A REPORT ON

OCCUPATIONAL STRESS AND JOB

BURNOUT AMONG NURSING STAFF
WORKING IN DIFFERENT HOSPITALS
OF DELHI

SUBMITTED TO THE IGNOU FOR THE AWARD OF THE

MASTER OF ARTS DEGREE IN PSYCHOLOGY

(MAPC)

BY SUBMITTED

……………………………

…………………

SCHOOL OF SOCIAL SCIENCES

INDIRA GANDHI NATIONAL OPEN UNIVERSITY

MAIDAN GARHI, NEW DELHI - 110068

 TABLE OF CONTENT

SR. CHAPTER NAME

NO
1. INTRODUCTION
2. REVIEW OF RELATED

LITERATURE
3. RESEARCH METHODOLOGY
4. DATA ANALYSIS &

INTERPRETATIONS
5. CONCLUSIONS & SUGGESTIONS
6. REFERENCES
7. QUESTIONNAIRE

2|Page
 CHAPTER 1

INTRODUCTION

3|Page
 CHAPTER 1

INTRODUCTION

INTRODUCTION

The Health care industry or Health profession treats patients who are injured, sick,

disabled, or infirm. The delivery of modern health care depends on the expanding

interdisciplinary team of trained Professionals. For the purpose of finance and

management, the healthcare sector is typically divided into several groups and sectors. The

Global Industry Classification Standard and the Industry Classification Benchmark divide

the industry into two main groups: (1) Health care equipment and services and (2)

Pharmaceuticals, Biotechnology and related Life Sciences. Health care equipment and

services comprise companies that provide medical equipments, medical supplies, and

health care, like hospitals, home health care providers, and nursing homes. Health care

providers or health professional is an organization or person who delivers proper health

care in a systematic and professional way to any individual those are in need of health care

services.

Today the health care industry is considered as one of the largest industry throughout the

world. It includes thousands and thousands of hospitals, institutions which will provide

primary, secondary and tertiary level of care. In order to deliver this care, these health care

industries require health care workers. Majority of these health care workers are nurses.

They are providing care to each and every patient in every aspect of treatment. It is seen

that, throughout the past decades the health care workers, especially nurses have manually

adjusted their personal activities to provide care to the patients.

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There are many ways of providing health care in the modern world. The most common

way is face-to-face delivery, where care provider and patient see each other 'in the flesh'. It

occurs in general medicine in most countries. However, health care is not always face-to-

face; with modern telecommunications technology, the absence of human interaction in

health care is becoming more popular. But the importance of face-to-face health care can

never be underestimated in the cases of major illness. The hospital business is growing up

to 30% approximately annually. In this industry the customer care / front office and

nursing staff are the most critical. These are the people directly accessible to customers

visiting the hospital with various complaints. The nursing staffs, customer care or the front

office are the most critical and important factors in their premium services. A hospital

should treat its employees especially its nurses in the same way as it treats its patients

because if the employees are not satisfied with their jobs, they will leave them. The stress

related factors out of work pressure, personal and family reasons also stimulate the nurses

to look for new avenues.

The ambition of every human being is to attain the desired wealth and luxury in their

material life. To attain this wealth, they are engaged in various activities. They constantly

work hard mentally and physically. Due to the continual drive of physical and mental

energy, the human anatomy aligns, realigns which leads to illness and diseases. In order to

overcome, the status of illness in both physical and mental forms, they need a system of

cure. This system which evolved during various tenures is collectively labeled as health

care industry.

The Health care industry or Health profession treats patients who are injured, sick,

disabled, or infirm. The delivery of modern health care depends on the expanding

5|Page
interdisciplinary team of trained Professionals. For the purpose of finance and

management, the healthcare sector is typically divided into several groups and sectors. The

Global Industry Classification Standard and the Industry Classification Benchmark divide

the industry into two main groups: (1) Health care equipment and services and (2)

Pharmaceuticals, Biotechnology and related Life Sciences. Health care equipment and

services comprise companies that provide medical equipments, medical supplies, and

health care, like hospitals, home health care providers, and nursing homes. Health care

providers or health professional is an organization or person who delivers proper health

care in a systematic and professional way to any individual those are in need of health care

services.

Stress is normal. Stress is generally related to work, family, decisions, future and so on.

Stress is both physical and mental. It is caused by major life events such as illness, a

change in responsibilities or expectations at work, job promotions, loss, or changes. The

stress and stressors are induced due to feeling out of control, feeling direction-less, guilt

over procrastination or failing to keep commitments and more commitments than one can

manage. Changes initiate or institute, uncertainty and high expectations of self. Eustress is

a type of short-term stress that provides immediate strength. It arises at points of increased

physical activity, enthusiasm, and creativity. It is a positive stress that arises when

motivation and inspirations are needed.

Distress is a negative stress brought about by constant readjustments or alterations in a

routine. It creates feelings of discomfort and unfamiliarity. There are two types of distress.

Acute stress is an intense stress that arrives and disappears quickly. Chronic stress is a

prolonged stress that exists for weeks, months, or even years. Someone who is constantly

6|Page
relocating or changing jobs may experience distress. Hyperstress occurs when an

individual is pushed beyond what he or she can handle. It results from being overloaded or

overworked. When someone is hyper stressed, even little things can trigger a strong

emotional response. These are the categories of stress normally experienced by individuals

especially nurses at work places.

Service is a continuum which is intangible in nature. Among the various service operations

in real life, hospital service is a prominent one because it is a pure service which requires

patience cum client support. The people employed in hospital sector have a mission to

serve the disabled. Among the various responsibility centres in hospital profession ranging

from doctors, nurses, lab technicians, patient care, reception, administration, accounts and

housekeeping, the occupation of nurses plays a significant role that leads to the success of

the service in hospital sector. Nursing is a kind of care taking service which involves

round-the-clock responsibility with more attention and patience. Only the individuals

having the qualities of courtesy, courage and conviction can meet the job profile of

nursing. Especially, in a country like India the nursing jobs in various hospitals are

occupied by women employees. According to a recent statistics disclosed by Indian

Medical Association, 65% of nursing occupation in India is filled and continuously

balanced by women nurses.

Burnout among doctors was first described in 1974. It is a work-related syndrome. It was

initially ill-understood but over time has become increasingly accepted. It is characterized

by emotional exhaustion that results in decreased accomplishment at work1. It is

characterized by a cynical attitude to common-day activities and patients may be viewed in

a detached manner. Its causation is complex. A key question is whether the institution

7|Page
makes the individual dysfunctional or whether he has an underlying susceptibility to begin

with. Stress and burnout can be generated by a combination of excessive workloads,

excessive work hours, complaints from patients, and inadequate access to administrative

supports. There is data that suggests that there are gender differences in the response to

stress over a long period of time. Men show an increased level of physical deterioration,

while women show more psychological symptoms. Victims of burnout may adopt

unhealthy lifestyles including excessive eating and increased alcohol intake. Health-care

systems are adversely affected by the reduction in the physicians’ work output.

Burnout is a syndrome seen in demanding jobs and in people who care for others such as

social workers, teachers, and healthcare professionals.

Healthcare workers, particularly physicians, are exposed to high levels of distress at work.

Persistent tension can lead to exhaustion, psychological, and/or physical distress.

Moreover, burnout syndrome may increase the risk of medical errors and decrease job

satisfaction, which incites early retirement.

According to Maslach et al.(1998), burnout has three interrelated dimensions: emotional

exhaustion, depersonalization, and low personal accomplishment. Prolonged exposure to

stress is usually the main cause of emotional exhaustion and it manifests through the loss

of enthusiasm for work, feeling helpless, trapped, and defeated. Depersonalization occurs

when physicians treat patients indifferently, objectify them, and develop a negative attitude

toward their colleagues and profession. Inefficiency, or the lack of a sense of personal

achievement, is characterized by the individual's withdrawal from responsibilities and

detachment from the job.

8|Page
Normally women nurses give more attention to their responsibilities. They give extra care

to the patients while compared to male nurses. Women nurses are considered to be devoted

to their jobs with overloaded responsibilities. Due to physical, social and environmental

changes, their duties and responsibilities induce unexpected occupational stress related to

their job. It causes physical and mental damages in them. Stress and distress related aspects

among women nurses bring individual and family problems. Both private and government

hospitals offer various training and counseling programmes to nurses in order to manage

and reduce the level of occupational stress. In order to understand the consequences of job

related stress towards the social life balance of nurses in various hospitals irrespective of its

size of operations, the researcher decided to organize a study in the title of occupational

stress and job burnout among paramedic staff in nursing.

