labor

over the last several years. New types of work organization, labor rights, and unemployment

have all had a role in the rise of stress and associated illnesses in the workplace. Aside from the

potential for economic growth that has arisen as a consequence of globalization, the threat of

global vendor evaluation that erodes the respect for work practices and basic rights has also

increased. The globalization of the economy has shifted work experiences in favor of component

and temp work, as well as the recruitment of outsourcing people, in order to boost business

agility. A rise in the demand for labor, diminished job stability, weakening control mechanisms

and an increased risk of redundancies are all possible outcomes. Technical advances and the

introduction of the Web have resulted in many developments and adjustments in industrial

applications, further blurred the lines among work and personal life for many people. Having the

ability to contact with a company out beyond work time and continuing to work from homes may

lead employees to assume that they are performing at an exceptionally high level.

Because of mismatch between work and personal life, which may result in problems at

work owing to variation in behavior and time limits, as well as stress, it can make it very hard or

difficult to carry out responsibilities at home, and conversely. The current downturn in the

international economy has led to an increase in unemployed, impoverishment, and isolation,

among other things. A large number of businesses were obliged to reduce their business growth

as a consequence of this in order to preserve their viability. Restructuring, optimization, and

mergers have grown common, as has the use of outsourced and leasing, as well as the
 18

employment of massive layoffs. Not only can reorganization result in layoffs, but it also leads to

confusion and animosity among employees. Workers who have retained their positions as a

result of the optimization may feel remorse for their former coworkers who were fired. Apart

from the dread of losing their employment, employees must also deal with the reality of having

restricted career options. The remaining staff may be pushed to combine jobs, work under

increasing load circumstances, work longer hours, operate under situations of loss of oversight,

and work in roles that are unclear of their future (Gordon et al., 2018).

Reorganization and organizational adjustments during a moment of crisis are necessary

that administration must focus more on cost-cutting than on controlling production hazards, as

shown by prior disasters experienced. Since many firms consider occupational safety and health

to be an expense rather than expenditure, some companies attempt to decrease costs by

disregarding applicable rules. Public expenditure reductions also jeopardize the capacity of the

Work Inspection Bureau and other authorities to apply the rules. A higher percentage of people is

so essential to them that many individuals would rather work under challenging circumstances

than be out of work altogether. Employment is not just a source of income, but it also helps to

maintain fundamental mental mechanisms such as a feeling of time, socialization, and a feeling

of one's own identity. It has been shown that jobless is connected with lower overall happiness,

social stigmatization, and a sense of being a stranger to oneself.

Workers are exposed to stressful situations when they are exposed to components of their

workplace such as organizational structure, leadership, and the situational relations of the

workplace that are potential of inflicting physically or emotionally damage to them. For instance,

long hours, which does not enable one to dedicate sufficient time to one's relatives; a judgment

procedure in which staff members do not take part in the resolution of things that concern them;
 19

and a poorly balanced customer who requires out his bad feelings on a worker are all instances of

stressors that, whether they occur actively or over time, can have a negative impact on one's

health. Stress that would seem in life is not usually restricted to the workplace, and

distinguishing between work-related stress and personal stress can be challenging, if not

unthinkable, at times - for example, dealing with the disease of an adored one, the start of the

school year in children, or the separation from a loved one can be extremely difficult have an

effect on the effectiveness of the employee However, although such instances fall beyond the

range of an employer's obligation for the welfare of its workers, a decent boss might provide

assistance to an employee in order to avoid potential bad implications for the work flow in

question.

A moral commitment, as well as a legal one, for the company is to reduce the degree of

stressors and consequently results at work. For example, like in other European Community

nations, the Estonian Healthcare Act requires businesses to consider the safety and welfare of

people at work in every job circumstance. An business ought be able to handle job anxiety in the

same way that every other potential problem in the health service is managed, by analyzing the

harm to the laborer's health posed by the behavioral aspects of health system via risk assessment

(Jalagat, 2017). In research performed with employees at a facility in the United Kingdom,

several issues were discovered, including significant levels of employee unhappiness, a high

level of readiness to quit, a low having the ability to make, and a high incidence of impairment.

Outside specialists were brought in to examine the reasons of the crisis and come up with an

answer. With their assistance, a psychological risk assessment was conducted out.

The stressor on wellbeing is dependent on the reaction of the host; even so, stressful

situations can result in a variety of health complications, such as depressive disorders such as
 20

tiredness, anxiousness, and depressed mood, as well as serious illnesses such as cardiac or

muscle breakdown. Strain is a natural part of life, and it is important to manage it. Industrial

accident study puts an emphasis on "due to injuries" employees in order to limit the number of

injuries via a screening procedure in the initial stages. A personal component in workplace

accidents is now widely acknowledged to be marginal, and risky conduct is mostly the product of

a drive for speed and inexperience, rather than the fault of a single worker, according to several

new researches. An increasing amount of research is dedicated to the investigation of the link

between insufficient job strain conditions and job stress that is connected with the danger in the

workplace. Stress-related mental or physical ailments might raise the probability that a worker

will get sidetracked, make an error, or make a miscalculation when doing normal operations. A

number of studies showed that variables including a high level of course load and requirements,

a low level of commitment in judgment and liberty to behave, a lack of organizational assistance,

quarrels with co - workers and supervisors, and repetitive work all increase the probability of

workplace injuries.

In addition, research findings indicate that poor psychological health (exhaustion or

tiredness) is inversely connected with safe behaviors, raising the risk of an accident occurring.

Harsh work situations, according to research, may have a significant influence on employees'

well enough by encouraging them to engage in harmful activities. According to the existing

research, social hazards and anxiety are connected with behavioral health hazards such as greater

alcohol use, obesity, lack of physical activity, tobacco, and disturbed sleep. An increasing

thorough look into the connection between stress and health and conditions of employment and

alcoholism, and they have discovered that levels of fear, volume of work (such as long hours),

misaligned attempts, and bullying at work are all critical to the creation of alcohol addiction.
 21

When it comes to the issue of stress and health, there are significant distinctions among men and

women. While cigarettes are affiliated with work - related stress and heavy workloads in men,

the main causes of schizophrenia tobacco consumption in women are increased expectations

placed on them (both physically and psychologically), as well as discrepancies between attempts

and outcomes. The consequences of these habits of hazardous behavior are obvious, with around

6 million fatalities per year due to smoking and over 3 million deaths per year due to alcohol

misuse. Dietary imbalances and physical inactivity are also significant contributors to obesity,

which is a significant risk factor for neurological illnesses (NCDs) such as heart events, cancers,

and insulin. Lowering the producing aspects related with poor diets and no communicable

diseases (NCDs) leads to the general treatment of ailments and very well in a society, Research

on insomnia have revealed a reciprocal association between the latter and emotional hazards at

work in a lot of incidents.

1.3 Research Questions

RQ1: what is the relationship between job stress, job satisfaction, and employee performance?

RQ2: how does job satisfaction mediate between job stress and employee satisfaction?

1.4 Objectives of the study

1.4.1 General Objectives

Job stress, employee performance, and job satisfaction are all ideas that are intertwined

and have substantial links with one another, according to the research. In particular, this is true

for jobs that are very demanding and need individuals to keep performing at or beyond the

required levels. In Pakistan, particularly in the South Waziristan area, employees in the health

industry as well as others who struggle from work experience or job strain on a continuous basis,

which negatively impairs their ability to execute their duties. Therefore general objective of this
 22

study is to understand the relationship between job stress and employee performance in the

presence of job satisfaction as a mediator.

1.4.2 Specific Objectives

Workplace dynamics are continuously shifting. Many good features are associated with

the occurrence of technological advances, globalization, and population changes. These variables

have also resulted in the formation of new fields of tasks and procedures as a result of these

developments. Labor has grown more flexibility; it has been more integrated with personal life;

the number of physically demanding and potentially hazardous work has dropped; and the

workplace has become more diversified. New risks arise as a result of the adjustments, including

competitive pressures, intensified labor, and tighter prerequisites for employees; the fast

development in employment opportunities in the hospitality industry, where fighting,

unfortunately, is not unusual; and the increased risk of job loss as a result of economic

instabilities. The advancement of technology has resulted in a blurring of the lines between work

and personal life for many people. There is a requirement and a chance to be accessible at all

times to resolve work-related difficulties. Renting labor, work plan, and private business are

examples of new types of employment that have increased the fragile nature of the working

world. In addition, the growth of immigrant and elderly employees necessitates a more

conservative view to their unique features (Anjum & Ming, 2018).

It goes without saying that nearly no job is pressure. A certain amount of stress is

unavoidable and necessary in the workplace: tension serves as a driving stimulus for leadership

learning. However, if any job is available; In the event that a job or connection generates lengthy

strain and an employee discovers that they are no longer capable of keeping up with the

expectations, work stress may set in, having a severe influence on both performance and health.
 23

Examining the issue more widely, we can see that stress has a detrimental influence on the

person, the business where the worker performs, and the larger society in which they live. Stress

in the healthcare industry is a very important issue. Stress-related health issues are the 2nd most

common kind of effort health complications in the European Union, behind muscle spasms,

when it comes to effort health complications. Disability as a result of work-related stress often

lasts for a lengthy period of time.

It is estimated that work - related stress is responsible for around half of all lost working

days each year. According to studies, society suffers a loss of 1-3.5 percent of its national output

product as a result of workplace violence and tension (GNP). In this informational guide, we will

discuss the phenomena of stress at work, as well as the factors that contribute to its development,

with both workers and employers. There is an explanation of the obligations of an employer

when dealing with psychological work - related stress, as well as advice on how to avoid stress in

the workplace at the organizational and team levels, among other things (Basit and Hassan,

2017). It is a condition of stress that refers to the perceived is aware of a disparity between the

obligations placed in their workplace and their own abilities.

An adequate response is initiated in the body when an individual’s perceive that he or she

is at risk of stress as a result of brain chemical activities. The reaction's mission is to assist the

body's ability to function in a new circumstance, such as while under a tremendous deal of strain

or pressure. Heart rate and respiration rate both rise as a result of this response, and sensation

becomes more sensitive as a result of this response, among other things. All of them are

obligatory reactions in a circumstance when there are only 2 choices: fight or flight, and none of

them are optional. This response, which was absolutely necessary in ancient, cannot explain

itself now in the face of lengthy, often recurring stress in the workplace - the body becomes
 24

fatigued, and a variety of psychologically and physically diseases manifest themselves. Various

factors influence the incidence of stress and the consequences of this stress on one's health. One

individual may find comfort in a circumstance that causes them terrible stress, while another may

find it invigorating. Even the most routine and doable job may, for a variety of reasons (for

example, personal troubles), seem to be unattainable one day. The well-being of the individual

and the connections between coworkers may also have an influence on productivity. According

to a stress survey conducted by the Labor Inspection in 2009, over 10% of participants had been

exposed to harassment in the health industry in the previous 12 months. Extreme abuse was

perpetrated against 1.4 percent of employees, and threatening of actual assault was leveled at 3.7

percent of employees.

Harassment in the healthcare market is defined as persistently disagreeable, insulting, or

demeaning conduct directed at a worker who has had to successfully respond. Examples of

bullying include fostering emotions of inferiority or fear by using teamwork or circumstances as

a means of achieving this goal. Harassment often includes the misuse of authority, the

propagation of rumors, public embarrassment, or the premeditated harassment of a worker in

order to lower his or her productivity. The result of intimidation in the healthcare industry is that

a worker is forced to sign a termination notice from his or her position. Using force to

accomplish tasks in the health industry or while performing job obligations is referred to as

aggression at work (also known as workplace bullying). If, as is common in many nations, the

employer is viewed as harassing, it is also common for people who not exist in the business, such

as consumers, to turn violent. Therefore specifically the study is aimed to examine the

relationship between job stress and job satisfaction, job satisfaction and employee performance,

and mediation on job satisfaction.

 25

2.6 Gaps in the Literature

A wide range of research has been done on the relationship between workplace qualities of work

life, but few studies have been able to pinpoint the primary stressors that are responsible for this

connection. Rising patient loads, as well as linguistic and psychological stress, all cause a

buildup of work-related stress in the healthcare industry, which has an adverse effect on both

employees and patients. The person may not get the attention they need if they are under too

much stress. A lack of studies including patients who comment on their interactions with a bad

medical system is causing a lack of research in this area.

Inquiry's value to society that workers in fields such as human resources and organization.

Effectiveness has several challenges, including how to ensure that workers in a wide range of

occupations can adapt effectively to ever-evolving work environments (Ali et al., 2016).

There is a lack of study on the particular effects of technological advancement and changing

organizational processes on occupational stress among workers, while the bulk of studies

concentrate on project management and opposition. Increased stress and unhappiness is caused

by workers having to deal with new and sophisticated technology, enormous information flows,

and difficult choices that they are ultimately accountable for. It also enhances the importance and

accountability of one's personally and professionally actions and their outcomes. New

organizational modifications are a result of the dynamic nature of professional activities, the shift

in dominant forms of labor, the complexity of innovation activities and the movement of labor

resources, and the increasing needs for maintaining labor safety.

