Chapter 13: Stress in the Workplace and

Stress Management
Nancy Borkowski & Katherine Meese

Andi Raisyiah Akrimah Imran (K022211013)

Widyatma Adinda Jubhari (K022211029)

Program Studi Magister Administrasi Rumah Sakit

Fakultas Kesehatan Masyarakat - Universitas Hasanuddin
2021
 Learning Outcomes
The definition of stress.

The process model of stress and coping.

How stress can negatively affect individuals and organizations.

The various forms of stress.

The three stages of the General Adaptation Syndrome.

How personalities, race, and gender affect an individual’s level of stress.

The definition and phases of burnout.

The four categories of stress in the workplace.

The various coping strategies available toorganizations and individuals.

The definition of stress management and the various programs used by organizations
Overview
 Stress
Cognitive-transactional theory

01 Definition a particular relationship between the person and the

environment that is appraised by the person as
taxing or exceeding his or her resources and
endangering his or her well-being

Affecting factors
Affecting
02 Factors
level of self-efficacy
adaptability
resources available to them
The Process Model of
Stress and Coping
The Process Model of Stress and Coping
03 Perceptual Outcomes
Challenge
Threat
Demand Appraisal Harm/loss
01
Physical Demand
Task Demand Perceptual Outcomes
Role Demand
Interpersonal Demand

Demand Appraisal
Resource Appraisal
Coping Strategies
02 Resource Appraisal
Material 04 Coping Strategies
Personal Reactive
Social Anticipatory
Preventive
Proactive
Work Related
Stress
 Work Related Stress

a common phenomenon in today’s

01 Definition workplace

occupation-related
02 Cause pressures → leading
source
 Workplace Violence
Workplace Violence
Leads to physical violence in 1 out of 10
work environments

Study about “desk rage” Workplace Violence

Yelling and verbal abuse→ common Interaction among healthcare team
(Integra Realty Resources, 2001) (umum terjadi)
Interaction with patients & family
members(>>)
Desk Rage Rate
Behaviors or acts of aggression, 71% workplace intentional injuries →
hostility, health care and social services
rudeness, and physical violence. workplaces

Sentinel Event Alert

The Joint Commission → Sentinel Event Alert +
developed standard→ code of conduct as
well as a process for managing disruptive and
inappropriate behaviors
 Stressor
01 Positive / Negative

02 Internal / External

03 Acute / Chronic Internal → lifestyle,

mental state,
Positive → personality
euphoria + stress Acute → reaction to threat (fight-or-flight Eksternal →
Negative → response) environment, other
overwhelmed + Kronik → continuous, work, relationship, people, work, major life
poorly managed financial events, hassles
 Distress
Unhealthy, negative, destructive outcomes of stressful
events(Quick et al, 1997)

Behavioral, physiological, and/or psychological effects

Stimulus (-) → fight-or-flight response

General Adaptation System (GAS):

Alarm phase
Resistance phase
Exhaustion phase
Individuals and Stress

Personalities
01
02 Underrepresented Populations

Gender
03
 Personalities
Rosenman et al, 1966
Rotter, 1966 Savery and Hall, 1986
Relationship between Another dimension
stress and personality → managers are beleaguered
of personality → by demands (superiors,
linking CHD & personality stress → perception
profiles government, community
of control

01 02 03 04 05 06

Personality Types Kushnir and Kasan, 1991 Savery and Hall, 1986
Type A (agressive, High demand jobs + high Managers’
competitive) and workload + ↓perceived perceived lack of autonomy→
Type B (patient, control = stressor for type decision making + stress
low-key) A, ≠ tipe B related illness
Underrepresented Populations
Underrepresented ethnic groups
prone to stress because
prejudice, discrimination,
language difficulties,
differences cultural
values and attitudes
James, Lovato, Khoo,
1994
differences in cultural
values and attitudes →
major source

Quick et al, 1997 Richard and Grimes, 1996

blatant prejudice → Work harder to socialize, or
stress for those in assimilate,
minority ethnic groups
 Gender
Female, health care employers need to be
sensitive to the work-related stress issues
experienced by women. Stress → Women >> Men

Swanson, 2000

Women face gender Barriers to financial and On-the-job sexual

specific work stress → career advancement harassment →
sex discrimination, need based on sex psychological
to balance work & discrimination symptoms, and physical
family, + general job → psychological and symptoms
stressors → work physical symptoms,
overload, lack of control,
underutilization skills.
 Belief About Stress