RATIONALE OF THE STUDY

Health is the prominent aspect which is given due importance by every individual. The

awareness of health care among individuals is increasing both in family and work places.

In addition to that, the work place demand makes the individuals update their health

condition. It is considered as a performance component in modern day organizations. In

this aspect, the individuals, irrespective of genders give priority to health management.

The demand for health care management among the modern day people pave the way for

the growth of health care industry. Especially the importance given by people in India

towards health care has been growing in recent years. The special care on different health

aspects has elevated the industry to the top most priority. For this reason, the health care

sector in India is dominated by government, private and foreign equity and tie ups. The

emergence of hospital sector to such importance in health care, fetches funds and advanced

9|Page
technologies in this industry. Even though the material and infrastructure developments

have taken place, the service sector depends on manpower only.

Health care sector comprises of various functional areas like hospitals, medicare and

ancillary services. But amongst, hospitals are the core sector for the health management.

Hospitals offer pure services which are intangible and non-inventorisied. These services

can be effectively delivered only by the support of manpower especially nurses.

Nursing is the form of noble service which helps the ill by offering not only medicine, but

also kind care and courtesy. It is a round-the-clock service that should be delivered with

care and smile. It is the service which cannot be compared with other forms of services. It

involves deep concentration, simultaneous presence and effective managing of human

anatomy. Since the nursing services need a comprehensive human understanding before,

during and after delivering the services, women are preferred more than men in this

particular occupation. It is because women always possess the nature of patience, service

attitude and empathy while compared to men.

In addition to that, nursing is the kind of professional occupation that needs to manage the

human beings and address their complaints. Due to the fierce competition that prevails in

the hospital sector, especially due to the participation of private and foreign investments,

the nurses are expected to focus on delivering more sophisticated services. In addition to

that, the structure of service delivery processes are also changed in terms of approach,

attitude, time, reporting, dealing with technology and accountable HR practices.

Due to these changes in the working pattern and environment of work, the female nurses

working in multiple categories of Government, Private and Foreign Hospitals, face a lot

occupational pressure. These aspects are again coupled with the personal, social, family

10 | P a g e
and environmental related issues among the nurses. The female nurses also encounter

issues on the basis of work place attitude, care process and gender discrimination. All these

together contribute stress among them.

But the consequences of occupational stress among the nursing staff add to the

disadvantages in terms of their personal, health, social, family and work related avenues. In

addition to that, it is a fact that the causes of occupational stress among the male and

female nurses have impact on various aspects. It is also observed that the attitude of male

and female nurses about the occupational stress and its impact on their outcomes at various

levels significantly differs. In this aspect, the continuity of research is required to study the

occupational stress among the nursing staff in hospitals.

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CHAPTER 2

REVIEW OF

RELATED

LITERATURE

12 | P a g e
 CHAPTER 2

REVIEW OF RELATED LITERATURE

REVIEW OF RELATED LITERATURE

The review of related literature gives the researcher an understanding of the research

methodology which refers to the way of the study is to be conducted. It helps the

researcher to know about the tools and instruments which prove to be useful and promising

in the previous studies. The advantage of the related literature is also to provide insight into

statistical methods through which validity of results is to be established. By reviewing the

related literature the researcher can avoid unfruitful and useless problem areas.

Every research work is a step towards acquiring new knowledge and this knowledge is

always based on previously gained knowledge. Hence, it should take into account, all the

relevant information, thinking and researches that have preceded it. A researcher ought to

be well acquainted with the previous researches related to his/her area of investigation.

Review of literature helps to develop the resarcher, an insight of the problem to be

investigated, to get information of what others have done in related field, and what

remains to be done.

13 | P a g e
Edwards et al (2015) carried out a study to investigate stress, burnout and coping amongst

the community mental health nursing work place. The aim of the study was to examine the

variety, frequency and severity of stressors, to describe coping strategy used to reduce

workbased stress and to determine stress outcomes. Findings revealed that stressful items

were trying to maintain a good quality service in the midst of long waiting lists, poor

resources, and having too many interruptions while trying to work in the office. The coping

strategies were having a stable home life and looking forward to going home at the end of

the day, having outside interests and hobbies and talking to people that they got on well

with.

Gray-Toft and Anderson (2010) in their study titled “Stress among Hospital Nursing

Staff: its Causes and Effects” of patient-care units including medical, surgical,

cardiovascular, surgery, oncology and hospice nursing found that the major sources of

stress experienced to be workload, death and dying and feelings of inadequacy in meeting

the needs of the patients and their families. Other sources of stress varied as a function of

type of a unit. With regard to type of unit the variable uncertainty over treatment’ was

higher in the medical and oncology units but lower in the hospice environment (i.e.

palliative care for terminally patients). The authors pointed out that the medical unit

included patients with a wide variety of conditions and communicable diseases that

requires isolation. Not surprisingly, levels of uncertainty were high. In contrast, the hospice

unit was a new unit with well trained staff and a high staff-patient ratio.

Srivastava (2009) in his article titled “A study of the role stress-mental health relationship

as a moderator by adopting coping strategies” surveys 300 employees of the Life Insurance

Corporation and reports that there is a significant positive correlation between various

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dimensions of role stress and symptoms of mental ill health. Stress arising from role

ambiguity and role stagnation is most intensively correlated with anxiety.

Dwivedi (2008) in his study titled “Trust and role stress” assesses the magnitude of trust,

distrust, and ORS to determine the extent of this relationship among public and private

sector organization. Surveying 55 executives from the public sector and 62 from the private

sector, the author finds that stress levels are low in high-performance organizations and

high in low-performance organizations.

J.T. Bailey et al (2010) in their study titled “The stress audit: Identifying the stressors of

ICU nursing” included management difficulties, interpersonal relationships with other

nurses and medical staff, issues involving patient care, concerns about technical knowledge

and skills, workload and career issues. Irrespective of the specialized nursing involved,

critical or intensive care nurses appear to be as vulnerable to workload issues, patient

conflicts and the difficulties imposed by adequate resources, as nurses in other areas.

K. A. Sanders and N. W. Bruce (2016) in their research work on “A prospective study of

psychosocial stress and fertility in women” compared average stress levels during the

month of conception to those of previous infertile months. They postulated that stress level

during the actual month of conception would be lower than that during previous non-

conception cycles. On average, women reported significantly more favourable mood states

on standard psychometric tests, during the month of conception than during the previous

non-conception cycles. In addition, they felt significantly less 'hassled' during the month of

conception. There was little relationship between the psychological measures of mood state

and excretion of adrenaline and cortisol. There was no evidence of increased coital

frequency during the month of conception when mood states were improved, suggesting

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that stress effects on libido were unlikely to account for the findings. The results support

the conclusion that psychosocial stress influences fertility in females, but as yet

mechanisms remains unclear.

Paul D Tyson and Rana Pongruengphant (2014) in their study related to “Five-Year

Follow-up Study of Stress among Nurses in Public and Private Hospitals in Thailand”

examined sources of occupational stress, coping strategies, and job satisfaction. He

revealed a significant increase in nurses’ workload, involvement with life and death

situations, and pressure from being required to perform tasks outside of their competence.

Although nurses working in public hospitals generally reported more stress than private

hospitals, surprisingly nurses’ satisfaction with their job increased particularly in public

hospitals, which may be attributable to age, improvements in monetary compensation, and

organizational support.

Nirmanmoh Bhatia et al (2011) in their study titled “Occupational Stress amongst Nurses

from Two Tertiary Care Hospitals in Delhi” analysed the individual contribution of various

stressors; operational in nurse’s personal and professional life, to the overall stress levels.

Time Pressure’ was found to be the most stressful whereas ‘Discrimination’ was the least

stressful of the given possible sources of stress in everyday life. Other highly stressful

sources were: handling various issues of life simultaneously with occupation such as caring

for own children/parents, own work situation and personal responsibilities. ‘High level of

skill requirement of the job’ was the most important stressor and ‘helpfulness of

supervisors/senior sisters’ was the least significant stressor directly related to nursing

profession.

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According to Callaghan (2011) in his study titled “Organization and stress among mental

health nurses” identified that increased workload has been confirmed as a stressor.

According to Pines and Ȁanner (2008) in their research work titled “Nurses’ burnout:

Lack of positive conditions and presence of negative conditions as two independent

sources of stress” found that workload has a negative impact on the relationships among

nurses, as they have no time for social contact, interpersonal interaction and positive

feedback, discussions on professional issues, determination of the healthcare unit targets

and assurance on the importance of their work.