Existing research tries to identify a complicated array of criteria that decide the specifics of

contemporary working lives and brings up the question of whether personal funds and activity
 26

costs should be taken into account, which influence the overall success of implementing a

working population and have not been investigated by other studies (Abdulkhaliq &

Mohammadali, 2019). A crucial component of determining how best to organize human labor is

to examine and evaluate the functional states of those doing the job, which is a crucial aspect of

determining how best to improve and optimize their respective task. So, it has been included into

our study to cover the gap in our knowledge. The researcher also found a gap in the provision of

effective mental measure to assess and attempting to prevent unfavorable understand the

processes of an individual and, in specific, work stress, which are primary contributors of

lowering utilization of human resources and lead to emotional health abnormalities of experts.

As a result, it is crucial to keep in mind that stress is the most significant topic in the study of a

broad variety of operational states at this point in time. "Drawback at work" is widely seen in

contemporary literature as a result of their negative influence on progress in terms of numerous

personal disadvantages.

Other study has shown a significant dearth of knowledge on how to avoid workplace stress, as

well as the elements that might help alleviate it (Ruch, 2019). Statistical evidence shows that

extended or extensive chronic stress situations in the workplace may lead to major mental and

somatic problems, such as psychological illnesses, delocalization, and a variety of professionally

and personally delaminating, such as a lack of social support. With respect to stress preventive

and corrective measures, it is important to recognize early signs of stress as well as the specific

propensity of a specific person, and also numerous tactics for handling stressful circumstances,

so that they may be used to their fullest potential.

Specialists operating in the "guy" system are particularly vulnerable to the negative effects of

work stress. Managerial people or managers of different profiles is one of the most common and
 27

ubiquitous occupations. In spite of the fact that the issue of stress as a major cause of illness and

decreased management efficacy is often discussed, it has not yet been comprehensively explored

in the literature (Wu et al., 2017). There are many studies that concentrate on the broad effect of

job stress and workplace unhappiness on all workers, but they do not take into consideration the

stress that managers endure due of their expanded duties.

Excessive workload and long hours may cause a reduction in performance due to night shifts,

which can lead to sleep deprivation, says the study's author. Employee well-being is directly

correlated to their ability to produce high-quality work, which in turn has a positive influence on

their productivity. A clean and relaxing work environment has been shown to increase

productivity, 

The amount of work required in the health system is directly proportional to the presence of

patients. If no patients are present, no workers are needed. Workload in the healthcare industry is

thus variable. Excessive workloads in hospitals caused by a shortage of workers have been found

to harm the healthcare system. Excessive workloads put nurses under a lot of stress, which may

lead to job dissatisfaction and resignations. Additionally, it has been found that many hospitals

have a shortage of workers, resulting in an increase in the burden they have to deal with

(Vijayan, 2017).

Healthcare professionals face a unique set of challenges, many of which have been studied

extensively over the last several decades, resulting in a growing body of study on the effects of

these challenges on both mental and physical health. An increasing reliance on management

effectiveness to ensure an organization's long-term sustainability highlights the challenge of

sustaining the health of managerial employees and assuring their making such study very
 28

important. Educators have discovered, via such investigations, the importance of good health for

both patients and healthcare providers. It is important to note that closing the knowledge gap in

this area requires not only acknowledging the existence of problems and the subsequent decrease

in management staff' employment possibility, but also conducting in-depth psychological

analyses of the stress expressions unique to specific types of strategy implementation, allowing

researchers to better understand the mechanisms at play and select the most effective strategies

for eliminating the negative effects (Hussain et al., 2019). Thus, a huge research deficit was

discovered in an important field of study.

The assessment of the literature also revealed a lack of information on the stress experienced by

healthcare managers. Work demands, information processing, expenses, and accountability for

the care delivery company's whole personnel are all related with the actions of managers at all

levels, regardless of their position in the organization. The uniqueness of this job rests in the

sheer volume of psychologically charged and intellectually demanding interactions that occur on

a daily basis, necessitating a strong personal investment on the part of the medical manager. In

addition, just like in other positions that require interaction with others, it is critical to get

suggestions on the achievement and quality of one's work, such as from coworkers who show

respect for one's efforts and from management about the quality of any changes or new

initiatives that have been implemented.

Due to a dearth of research on this pressing issue, an important analytical framework is required

for an in-depth evaluation of workplace stress. The research on work engagement, on the other

hand, does not provide any particular approaches for detecting occupational stress or in the

business. In these cases, approaches with a broader scope are more often utilized, measuring
 29

psychological stress through indirect signs or by looking at just a few of their appearances. The

study observed that these deficiencies are related to the broader working atmosphere 

1.5 Significance of the Study

1.5.1 Theoretical Significance

So, the overall goal of this present study is to investigate the relationships that exist among

health care providers in Pakistan's South Waziristan tribal area, including workplace stress,

employee productivity, and job involvement. It has also been added to the original overall goal

of the present study to examine the effects of work - related stress on Pakistani employees' ability

to do their jobs effectively. It has been determined that the overall goal of the present study may

be split down into distinct goals in order to increase the efficacy of research and inquiry. Each

aim of the research is associated with a particular addition that the study offers to the field of

study. Whether in business, on the job, with family, or in our personal interaction, stress has

become a component of our regular lives in every situation. Each and every person in living in a

fast society is faced with a range of difficulties.

Workplace stress and employee productivity are crucial aspects of every company's

operation in today's marketplace. After that, the national healthcare divisions in COVID-19 are

under a significant lot of pressure to perform their duties. Because of this, it is necessary to

recognize and understand workplace conflict, poor job performance, and business influence.

Companies cannot fulfill their aims and outcomes if their staff is suffering from stress-related

symptoms such as worry, despair, or high pressure. Staff members who work in the health field,

in particularly, need a stress-free environment because if they are experiencing compressive

force, the group's image will be hurt and customers in this area deserve excellent services as

well. Because the healthcare business is so sensitive, it is important to keep risks to basic
 30

essentials. For those working in the health industry, epidemics bring up a plethora of challenges

that must be acknowledged and handled if they are to improve staff productivity by lowering

stress at work. Performance appraisal, on either hand, is an issue that affects every company, not

just the healthcare market.

1.5.2 Practical Significance

Numerous studies have found increased job stress in a variety of industries, including

banking, building, and others. There are a few research on the health sector in Pakistan, however

don't see many of them. So, it is hard to get data on the difficulties that occur as a consequence of

stress at work in the healthcare field in Pakistan, which is understandable. This study is required

since it includes all of the topics on which a comprehensive study will be based; otherwise, the

study would be incomplete. Worker quality is a vital concern for the investigator, who has not

only highlighted work stress but also plans to investigate its positive effect on employee

performance. KPK Unlike other parts of Pakistan, South Waziristan District does not have a lot

of personnel or financial capital.

South Waziristan's populace has access to just a limited number of resources, which

creates significant difficulties for workers across a wide range of industries. The limited supply

has a particularly negative effect on the health sector. The lack of basic infrastructural facilities

in the area is being held responsible for the backwardness of the area. Nevertheless, the present

study is relevant because it gives insights into the influence of a bad work place on occupational

stress and, as a result, on staff efficiency and results. The recent research, despite the fact that it

is hard to assess the value of medical services in the utter lack of essential considerations such as

media attention by the inhabitants, access to healthcare, utilization, and cost efficiency, makes

use of successful methods to discover relatively undiscovered lines of study as well as provide
 31

special and unique information about the factors that end up causing occupational stress in the

South Waziristan area.

The impact of job demands and high in job performance has been explored infrequently

in the setting of cash rewards, despite the fact that there is a large body of data to support this

association. As a result, the present study gives important knowledge and addition to the

scientific community about the link between occupational stress and performance of employees,

in the setting of cash incentives, burden, and job involvement, among other variables. Based on

their underlying linkages and influences on one another, the present study establishes a

connection between these factors. As a result, the study is crucial because it analyses the

fundamental link between the main characteristics that are often connected with employee

productivity.

As a result of the current studies, the scientists have gained valuable insight into the

interaction and links that exist between workplace stress, career progression, employee outcomes

and financial reward, as well as the connection as well as links that exist between course load

and financial compensation. Some of the most significant factors in human managing resources

are those listed above, and study into these particular areas may aid in better knowledge of the

practical effects of these factors when they are implemented in an actual world in combination

with other factors. Aside from that, this study may help professionals make better judgments on

aspects that should be addressed in assumes the risk, enhancing firm productivity, building a

good on the part of companies, and increasing the efficacy of talent acquisition.

It is also important for players in the healthcare business in Pakistan, particularly in

undeveloped regions such as the South Waziristan district, to be aware of the current studies. The
 32

Pakistani government owns and operates the vast bulk of the country's healthcare services and

equipment. Due to the obvious bureaucracy of the health service, the system itself may be rather

complicated. Nevertheless, there are several government-sponsored health groups that are

offering very efficient care services around the world. Moreover, there are several quasi and

commercial for-profit healthcare organizations that offer far superior services than the

government-run facilities. However, because the present investigation is concentrated in the

poorly developed region of South Waziristan, the findings of this study will be of particular

interest to healthcare organizations in Pakistan, where coworkers are undergoing stressors as a

result of higher volume of work and relatively low remuneration. The findings of the study give

insight into the factors that contribute to chronic stress among workers, which in turn negatively

impacts their performance. The leadership of such organizations will be in a better position to

take appropriate actions and enhance the workplace conditions of health personnel in such

companies as a result. Moreover, the administration will be made aware of the difficulties that

the healthcare professionals are experiencing, and they'll be aware and take action to fix their

concerns in the future.

Furthermore, the present study is important for healthcare personnel and employees of

medical institutions, as well as for the general public. According to the logic behind the present

study, healthcare personnel who profit from it will be able to identify the reasons that are

contributing to their increased levels of workplace stress. It is feasible for people to adopt a

variety of activities in order to cope with their heightened levels of work stress if they have the

necessary resolve. Professionals may propose to their bosses that their existing working settings

be changed in a way that would enhance the process of workplace stress. Additional actions that

may be undertaken to assist with the management and prevention of work stress are also
 33

available to individuals to choose from. In the end, the importance of the research resounds with

the prevalent folks who reside in South Waziristan district because when the workplace

environments and ability to cope with stress of healthcare professionals in their municipalities

enhance, they will be eligible to receive good medical care and be handled in accordance with

their specific requirements. The general public may also help to the betterment of employment

conditions for healthcare personnel by recognizing their own involvement in the situation and

guaranteeing that they really do not cause stress among the staff.

Chapter 2 Literature Review

2.1 Introduction

Making wellness more efficient is a major problem in case of industrial modernization,

and the solution is heavily influenced by the actions of organizational and economic variables.

The main factors contribute to the wide variety of concerns that must be considered when

evaluating the efficacy of budget use in medical services: A lack of effectiveness in the health

personnel, poor decision and organization of operations, a reduced degree of performance, as

well as a scarcity of certain groups of health employees, with such a subsequent increase

throughout staff shortages in the long term, are all factors that contribute to the waste of 20–40

percent of all money earmarked to wellness care. Department of health helps to supply capital

more effectively and evenly, but it is frequently hindered by inadequate underlying economic

making plans, which results in under resourced health services and lost chances for creating jobs,

economic expansion, and enhanced efficiency, rather than making sure financial prosperity

healthcare.

It is necessary to quantify inputs and outcome variables, as well as the connection among them,

in order to determine effectiveness. It has been pointed out by the World health Organization
 34

(WHO) that operations inside a health care system might be wasteful for two distinct, but

interconnected, causes. The first argument is that the money and resources spent in the health

service might be redirected to achieving goals that are not seen to be of high significance from

the perspective of society at large. The second factor contributing to systemic inefficiencies is

the inefficient level of investment in the pursuit of significant iterations. The amount of empirical

study conducted on the issue of stress has expanded dramatically during the past 33 years.

Scientists have been concentrating their efforts on the consequences of depression, the figments

of strain, the mediator of the pressure connection, and the different types of pressures faced by

different work populaces, as well as the various managerial plans put in place by handling

multiple to cope with stress, among other topics (Pestongee, 1992). When it comes to writing,

there are two forms of stress: positive stress (positive strain) and trauma (poor strain) (Kolt,

2003; Bhaghat, 1992). Occupational stress occurs when the duties imposed on a person do not

correspond to his or her expertise, abilities, and capacities in the work, which is known as

positive stress. Workers in an environment become more capable of dealing with their

physiological and mental pressures (Adler, 2006). Job stress, on other hand, manifests itself

when the duties imposed on an individual do not correspond to his or her expertise, abilities, and

talents in the context of the organization. The worker becomes unable of dealing with

physiological and behavioral pressures including such interruptions in their daily regular tasks,

and as a result, they are unable of doing their finest in the job (Warn, 2003). Job stress may have

negative consequences for both the person and the company since it has the effect of lowering

motivational level and diminishing actual quality (Bames, 1996). Every company experiences

stress from time to time. It occurs as a result of the high level of complexity in the job. Stress has

a significant influence on the ability of employees to do their jobs (Anderson, 2003). As

 35

according Rose (2003), time has a significant role in the production of high levels of stress, and

increased working hours reduce workers' willingness to perform at their highest levels of

performance. Workers want to operate at their highest levels at work, but load and long years of

overtime have a negative impact on their ability to do so (Ahmed & Ramzan, 2013).