01 An individual’s beliefs 02 Both stress and one’s

about stress → shaping beliefs about stress →
whether or not stress will how stress affects one’s
have harmful effects on health.
that person’s health.
 Burnout
Stress Maslach & Goldberg, Maslach & Jackson,
Occurs when job 1998 1981
requirements do Dimensions associated with
Burnout → an occupational
not match the burnout: emotional
hazard in people oriented
employee’s exhaustion,
professions (health care,
capabilities, depersonalization,
human services, and
resources, or diminished personal
education)
needs. accomplishment

Burnout Jha et al, 2019

An extreme case of job
related stress.
Burnout → public
Overwhelming
health crisis
exhaustion; frustration,
anger, cynicism, sense
of ineffectiveness and
failure.
 Golembiewski’s
Phases of Burnout
 Phases of Burnout
Broad ranges of perceptions or attitudes about the worksite deteriorate

Performance appraisals ↓

Physical symptoms ↑

Turnover ↑

Self-esteem ↓

Various clinical indicators of mental health show deterioration.

The quality of social and emotional life at work declines.

 Presenteeism

01 A low rate of absenteeism ≠ employees are not suffering

from burnout.

02 Presenteeism → Employees show up for work but are

less productive because of illness.

Presenteeism has the largest health-related economic

03 impact on the company, ahead of absenteeism, health
insurance, and workers’ compensation (Berry, Mirabito,
& Berwick, 2004).
Causes of Workplace Stress

01 Individual Task Demand

 Workload
 Autonomy
 Shift work
 Physical environment

02
 Variety of work
Individual Role Demand
 Isolation at workplace

 Role conflict
 Role ambiguity
 Level of responsibility
 Dificulties balancing work & personal lives

03 Group Demands
 Relationship at work
 Threats to personal safety
 Lack of participation
 Inappropriate leadership/ management style

04 Organizational Demands
 Communication patterns
 Career development opportunities
 Management / leadership styles
 Job security
Coping Definition

with Stress “An effort by a person or an organization to manage and

overcome demands and critical events that pose a
AT WORK challenge, threat, harm or loss to that person and
that person’s functioning or to the organization as a
whole” (Schwarzer, 2004)

According to Whetton & Cameron (1993),

“Coping with stress was second on a list of 10
skills attributed to effective managers.
 Stress
Management
“A narrow set of individual-level interventions (e.g., relaxation training, biofeedback,
meditation) or a broader meaning that includes any type of stress intervention”
(Murphy, 1995)

To be successful, stress management interventions need to target

characteristics of the individual worker, the job, and the organization.
 Stress Management
Four perspectives to coping with job-related stress
(Schwarzer, 2004)

REACTIVE COPING ANTICIPATORY COPING

Effort to deal with a stressful encounter Efforts to deal with an inevitable event that is
that either is ongoing or has already
happened (job loss, demotion) 2 certain to occur in the near future (public
speaking, a job interview, or downsizing)

1
3
4
PROACTIVE COPING PREVENTIVE COPING
Effort to build up general resources that
Effort to build up resistance resources, whereby the
facilitate movement toward challenging goals
level of stress felt by an individual is reduced, if a
and personal growth
critical event is expected to occur in the future
(hardiness training and learned optimism ) (return to school in anticipation of possible job loss
due to buyout)
Individual Coping Strategies
EVIDENCE-BASED STRESS REDUCTION STRATEGIES

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 Individual Coping Strategies
ANOTHER EXPERTS SAID ..

(FRIEDMAN, 1999) suggests training employees by:

• Improving problem-solving and conflict resolution abilities
• Developing leadership skills
• Balancing between work, family, and leisure activities

(SCHWARZER, 2004) suggests that with healthy lifestyles

(e.g., nutrition and exercise), learned optimism and resilience
training  cope with stressful situations

(MARTIN SELIGMAN,1991) developed the concept of Optimism Theory, suggests that people can undo pessimistic
thinking and learn optimism by recognizing and then disputing their own negative thoughts and beliefs. That learned
optimism applied directly to workplace productivity.
 Optimists vs. Pessimist
Tend to attribute negative events to Tend to attribute failure and
nonpersonal, nonpermanent, and negative events to permanent,
nonpervasive factors. personal, and pervasive factors.