Pateraki, et al (2005) in their research paper titled “Nursing burnout: Causes, prevention

and treatment” found that occupational stress can negatively influence a nurse’s personal

and family life. Introducing a time interval between work and return to home, as well as

having leisure activities helps a nurse relax and block carrying stress in family life.

According to Adali and Lemonidou (2001) in their research paper titled “Contributing

factors to the appearance of nursing work burnout” said that reduction of work overload

with rational management of human recourses regarding nursing staff establishes a balance

between work demands and capabilities of the nursing staff (ICN).

Jha (1988) deals in his reports that the effects of job stress on strain, the pattern of stress

and strain in three different work groups, and differences in the levels of job stress and

strain due to occupational level. The respondents consisted of executives from a

large steel manufacturing organization. Regression analyses indicated that job future

ambiguity had a significant negative effect on job satisfaction in each group of

executives. Further, role overload (in the case of production executives) and role

ambiguity (in the case of data processing executives) had negative effects on job

17 | P a g e
satisfaction. Role overload accounted for fatigue among the personnel as well as among

production executives. The data indicated that the patterns of stress and strain were

different in the three groups of employees. The examination of differences due to

occupational level indicated that the employees of middle levels had more role ambiguity

than those at the higher levels. No significant differences were observed on other

dimensions.

Aldred and Carolyn (2004) observed that employers should investigate and actively

manage employment-related stress. In addition, employers should apply management

techniques that are more sympathetic to employee concerned about stress.

Mohsin Aziz, (2004) discussed in their study that organisational stress originates in

organisational demands that are experienced by the individual. Stress is built up in the

concept of role which is conceived as the position a person occupies in a system. This

paper investigates the intensity of organisational role stress among women

informational technology professionals in the Indian private sector .

Organisational role stress scale is used on a sample of 264 to explore the level of role

stress. Resource inadequacy has emerged as the most potent role stressor, followed by role

overload and personal inadequacy. The research finds differences in the level of stress

between married and unmarried employees on several role stressors. However, the level of

education does not emerge as a significant differentiator of stressors.

Riti Desai and Ray Gaur (2004) observed in their study that the work posture of

women workers (experimental group) engaged in small-scale industries who have to

maintain a constant seated position (squatting cross-legged) on the floor. Along with the

worker group, an equal number of housewives belonging to the same socio-economic

18 | P a g e
status were also studied as a control group. The latter group never maintained such

kinds of posture for prolonged periods. To ascertain the effect of work posture,

qualitative and quantitative assessment procedures were followed for both groups in the

field and in laborator y studies. It was observed that there was a significant difference in

body pain and discomfort among the experimental and control groups, which can be

attributed to the prolonged sitting postures. The results of various other assessment

procedures were considered and recommendations for suitably designed workstations

were given.

Tyson, Paul D.; Pongruengphant and Rana (2004) examined the sources of

occupational stress, coping strategies, and job satisfaction. A sample of 200 nurses was

compared to 147 nurses sampled from the same hospital wards after 5 years and revealed a

significant increase in nurses‘ workload, involvement with life and death situations, and

pressure from being required to perform tasks outside their competence.

Although nurses working in public hospitals generally reported more stress than

private hospitals, surprisingly nurses‘ satisfaction with their job increased particularly in

public hospitals, which may be attributable to age, improvements in monetary

compensation, and organizational support.

Aldred, Carolyn (2005) reported that recent Appeal Court ruling lowers the standard

for stress claims against Great Britain employers and allows companies to be held

vicariously liable for the actions of workers' supervisors. The Court of

Appeal in London ruled March 16 that an employee could sue his former employer under

the Harassment Act of 1997 for alleged harassment by his manager. The ruling marks FOR

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the first time the Harassment Act which is a public order statute has been successfully used

as a ground for an occupational stress claim.

Arthur and Andrew R. (2005) found that 86 per cent of employees (n = 111) who

experience stress in the workplace have sought help from their workplace counselling

schemes. This study found that almost high levels of mental health problems existed

(86 per cent) in employees who remained at their work and that participants had higher

rates of anxiety than depression. This finding was at variance with the usual co-morbid

presentation of anxiety and depression found in community based mental health services

and suggests that depression may be an important differentiating factor between those

who can remain at work and use counselling and those who cannot.

Béjean, Sophie; Sultan-Taäeb and Hélène (2005) have evaluated the costs of work-

related stress in France. Three illnesses-cardiovascular diseases, depression,

musculoskeletal diseases and back pain-that may result from exposure to stress were

identified and the proportions of cases attributable to the risk factor were calculated from

epidemiological studies. Two methodological hypotheses allowed them to provide

complementary evaluations of the social cost of occupational stress and raised the

ethical questions inherent in the choice of methodology. Work-related stress costs the

society between €1,167 million and €1,975 million in France, or 14.4- 24.2percentage of

the total spending of social security occupational illnesses and work injuries branch.

Demetri Kantarelis (2005) found that the theoretical concepts are proposed to capture

the substance of issues associated with occupational stress. Reduction below the profit

maximizing stress level may be achieved only if a firm's increase in cost for stress relief in

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the work place guarantees productivity and profit improvement in exchange for a reduction

in employee health damages due to stress.

Leemamol Mathew (2005) deals in his study that examines the sources, effects, and the

coping strategies of occupational stress among special educators in India. The

Government policies are tailored to enhance the education of children with disabilities, but

very few of these policies focus the special educators who take care of students with

disabilities. These educators have largely been clubbed together with teachers of regular

schools. Therefore, the issues of special educators have always been a neglected field in

India. Of the 21 million disabled population of the country, 12 million are children with

various disabilities, according to the Census of India 2001. And the level and nature of

stress experienced by this population have hardly been the focus of study. Hence, an

attempt is made to study the nature and levels of occupational stress experienced by

teachers of special schools. The geographical area of the study was two districts, Calicut

and Malappuram, of the state of Kerala, South India. 35 special educators, who had

more than two years of teaching experience, were randomly selected for the study from

the schools in this geographical area. The methodology adopted was both quantitative

and qualitative. To collect the quantitative data, the occupational Stress Indicator,

developed by Cooper, et. al., (1988) was used. The Indicator evaluates occupational

stress by analysing five key factors: i) Sources of stress, ii) Individual characteristics,

iii) Locus of control, iv) Coping strategies, and v) Effects of stress. To collect qualitative

data an unstructured personal interview was used. The quantitative results revealed

that the sources of stress spread from: i) school structure and climate, ii) home/work

interface, iii) relationship with other people, iv) intrinsic job factors. The common effect

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of stress on special educators was found to be health related problems - both

physical and mental - and job dissatisfaction. There was no organised method to

redress the problem rising from occupational stress. As a result, the most commonly used

coping strategy was social support, task strategies, and home/school relationship. While

the qualitative data confirmed the findings of the quantitative data, it pointed out some

other issues, which the quantitative indicators did not cover. The sources of stress as

repeatedly reported in the qualitative interviews were that of low salary - due to the

subcontracting by the Government to NGO's, job insecurity, work overload, and high

teacher-student ratio. The results point to the need of Government policies targeting

specifically to the special educators if there has to be tangible improvements in the quality

of life of the children with disabilities.

Michailidis, Maria; Georgiou and Yiota (2005) have emphasized the importance of

assessment and management of work related stress. The recognition of the harmful

physical and psychological effects of stress on both individuals and organizations was

studied by them. A sample of 60 bank employees at different organizational levels and

educational backgrounds was used. Data collection utilized the Occupational Stress

Indicator (OSI). It implied that educational levels affect the degree of stress they

experience in various ways. Finally, the drinking habits (alcohol) of the employees were

found to play a significant role in determining the levels of occupational stress.

Ogińska-Bulik and Nina (2005) explored the relationship between emotional

intelligence and perceived stress in the workplace and health-related consequences in

human service workers. They selected 330 respondents as sample size. Three

methods were used in the study: The Emotional Intelligence Questionnaire

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INTE with Polish modification, the Subjective Work Evaluation Questionnaire

developed in Poland, and the General Health Questionnaire (GHQ-28) with Polish

modification. The results confirmed an essential, but not very strong, role of emotional

intelligence in perceiving occupational stress.

Ryan, P., Hill, R., Anczewska, M.k Hardy, P.k Kurek, A.k Nielson, K. and

Turner, C.23 (2005) have attempted to address the issue of work-related stress through

whole team training programmes, on a background of largely ineffective stress

reduction training programmes offered to individuals within the workplace. The findings

have significant implications to the conceptual, methodological and ever yday

organizational practice levels of tackling this central issue to the health of the

workplace.