Moreover, diverse aid agencies (WHO, OECD, OECD), credit ratings, health officials, and

researchers from various nationalities are establishing various sets of methods to measure the

efficacy of medical services, which are often associated with a comparison of outcomes. The

health state's operations provide a substantial positive impact on the economy of an area, and

underdevelopment of its functionality and poor efficiency lead to a decline in the town's worker

capacity as well as economic harm. The relationship between health and work is intricate. Work

that is of high-quality fosters self-respect, a sense of purpose, and satisfaction, as well as a strong

connectedness with and community engagement. Persons gain from jobs financial or

psychological assets because they enhance their life situation and facilitate the management of

their personal health, which in consumers a range society and the environment overall.

Work may be seen to be part of a vicious loop in which excellent health is the motor: it enhances

the likelihood of getting work while also contributing to increased output. People who are in bad

health, on the other hand, have much lower levels of production. As a result, persons of formal

employment who assess their condition as bad are much more likely to withdraw from work due

to wellness causes than those who evaluate their heath as good 

Holding a work is not always beneficial to one's health, especially if the job is dangerous.

Employees' overall health, as well as the wellness of their households and the wellness of their

societies, are negatively affected by the increase in unskilled labor (momentary, component, on-
 36

call, or identity), which does not have employees with much the same amount of safety as stable

jobs. The negative health consequences of insecure labor are unequally spread throughout the

economic range, with the most severe consequences falling on those who are economically poor.

Furthermore, physiological, psychological, and environmental risks; these risks, extremely

demanding or dangerous employment, lengthy or unpredictable hours worked, especially rotating

shifts and extra, and extended sedentary labor may all have a huge impact on the mental of these

individuals.

Workers that are on a transitory or portion basis, careers, and the aged are all at greater

risk of having poor medical results. Children are extremely prone to unstable work and

workplace conditions that are less than optimumn. Young adults who have been jobless for a

long period of time, particularly those from wealthy households, are more inclined to disclose

wellness behavior than someone who has not been jobless for an extended period of time. In the

15-24 age range, there has been no increase in long-term workforce participation (for example, in

nations of the European Union (EU)), and there has been a continuing deterioration in

psychological health. Early on in life, economic volatility may be particularly severe, since both

economic and illness is more sensitive to disruptions later in life.

When it comes to work, the vocational rehabilitation defined as the difference here between job

growth of disabled individuals and the labor participation rate anyone who is not hampered by

sickness or disability. This disparity is either expanding or remaining stagnant in the WHO

European Region. Persons with chronic diseases and disabled persons who desire to come back

to work are often misunderstood when it comes to the difficulties they confront. Personnel and

role (e.g. are required to guarantee the return of disabled people to the workforce and to avoid
 37

future alienation of these disadvantaged individuals from the labor force (Ahmed & Ramzan,

2013).

Aspects of psychological health and its influence on actors and their behavior in the

health business have been dominated, until lately, by research into the effects of exercise illness

on a participant's engagement in the health field. In some, this is due to a lack of knowledge and

awareness on mental disorder, although in recent years, specialized surveys have started to arise

as a result of increased national good in the subject matter. Accountants are becoming more

concerned about their own psychological health. According to the World Health Organization,

subjectivity of one's own fellow human, independence in one's life, competency, and the capacity

to develop one's own cognitive and affective capacity, among other things, are critical parts of

sentimental stability. Only the idea of psychological health as a term that encompasses more than

just the avoidance of mental problem is universally acknowledged across the globe (WHO 2001).

In the case of this research, it is critical to clarify vocabulary, since we will be utilizing

the phrase "psychological wellbeing," which is commonly used in the fields of medical science

and psychological research. To a certain degree, psychological state is identical with one's

emotional condition, namely the existence of depressive symptoms. Sadness, on the other hand,

is a notion that is quite widely utilized. As a result, people imbue the notion with their very own

set of qualities, making comparisons more challenging. As a result, when analysts refer to

"psychological health" in current research, they are not necessarily referring to the same physical

disorder in each person. Often a person's mental disease manifests itself as a prolonged period of

depression. In certain works, the phrase is used to refer to the existence of massive psychological

diseases, such as psychosis, and is defined as follows:

 38

People suffering from conditions such as autism or Parkinson's, for instance, are less

likely to be active in medical than those who suffer from serious mental illnesses, their

avoidance, and the costs associated with their treatment. Because of this, we believe that

investigating the subject of the effect of anxiety attacks and downturns on the output of persons

is more important in order to understand the processes at work in healthcare than investigating

other topics. In the future, when we refer to a person's mental health in the context of this

research, we shall be referring to the existence or lack of sadness or anxiety attacks in that

individual. We want to underline that the selection of these sorts of illnesses was based on their

widespread and widespread occurrence. The term "psychological wellbeing" is commonly used

in Russian medical journals, and the World Health Organization describes it as "...not yet merely

the utter lack of a mental illness, but rather a condition of very well in which each individual can

realize their possess possibility, deal with the cope with the normal, professional and

constructively, and participate in society." The World Health Organization (WHO) proposes a

number of aspects, the sum of which is related with psychological adjustment in a person, in

response to the fact that both the concept and concept of psychological health are complicated

and complex. These components are as follows:

1. Thoughts and sentiments,

2. Cognition (the capacity to comprehend),

3. And the capacity to work in a social environment are all important 

A long while ago, scientists were interested in the issue of stress response tolerance in a variety

of occupations and settings. It has been formed that there are a number of specializations where

an individual starts to encounter a sense of deep sentimental nothingness as a result of

continuous contact with humans or as a result of the existence of specific manufacturing

 39

situations. These specialties include nursing, teaching, and social work. An investigation of these

symptoms uncovered different mental phenomena known as the condition of mental fatigue. Job

burnout is a psychological concept brought into psychiatry by the American physician Herman

Participants in 1974. It is characterized by growing emotional tiredness and is expressed as a

state of being. He witnessed tremendous exhaustion, impatience, and anger in his coworkers in

the health field, as well as in clients who had been in the professions, and he decided to

investigate. When it comes to interacting with customers, burn is defined as a condition of

physically and mentally tiredness that develops as a result of psychological over tightens.

Burnout may also be defined as a work catastrophe that is related with not just interconnections,

but with one's overall job performance (Ahmed & Ramzan, 2013).

Medical professionals are particularly susceptible to the risk of perceived stress. Connections

in health coverage include those between both the medical provider and the relatives of sick

people, those between both the leaders and the followers in the method of fixing convicts, and

those here between doctor's confidence and self and the mindset of his or her coworkers forward

into him or her. The occupation of a physician is among the first to come to mind when

considering the possibility of developing stress and burnout. The working circumstances of

nursing personnel are often cited as a contributing factor to this sickness. During the course of a

nurse's professional day, she is in the most constant touch with individuals, mostly with clients

who need careful love and assistance. If a nurse is confronted with fear and anxiety, she will

unwittingly and unintentionally get embroiled in them, resulting in her own rise in mental

trauma. The job of a nursing in the surgery unit, in the operating theatre, is given more emphasis

since it is connected with a high level of authority, ambiguity and volatility in the course of

occurrences, physiological strain on the brain, and crazy bitch strain. A job burnout grows slowly
 40

as a consequence of this, resulting in exhaustion, a disinterest to one's job, a decline in the overall

quality of medical treatment provided, and occasionally a hostile and even sarcastic approach

towards clients (Lazarus & Folkman, 1984).

2.2 Job Stress

Occupational stress is defined as the interaction with individuals and his or her

surroundings that is seen by the user as surpassing or jeopardizing his or her capabilities and very

well on the work (Lazarus & Folkman, 1984). In the presence of stresses such as terrible work

connections, a high load, an insufficient support, or constructive reviews from superiors, a

typical syndrome of bodily responses arise in the employee population (Yadav et al., 2017). This

stress reaction may manifest itself in a variety of ways, including physiological, mental, social,

and religious. People who are worked out at work are more likely to be dissatisfied with their

jobs (Yadav et al., 2017). The delicate nature of their occupation, as well as factors such as

restricted ward doors, place mental caregivers in an unusual work place, increasing the

likelihood of their experiencing workplace stress (Ghanei-Gheshlagh et al., 2017; Yada et al.,

2015).

In addition to the difficulties of the job done by nurses, organizational variables within

the work place contribute to poor quality of work life among nurses. The ability to create

empowered and supportive working conditions that increase quality of working life has the

ability to reduce stress in physicians' jobs (Hayes et al., 2015; Wang et al., 2013). As according

Kohlberg, occupational stress is a role in maintaining good cleanliness. It was shown that the

existence of cleanliness variables did not result in quality of work life, but that their absence did

result in job discontent. The research covering the emotions of freshly minted doctors when they

join the workforce clearly demonstrates the stress they suffer while starting their first job as a
 41

nurse practitioner for the first time in their career. The idea of stress, on the other hand, has to be

articulated in this situation as well. Stress is an ambiguous concept that has been researched from

a variety of approaches (Cooper & Dewe, 2007). Stressors, reactions to stressors, qualities of an

environment or a person, and the relationship between a person and the situation have all been

referred to as "stressors" (Parker & De Cotiis, 1983). Stress is conceived within the setting of this

research in accordance with the relational viewpoint. Generally stress can contribute to an

organization in relation to a circumstance or part of the surroundings that is seen to be unpleasant

and a danger to one's health and well-being. According to (Lazarus & Folkman) Even the most

mundane situations will not elicit the same emotional response in every person; what is difficult

for one person may not be distressing for the other.

Not only can external conditions cause a stressor, but so does an organization’s culture of

the circumstance, which results in a stress reaction. The study's primary emphasis was on stress

faced on the work, and as a result, the relationship between a person and the workplace was of

particular interest to the researchers. Occupational stress is defined as the knowledge of an

unpleasant reaction to certain situations that results in departures from constantly finding; yet, it

is typically considered to be a temporary state (Parker & DeCotiis, 1983). The word "burnout"

was coined by the physician Rotter (1974) from the neurologist’s vocabulary to describe the

debilitating consequences of persistent drug consumption on the body, and it has since been

widely used in various disciplines to describe stress. This word was first used by sociologists

who were working with persistent mental trauma in service employees at the same time and

separately of one another (Maslach C., 1974). As indicated by a diverse range of magazines that

include many papers on PT - psychological, pharmacological, physiological, social, ecological,

and economical - in the future, the creation of a complicated issue of emotional harm was
 42

worked out by professionals from practically all human disciplines. Originally, the problem of

exhaustion was thought to be caused by the professions of medical personnel, and thus far, the

majority of books and articles have been dedicated to this field. Current studies are looking at

physical therapy as a potential hazard identification and risk element for all forms of work. It is

also being looked into as a component of generalized exhaustion (ICD-10 code Z73.0), which is

connected with difficulty in sustaining a regular lifestyle (code Z73). In this context, burnout is

described as a condition of physical, intellectual, and social weariness brought on by having been

exposed to incredibly stressful events (either personally or professionally). Using this

description, along with the belief that tiredness is the most essential element of tiredness and,

besides that, that fatigue is nothing more than tiredness, we can begin to examine the possibility

that the body will experience workable overstrain while continuing to work in stressful life

occupations.

When it comes to mental illness, the word "burnout" does not appear in the worldwide

categorization "The Pharmacological and American Psychiatric association’s Diagnostic (DSM-

5)," which was produced over several years by thousands of professionals in the healthcare

profession. The notion of burnout is unsupportable in diagnostic (ontological) and theories,

according to a recent analysis, growing interest of doctors in PV in recent years. The notion is

unsupportable because of epistemological errors in its advancement, the resemblance between

states of emotional exhaustion, uncertainty about the trainer framework of PV, and the

incoherence of the situation that PV is a special representation of a person affiliated with his or

her work. According to the MBI technique, when burnout progresses, all of its components —

tiredness, skepticism, and inefficiencies — progress together as well. But this is only true for a

few expressive occupations, such as journalism. It has been demonstrated that a drop in the
 43

amount of weariness is linked to increase in skepticism and inefficiencies in law enforcement

officers' performance (Hayes et al., 2015).