See the problem as a result of the See no relationship between

environment or setting they are in their actions and goal attainment,
rather than being inherent in deficits in future learning,
themselves. motivational disturbances

Have high Do not make

selfefficacy and progress
view setbacks, forward, due to
obstacles as giving up is a
challenges that rational response
provide excitement (learned
in their lives helplessness)
 Individual Coping Strategies
ANOTHER EXPERTS SAID ..
Seligman identified three primary elements of an individual’s explanatory style:
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1 2
STABILITY GLOBALITY
refers to whether the event’s refers to whether the event’s
outcomes are temporary or outcomes are specific to this
permanent. one situation or whether the
outcomes apply to everything in
a person’s life.
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3
LOCUS OF
CONTROL
refers to whether the individual
believes that the outcome is
attributable to their actions or to
factors in the environment.
Learned Definition
Helplessness A phenomenon in which people who experience failure at a task, determine
that the task cannot be accomplished, so they stop trying, internalize their
failures (selfblame) and develop a helpless attitude.

It is an acquired condition that has a negative

impact on an individual’s
physical, emotional, mental, and spiritual
wellbeing  source of stress at workplace

Optimism may serve as a buffer against the

physiological effects of stress  so they can
work through the problems and develop
solutions rather than feeling helpless or like
victims.
 Organizational Coping Strategies

The distinction between these four perspectives of coping is highly useful because it moves the individual’s focus
away from mere responses to negative events towards a broader range of risk and goal management (the positive
experience of stress).”
 Illustration of coping concepts  SCENARIO
A physician displays inappropriate behavior toward a nurse (a stressor),
which leads to the nurse experiencing anxiety (stress response) and, in turn, the
nurse resigns (an organizational consequence of distress).

Primary Secondary
01 Prevention Prevention
02
Attempt to eliminate the stressor by having Address the problem by providing programs
the hospital establish a zero-tolerance policy to improve interpersonal relations between
regarding inappropriate physician behavior physicians and nurses (anticipatory coping)
(preventive and/or proactive coping).  improving team building and
communication skills.

03 Tertiary Prevention
Establishing an employee assistance program designed to help nurses cope with
inappropriate behavior by physicians (reactive coping)
Joy in Work

IHI suggested the “Joy in Work” framework to help senior leaders, managers, and individuals
identify their roles in reducing stress and burnout in the workplace by seeking to increase joy in
work, resulting in happy, healthy, and productive Employees.

The employees can better withstand the stressors that are inevitable
in health care if they can find joy in the work they are doing.
Components for Improving Joy in Work
 Job Design
MFL Occupational Health Centre (2000) suggest that the
employers can better design jobs by doing the following:

01 Clearly defining jobs and responsibilities

Giving workers opportunities to Making work schedules flexible for

05
02 learn new skills responsibilities outside of work

Allowing time for social

03 interactions among workers
Training managers to apply
participative management styles 06
Ensuring that effective change
04
management accompanies organizational
Implementing effective performance
management systems with clear 07
change expectations and procedures

Communicating about job security 08

 Stress Management
Programs
• Often consist of breathing and stretching exercises, yoga,
meditation, and/or massage.
• The programs’ goals are to lessen the adrenaline response
to minor stress.
• EXAMPLES

St. Paul Fire and Marine Baptist Health South

Insurance Company Florida (BHSF)

Program activities included :

(1) employee and management education on job
stress,
(2) changes in hospital policies & procedures to
reduce organizational sources of stress,
(3) establishment of employee-assistance
programs.
The Wellness Advantage, a healthy lifestyle
program for its employees.
Onsite fitness coaches are available to employees
at hospital fitness centers to provide screening
and personal training.
To meet both organizational and individual goals, Crampton and
colleagues provide the following recommendations:

Preventive and/or Proactive Coping

01 (Primary Prevention)

• Identify the major stressors in the workplace and

assess which ones are controllable.
• Communicate with employees about the benefits of
stress management.

Anticipatory Coping
02 (Secondary Prevention)

 Help employees identify their stressors and stress-

tolerance levels.
 Develop individualized stress management programs
that meet the needs of the organization’s employees.
 Communicate with employees.
To meet both organizational and individual goals, Crampton and
colleagues provide the following recommendations:

Reactive Coping
03 (Tertiary Prevention)

• Make sure employees learn to recognize symptoms of distress.

• Exercise and maintaining a nutritious diet are two of the most
agreed-upon stress management techniques
• Help employees keep a positive perspective on life and feel a
sense of purpose.
Summary • A certain degree of stress is necessary for good
mental and physical health; it can be viewed as
positive or constructive stress, which compels
us to act with optimum performance, where by
we achieve
• Organizations and individuals can use
preventive or proactive coping strategies
(primary prevention) to change negative events
into positive experiences and growth
opportunities our goals.

Today, the healthy organization focuses not only on financial

soundness but also on the physical and mental well-being of its
employees. Healthy employees create stronger businesses and
healthier profits
THANK YOU