Salmond, Susan; Ropis and Patricia E., (2005) analysed the job related stress among

medical-surgical and home care nurses in the U.S. High stress leads to negative work

environments that deprive nurses of their spirit and passion about their job. Key factors

contributing to workplace stress includes team conflict, unclear role expectations, heavy

workload, and lack of autonomy.

Stetz, Thomas A., Stetz, Melba C., Bliese and Paul D.25 (2005) showed that three out

of four regression equations had significant three-way interactions.

Organizational constraints×supervisor support×self-efficacy had statistically

significant interactions in the prediction of job satisfaction and psychological well-

being. Organizational constraints×co-worker support×self-efficacy had a significant

interaction in the predicted of psychological well-being. These results indicate that

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interventions aimed at reducing strains by increasing social support should consider an

individual's self-efficacy.

Vakola, Maria, Nikolaou and Loannis (2005) suggested that occupational stress and

organizational change are now widely accepted as two major issues in organizational life.

The study explored the linkage between employees' attitudes towards organizational

change and two of the most significant constraints in organizational behaviour;

occupational stress and organizational commitment. The results were in the

expected direction showing negative correlations between occupational stressors

and attitudes to change, indicating that highly stressed individuals demonstrate

decreased commitment and increased reluctance to accept organizational change

interventions.

Wiesner, Margit, Windle, Michael, Freeman and Amy (2005) considered main and

moderated relationships between 5 job stressors. Alcohol consumption, drug use, and

depression were examined using data from a community sample of 583 young adults

(mean age = 23.68 years). Analyses revealed a few direct associations between high job

boredom, low skill variety, and low autonomy and depression measures and heavy

alcohol use. There were no direct relationships between job stress and binge drinking,

alcohol consumption, drug use, or heavy drug use.

Yates and Iva (2005) in their study have found from the families and work institute that 40

percentage of the workers reported their job was very or extremely stressful. Another

25percentage view their jobs as the number one stress factor in their lives. They also

have identified several job conditions which can lead to occupational stress.

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Adams, Richard E., Boscarino, Joseph A., Figley and Charles R. (2006) discussed in their

study (a) assessed the psychometric properties of a CF scale, and (b) examined the scale's

predictive validity in a multivariate model. Factor analyses indicated that the CF scale

measured multiple dimensions. In the light of increasing the ability of professional

caregivers to meet the emotional needs of their clients within a stressful environment

without experiencing CF.

Adriaenssens, Liesbeth; De Prins, Peggy; VloeberghS, Daniël (2006) investigated (1)

the well-being (job stress and job dissatisfaction) of academic staff at the University of

Antwerp, (2) the specific factors of the work environment that have an impact on employee

well-being, and (3) the interaction between HR practices and employee well-being.

Finally they also have given suggestions of improvement for the work environment.

Botha, Christo; Pienaar and Jaco (2006) conducted a study to determine the dimensions

of occupational stress of employees of the Department of Correctional Services in a

management area of the Freestate Province of South Africa. The results indicated that an

external locus of control and negative affect contributed to the experience of

occupational stress.

Coetzer, W.J. and Rothmann, S. (2006) in their study identified occupational

stressors for employees in an insurance company and assessed the relationship between

occupational stress, ill health and organisational commitment. The results showed that

job insecurity as well as pay and benefits were the highest stressors in the insurance

industry.

H., Azlihanis A. L., Naing; D. Aziah B. and N., Rusli33(2006) conducted a study to

identify the prevalence and factors associated with job strain among teachers working in

25 | P a g e
secondary school in Kota Bharu, Kelantan. A sample size of 580 teachers was taken. And

the result was significant. The result reveals that there was linear relationship between

job strain and duration of current employment, duration of working hours job

insecurity and social support.

Jackson, Leon; Rothmann and Sebastiaan(2006) discussed to determine the

differences between occupational stress and strain of educators in different biographical

groups, and to assess the relationship between occupational stress, organizational

commitment and ill-health. A sample of 1170 was selected and Organizational Stress

Screening Tool (ASSET) and a biographical questionnaire were administered. They found

differences between the occupational stress, organizational commitment and ill-health

of educators in different types of schools, age, and qualification groups.

Keeva and Steven (2006) in their article deal with the high rates of mental depression

among lawyers in the U.S. Studies which highlighted the depression problem among

lawyers are cited. It discusses the suicide of Judge Mack Kidd of Austin, Texas. It

explored the role of occupational stress among lawyers.

Kushnir, Talma; Melamed and Samuel (2006) in their study focused on the

―Domestic Stress and Well-Being of Employed Women‖. Respondents were 133

mothers employed in secretarial and managerial jobs. It was suggested that in families (as

in teams), shared decision control may be a more potent coping resource than

personal control.

Upson, John W.; Ketchen Jr., David J.; Ireland and R. Duane (2007) focused on

potentially dangerous role of stress among supply chain members, and how this stress

can be addressed, after identifying supply chain activities that create employee stress. The

26 | P a g e
researchers concluded that by using the suggested initiatives, both employees' quality of

life and the organization's performance can improve.

Buddeberg-Fischer, B, Klaghofer, R, Stamm, M, Siegrist, J and

Buddeberg, (2008) in their study investigated the perceived job stress, its

association with the amount of working hours, and its impact on young physicians‘ self-

reported health and their satisfaction with life during residency. Stress at work in young

physicians, especially when be experienced over a longer period in postgraduate

training, has to be a matter of concern because of its negative impact on health and life

satisfaction and the risk of developing symptoms of burnout in the long run.

Christopoulos, M. and Hicks, R.E.(2008) carried out a study and examined that role

perfectionism play on occupational stress and depression in the context of an Australian

university student population. As expected maladaptive perfectionism significantly

correlated with occupational stress and depression; however, unexpectedly

adaptive perfectionism did not correlate significantly with occupational stress and

depression.

Gbolahan and Gbadamos (2008) have conducted a study which explored the relationship

among Perceived stress, Perception of sources of stress, Satisfaction, Core self-evaluation,

Perceived health and Well being. Survey data were collected from 355 employees in

Botswana. Results indicated that significant links between Perceived stress,

Satisfaction, Core self-evaluation and Well being. Overall, much of these findings were

consistent with what had been reported in the literature.

Kopp, Maria S; Stauder, Adrienne; Purebl, Gyorgy; Janszky, Imre; Skrabski

and Arpad(2008) conducted a study to analyse the association between work-related

27 | P a g e
factors and self-reported mental and physical health after controlling the negative affect

and hostility as the personality traits. This study indicated that independent of

negative affect and hostility, a cluster of stressful work-related psychosocial

conditions accounts for a substantial part of variation in self-reported mental and physical

health of the economically active population in Hungary.

Nagesh, P. Murthy, M. and Narasimha S. (2008) in their study identified the six factors

that contribute to workplace stress. They were demands of the job, control over work,

support from colleagues and management, working relationships, clarity of role, and

organizational change. This paper also suggested measures in the form of training to

enable organizations and individuals to manage stress at workplaces in general and

IT call centres in particular.

Rashmi Shahu and S.V. Gole (2008) discussed in their article that the occupational stress

is commonly acknowledged to be a critical issue for managers of private manufacturing

companies. This study attempts to fill part of this void in literature by examining the

relationship between job stress, job satisfaction and performance among 100 managers

of private manufacturing firms. The findings of the study suggest that higher stress

levels are related to lower performance whereas higher job satisfaction indicates higher

performance.

Richardson, K. M., & Rothsetin, H.R.49(2008) in their article provided an empirical

review of stress management interventions, employing meta-analysis procedures. The

results also revealed that relaxation interventions were the most frequent type of

intervention. Further, there were few stress interventions focused at the organizational

28 | P a g e
level. More specific results also indicated that cognitive- behavioural interventions

produced larger effects than other types of interventions.

A.S.Ramesh and C.Madhavi (2009) discussed in their article that during the last 25

years, agricultural sector has gone through a lot of changes and it is also found to be one

of the potential areas for stress. Greater use of automation technology, excessive use

of organic production, low price for agricultural products and new complicated

legislations has made the life of farmers more stressful. In this study an attempt was made

to find out the potential factors which cause stress and make the life of farming

community more miserable. Results have clearly indicated that the occupation farming

leads to stress due to financial, weather, work overload, social interaction and farm

hassles. It was inferred that all the selected dimensions produce either high or medium

level of stress to farming people. It was also found that stress due to financial factors was

found to be slightly higher than other stresses.