An examination of numerous conceptions of exhaustion as a nation of excessive

workload ("over fatigue") in internal and overseas articles published has revealed that its key

characteristic is an absence of rest (DR) that happens as a result of recurring acute tiredness, the

remnants of which persist between daily / monthly workloads. The idea of excessive workload is

typically defined as a situation that develops when the sentient body is deprived of adequate rest

for an extended period of time; work overload is a psychopathic functioning state of the skin for

which it is essential not only to provide supplemental rest but also to administer special therapy;

the most common cause of overwork is a significant disparity between the presence of chronic of

job and rest time. Fatigue is classified into three categories: acute (affecting the business day

during week), protracted (affecting more than 2 weeks), and chronically (affecting and over two

weeks) (more than 4 months). This latter kind of weariness is referred to as "chronic

undifferentiated fatigue." The illness known as "chronic fatigue" (CFS) is regarded to be a

subgroup of the stages of lengthy exhaustion that may be experienced. Throughout the last

century, Cameron's (1973) lengthy notion of tiredness, which is based on the assumption that the

only quantifiable requirement that differentiates tiredness from other sentient physiological

mechanisms is the amount of time taken to recoup from it, has found widespread applications

among researchers. Heavy workload and exhaustion are conceptually equivalent, and their

occurrences are caused by the same brought about by rapid reason, which provides a valid

foundation for the effective prediction and mitigation of occupational dangers. However,

although some new burnout scientists have reached this conclusion, the majority of burnout
 44

scientists claim that burnout and tiredness are two separate but related disorders (Hayes et al.,

2015).

It is possible to distinguish between the diagnosing signs of work stressors (job

depersonalization) and the diagnosing signage of tiredness at work (tiredness at job), in part due

to a similarity in the queries and groups of queries (for instance, "physiological fibro fog,"

"psychological fatigue," "depressed mood") in second or foreign vocational tiredness surveys

and those in older surveys on tiredness during in the having to work day (for instance, "tiredness

during having to work day"). It has recently been shown via research that exhaustion is the most

prominent symptom of the emotional exhaustion, which also has many characteristics with brain

disorders such as sadness (appendix P4). As a result, the revealed supports the claim that the

present state of knowledge permits us to define exhaustion as depressive moods rather than as a

distinct disorder known as "stress and burnout." Even so, sadness, which many scientists of

overall exhaustion (burnout) take into account to be its core (according to information from the

Core for Psychology and Necrology decided to name after VP Serbsky), emerges mainly as a

result of societal factors; this threatening mental condition (which is the motif of Global Health

Day 2017) is only rarely a part of successful exhaustion (which would be the motif of Global

Health Day 2017). A small number of actual scientists are convinced that burnout is truly a kind

of stress that causes stages of the general adaption syndrome to occur. "Burnout may be defined

as "professional stress" that is experienced at the place of employment." The relationship

between occupational strain and exhaustion (overwork) is examined in this IMP as causal

relationships (Appendix P2). Work stress as a form of personal exhaustion, according to the

article "Worker role as a source of support exhaustion," is a leading cause of morbidity in 30

percent to 1.5 percent of people. Employees who suffer from serious strain and job burnout have
 45

a faster ageing of their bodies, and their risk of developing all illnesses associated with stress

rises, including clinical conditions and cardiovascular disease, inflammatory, sleep problems,

muscle spasms and migraine, depressed mood, and anxiousness. Other stress-related diseases

include digestive problems, respiratory distress, adiposity, and kidney disease. "Health

Determinants of Fatigue" is a magazine that provides information on the prevalence of burnout.

The majority of research on health concerns in PV is addressed to the danger of cardiac ailments

in this population. According to Hans (Institute particular de santé mental de Montréal 2012), the

term "stress" is taken from the scholar Hans. Work stress occurs when the qualifications required

do not match the employee's abilities or the resources made available by the organization, as

defined by the company (Park, 2017). Mental tension was caused by the lack of organizational

encouragement, which was felt by the employees (Arnold & Feldman, 1986). Job stress is a

complicated state of mind that affects many aspects of one's life (Akanji, 2015). When the

leadership or the management does not provide assistance, it will result in work stress for the

employees (Jungwee, 2007). Another researcher describes work stress as a consequence of a

misalignment between job needs and the abilities of those who hold the position (Sauter &

Murphy, 2013). It is likely that establishing unreasonable expectations for workers will lead to

poor mental health among employees, who will be unable to be creative while also being unable

to perform successfully and efficiently (Jacobson, 1987). Job stress may be either beneficial or

bad, depending on how a person perceives the situation (Ahmed & Ramzan, 2013). Workers who

are requested to complete more than the needed work will be considered to be under positive job

stress, whilst employees who are asked to perform tasks that exceed their capabilities will be

considered to be under negative job stress. Positive job stress may be defined as follows:

(Armstrong, 2015). The second point to mention is that establishing objectives that are lower
 46

than the real demand causes negative tension for upper management and may result in good

stress for workers (Sauter & Murphy, 2013). In companies, occupational stress is and has always

been the most significant problem (Wani, 2013). Employees' work has been negatively impacted

as a result of this. Anxiety and strain are deemed to be concerning factors by management and

other stakeholders in an organization where it is a disconcerting wonderment with a sizable

number of use cases in a variety of models developed, and where it is a bewildering wonderment

with a large variety of metrics in an impressive array of competing hypotheses (Kesmodel,

2018). Some elements influence employee motivation, such as compensation, which is the most

fundamental and important motivating factor for workers. While a large number of employees at

a company believe that self-awareness is a non-issue in their profession, recognition and prestige

are important goals for which they strive. Other important tools for increasing the motivating

level of workers include benefits and recognition for doing work that is worth justly

compensated, among other things (Ahsan, 2009). Better, more defined organizational plans; on

the other hand, result in high levels of efficiency, as well as motivated, inspired, and loyal

employees. As a result of the less good working environment provided by the workers of a

bigger firm, the degree of employee morale declines as a result (Lu, 1999).

Workplace Stress Job pressure is defined as the quantity of work that has been given to a

person and that must be completed within a certain length of time. When the tasks exceed the

capacity of the employee, this is classified as high working, and when the tasks are within the

capabilities of the employees, this is known to as reduced job (Mimura & Griffiths, 2003). Job

happiness and work to family are negatively proportional to one another in the workplace.

Employees who are under a lot of strain are more likely to explore for alternative options in the
 47

market, which has a good impact on their desire to leave their current position. Job stress is not

just focused on the amount of work one has to do (Ahsan, 2009).

Job stress can also result in increased caseloads, workers' feelings of shyness about one

‘s employment, low pay scales, not gained political from senior leadership after finishing up

tasks, technological changes that the working population is unfamiliar with, and a variety of

other factors that contribute to job stress for staff (Mäki et al., 2008). In addition to this,

occupational stress or work to family might also be described as the effect of the around it on the

management knowledge of workers that has the ability to adversely affect efficiency as well as

impact the worker motivation to leave their current position (Ahsan, 2009). The conclusion of a

research project on occupational stress is reached; Hans Selye (1956) is regarded as the "Mother

of Psychological Science." Hans Seyle's work The Strain of Life (1956) was the first to convey

the notion of tension to the general populace, and his Generalized Adjustment Disorder [GAS] is

a well-known term among psychologists and managers who do study in these fields. Stress,

according to Selye, is "a condition characterized by a distinct syndrome of physiologic

processes" (1974). He maintained that stress is not always a negative experience. Stress,

according to him, is the physical body's response to a difficult circumstance or incident that has

occurred. "Any other kind of everyday activities can create significant stress without having

caused any negative impacts," according to Selye (1974). Selye (1982) states unequivocally that

the vague and general inference of any requirements placed on the body, regardless of its effect

on the mind or the body's physical state, is stress. Corporate, unit, team, and project level are all

affected by ambiguity. In the words of Edwards (1988), stress is defined as "a negative

difference between a people’s observed situation and desired condition, given that the existence

of this mismatch is viewed as relevant by the person." Using the following phrases, Taylor
 48

(1992) described the effects of stress: The following are examples of demands placed on us

[privately or publicly] that we feel to be in excess of our adaptation funds: The tension that

results from attempting to cope and failing results from our attempts to deal. If this stress

continues for an extended period of time, long-term psychologically and physically harm may

result." When we say "requirements," we are referring to those that develop as a result of the

load or job strain. In Cox's (1993) interpretation of stress, he starts with the premise that stressors

are unpredictable and time restricted, and that numerous occurrences in one's life that need

modifications or adaptations are inextricably linked to stress. Murder of a partner, relationship

breakdown, wedding (not all negative), being fired from a job, marital rapprochement,

superannuation, reorganization of one's business, change in work commitments, conflict with

one's boss, and start changing in working conditions were all ranked by James and Urry (1967)

as the most traumatic situations in one's life. "Job stress is defined as the sum of all

circumstances encountered in the context of one's job that have an adverse effect on the laborer's

social and physical equilibrium." The individual unit is referred to as a source of stress, and

stress is defined as the particular laborer's response to threat." Add a new made the suggestion

(1977). Because "a small number of individuals perceive stressor to signify the person's

response," Beehr and O'Hara (1987) used the term’ stressor' rather than’ stress' to refer to

causative elements in their study. 'Strain,' on the other hand, is defined as "the condition of being

stressed as shown by physical, mental, or medicinal indicators." Specifically, according to Hans

Selye's 1951 report on the Public Adjustment Aspergers [GAS], in response to a particular

situation, a preliminary "emergency alert reaction" is accompanied by a "evolutionary stage of

resistance," during which friction coefficient to the initial stressful life increases while the ability

to withstand new stressful events decrease. At some point, a condition known as "stage of
 49

fatigue" develops, which leads to a disastrous incapacity to deal with any sort of stress. In 1951,

Selye H published a paper in which he said that

Nurses experience burnout at a younger age than physicians, on average 5–9 years

earlier. Consequently, this occupation requires frequent and extensive meditation on the

substance of the subject matter of its action, and is one of the major causes of stress for those

who do it. According to a study conducted by the Parents and Working Center in 1997, 42

percent of workers are utterly exhausted at the end of each day, 80 percent say that work requires

far too much time and energy, and 65 percent consider that the speed of their activities is too fast.

Stress is linked to impairment in over half of all occurrences of nursing disability in the

United States. A significant degree of anxiety was discovered in 41 percent of instances

investigated by British investigators into this condition, and clinically evident melancholy was

found in 26 percent of cases evaluated in this nation, according to the scientists. A third of

physicians and nurses use drugs to treat mental stress, and the quantity of alcohol taken by

physicians and nurses is higher than the national average.

Portuguese scientists performed a study among 368 workers of a medical Centre using

one of MBI Social Service Study (MBI-HSS) surveys and discovered that doctors (59 percent)

are the most susceptible to stress when contrasted to administration employees (50 percent) and

technicians (Fifty percent of the time.) Furthermore, it was shown that there was a considerable

correlation here between priority group and a high level of burned out.

During their investigation into the symptoms of negative messages, English scientists

found that even among doctors and nurses, first and foremost, specialist effectiveness is affected

(36 percent), and indirectly, compassion fatigue is witnessed (22 percent); deprivation is noted in

7 percent of doctors.
 50

In addition to its tendency to worsen from week to week, emotional exhaustion poses a

serious threat to one's health. It is quite difficult to stop this cycle from progressing. Knowing the

characteristics of how professional burnout develops in medical professionals, for example, is

vital in order to enhance their job performance in their respective fields. Although the issue is

urgent and a solution is required, the system of diagnoses and treatment, as well as the decrease

of professional high levels of stress between health workers, is still in its early stages and has not

yet been fully established in health centers.

2.3 Employee Performance

Employee performance can be defined as an owner's capacity to satisfy the duties assigned to

them within the time frame specified by the employer (Alnaqbi, 2011). In the opinion of some

other investigator, assessing the market performance of the organization in which the workers are

employed might be used to adjust their strategies (AlQudah, 2011). Effectiveness can be defined

as the successful transfer of skills, abilities, and expertise in order to meet the goals set by

higher-level administration (Bowra et al., 2012). Performance is a multifaceted notion that may

be described as the behavioral dedication of employees towards their jobs in various contexts

(Campbell et al., 1993). The notion of employees’ performance is defined as the degree to which

a person is capable of completing the responsibilities of his or her position (Lia, 2019). Workers'

productivity is assessed by their efficiency, the value of their work, and the amount of time and

money they spend doing their jobs (Lia, 2019). When it comes to job productivity, there are

many different aspects that impact a person's capacity to effectively do the duties that have been

assigned to them while being subjected to fewer restrictions at the work (Matsuo, 2019). The

phrase "performance appraisal" refers to a person's job success as a result of putting out the

necessary effort at work, which is related to obtaining essential employment, being associated
 51

with one's profile, and having generous relationships in the vicinity (Jackson, 2010). Productivity

is a multi-factorial notion, and at the most basic level, it is possible to differentiate between the

procedure area of performance, which is comprised of behavioral interactions, and the

anticipated result standard of work (Roe, 1999). Specifically, the action people do in order to

complete a task is denoted by the behavior component of this equation, while the outcome

element describes the result of a patient's job activity (Campbell, 1990).