Chang-qin Lu, Oi-ling Siu, Wing-tung Au and Sandy S. W. Leung51 (2009) in

their article were of the view that managers in private enterprises experienced

higher levels of occupational stressors and psychological strains than those in state-

owned enterprises. Moreover, ‗Organizational structure and climate‘ was also found to

be a major stressor when predicting both psychological and physical strain in both

economic sectors.

Katherine Pollak. Eisen. George J. Allen. Mary Bollash and Linda S. Pescatello52

(2009) suggested that work stress contributes significantly to corporate health costs.

Traditionally, these interventions have been delivered in small, instructor-led

groups. Outcomes from a stress-management intervention provided via an instructor led

29 | P a g e
versus a computer-presented format were compared through a randomized, controlled

design. Attrition was significantly higher in the computer - presentation format.

Pal, S., and Saksvik, P.53 (2009) conducted a study on job stress among 27 Norwegian

doctors and 328 nurses and 111 Indian doctors and 136 nurses. The result was that work-

family conflict was not predictive of job stress in Norwegian doctors, but work-family

conflict, high job demands, and low flexibility in working hours did predict job stress in

Norwegian nurses. For the Indian sample, job stress was predicted by high family-

work conflict and low social support in nurses and low job control in doctors. Hence,

there seem to be some overlap and some differences in cultures when considering the

role of demands, control, support, and flexibility in predicting strain.

Antonovosky (2000) in his research work titled “Health, Stress and Coping” outlined

stress as a “demand made by the internal or the external environment on an organism (such

as you or me), that upsets its homeostasis (or equilibrium), restoration of which depends on

a non-automatic and not readily available energy-expending action”, whether or not a

given stimulus or experience means to the individual, as well as on the repertoire of ways

that he /she uses in order to cope with such demands.

Robert E. Levey (2001) in his research publication titled “Sources of Stress for Residents

and Recommendations for Programs to Assist them” analyzed The fact that stress is typical

during the residency training period: heavy work-load, sleep deprivation, difficult patients,

poor learning environments, relocation issues, isolation and social problems, ¿nancial

concerns, cultural and minority issues, information overload, and career planning issues.

Stress can also stem from and exacerbate genderrelated issues and problems for others,

spouses, and family members. Common effects of stress include anxiety, depression,

30 | P a g e
obsessive-compulsive trends, hostility, and alcohol and substance abuse. To respond to the

problems that these many stressors present to residents, the Accreditation Council for

Graduate Medical Education (ACGME) requires that all post–medical-school medical

training programs make assistance services available for all residents.

Mitra Mollaiy nezhad et al (2001) in their article work titled “Infertility Related Stress

and Marital Life in Iranian Infertile Women who referred to Isfahan Infertility Treatment

Clinic”, found linkage between infertility and stress and deleterious impacts that infertility

stress can have on the functioning of a marriage and the couple’s life quality. It was

designed to determine the correlation between infertility related stress and marital

adjustment in women who referred to Isfahan and infertility treatment clinic. All of the

participants had experienced infertility stress (in different degrees) and about half of them

were maritally distressed. For these women, infertility stress scores were significantly

related to economic problems, family composition, duration of treatment and confidence

one will have a child. Duration of infertility and a positive history of failed pregnancy were

the only variables that were significantly related to this variable.

S. Michie (2002) in his research work titled “Causes and Management of Stress at Work”

conceived stress as pressure from the environment, then as strain within the person. It is the

psychological and physical state that results when the resources of the individual are not

sufficient to cope with the demands and pressures of the situation. Thus, stress is more

likely in some situations than others and in some individuals than others. Stress can

undermine the achievement of goals, both for individuals and for organisations. The

workplace is an important source of both demands and pressures causing stress, and

structural and social resources to counteract stress. The workplace factors that have been

31 | P a g e
found to be associated with stress and health risks can be categorised as those to do with

the content of work and those to do with the social and organisational context of work.

Most interventions to reduce the risk to health associated with stress in the workplace

involve both individual and organisational approaches. The prevention and management of

workplace stress requires organisational level interventions, because it is the organisation

that creates the stress. Success in managing and preventing stress will depend on the

culture in the organisation. Stress should be seen as helpful information to guide action, not

as weakness in individuals.

Hirak Dasgupta and Suresh Kumar (2009) in their study titled “Role stress among

Nurses working in a Government Hospital in Shimla” concluded that role overload, self-

role distance, role isolation, inter role distance, role stagnation, role expectation conflict,

role ambiguity and role inadequacy are the factors causing role stress among nurses. The

study proved that there is no significant difference between the stress levels among the

male and female nurses except in the cases of inter role distance and role inadequacy where

the male nurses are more stressed than the female nurses.

Seema Bhatt and Pramod Pathak (2010) in their research publication titled

“Occupational stress among IT/ITES women professionals in leading metros in India: A

case study” identified the occupational stress among IT/ITES professionals and examined

whether there exists any significant differences in the nature and intensity of stress pattern

among IT/ITES professionals with respect to gender and marital status. It was evident that

male and females are affected differently by some stressors; therefore their problems need

to be addressed in different ways. It was further inferred that marriage did not have any

impact on these professionals. They concluded that the IT/ITES professionals were

32 | P a g e
vulnerable to stress and some interventions were needed to help them cope with the

situation.

Nidhi Turan and Sultan Singh (2011) in their study titled “Association of Organisational

Stress Symptoms with Employees’ Demographic Variables” examined the association

between different manifestations (headache, diabetes, depression, general stress, high

blood pressure, ulcer, fatigue, backache or pain) of stress and employees’ demographic

variables (age, gender, education and length of work experience). The study revealed that a

majority of the respondents have ascribed headache, depression, general stress, high BP,

fatigue and back pain to their roles on the job. They suggested that there was a need for

special precautionary measures in case of employees in higher age groups, particularly for

the females.

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 CHAPTER 3

RESEARCH

METHODOLOGY

34 | P a g e
 CHAPTER 3

RESEARCH METHODOLOGY

RESEARCH METHODOLOGY

Research methodology is a way to systematically investigate the research problem. It gives

various steps in conducting the research in a systematic and a logical way. It is essential to

define the problem, state objectives and hypothesis clearly. The research design provides

the details regarding what, where, when, how much and by what means enquiry is initiated.

Every piece of research must be planned and designed carefully so that the researcher

precedes a head without getting confused at the subsequent steps of research. The

researcher must have an objective understanding of what is to be done, what data is

needed, what data collecting tools are to be employed and how the data is to be statistically

analyzed and interpreted. There are a number of approaches to the design of studies and

research projects all of which may be equally valid. Research is a systematic attempt to

obtain answers to meaningful questions about phenomenon or events through the

application of scientific procedures. It an objective, impartial, empirical and logical

analysis and recording of controlled observation that may led to the development of

generalizations, principles or theories, resulting to some extent in prediction and control of

events that may be consequences or causes of specific phenomenon. Research is a

systematic and refined technique of thinking, employing specialized tools, instruments and

procedures in order to obtain a more adequate solution of a problem than would be possible

under ordinary mean. Thus, research always starts from question. There are three

35 | P a g e
objectives of research factual, practical and theoretical, which gives rise to three types of

research: historical, experimental and descriptive.

Research design has been defined by different social scientists in a number of ways. All

these definitions emphasize systematic methodology in collecting accurate information for

interpretation. Selltize et al. (1962) expressed their views as, “Research designs are closely

linked to investigator’s objectives. They specify that research designs are either descriptive

or experimental in nature.” Research design tells us how to plan various phases and

procedures related to the formulation of research effort (Ackoff Russell, 1961). Miller

(1989) has defined research design, “as the planned sequence of the entire process involved

in conducting a research study.”

Kothari (1990) observes, “Research design stands for advance planning of the method to be

adapted for collecting the relevant data and the techniques to be used in their research and

availability of staff, time and money.” In this way selecting a particular design is based on

the purpose of the piece of the research to be conducted. The design deals with selection of

subjects, selection of data gathering devices, the procedure of making observations and the

type of statistical analysis to be employed in interpreting data relationship”.

STATEMENT OF THE PROBLEM

The statement of the problem is “OCCUPATIONAL STRESS AND JOB BURNOUT

AMONG NURSING STAFF WORKING IN DIFFERENT HOSPITALS OF DELHI”

36 | P a g e
OBJECTIVES OF THE STUDY

1. To study the impact of occupational stress and job burnout among the nursing staff

of different age groups (20-30 years, 31-40 years and 41-50 years).

2. To study the impact of occupational stress and job burnout among the nursing staff

based on marital status.

3. To propose some viable recommendations to alleviate the occupational stress levels

among the nursing staff.

HYPOTHESIS

HYPOTHESIS 1: There is no significant difference in the occupational stress and job

burnout among nursing staff of different age groups (20-30 years, 31-40 years and 41-50

years).

HYPOTHESIS2: There is no significant difference in the occupational stress and job

burnout among nursing staff based on the marital status.

Research Method

Descriptive Survey method was employed to carry out this piece of research work.

POPULATION

All nursing staff working in different hospitals of Delhi were constituted the population of

the study for the present investigation.

SAMPLING PROCEDURE
37 | P a g e
To conduct this study, the investigator selected a representative sample of total 90 nursing

staff. While selecting the sample care was taken that equal number of nursing staff,

working in different hospitals of Delhi of different age groups were selected.

LAYOUT OF SAMPLE

To conduct this study, the investigator selected a representative sample of total 90 nursing

staff of different age group, i.e. from 20 to 30 year of age number of nursing staff were 30

and from 31 to 40 years of age number of nursing staff were 30 and from 41 to 50 years of

age number of nursing staff were 30 working in different hospitals of Delhi.

TOOL USED FOR DATA COLLECTION

Occupational Stress: A well developed and widely used Occupational Stress Index (OSI)

in the Indian context (Srivastava and Singh, 1981) was chosen to assess the occupational

stress of the sample. The questionnaire is consisted of 46 statements with five alternative

responses e.g., 5 for strongly agree, 4 for mildly agree 3 agree, 2 for disagree and 1 for

strongly disagree. Total score on this scale was considered for the assessment of

occupational stress. More the score on this scale indicates more stress.

Main features of the Tool

The scale consists of 46 items, each to be rated on the five- point scale. Out of 46 items, 28

are ‘true- keyed’ and rest 18 are ‘false- keyed’. The items relate to almost all relevant

components of the job life which causes stress in some way or the other, such as, role over-

load, role ambiguity, role conflict, group and political pressures, responsibility for persons,

under participation, powerlessness, poor peer relations, intrinsic impoverishment, low

status, strenuous working conditions, and unprofitability.

38 | P a g e
The following Table gives an account of the items constituting various sub- scales of the O.

S. I. along with their indices of internal consistency.

Sub- Scales (Occupational Stressors) Serial number of the items Range of rabis
in the schedule
Role overload 1, 13, 25, 36, 44, 46 .30 - .46
Role ambiguity 2, 14*, 26, 37 .20 - .48
Role conflict 3, 15*, 27, 38, 45 .36 - .53
Unreasonable group & Political pressures 4, 16, 28, 39 .21 - .52
Responsibility for Persons 5, 17, 29 .30 - .57
Under participation 6*, 18*, 30*, 40* .55 - .73
Powerlessness 7*, 19*, 31* .44 - .62
Poor peer relations 8*, 20*, 32*, 41* .24 - .49
Intrinsic Impoverishment 9, 21*, 33*, 42 .32 - .64
Low status 10*, 22*, 34 .48 - .63
Strenuous working Conditions 12, 24, 35, 43* .40 - .62
Unprofitability 11, 23 .48 - .51

Reliability

The reliability index as

certained by split half (odd-even) method and Cronbach’s alpha-coefficient for the scale as

a whole were found to be .935 and .90 respectively. The reliability indices of the 12 sub-

scales were also computed through the split half method.

Sub Scales Reliability Index

(r)

39 | P a g e
 1. Role overload .684

2. Role ambiguity .554

3. Role conflict .696

4. Unreasonable group. & pol. pressure .454

5. Responsibility for persons .840

6. Under participation .630

7. Powerlessness .809

8. Poor peer relations .549

9. Intrinsic Impoverishment .556

10. Low status .789

11. Strenuous Working conditions .733

Validity

The validity of the O.S.I. was determined by computing co-efficient of correlation between

the scales on the O.S.I. and the various measures of job attitudes and job behaviour. The

employees’ scores on the O.S.I. is likely to positively correlate with the scores on the

measures of such work-manifest attitudinal and motivational and personality variables

which have proved lowering or moderating the level of occupational stress. The co-

efficient of correlation between the scores on the O.S.I. and the measures of job

involvement (Lodhal & Kejner, 1965), Work motivation (Srivastava, 1980), Ego-strength

(Hasan, 1970), and Job satisfaction (Pestonjee, 1973) were found to be -.56 (N=225)

-.44 (N=200) -.40 (N=205) and -51 (N=500), respectively. The correlation between the

40 | P a g e
scores on the O.S.I. and the measure of Job Anxiety (Srivastava, 1974) was found to be

0.59 (N=400).

The employees’ scores on the O.S.I. have been found to be positively correlated with

their scores on the measures of mental ill Health, standardized by Dr. A.K.

Srivastava (Prof. of Psychiatry). The following Table presents the indices of ill

mental health of the high and low occupational stress groups of the employees:

HOS
Symptoms of ill Group LOS (N=97)
C.R.
Mental health Mean S.D Mean S.D.
Free floating Anxiety 6.17 3.46 4.12 3.55 4.1*
Obsessive traits & symptoms 7.86 3.09 7.69 3.24 0.47
Phobic Anxiety 6.13 3.62 4.43 3.15 3.54**
Somatic Con-comitent 6.50 3.77 4.35 3.39 4.23**
Anxiety
Neurotic Suppression 5.35 3.30 4.29 3.60 4.90**
Hysterical Traits 5.24 2.88 4.44 2.78 2.00*
**P < .1; *P < .05

Scoring

Since the questionnaire consists of both true keyed and false- keyed items. Two different

patterns of scoring have to be adopted for two types of items. The following table provides

guide line to score the responses given to two categories of items:

Scores
Categories of response For true- keyed For false- keyed

41 | P a g e
 Never / Strongly disagree 1 5

Seldom / Disagree 2 4
Sometimes / Undecided 3 3
Mostly / Agree
4 2
Always / Strongly agree
5 1

Maslach Burnout Inventory (MBI)

Job burnout will be measured by the Job Burnout Questionnaire, developed and

standardized by Maslach and Jackson (1981). This is a widely used scale, and it consists

of 22 statements that assess the three facets of professional burnout, emotional

exhaustion, depersonalization and lack of personal accomplishment. The respondents

identity as to how often they feel professional burnout on a "six-point Likert-type rating

scale" ranging from "never" (0) to "every day" (6). The validity and reliability of the

MBI-ES were substantiated in two studies. Both Iwanicki and Schwab (1981) and Gold

(1984) found through factor analysis support for the three-factor structure of the

MBI-ES. Iwanicki and Schwab (1981) report Cronbach alpha internal reliability

estimates of 0.90 for emotional exhaustion, 0.76 for depersonalization, and 0.76 for

personal accomplishment. Gold (1984) reports slightly lower estimates of 0.88, 0.74,

and 0.72, respectively. Internal reliabilities for the burnout subscales with this population

were 0.90 for emotional exhaustion, 0.74 for depersonalization and 0.66 for personal

accomplishment.

Methods of Data Analysis

42 | P a g e
In this proposed study, various statistical tool and techniques were used according to the

requirement of the study. Mean, SD and t-test were calculated.

Delimitations of the Study

 The study was based on the data collected from nursing staff working in different

hospitals of Delhi of different age groups only.

 The study was further delimited to 90 nursing staff of different age groups only.

43 | P a g e
 <

CHAPTER 4

DATA ANALYSIS AND

INTERPRETATIONS

44 | P a g e
 CHAPTER 4

DATA ANALYSIS AND INTERPRETATIONS

DATA ANALYSIS AND INTERPRETATIONS

After collecting data, the investigator analysed the data as it was difficult to explain the

raw data because raw data gathered on certain tests have no meaning rather it is heap of

certain facts or observation. Keeping in view the objectives of the study and their

corresponding hypotheses, the data was statistically processed using appropriate design

and technique. Hence, after the data has been collected this must be processed an analysed

to draw proper inference.

Statistics is a good tool in the hands of a research. It can help in attaining some objectives

only if one is clear about the theoretical basis of the variables and their relationship so it is

necessary to interpret the result obtained statistically. It is only then one can give meaning

and direction to research. According to Good, Barr and Scates (1941), “The process of

interpretation is essentially, one of stating what the results show? What they mean? What

is their significance? What is the answer of the original problem? ” That is all the

limitations of the data must enter into and become the part of interpretation of the result.