In earlier research, the degree of empowering (Kennedy et al., 2001), management

culture, genuine support (Borman et al., 2001), and top player (Kennedy et al., 2001) of

employees were shown to be important indicators of overall success (Turner et al., 2006). An

additional researcher describes this idea as a worker's capacity to adapt to and cope with changes

in their work place (Baard et al. 2014).

This implies that even if the 36-factory floor or the business unit’s circumstances change, an

individual should be able to maintain their level of performance at all times (Tetik, 2016).

Specifically, work happiness is employed as a predictor of ability to do the job in this research.

As previously said, contented people may function best and be more creative, and there is a clear

correlation between employee satisfaction and the success of an organization (Tetik, 2016).

According to McCook (2002), workers who are content with their jobs are more productive.

Similarly, numerous past studies have shown that job happiness is strongly tied to ability to do

the job, and that if employees function better; the firm would be in a good position in the

marketplace (McCook, 2002). When workers are required to work under time constraints, it has

a detrimental influence on their enthusiasm. When workers are given the freedom to share

suggestions and are given tasks that are tailored to their needs and requirements, their

inspirational levels will be directly influenced. On either side, when staff members are asked to
 52

complete tasks that are not tailored to the specific and requirements, their inspirational levels will

be negatively impacted, as will their achievement.

According to research, when higher ups are helpful, it relieves tension in the workplace and

inspires people. As a result, it is necessary to establish a stress-free atmosphere for staff to

promote them. Worker protection is a step taken to safeguard the cognitive and psychosocial

well-being of employees by providing them with optimal working circumstances (Claudine et al.,

2019). Support from senior managers in safety activities, promotion of health and safety

inspectors to higher levels in an organization, a start concentrating on safety procedures, and

inspiring staff to work harder are all examples of systems that can be established to promote

stress-free working environments (Zohar, 1980). Workers' ability to succeed is significantly

influenced by the working environment (stress) they are subjected to.

When employees work in a healthy environment, their capacity to perform is enhanced.

A report written by Jilchaw and founder Kitaw in 2016 highlighted various results related to a

safe and healthy workplace and its impact on the employment of those who work in that

environment. In a recent study, Manay et al. (2014) found that employee satisfaction is 42

significantly linked to the quantity of safe setting that is provided to them, and that working in a

stress-free setting improves work engagement (Manikandan et al., 2017). Personal ability,

according to Rotundo and Sackett (2002), is defined as those activities and actions that are within

the company's control and that serve to the objectives of the organization. When referring to job

performance of employees, it is commonly understood to refer to the quantity of output created

through implementation by a worker during a certain long period (Dhammika, 2013). Worker

performance is a measure in this research, and it is reported as such.  Performance may be

characterized as a mix of factors such as availability of troops and equipment, skill, productivity,
 53

and reactivity (WHO, 2006). Based on the material reviewed, it can be stated that work inflation

has a negative relationship with work satisfaction.

Workers' performance level is affected by a variety of variables. Higher patient loads, the

HIV/AIDS pandemic, long hours, shift work, inadequate basic infrastructure, and a scarcity of

personnel were among the concerns highlighted as hurting conditions for workers at government

hospitals. Unsatisfying work activities have a detrimental influence on the health and emotional

wellness of workers, according to the findings of the investigation (Manyisa & Aswegen, 2017).

Workplace routineness refers to the working conditions or employment culture of an individual

in any firm (Kayal & Baisakhi, 2016). According to the latter, work happiness is based on

routine and consistency. A point to keep in mind is that regular jobs have low job variety—that

is, there is a narrowband of unforeseen as well as book occurrences are easier to predict

throughout essence. However, problems emerge because key employees face increased

unknowns and variables further than their regulation when completing their duties (Gong & Kuo,

2019). 20 World Health Assembly (WHO) reports that the African peninsula is now

experiencing a serious human capital crisis in the health sector, which looks to be interfering

with the provision of high-quality, effective medical care. Post Africa does have the hit points

employee ratio in the globe (Houston, 2005), and it has the hit points employee proportion in the

globe (Friederike, 2009) According to a wide definition, hrm (HRM) is "an area of organization

and practical skills" (Tabassi & Abu, 2009). However, despite the enormous significance of

Human Resources (HRM) practices in achieving improved quality of work life in particular and

improved organizational performance in overall, many organizations do not place a strong

emphasis on their successful usage in order to ensure organizational performance in development

countries (Tabiu & Nura, 2013).

 54

HR department, as a critical factor in the supply chain, have an unassailable influence on

the earnings and performance of the organization. This is due to the fact that leadership roles that

will impact employee gratification may be remarkably beneficial for a business, or, on the

opposite, may result in significantly higher costs for the organization (Bayram, 2018). Some

courses may be included in growth, although the term is often used to refer to formal schooling,

on-the-job experiences, interpersonal interactions, as well as character and skill evaluations, all

of which assist people plan for potential professions or roles (Irakoze, 2018). In Bangladesh, for

instance, human capital planning is a vital and comprehensive approach to managing persons as

well as the working condition, society, and surroundings, among other things (Neser, & Rahman,

2016).

2.4 Mediating Variable

Job Satisfaction

Job satisfaction is a construct that is based on diverse factors for various individuals (Mullins,

2005). Worker related positively with someone is sense of satisfaction; if a manager is eager to

perform his or her responsibilities, then that prospective employee is experiencing a high degree

of quality; on the other hand, if a contractor is not trained to achieve his or her responsibilities,

then that individual employee is experiencing a low sense of happiness with the role that has

been assigned by upper management (Arasli & Turner, 2008). In terms of job drive, it refers to

the actual attitudes and actions that a person has toward their job (Wasif Ali, 2016). Furthermore,

work engagement is more concerned with the employee's perception of successful job

performance (Kaliski, 2007). Individuals' levels of involvement are strongly related to their

levels of productivity; if a person's level of production is high, because that individual is driven

and fulfilled, and may be termed a top performance (Kaliski, 2007). As an alternative, low pay
 55

among staff members indicates that the contractor is dissatisfied and unmotivated (Kaliski, 2007)

with his or her job, and the causes for this discontent and poor leadership could be numerous,

such as an unsafe workplace, role clarity, increased behaviors and many others (Vijayan, 2017).

An additional researcher said that work engagement is the consequence of an individual's

feelings or perceptions about their tasks in relation to their physical and emotional requirements

(Aziri, 2008).

2.5 Relationship between Job stress and Job satisfaction

Workplace Stress and Job Happiness among Management is the title of a research study

conducted by K. CHANDRAIAH et al. in 1990. It argues that those who are under severe stress

tend to regard their professions to be less enjoyable. Some of their inherent or extrinsic

requirements may be sabotaged or not adequately addressed, depending on the situation. The

results of the current research confirm the findings of several previous investigations

(Hollingworth et al. 1988; Keller, 1975), and they are consistent with these findings. Comparing

respondents with greater work satisfaction and those with low morale, it was discovered that the

individuals with low morale experienced more tension in the forms of role conflict and role

uncertainty and dispute, under involvement, helplessness, and poor status. As a result, the

outcomes of this investigation revealed that age was a significant factor. The findings of the

research confirm the importance of demands at each stage of a person's professional growth, as

previously stated by Hallingworth. In addition, as Erickson anticipated, people face crises at each

step of their developmental journey. Managers' stress levels were found to be much lower and

their work satisfaction levels to be considerably higher as they aged, confirming the relevance of

the growth stage. Chandraiah and colleagues (1990)

 56

2.6 Relationship between Job satisfaction and Employee Performance

The fact that job satisfaction has a direct impact on the overall success of the business

means that productive workers are helping the company maintain a competitive position in the

marketplace. Organizations may achieve employee satisfaction via factors such as reward

schemes, employee empowerment, and a safe working environment. These findings and the

existing literature have led writers to postulate that the link between independent factors and the

dependent variable is mediated by ES. Supervisor aid helps employees increase their devotion

and loyalty by providing them with a sense of accomplishment at work (Hossain & Aktar, 2012).

Supervisor support is defined as the degree to which workers believe their superiors recognise

and appreciate their efforts, help them, and care about their well-being (Kossek et al., 2011;

Kottke & Sharafinski, 1988).

Supervisor assistance is essential even though supervisors are legislators of the venture,

and trying to measure it allows management to take school discipline action to ensure that

employees have a positive attitude toward supervisors and that organizational relations are

bolstered. Supervisor assistance is measured in a variety of ways. For instance Sharma and Jyoti

(2006) conducted a study on school instructors and observed that there is a substantial

relationship between supervisor support and employee job happiness, and that this relationship

increases employee performance while simultaneously decreasing turnover in the organization.

According to Tao et al. (2018), a narrative bridge design was used to investigate the

relationship between workplace and work performance among 969 nursing in the Southwestern

area of China. They discovered a moderately serious negative connection between occupational

stress and job contentment, indicating that greater levels of work stress are associated with lower

levels of employee satisfaction. Career - related progress, working condition and assets, strategic
 57

planning and human relationships, caseloads and work duration, and strategic planning and

social interactions were all significant sources of job gratification (p 0.05) in their research.

According to Herzberg's theory, job stress is a role in tooth brushing. If tension is missing, it has

no effect on work happiness; but, if stress is prevalent at any degree, it may result in job

discontent at any level. The previous year, Nam et al. (2016) performed an exploratory statistical

cross-sectional questionnaire to examine the relationship between workplace qualities of work

life among 59 health-care professionals working in gastroenterology units in Korea. Employment

stress varied according to job status, with nurses reporting considerably greater levels of stress

(48.927.97) than physicians (42.596.37), according to the findings. A negative connection was

discovered between work stress and job happiness (R 2 = 0.340, p0.001), according to the

researchers. The following were recognized as the most significant stressors in the

gastroenterology unit: high demand for services, poor work control, and rising unemployment

(Nam et al., 2016).

Hosseinabadi and Etemadinezhad (2018) conducted a comparative, cross-sectional research in

which they assessed the work satisfaction and its relationship to reported work stress among 406

female staff nurses in general hospital in Babol throughout the study period. It was shown that

there was a strong relation between work stress aspects. On the other hand, Ella et al. (2016) did

a statistical, cross-sectional exploratory method to assess the influence of workplace stress on

doctors' work engagement in a public hospital. They included 115 nurses who worked in the

clinic. The findings demonstrated that there was a statistically significant association between

work stress and work satisfaction (p less than 0.05). Organizational characteristics such as

workloads and the workplace conditions are causes of occupational stress and are associated with

lower levels of quality of work life. According to Herzberg's theory, the work place, which is an
 58

element of hygiene in and of itself, cannot result in job satisfaction. 39 Nurses' work happiness at

a hospital might be affected by their level of job stress (Ella et al., 2016). Salam (2016) examined

the characteristics of work stress and job satisfaction, as well as the drivers of these outcomes,

among 626 health care providers from two Saudi Arabian hospitals. To determine the origins of

work stress and levels of work satisfaction on the job, researchers conducted numerical, cross-

sectional research design. In this research, the overall incidence of work stress was 66.2 percent,

with a high percentage of work satisfaction (97.0 percent) among some of the selected healthcare

workers, according to the findings. According to the findings, various indicators of workplace

stress were discovered, including working all the time, not receiving compensated for spare time,

and feeling under time constraints to fulfill goals (Salam, 2016). Despite this, there was no

significantly relationship between work - related stress (r = -.003, p =.941), according to the

findings.

2.7 Underlying Theory

Motivational theories examine the elements that impact a person's desire to do something. A

significant portion of their subject material is devoted to the investigation of wants and the

influence of those requirements on drive. These theories address the architecture of needs, the

substance of those needs, and the relationship between those needs and a woman's desire to take

action. With the help of these ideas, we may try to figure out what drives a person to do anything

(Agarwal, 2015). The Need Theory Of motivation developed by Abraham Maslow serves as the

primary underpinning theory in the present study.

2.7.1 Maslow's Need Motivation Theory

Basic concepts and assumptions of drive are included in Maslow’s framework, which comprises

the following principles and assumptions:

 59

• A person has a continual sense of need;

• A human has a specific set of clearly stated needs that may be classified into specific

categories;

• A people have a continuous sense of need;

A hierarchy arrangement of requirements is used to organize them in relationship to one another.

The inability to satisfy one's needs leads to one's taking action. Humans are not motivated by

their demands being met. In the event that one needs can be met, an unmet need will be filled in

its place. The majority of the time, a human is experiencing numerous separate wants at the very

same time, all of which are different constructs interconnected. Demands at the bottom of the

"ladder" must be met first; based on strict only become active when the lesser wants have been

met to a reasonable degree. High requirements may be met in much more ways than lesser

demands, and vice versa (Chao et al., 2015).