Thus, the analysis of data means studying the tabulated material in order to determine

inherent factors or meanings. It involves breaking down the existing complex factors into

simpler parts and putting the parts together in new arrangement for the purpose of

interpretation.

45 | P a g e
As it is of much importance to get a sum correctly solved. It is also equally important to

interpret it correctly. Interpretation is the most important step in the total research process.

It calls for a critical examination of the results of one’s analysis in the light of all

limitations of data gathered. Thus analysis and interpretations of data help researchers to

attack the related problems with appropriate statistical techniques to avoid the

unnecessary labour.

46 | P a g e
HYPOTHESIS 1: There is no significant difference in the occupational stress and job

burnout among nursing staff of different age groups (20-30 years, 31-40 years and 41-

50 years).

Table 1: Means, SDs and ‘t’ values for Occupational stress scores

Age Group Mean SD ‘t’ values

A (20-30yrs) 127.50 10.23 AB 4.21 P < 0.01

(n = 30)
B (30-40 yrs) 122.01 9.05 AC 10.23 P < 0.01

(n = 30)
C (40-50 yrs) 127.50 10.23 BC 4.21 P < 0.01

(n = 30)
Higher the score greater the stress
A = Young Adult B = Middle Age C = Late Middle Age

The results obtained above show significant decreases in the mean stress score could be

seen from young adult group to late middle age. The ‘t’ values obtained in the table 1 show

significant difference between young adults (20-30 yrs.) and those in early middle age

(30-40 yrs.) and late middle age (40-50 yrs.). Young adults were found to have experienced

more occupational stress than the middle aged.

The scores of the subjects were further analyzed age wise and factor wise (OSI) using‘t’

tests.

47 | P a g e
 Table 2: Means, SDs and ‘t’ values for job burnout scores

Age Group Mean SD ‘t’ values

A (20-30yrs) 124.04 8.23 AB 3.02 P < 0.01

(n = 30)
B (30-40 yrs) 118.03 9.40 AC 9.30 P < 0.01

(n = 30)
C (40-50 yrs) 126.06 11.21 BC 4.36 P < 0.01

(n = 30)
Higher the score greater the stress
A = Young Adult B = Middle Age C = Late Middle Age

The results obtained above show significant increase in the mean stress score could be seen

from young adult group to late middle age. The ‘t’ values obtained in the table 2 show

significant difference between young adults (20-30 yrs.) and those in early middle age

(30-40 yrs.) and late middle age (40-50 yrs.). Young adults were found to have experienced

more job burnout than the middle aged.

48 | P a g e
HYPOTHESIS2: There is no significant difference in the occupational stress and job

burnout among nursing staff based on the marital status.

Table 3: Mean scores of nursing staff on various components of job burnout on

marital status

‘t’ P Value
Components of Gender Mean S.D
value
Job Burnout

Emotional single 16.29 11.03

exhaustion .436 .663
married 15.79 11.40
Deperson alization single 9.52 5.99
.010 .992
married 9.53 6.84
Personal single 36.18 10.65
accomplishment 2.746 .006
married 33.23 10.50

df=98; Significant at 0.05 level

The mean personal accomplishment score of single nursing staff were found to be

36.18 as against 33.23 of married nursing staff. Independent samples‘t’ test revealed a

significant difference between mean personal accomplishment scores of single and

married nursing staff (t= 2.746; p=.006). As shown in table 3 single nursing staff have

higher score than married. The mean emotional exhaustion score of single nursing staff

were found to be 16.29 as against 15.79 of married nursing staff. Independent samples ‘t’

test revealed a non-significant difference between mean emotional exhaustion scores of

single and married nursing staff in India (t=0.436; P=.663). The mean depersonalization

score of single nursing staff were found to be 9.52 as against 9.53 of married nursing staff.

Independent samples ‘t’ test revealed a non- significant difference between mean

49 | P a g e
depersonalization scores of single and married nursing staff in India (t=.010; P=.992).

Mean scores of primary and high school nursing staff on various components of

occupational stress and results of independent samples ‘t’ test

Source Single Married

‘t
Mean SD Mean SD
values’
Role Overload 17.19 4.04 16.44 3.64 1.64@
Role ambiguity 11.29 3.64 11.65 2.78 0.92@
Role Conflict 10.11 3.40 9.23 2.81 0.67@
Unreasonable group and 11.89 2.45 10.98 2.33 3.17**

political pressures
Responsibility for person 8.56 2.72 8.66 2.11 0.31@
Under Participation 12.21 2.28 12.19 3.74 0.05@
Powerlessness 10.96 2.51 9.54 2.31 4.94**
Poor Peer Relation 10.82 2.72 10.48 2.06 1.17@
Intrinsic Impoverishment 10.94 3.16 9.86 2.65 3.07**
Low Status 8.79 3.16 7.77 2.4 2.95**
Strenuousworking 8.93 3.32 8.84 2.20 0.25@

condition
Unprofitability 5.78 2.54 5.76 2.37 0.05@
** P < 0.01 * P < 0.05 @ Not Significant

50 | P a g e
 CHAPTER 5

CONCLUSIONS &

SUGGESTIONS

51 | P a g e
 CHAPTER 5

CONCLUSIONS & SUGGESTIONS

DISCUSSION

The subjects in the young adult group must have put in 1 to10 years of service in their job

which is relatively a short period. They may be getting adjusted to their jobs as well as to

the demands and adjustments of young married life. Perhaps the reduced job satisfaction in

young adults might have resulted from their occupying lower status positions in

organization as a result of which they have minimal organizational power and little control

over work demands. Under such circumstances it may be expected that, compared

to the middle aged who are more or less settled in their personal as well as work life’s,

young adults found their jobs much more stressful. Subjects’ age, as a main variable, was

for lower occupational level employees the effects of role conflict are more

important than role ambiguity which might have resulted in their high score on intrinsic

impoverishment, powerlessness and low status.

The high mean scored of member of the young adult group on unreasonable group and

political pressures shows their intolerance of pressures which might create role ambiguity

and role conflict in their work. Since they are in a state of adjusting to both their work and

personal lives’. They perceive involvement of such pressures in work as the rigidity, as

many gerontological studies state, (Jamuna and Sujata Ramamurthi, 1984) grows with age

or long tenure of the job perhaps makes the individuals (by them in their late middle age)

52 | P a g e
resist and result the directions of unreasonable group and political pressures that might be

involved in several aspects of their job starting from supervision of their subordinates to

their products, this might have caused them to feel more stressful on this factor. New

entrants, typically have high expectations as young executives, and coming from their

training institutions they may find a industrial environment as too ill-designed and

without much scope for applying their knowledge. They may feel to have few or now

chances to realize their abilities.

The results obtained show significant decreases in the mean stress score could be seen from

young adult group to late middle age. The ‘t’ values obtained in the table 1 show

significant difference between young adults (20-30 yrs.) and those in early middle age

(30-40 yrs.) and late middle age (40-50 yrs.). Young adults were found to have experienced

more occupational stress than the middle aged.

There is significant increase in the mean stress score could be seen from young adult group

to late middle age. The ‘t’ values obtained in the table 2 show significant difference

between young adults (20-30 yrs.) and those in early middle age (30-40 yrs.) and late

middle age (40-50 yrs.). Young adults were found to have experienced more job burnout

than the middle aged.

The mean personal accomplishment score of single nursing staff were found to be

36.18 as against 33.23 of married nursing staff. Independent samples‘t’ test revealed a

significant difference between mean personal accomplishment scores of single and

married nursing staff (t= 2.746; p=.006). As shown in table 3 single nursing staff have

higher score than married.

53 | P a g e
The mean emotional exhaustion score of single nursing staff were found to be 16.29 as

against 15.79 of married nursing staff. Independent samples ‘t’ test revealed a non-

significant difference between mean emotional exhaustion scores of single and married

nursing staff in India (t=0.436; P=.663).

The mean depersonalization score of single nursing staff were found to be 9.52 as against

9.53 of married nursing staff. Independent samples ‘t’ test revealed a non- significant

difference between mean depersonalization scores of single and married nursing

staff in India (t=.010; P=.992).

In this context, the null hypothesis that there is no significant difference between single

and married high school nursing staff with reference to job burnout, in emotional

exhaustion and depersonalization components is accepted, and in personal

accomplishment component is rejected.

CONCLUSIONS

The growing importance of health care throughout the world being catered by different

forms of hospitals and its allied sectors. The changes in environmental conditions, human

consumption pattern, system of work and its culture, habituated pattern of consumption of

food demands comprehensive health protection among the individuals. In addition to that,

the growth of hospitals promoted by private and international participation away from the

services of government and aided pattern elevated the need of enhanced health services

where the patients are being treated as customers. The patient relationship management has

become an imperative tool in present day hospital services. The emergence of substitution

54 | P a g e
based medicine practices shift the loyalty of patients from one service to multiple services.

The inclusion advanced equipment and medical technologies, the role of information and

communication era in the field of medicine created an avenue of expectation among the

patients in terms of quality and speedy services with absolute panacea for any kind of

diseases. The attitude of value for money is also perceived by the beneficiaries even in the

field of health care services.

This changing era of health care industry especially the hospitals need to provide

comprehensive services in order to compete in the market and expedite the survival of

fittest for its brands as well as venture. The service strategies needed to address with

competitive environment insist of enhanced and potential services to patients by different

forms of hospitals. One among the potential service needed for every beneficiary from any

form of hospital is patient – employee interaction and understand the latent need of patients

away from core service need. The present day hospital services expect the employees to

execute the role of patience intensive and continuous problem solving attitude. The

characters of patient intensive care management is especially needed from the employment

category of nursing. The nursing services demand rent less service approach in present day

hospital industry.

The role of nursing in traditional and modern hospital services is incomparable. The

environmental cues in present services like technology front, patience knowledge system,

data base management, comprehensive service approach need every nurse to update their

individual caliber according to work places. But the field of hospital services prefers to

have more women enrollment in the pay roll of nursing job than their male counterpart. But

55 | P a g e
unexpectedly, the work pressure of women nurses in addition to their family care,

individual need requirement, physical and emotional constraints induce occupational stress

among them. The influence of occupational stress leads to personal, physical, emotional,

psychological and health related issues among women nurses. But the outcome of

occupational stress not only affect the individual employees but it also affects the patients

who are under different forms of treatment.

Nursing staff under excessive stress tend to find their jobs less satisfying. Some of their

intrinsic or extrinsic needs may be thwarted or not met sufficiently. Corroborating many

studies in the literature (Hollingworth et. al. 1988; Keller, 1975), the findings of the present

study also reveal the same. The subjects with lower job satisfaction were found to

experience more stress in the form of overload, role ambiguity, role conflict, under

participation, powerlessness and low status compared to those with higher job satisfaction.

Age, therefore, was found to be of importance in these study findings. The results of

the study reiterate the significance of demands at each career development level as pointed

out by Hallingworth. And the individuals encounter crisis at each developmental stage as

hypothesized by Erickson. Significantly decreasing stress and increasing job satisfaction

with increasing age was found among the managers and these confirm the importance of

the developmental process.

RECOMMENDATIONS

The administrators of hospital specifically supervisors, managers, and policy makers

should be aware of some recommendations based on this research study’s findings. The

56 | P a g e
results of this research suggest that supervisory support, pay, promotion, coworker itself

and work itself has relation and effect on productivity level. If all these factors are

provided to nursing staff’s productivity can be improved, hence the sales will increase.

The nursing staff are satisfied with the support they receive from their supervisors and

managers.

Managers and policy makers should see that there are some other factors that are effecting

and becoming obstacle for achieving desired productivity level. May be the working

condition or holiday/ vacation be the factors, which they should look upon to sort the

problem.

57 | P a g e
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QUESTIONNAIRE

73 | P a g e
 QUESTIONNAIRE — I

OCCUPATIONAL STRESS INDEX

Name………………………………………… Sex ……………… Age…………..

Occupation……………………………..

Designation……………………………………….

Experience……………………………..

Date…………………………………………….

[ NOTE : - Please check on a 5 points scale of agreement of all the following

statements i.e. Strongly Agree (SA), Mildly Agree (MA), Agree (A), Disagree (D),

Strongly Disagree (SD).]

S.NO STATEMENT SA MA A D SD

.
1 I have to do a lot of work in this job.

2. The available information relating to my

job role and is outcomes are vague and

insufficient.

3. My different officers often give

contradictory instructions regarding my

work.

4. Sometimes it becomes complex problem for

me to make adjustment between

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 political/group pressures and formal rules

and instructions.

5. The responsibility for the efficiency and

productivity of many employs is trust upon

me

6. Most of suggestions are headed and

implemented here.

7. My decisions and instructions concerning

distribution of assignment among

employees are properly followed.

8. I have to work with persons whom I like

9. My assignments are of monotonous nature

10. Higher authorities do care for my self-

respect

11. I get less salary in comparison to the

quantum of my labour/work

12. I do my work under tense in circumstances

13. Owing to excessive work load, I have to

75 | P a g e
 manage with insufficient number of

employees and recourses.

14. The objectives of my wok role are quite

clear and adequately planned.

15. Officials do not interface with my

jurisdiction and working methods.

16. I have to some work unwillingly owing to

do certain group/political pressures.

17. I am responsible for the future of a number

of employees.
18. Co-operation is frequently sought in solving

the administrative or industrial problems

at higher level.
19. My suggestions regarding the training

programmers of the employees are given

due significance.
20. Some of my colleagues and subordinates

try to defame and malign me as

unsuccessful.
21. I get sample opportunity to utilize my

abilities and experience independently.

22. This job has enhanced my social status.
23. I am seldom rewarded for my hard labour

and efficient performance.

24. Some of my assignments’ are quite risky

and complicated.
25. I have to dispose off my work hurriedly

owing to excessive work load.

26. I am unable to perform my duties smoothly

76 | P a g e
 owing to uncertainty and ambiguity of the

scope of my jurisdiction and authorities.

27. I am not provided with clear instructions

and sufficient facilities regarding the new

assignments trusted to me
28. In order to maintain group conformity

sometimes, I have to do/produce more than

the usual
29. I bear the great responsibility for the

progress and prosperity of this

organization/department company.
30. My opinions are sought in forming

important policies of the organization and

department.
31. Our interests and opinion are duly

considered in making appointments for

important posts………….
32. My colleagues do co-operate with me

voluntarily in solving administrative and

industrial problem…………..
33. I got ample opportunity to

develop………………….
34. My higher authorities do not give

significance to my posts and work

35. I often feel that job has made
36. Being too busy with official work, I am not

able to devote sufficient and personal

problems
77 | P a g e
37. It is not clear that what type of work and

behavior my higher authorities and

colleagues expect from me

38. Employee attach due importance to the

official instruction and formal working

procedures.
39. I am compelled to violate the formal and

administrative procedures and policies

owing to group/political pressures

40. My opinion is sought in changing or modify

the working system implements and

conditions
41. There exists sufficient mutual co-operation

and team spirit among the employees of

this organization

42. My suggestions co- operations are not

sought in solving even those problems for

which, I am quite competent.

43. Working conditions are satisfactory here

from the point of view of view of our

welfare and convenience.

44. I have to do such work are ought to be done

by others

45. It becomes difficult to implement all of a

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 sudden new dealing procedures and

policies in place of those already in practice

46. I am unable to carry out my assignments to

my assignments to my satisfaction on

account of excessive load of work and lack

of time

79 | P a g e
 QUESTIONNAIRE — II

Maslach Burnout Inventory (MBI)

Please read each statement carefully and decide if you ever feel this way about your job.
If you have never had this feeling, write a "0" (zero) in the space before the statement. If
you have had this feeling, Indicate how often you feel it by writing the number (from 1 to
6) that best describes how frequently you feel that way.

0 1 2 3 4 5 6
Never A few Once a A few Once A few Every
times a month times a a times day
year or less or less month week a week

How Often

0–6 Statements:
1. I feel emotionally drained from my work.
2. I feel used up at the end of the workday.
3. I feel fatigued when I get up in the morning and have to face another day on
the job.
4. I can easily understand how my students feel about things.
5. I feel I treat some students as if they were impersonal objects
6. Working with people all day is really a strain on me.
7. I deal very effectively with the problems of my students.
8. I feel burned out from my work.
9. I feel I’m positively influencing other people’s lives through my work.

80 | P a g e
10. I’ve become more callous toward people since I took this job.
11. I worry that this job is hardening me emotionally.
12. I feel very energetic.
13. I feel frustrated by my job.
14. I feel I’m wording too hard on my job.
15. I don’t really care what happens to some students.
16. working with people directly puts too much stress on me.
17. I can easily create a relaxed atmosphere with my students.
18. I feel exhilarated after working closely with my students.
19. I have accomplished many worthwhile things in this job.
20. I feel like I’m at the end of my rope.
21. In my work, I deal with emotional problems very calmly.
22. I feel students blame me for some of their problems

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