After publishing Towards a Philosophy of Someone being, Maslow went on to include a list of

additional wants, which he dubbed "reach up," in his book (being values). Maslow, on either

hand, observes that they are hard to specify because they are all interrelated and cannot be totally

isolated from one another; consequently, in order to define one of them, it is required to make

reference to the other. Purity, perfection, wholeness, fairness, life, variety of expressions; simple;

elegance; compassion; personal uniqueness; truthfulness; comfort; a proclivity to pleasure;

integrity; ego; and self-actualization are among the fundamental ideals listed by Maslow

(Hoboubi et al., 2017). In the words of Maslow, ontological values are frequently a potent

motivator for human Endeavour and are an integral aspect of the framework of personal

development.
 60

Conceptual Framework

Job satisfaction
H1 H2

Job stress Employee

performance
 61

Chapter 3: Methodology

3.1 Population

The research population for this thesis was comprised of health-care personnel who

worked in hospitals in the South Waziristan region of Pakistan. Nevertheless, since the

population number is uncertain owing to the huge populace, a broad selection that was indicative

of the community was collected. A sample is a key component of the whole appropriate range of

participants that is taken into consideration. The basic idea is that by selecting certain

characteristics within a society and focusing on this small subset, it is feasible to link the findings

of the research to everyone in the population of interest in question. It is the solitary element of

the sampling on which measurements and measurements are made that is referred to as a

population’s constituent (Saunders et al., 2009:211). In terms of the research's participants, it is

intended to include those who work in a Public-Private Hospital in the South Waziristan region

and who are willing to participate in the study. There are many reasons for selecting them. The

first is that it would be beneficial to have comparing layouts of both public and private hospitals

so that the amount of job stress can be analysed, which may impact the performance of the

employees.

3.2 Sample size

The non-probability selecting approach was utilized for this research since the size of the report's

community was unknown at the time of the study's inception. Using a random selection, researchers can

choose the method used by researchers while ensuring that any representative or component of the

community has an equitable possibility of being chosen for the analysis. This eliminates biasness and

prejudices while also allowing the consequences to be extrapolated to the sample group. As a result, the

scientist is unable to purposefully eliminate a specific class of people while using the chance sample

technique. It is necessary to pick sampling at randomness in order to obtain this level of certainty (Burns
 62

& Grove 2001:297). When choosing respondents for a research, non-random selection is used because it

increases the likelihood of getting a selection from the community (Burns & Grove 2001:301).

3.3 Research design

This study is quantitative in nature. It aimed to confirm previous results in relation to any of

such three factors in order to give crucial direction and tools to increase prescribers' abilities. Cross-

sectional surveys are being used to collect data and information, with each questionnaire being tailored

to a particular concept. Each research methodology gave a quantitative measurement of movements,

views, and views of the sampling by investigating a random selection with respect to the factors of

interest. Furthermore, the questionnaires yielded replies that were based on empirical analysis, allowing

the researchers to be certain results may be generalized and duplicated in the future (Creswell,

2014).We have used a positivist paradigm in which all of the parameters have been addressed with

respondents in accordance with a questionnaire that is in text format, according the questionnaires.

Then these sentences were transformed to numerals, which were processed in SPSS for analysis and

assessment. Due to the fact that this is cross-sectional research, the JS questionnaires were factored.

Workers' perceptions of employment characteristics that have an effect on achievement are measured

using the Job Satisfaction Scale (JSS). A Likert scale is also utilized in the research, with 1 representing

Strongly Agree and 5 representing Strongly Disagree, as seen in the chart below. This measure has been

used to explore the opinions of the participants, who are medical professionals, when they are asked to

rate the amount towards which they agree or disagree with such a given issue on a particular topic

(Joshi, Kale, Chanel, & Pal, 2015).

3.4 The Research Instrument

Participants in this study were asked to answer a similar bunch of questionnaires, which were

then mixed together to eliminate any biasness. Participants in these dissertations were asked to respond

a bunch of questionnaires that were combined to avoid preconceptions. The poll included a total of 44
 63

questions. There would have been close - ended and open items that were categorized, substantive, and

separate from the first part of the report (Section A). A five Likert kind of questioning was used for

experimental items (Section B) that produced categorized and quantitative information to gather the

answers' view on their job stressors, performance, but also satisfaction. To each answer, a scale of 1 to 5

was used, with 1 being "totally disagree" and being 5"agree wholeheartedly." In order to answer

research goals, it was necessary to determine the evidence that would be necessary to gather. Surveys

were often developed in a way that made it easy to gather just the needed details and regarded reliable.

Items were scored based on the total of the replies. The information provided via the surveys was

critical in helping the dissertations team meet its goals.

While there are several aspects that influence work stress, the component of job stress examined is the

Chinese edition of the ERI survey, which were be used for proclaiming the failure of equality when the

maximal effort and minimal incentives are offered (Siegrist & Li, 2017). External rewards effort is

represented by six items on this measure, whereas compensation is represented by eleven items, and

over-commitment is represented by 14 elements on this scale. These relate to the subscale scores in the

survey that is broken into 6 dimensions for each of the three. On a scale of 1 to 5, the external attempt

combined compensation reactions were be scored, overall better maximum ratings indicating more

worry about the attempt and accompanying benefits. Job satisfaction is dependent on a more favorable

work setting, a higher compensation, advancements, and the provision of incentives (Jalagat, 2017).

3.5 Data analysis

The Structural equation modeling technique has been applied to examine the structure's measurement

model and structural model. Since the study is predictive, the variance-based structural equation model

has helped analyze the data. For the analysis, SmartPLS software is utilized.  PLS is considered a mature

estimation method, especially in estimating the path coefficient in causal models (Fornell, Lorange, &
 64

Roos, 1990). The measurement model has been analyzed by factor loading, whereas the structural

model has been analyzed through path coefficient analysis.

 65

Chapter 4: Results

4.1 Descriptive statistics

Table 4.4 : Respondents Profile

S. No Demographics Nomenclature Frequency Percentage Mean Standard

Deviation

1 Gender Male 75 50.0

2 Female 75 50.0 2.040 1.11054

Total 150 100

1 20-30Year 61 40.7

2 Age 31-40Year 46 30.7

3 41-50Year 23 15.3

4 51-60Year 16 10.7 1.500 .50168

61 and above 4 2.7

years

Total 150 100

4 Matric 18 12.0

5 Qualification FA 75 50.0 2.260 .65977

BS/Graduate 57 38.0

Total 150 100

1 Experience 1-5 year 54 34.8 1.620 .74788

2 6-10 year 71 45.8

3 11-15 year 25 19.4

6 155 100

1-50000 79 52.7

51000-100000 51 34.0

Income 100001-150000 18 12.0 2.006 1.09604

 66

151000-200000 2 1.3

Total 150 100

Marriage status Married 1.000 .00000

Unmarried

Total 150 100

Working Hours Per week 100 100 2.326 1.21233

Total 150 100

Table 4.4 reveals that the gender responses are split 50/50 between men and women, as shown by
the percentages in the table. The average of the genders was 2.04, indicating that the great majority of
those who answered the survey were male. In terms of gender, the standard deviation was one hundred
and tenth of a percent. 32.9 percent of those who responded were between the ages of 20 and 30, 40.7
percent were between the ages of 31 and 40, 30.7 percent were between the ages of 41 and 50, and 15.3
percent were between the ages of 51 and 50, and 2.7 percent were beyond the age of 60. The mean age of
the respondents was 1.500, indicating that the vast number of individuals were in their twenties. The age
was distributed with a standard deviation of 0501. According to the participants' educational backgrounds,
12 percent had matriculated, 50 percent had FA degrees, and 38.0 percent had BS/MBBS credentials. The
average qualification level was 2.26, indicating that the vast number of those who answered the survey
were postgraduate students. There was a 659-point difference in standard deviation across education
levels. According to the participants' knowledge, 34.8 percent of participants had 1-5 years of expertise,
45.8 percent had 6-10 years of experience, and 19.4 percent had 11-15 extensive experience. The average
degree of experience was 1.62, indicating that the large number of those who answered the survey were
postgraduate students. The SD of academic achievement was.747, and it was the same as the SD of
income and marital status, as previously stated.
 67

4.2. Measurement Model Analysis

Figure 1: measurement model

4.2.1 Reliability Analysis

For internal consistency reliability measures, composite reliability and Rho-A have been

administered. In Table 2 employee performance provides significant internal consistency

reliability with Rho_A 0.914, job satisfaction has internal reliability with Rho_A 0.844, and job

stress has approved internal reliability with Rho_A 0.742. Therefore all the observed variables

are reliable at Rho_A >0.7 and hence ensure internal consistency reliability.

Table 2. Reliability Analysis

Cronbach's rho_Aa Composite Reliability Averageb Variance

Alpha Extracted (AVE)

EP 0.897 0.914 0.936 0.830

JS 0.712 0.844 0.829 0.686

Jst 0.633 0.742 0.744 0.653

Note: a. all the rho-A>0.7 indicates internal consistency reliability (Dijkstra & Henseler, 2015); b. All average variance
extracted(AVE)>0.5 indicates convergent reliability (Fornell & Larcker, 1981).
 68

4.2.2 Convergent Validity

Once the reliability of the questionnaire was established, the variance of the indicators explained

by the constructs was tested. According to Table 2, the Average variance extract is applied to

assess convergent validity. The Employee performance has AVE 0.830, and jos satisfaction has

AVE 0.686, job stress has AVE of 0.653. Since all the AVE values are greater than 0.5, the

constructs explain more than half of the variance of its indicators. Therefore it can be concluded

that there are no convergent validity issues for the constructs.

4.2.3 Discriminant Validity

The discriminant validity assessment ensures that a reflective construct has the strongest

relationships with its indicators compared to any other construct (Hair, Hollingsworth, Randolph,

& Chong, 2017). Discriminant validity assessment has become a generally accepted prerequisite

for analyzing relationships between latent variables. For variance-based structural equation

modeling, such as partial least squares, the Fornell-Larcker criterion and cross-loading

examination are the dominant approaches for evaluating discriminant validity.

Fornell and Larcker (1981) Suggest that the square root of AVE in each latent variable can be

used to establish discriminant validity if this value is larger than other correlation values among

the latent variables. Also, the overall value of Average Variance Extraction (AVE) was above

0.5, provided outer loadings above 0.7 ensure discriminant validity of the scale.
 69

Table 3. Fornell and Larcker criterion

EP JS Jst

EP 0.911

JS 0.510 0.828

Jst 0.675 0.722 0.808

Note: The diagonals are the square root of the AVE of the latent variables and indicate the highest in any column or row.

Following Table 3, the diagonal values are greatest among the row and columns. The values

confirm the discriminant validity of the items. Furthermore, Fig 1 highlights the relationship

between constructs and their respective indicators. Thus, the criterion of validity and reliability

for the measurement model is assured, heading to the structural model's assessment.
 70

4.3 Assessment of Structural Model

The structural model depicts relationship among constructs. Figure 2 exhibits the investigated

relationship among constructs. The inner model has been examined through following tests.

Figure 2: structural model

4.3.1 Path coefficient for the inner model

In the next step, a consistent PLS algorithm and bootstrapping have been run to measure path

significance. To best, all three of the T statistics for the latent constructs were greater than the

standard threshold, that is, t>1.96 p<0.01***. By using the bootstrapping technique at a

subsample of 5000, it was observed that JS (β=0.384, p<0.01) had a positive impact on EP, Jst

(β=-0.396,p<0.01) had a significant negative impact on EP. Table 3 below shows the overall path

significance of latent constructs.

Table 4. Path coefficient

Hypothesis β S.D T P Decision

JS  EP 0.635 0.064 9.626 0.0001 Supported

Jst  JS -0.735 0.061 11.538 0.0002 Supported

 71

Jst-JS-EP -0.465 0.062 6.954 0.0003 supported

Note: 1. JS_EP is significant at p<0.001; 2. Jst_JS is significant at P<0.001: 3 Jst-JS-EP is significant at P<0.001

4.3.2. Coefficient of Determinants (R-square)

The coefficient of determination (R2) of employee performance is 0.696, indicating that JS and

Jst explain 69% of the latent variable employee performance. The effect size F2 of the

coefficient of the determinants (R2) was essential because it explains the strength of variance.

Hence, Table 6 shows that JS and Jst both have the high effect on EP with f2= 0.154 and

f2=0.169.

4.3.3 Predictive relevance Q2

The Q2 values estimated by the blindfolding procedure represent how well the path model can

predict the originally observed values. According to Hair et al. (2017), a Q² value larger than

zero for a certain endogenous latent variable indicates the PLS path model has predictive

relevance for this construct. Therefore examining Stone-Geisser's Q² value (Geisser, 1974;

Stone, 1974). Table 6 indicates that the Q2 value is greater than zero and is a good indicator. 

Table 6 The predictive relevance (Q- square)

R Square R2 Adj f2 Q2

EP 0.451 0.439 0.2103

Jst 0.1541

JS 0.1692
Note: 1. Jst_EP f2<0.15 high effect; 2. JS_EP f2 >0.15 highest effect; 3. Q2>0 established prediction of the accuracy of the model
 72

Table 4.3.4

Mean

Description Mean Standard deviation

Job satisfaction

Monetary Rewards: I feel I am 3.85 1.49

being paid a fair amount for the
work I do.

Job satisfaction: There is really 4.36 1.24

too little chance for promotion on
my job.

Decision Making Authority: My 3.61 1.25

supervisor is quite competent in
doing his/her job.

Monetary Rewards: I am not 3.33 1.53

satisfied with the benefits I
receive.

Monetary Rewards: When I do a 4.25 1.37

good job, I receive the
recognition for it that I should
receive.

Decision Making Authority: Many 4.02 .99

of our rules and procedures make
doing a good job difficult.

Working Environment: I like the 4.07 1.33

people I work with.

Job satisfaction: I sometimes feel 4.21 1.31

my job is meaningless.

Decision Making Authority: 3.91 1.44

Communications seem good
within this organization.

Decision Making Authority: Raises 3.71 1.57

 73

are too few and far between.

Employee Performance: Those 4.18 1.37

who do well on the job stand a
fair chance of being promoted.

Decision Making Authority: My 3.66 1.44

supervisor is unfair to me.

Decision Making Authority: The 4.11 1.29

benefits we receive are as good
as most other organizations offer.

Worload: I do not feel that the 3.75 1.49

work I do is appreciated.

Employee Performance: My 2.99 .93

efforts to do a good job are
seldom blocked by red tape.

Employee Performance: I find I 2.74 .80

have to work harder at my job
because of the incompetence of
the people I work with.

Job Satisfaction: I like doing the 3.07 .88

things I do at work.

Decision Making Authority: The 2.73 .92

goals of this organization are not
clear to me.

Monetary Rewards: I feel 3.06 .89

unappreciated by the
organization when I think about
what they pay me.

Working environment: People get 2.98 .90

ahead as fast here as they do in
other places.

Decision Making Authority: My 3.25 .88

supervisor shows too little
interest in the feelings of
subordinates.
 74

Workload: The benefits package 3.26 .88

we have is equitable.

Monetary Reward: There are few 4.10 1.23

rewards for those who work
here.

Workload I have too much to do 4.12 1.24

at work.

Working Environment: I enjoy my 3.88 1.24

co-workers.

Decision Making Authority: I 4.02 1.35

often feel that I do not know
what is going on with the
organization.

Working Environment: I feel a 4.01 1.25

sense of pride in doing my job.

Monetary Reward: I feel satisfied 4.14 1.23

with my chances for salary
increases.

Monetary Reward: There are 4.83 1.31

benefits we do not have which
we should have.

Decision Making Authority: I like 3.89 1.32

my supervisor.

Work Load: I have too much 3.81 1.29

paperwork.

Working Environment: I don't feel 2.80 1.31

my efforts are rewarded the way
they should be.

Monetary Reward: I am satisfied 4.37 1.31

with my chances for promotion.

Working Environment: There is 4.49 1.22

too much bickering and fighting
at work.
 75

Working Environment: My job is 3.30 1.44

enjoyable.

Work Load: Work assignments 3.24 1.52

are not fully explained.

Table 4.6.1 reveals that item number Monetary Rewards: When I do a good job, I receive the
recognition for it that I should receive has the highest mean value (M=4.25, SD=1.37). Contrarily, item
number Decision Making Authority: The goals of this organization are not clear to me which indicates
has the least mean value (M=2.74, SD=.80).
 76

Chapter V

Discussion, Conclusion and Recommendation

5.1 Introduction

This study was assumed with the determination to discover the relationships between job

stress, employee’s performance and job satisfaction among healthcare workers in South

Waziristan tribal district, Pakistan this investigate may contribute from an academic, as well as

management perspective. The initial part contains purpose of the study, the foundation of the

study, also statement of the problem with research gap. To discuss objectives of the study and

research questions has been established. Significances of the study and limitations, delimitations,

definition of key terms are also stated in this section. The second section also described a

comprehensive theoretical and empirical previous study on these variables. They provide a

considerate of the relationship between these variables and to offer evidence on how they effect

to the performance of the organization

The third part offered the methodology procedure adopted in the contemporary research.

In this sector, entails of a set of fundamentals that cover research philosophical paradigm,

research design, population, sample size and sampling procedures, research instrument, pilot

study, validity and reliability of the tool, ethical research and data collection measures. They

encompass data analysis procedures to test research questions in this research. The reliability of

the tool was initiate to be good. The scale was authorized through expert belief. Essential

changes were completed in the light of pilot study. It was co relational research also data were

composed through cross-sectional review.

 77

The section four obtainable result of descriptive information, the outcomes of the

research question also an argument of the findings. The last sections deliberated the summary,

conclusions, as well as recommendations.

5.2 Discussion

The findings of this research revealed that, in combination to Karasek's model and

consciousness, the professional specialization causes significant variation in work stress and

organizational commitment. Comparative studies examining the distinctions amongst medicine,

emergencies, internal medicine, and perhaps other clinical consistent with the values are required

in order to find additional factors of occupational satisfaction and performance among nursing

professionals in other commercial different divisions. At addition, this research discovered that

employment in a health center was associated with a lower likelihood of intending to quit the

position. There has been some body of evidence to suggest that nurses working at teaching

hospitals have a wider perception on their work settings than nurses working with vulnerable

facilities. Researchers McGillis Hall, Doran, Sidani, and Pink (2006) discovered that healthcare

practitioners at medical centers had higher perceptions of the delivery of healthcare as well as the

overall quality of their area of employment health workers participation in community

institutions. Furthermore, while occupational stress was greater between many nursing

professionals in residency programs, employment was already stronger and gender pressure was

decreased in this group of professionals. Medical institutions may very well have distinct

features from neighborhood or minor institutions, which could have an influence on the desires

of new nurses to quit their positions after a span of years. Examples include discontent with

prospects for advancement or extra training between physicians in the United Kingdom, which is

a prominent cause of work frustration within physicians (Shields & Ward, 2001). In part due to
 78

the fact that medical institutions are often bigger and situated in metropolitan areas, it is possible

that they would give caregivers with more prospects for career advancement, which could

influence to their intents to remain. Alternatively, it is possible that medical centers provide a

more favorable learning environment for future nurses though one of their core purposes is the

training of new health care workers. A further cause of pressure for nursing professionals was the

disparity both their expectations and the reality of their job situations (Boychuk Duchscher,

2001). Furthermore, if the nurse managers have much medical training at education libraries

rather than other kinds of hospitals, they could've had a superior understanding of the risks when

they started as new employees at the hospital.   Moreover, this research discovered that having

more than one registered nurse post at the same time was strongly associated with plans to quit

the occupation. This was a surprising discovery, and it having not previously reported anywhere

else in the healthcare journal until now. Professors who carried a supplementary job compared to

their job growth, according to Jamal, Baba, and Rivière (1998), had reduced plans to leave their

jobs than about their colleagues whom held just one profession. This discovery, without a doubt,

warrants additional investigation in future study projects. Because of the unique nature of their

work situation, doctors in endoscopy departments have developed close working relationships

with one another. As a result, assessing stressor in a unit is critical to ensuring that stress is

managed in an acceptable manner. Anxiety among health-care personnel working in

gastrointestinal units is being investigated for the first time, according to the authors.

Health care employees in gastrointestinal departments were shown to have lower stress

levels compared to those in other professions. Surgical unit personnel had the highest stress

scores on the job characteristics scale, making them easy to spot. Telescopic treatments, which

require a high level of technical expertise, account for the high employment necessity score for
 79

physicians on the subtest. Another cause of worry is the possibility of unexpected abnormalities

during normal population gastroenterology. Increased patient labor turnover, dramatic shifts in

the physician's patient monitoring undergoing sedated colonoscopy, and environmental stressors

while giving help in gastrointestinal operations may explain the increased scores on the work

requirement sub - dimension for physicians including caregivers' helpers. Gastrointestinal unit

staff' anxiety levels differed significantly depending on their job title.

As per this study, the endoscope unit has a diverse workforce when it comes to stress

levels, which necessitates a stratified strategy based on job description. Inadequate contractor

supervision, organizational systems, and a dearth were the main stressors for caregivers,

according to a study. Nursing staff may be able to alleviate some of their burden by having open

talks with supervisor regarding life choice rules and good working conditions. Job instability was

shown to be strongly linked to greater levels of organizational mental anguish among fellows. In

order to strengthen the perception of job satisfaction of residents finishing associated hospitals

service efforts should be made to offer a sustainable regulation prescribed. Only the attraction -

selection anxiety scale number was high in the academics group, whilst the other anxiety scale

values were quite low. It is possible that academics' profession qualities, such as the need for

push information and evidence of success in the subject, are to blame. In reality, it's almost

impossible to change this aspect of the work without harming one's ability to grow professionally

and personally. Furthermore, academics are also under a lot of stress because of the vast amount

of people they have to on an everyday basis. Decreasing the doctor's reliance on academics to

generate more cash may involve managing this requirement.

 80

There are a variety of things that might influence stress ratings. Additionally,

psychological characteristics (such as character, consciousness, and coping methods) may have

an impact on stress sensitivity in addition to the ones investigated in this research. These

considerations were not taken into account in this research, but they should be taken into account

when analyzing variations in occupational stress across employees in various professions (e.g.,

professors, fellows, and nurses). The motivation might be in the form of a cash or non-financial

provision that is supplied to the employees. Per a study, a compensation package is the most

effective strategy to encourage workers personality while also meeting their requirements and

expectations (Mukherjee et al., 2012). A healthy workplace is described as providing workers

having something like a risk-free working area that enables them to concentrate on their task

while also motivating them to do greater than they would otherwise (Bentley et al., 2010). In

order to facilitate personal growth, employers must empower workers to make choices about

their companies and make adjustments in order to enhance workplace productivity. Individual

promotion is a process that increases workers' understanding of self while simultaneously

reducing the conditions that cause them to feel helpless (Conger et al., 2008). Burke, in 2016,

found evidence for this hypothesis from yet another study Aside from that, training programmed

that teach employees healthful responding skills for dealing with stresses may be a useful tool in

lowering workplace stress. There are several drawbacks to this research. The countrywide

monitoring of stress ratings been completed in 2005, resulting in an eighteen - month gap

between that research and this one. Because of the dynamic nature of Korean culture, the KOSS

ratings might fluctuate dramatically over the course of a semester. Nonetheless, there are no

other reference points that have been independently verified that might be used for comparing.

As a result, many current examinations continue to rely on this data. Because of the structured
 81

questionnaire used, the sample size was limited to those who were employed at the facility in

which it is being conducted. This is the primary restriction of the research. Furthermore, unlike

previous research, this investigation was performed confidentially and confidentially well with

permission of investigators, and the findings were secured and transmitted to the blinding

supervisor for processing, therefore reducing the likelihood of erroneous replies. Performance

appraisal has recently gained prominence in the healthcare professionals as a prominent issue of

discussion. It is customary to emphasize as performance boost initiatives the development of new

technological processes and healthcare products, both of which are expensive investments for

facilities to make. Reduce workplace evaluation and treatment; on the other hand, were

disregarded, despite the fact that these characteristics are crucial for advancement initiatives.

Additionally, work stress and job satisfaction ratings may be used to determine the overall

quality of a hospital's health-care delivery system. Professionals in gastrointestinal units should

be evaluated for work - related stress on a routine basis, and methods to address the results of

these assessments should be adopted in order to encourage patient outcomes (Rivière, 1998).Job

stress may have a negative impact on employees' mental health, which can lead to a decrease in

their overall job satisfaction. Researchers from the University of Florence in Italy examined the

links involving stress, work satisfaction, and promotion opportunities in caregivers. They

employed a similarly questionnaire and discovered that the scale items for responsibility and

partners' support had the greatest summary statistics, while the measurement for adjustment had

the average mean value, among so many aspects of work stress. According to their findings, the

maximum compressive factor was lower than the scores observed in the current research.

According to Edwards et al (2013), an identical set of results were observed in research done

between workers Empire in 2013. According to research conducted between British enforcement
 82

employees, the request and alterations factor structure had the minimum and maximum mean

scores, respectfully. Work - related stress is shown to be the most important factor that affects

job satisfaction, because of these data, and employee performance and displeasure are associated

with the role constructs. Order to perform a wide range of tasks in the medical system. Typically,

workers might not have a detailed understanding of their responsibilities that might lead to the

lack of openness in their understanding of their roles. In nursing, each function has its own set of

distinct qualities, and the standards for one role may be at odds with the demands again for the

next job and organization. As a result, there may be a conflict of roles. This research discovered

a significant public health concern for stressful conditions. s. Although, although these indicators

are congruent with results from Saudi research done in a medical council Hospitals in the

Southern Area, because experiment found that age and experienced were connected with stress,

but we did not announce this correlation even after adjusting for other factors (Al-Omar, 2003).

Work schedule was identified as one of the most significant predictors of employment stress in

two experiments conducted in the United Kingdom (Deary and others, 2003; Murphy & Hurrell,

1987). The findings of a study including specialists indicated health conditions for distress, such

as necessary repairs and family life, inadequate governance and resourcing, daily duties, and

coping with the suffering of their sufferers (Murphy and Hurrell, 1987). Surprisingly, despite the

high levels of stress experienced by selected respondents, there was also a relatively high level of

work engagement throughout them (97.0 percent). This will be much greater than just the levels

observed in previous research. For illustrate, the confidence percentage at a medical group in

Pakistan (Grunfeld and colleagues, 2005) was 48.7 percent, whereas the average score among

home care employees in Californian, USA, reached 59 percent (Delp and others, 2010).

According to the findings of previous research in this subject, there is a poor association
 83

involving work engagement and job contentment (Zangaro and Soeken, 2007), however that

would not be the case in our analysis. Women reported high levels of stress as well as high levels

of work fulfillment, which we believe is due to the fact that the Saudi Arabian medical insurance

system and promotional scheme are different and those in other nations.  Nursing midwifery'

work happiness and performance have been shown to be linked in other analyse. One of the

reasons people are dissatisfied with their jobs is because they have to work longer hours.

Doctors' contentment with health‐care suffers as a result, as does the quality of care they get.

Registered nurses both have about the same amount of work authority. Workforce

reduction has been shown to improve staff happiness and provide them greater control over

allocated responsibilities. Nursing professionals have different mental workloads because of the

workplace setting and indeed the fact that physicians are referred to by far more clients than

midwives.

As a result, the patients who come to nurses in the emergency department are often in a

state of acute or particular need, which may contribute to additional stress for the caregivers

Oliveira et al. (2015) found that nurses had a greater burden than other professions, and was

more closely linked to unfavorable working circumstances and a general lack of enthusiasm for

their work. The structure and profitability of the organization pleased midwives much; however,

the workplace culture and employment possibilities did not. This was found in research by

Muhammadani et al (2018). According to Gouzou et al. (2019) nurses' poor job contentment was

exacerbated by rotating shifts as well as heavy workloads. In this study, the helpers were

significantly influenced by factors such as age and work experiences. According to Wihardja et

al. (2019) there was no correlation between a company's seniority, work experiences, or extreme

trauma.
 84

The research found that older healthcare employees had a greater work satisfaction than

their younger counterparts. Mor et al. (2017) found that the newest and elderly professions were

the most pleased. Whereas another research found that middle-aged employees are now the most

content. In this research, there was no statistical correlation and work history and task identity.

Those with more talents have more influence over their jobs though it is based on their ability to

accomplish the position and is not reliant on their generation or work history. According to a

conceptual, employee performance was shown to be the most significantly associated with

occupational stress (Zangaro and Soeken, 2007).

 85

Chapter 6 Conclusion

The conclusion was reached on the source of the discovery as well as the numerical

analysis of data collected. Health care professionals in Pakistan's South Waziristan tribal territory

were the subjects of a study to determine the link between workplace stress, employee

performance, and job satisfaction among them. To address the research objectives and achieve

the study's goal, means and standard deviation, statistical (correlational statistics, and linear

regressions) were employed in conjunction with confirmatory factor survey data and linear

regression models. According to the results of recent study, there was a favorable relationship

among these factors. The findings reveal that Job Stress, employee Performance e is significantly

influenced by one's Job Satisfactions, according to the findings. As a result, the assumption that

the Job stress has a favorable impact on the job satisfaction is supported. According to the

findings, payment is significantly related with higher levels of job satisfaction in the workplace.

As a result, the prediction that financial compensation is positively linked with job satisfaction

has been confirmed. According to the findings, effort is significantly connected with work

performance in a good way. Consequently, the notion that effort is progress and ensure with job

satisfaction has already been acknowledged as true. The findings reveal that having extensive

decision-making power is significantly related with having high levels of job satisfaction. In this

case, the premise that decision making power is positively related to job satisfaction is validated.

Job satisfaction has a substantial positive relationship with employee performance, according to

the findings, and the premise that Job satisfaction is favorably connected with employee

performance is confirmed.

There are various issues people are facing in their workplace like job stress, anxiety, and

low support of their bosses, harassment, and bullying etc. which leads to major health issues,
 86

both physical and mental issues have been observed in the findings. Several workplaces have

maintained rules and regulation for employees’ while working which have helped many

organizations to achieve better health goals of their employees. World Health Organization have

also regulated certain policies for organizations to fully comprehend and apply in their

organization for the betterment of their employees.

 87

Chapter 7 Limitations and Recommendations

Based on the findings and conclusions of this study, the following research efforts are

recommended for future studies.

In the future, investigators would then be willing to define what skills and knowledge utilizing

qualitative and mixed techniques. A qualitative study also provides comprehensive information

on instructor’s perceptions concerning the variables of research. In further, the scholar may

select another department. They suggested scholars can conduct investigate using proportional

analysis of the public and private segments of health care worker. Lastly, they recommended that

equally public and private health care institution develop an atmosphere in which faculty are

conscious of the organizations.

Despite the enactment of some intriguing intellectual conclusions as well as management

discoveries, there are significant limits to this research. For starters, because the study is

restricted to only Pakistani consumers, the data findings of this examined analysis may be

difficult to interpret because not all people from various regions of the world experience the

actual components of job stress, employee performance, and job satisfaction, all of which are

related to a mediating variable, which is the nurse or doctor. Foremost, while conducting the

exploration for this analysis, there was a dearth of reliable data on a variety of levels, including

the capacity of the health healthcare professional, the degree of involvement, and the scale of

method, each of which had conflicting outcomes due to the differences in organizations', but the

specific subject of work - related stress corresponding to hospital staff members was available. In

addition, while the procedure employed for the study was based on a deductive methodology for

the questionnaires, where the percentage of jobs who completed the questionnaires initially

numbered, the observations of this quantification approach of relevant scientific allowed greater
 88

perspective for grasping the survey better—thereby enhancing credibility, adding value, and

being trustworthy. The researcher strongly urges that both employees and employers should see

work stress as a significant problem that requires attention from both parties. It has been shown

that when occupational stress increases, both performance appraisal and career progression suffer

as a result. Predictions for the coming years Greater work stress is being discovered in more and

more dynamic firms in the modern period, according to research. It is critical to provide workers

with the appropriate skills, strategies, and resources to assist them in reducing their employment

stress levels. Job stress may have a negative impact on the person, their clientele, and the

business as a whole. In certain cases, greater levels of work stress might result in a more rapid

fall in quality of work life. Stress has a significant impact on team and work satisfaction.

The names of them are as wants to follow: It is possible that future research may use a real

randomly search strategy rather than the one willingness to purchase in order to replicate this

result. Although a large portion of the previous research concentrated on the influence of work-

related psychosocial stressors, the demographic instruments did not include any sections

pertaining to medical information. The quantity of doctor appointments in the last three quarters

or the proportion from over medications prescribed for job stress-related problems might

potentially give instructive and intriguing information on the job stress epidemic. Despite the fact

that the duration of travel was not addressed in this study via scholarly investigation or the

journal article’s part, the segment of the population measure had a question involving to the

subject matter. Research findings may be better served to save this inquiry for a more critical

issue if no knowledge on this factor is revealed in the near future. In the literature, there is a great

deal written on pay schemes and their influence on the degree of work stress work engagement,

as well as on their quality of work life. Study participants who are concerned with both work
 89

engagement and job stress will be well encouraged to add a focus area on their descriptive survey

to this result. The possibility of a connection, if there is one, may make for a fascinating

conversation. Somewhere at end of the day, we suggest that successful studies on this topic in

this investigation decide three separate or better opportunities parts of the world to conduct an

investigation this relevant study on, using this modern information as a guide in the Pakistani

language and people, because the conclusions of this investigation provide scientists with an

attempt to enhance the individual's knowledge about job stress as well as job achievement, and

linking it effectively to the hospital worker as a mediator. The scientific analysis used in this

research is primarily based on data collected in Pakistani. Additional study may be conducted in

other nations as well as specialized health services. This study, as well as the preparation of

additional investigation, would therefore help organizations and top executive team members

learn their staffs' desires, while also bringing down work pressure and implementing quality

planning and assurance of job involvement. This will result in an enhanced effect for coworkers

and an increased level of achievement that will help the company to grow for the organizations.

It is possible to draw conclusions and make suggestions based on the findings. The organization

should give serious thought to the development of workers' abilities and the realization of their

possibilities. It is possible that the Personal Resources will undertake an adequate skills

assessment to uncover skills and abilities of workers who are properly motivated, since this has

been proved in the research to be a contributor of work pressure. Personnel who are

knowledgeable of their qualifications but do not use them because they believe that there are no

yields and incentives from doing so might even be given due attention under the recruitment

procedure. It seems there are occurrences where professionals are knowledgeable of with their

competences and not to use them so even though they believe that there are no profitability and
 90

incentives from doing so. An attention should be paid on reducing workplace stress for workers

since this has an impact on their overall effectiveness. Examples of excessive workloads may

have a detrimental impact on the success of workers since they will not only generate stress, but

they will also most likely be resulting in poor performances. Furthermore, this research

acknowledges that there are restrictions in terms of the number of users, the extent of the

investigation, and the parameters that were employed by the researcher. As a result, it is

recommended that many more investigations be undertaken with a bigger sample size, a broader

focus, and the introduction of additional factors as necessary.

 91

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Appendix A

Designation :_______________
Age: ______________
Marital status: ______________
Gender:_____
Education:__________-monthly income:____________ job seniority:______
Weekly hours worked:__________________

PLEASE CIRCLE THE ONE NUMBER FOR EACH QUESTION

Strongly Disagree

Strongly Agree
THAT COMES CLOSEST TO REFLECTING YOUR OPINION
ABOUT IT.

Disagree
Neutral
Agree
Job satisfaction

1 Monetary Rewards: I feel I am being paid a fair amount for the 1 2 3 4 5

1 work I do.

2 Job satisfaction: There is really too little chance for promotion 1 2 3 4 5

2 on my job.

3 Decision Making Authority: My supervisor is quite competent 1 2 3 4 5

3 in doing his/her job.

4 Monetary Rewards: I am not satisfied with the benefits I 1 2 3 4 5

4 receive.

5 Monetary Rewards: When I do a good job, I receive the 1 2 3 4 5

5 recognition for it that I should receive.

6 Decision Making Authority: Many of our rules and procedures 1 2 3 4 5

6 make doing a good job difficult.

7 Working Environment: I like the people I work with. 1 2 3 4 5

7

8 Job satisfaction: I sometimes feel my job is meaningless. 1 2 3 4 5

8

9 Decision Making Authority: Communications seem good within 1 2 3 4 5

9 this organization.

1 Decision Making Authority: Raises are too few and far 1 2 3 4 5

10 between.
 100

1 Employee Performance: Those who do well on the job stand a 1 2 3 4 5

11 fair chance of being promoted.

1 Decision Making Authority: My supervisor is unfair to me. 1 2 3 4 5

12

1 Decision Making Authority: The benefits we receive are as 1 2 3 4 5

13 good as most other organizations offer.

1 Worload: I do not feel that the work I do is appreciated. 1 2 3 4 5

14

1 Employee Performance: My efforts to do a good job are 1 2 3 4 5

15 seldom blocked by red tape.

1 Employee Performance: I find I have to work harder at my job 1 2 3 4 5

16 because of the incompetence of the people I work with.

1 Job Satisfaction: I like doing the things I do at work. 1 2 3 4 5

17

1 Decision Making Authority: The goals of this organization are 1 2 3 4 5

18 not clear to me.

1 Monetary Rewards: I feel unappreciated by the organization 1 2 3 4 5

19 when I think about what they pay me.

2 Working Environment: People get ahead as fast here as they 1 2 3 4 5

20 do in other places.

2 Decision Making Authority: My supervisor shows too little 1 2 3 4 5

21 interest in the feelings of subordinates.

2 Workload: The benefits package we have is equitable. 1 2 3 4 5

22

2 Monetary Reward: There are few rewards for those who work 1 2 3 4 5
23 here.

2 Workload I have too much to do at work. 1 2 3 4 5

24

2 Working Environment: I enjoy my coworkers. 1 2 3 4 5

25

2 Decision Making Authority: I often feel that I do not know what 1 2 3 4 5

26 is going on with the organization.

2 Working Environment: I feel a sense of pride in doing my job. 1 2 3 4 5

27
 101

2 Monetary Reward: I feel satisfied with my chances for salary 1 2 3 4 5

28 increases.

2 Monetary Reward: There are benefits we do not have which 1 2 3 4 5

29 we should have.

3 Decision Making Authority: I like my supervisor. 1 2 3 4 5

30

3 Work Load: I have too much paperwork. 1 2 3 4 5

31

3 Working Environment: I don't feel my efforts are rewarded the 1 2 3 4 5

32 way they should be.

3 Monetary Reward: I am satisfied with my chances for 1 2 3 4 5

33 promotion.

3 Working Environment: There is too much bickering and fighting 1 2 3 4 5

34 at work.

3 Working Environment: My job is enjoyable. 1 2 3 4 5

35

3 Work Load: Work assignments are not fully explained. 1 2 3 4 5

36