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Level of Job stress among Health Care Providers at ED of HUSM
during recent H1N1 Influenza Outbreak
Assoc. Prof. Dr. Rashidi AhmadDept. of Emergency Medicine
USM Health Campus
Introduction
In the 21st century, the world is being challenged by few contagious and life threat infection such avian influenza and SARS.
At current moment, no countries in the world are immune to an outbreak of a highly infectious disease.
Luckily, Malaysia did not encounter both SARS and avian flu outbreak.
We haven’t been challenged to the outbreak of deadly virus till now
Unfortunately, swine flu was disseminated rapidly throughout the world including Malaysia.
As a result, there was a sudden influx of patients with influenza like illness (ILI) to the ED including
HUSM. Longer shift hours, pressure to perform to meet
rising expectations from public and administrators and scared for being infected created a lot of tensions among the ED HCPs at HUSM
Cont…
Kathryn Wilkins. Work stress among health care providersHealth Reports, Vol. 18, No. 4, November 2007
135,573 respondents.
We are already in STRESS
Ping Wu, et al. The Psychological Impact of the SARS Epidemicon Hospital Employees in China:
Exposure, Risk Perception, and Altruistic Acceptance of Risk. The Canadian Journal of Psychiatry, Vol 54, No 5, May 2009
6-point Likert scale
Objectives
To determine the prevalence of job stress among HCPs in ED of HUSM during recent H1N1 influenza outbreak
To determine the significance of their level of job stress prior to and during the outbreak
To determine the association between the studied variables and stress level during the outbreak
Methodology
The sample size was determined using a single proportion (n = log β/log p’) for a population of about 100 people with an expected prevalence of job stress of 10% and a 95% confidence level with a precision of 5%.
The sample was obtained by non-probabilistic sampling.
The researcher approached the respected staff and explained the aim and how to score their stress level using VAS.
Cont..
The study was undertaken from 20 to 30 August 2009.
The considered variables were age, gender, race, co morbidities, marriage status and year of experiences.
Data were collected into single form and entered into a SPSS+ (12.0) statistical package and analyzed.
Visual analog Stress Scale
This scale consists of a 10 cm line drawn on a white paper that represents the variable to measure
The patient is informed that one end of the line represents the absence of the variable and the other symbolizes the most intense manifestation the subject can imagine or the worst stress experience.
The patient scores the intensity of the expression of the variable marking the point between both ends that more accurately represents the strength of the variable he/ she is experimenting.
VAS
The result is quantified measuring the distance from 0 to the point marked by the patient.
Stress scores obtained from the VAS were arbitrarily grouped in four degrees: I (0 to 2.5 cm scored on the VAS), II (2.6 to 5 cm), III (5.1 to 7.5) and IV (7.6 to 10 cm).
VAS > 7.5 cm was considered a high level of stress.
Results
Variables n(%)
Agemedian, range, IQR 31.0, 22 – 49, 5.5< 30 28 (45.2)30 and above 34 (54.8)
SexMale 29 (46.8)Female 33 (53.2)
Total respondents: 62 out of 110 staffs (56%)
Variables n (%)
RaceMalay 56 (90.3)Non-Malay 6 (9.7)
Marriage statusBachelor 23 (37.1)Married 39 (62.9)
Years of experience Median, range, IQR 6, 1 – 24, 7 <5 20 (32.3)5-9 25 (40.3)>10 years 16 (25.8)
Results
Variables n (%)
VAS before outbreakMedian, range, IQR 2.4, 0 – 6.6, 2.0Grade 1 35 (56.5)Grade 2 21 (33.9)Grade 3 6 (9.7)Grade 4 0
VAS during outbreakMedian, range, IQR 6.5, 0 - 10, 3.6Grade 1 4 (6.5)Grade 2 15 (24.5)
Grade 3 22 (35.5)Grade 4 21
(33.9)
Ranks
0a .00 .00
59b 30.00 1770.00
3c
62
Negative Ranks
Positive Ranks
Ties
Total
POST - VASN Mean Rank Sum of Ranks
POST < VASa.
POST > VASb.
POST = VASc.
Test Statisticsb
-6.682a
.000
Z
Asymp. Sig. (2-tailed)
POST - VAS
Based on negative ranks.a.
Wilcoxon Signed Ranks Testb.
Significance mean differencebetween pre and during outbreak
kateg umur * postvas1 Crosstabulation
12 9 7 28
8.6 9.9 9.5 28.0
7 13 14 34
10.4 12.1 11.5 34.0
19 22 21 62
19.0 22.0 21.0 62.0
Count
Expected Count
Count
Expected Count
Count
Expected Count
20 - 30
> 30
kategumur
Total
gred 1 gred 2 gred 3
postvas1
Total
Chi-Square Tests
3.832a 2 .147
3.860 2 .145
3.739 1 .053
62
Pearson Chi-Square
Likelihood Ratio
Linear-by-LinearAssociation
N of Valid Cases
Value dfAsymp. Sig.
(2-sided)
0 cells (.0%) have expected count less than 5. Theminimum expected count is 8.58.
a.
Age and stress level during outbreak
SEX * postvas1 Crosstabulation
10 9 10 29
8.9 10.3 9.8 29.0
9 13 11 33
10.1 11.7 11.2 33.0
19 22 21 62
19.0 22.0 21.0 62.0
Count
Expected Count
Count
Expected Count
Count
Expected Count
Male
Female
SEX
Total
gred 1 gred 2 gred 3
postvas1
Total
Chi-Square Tests
.572a 2 .751
.573 2 .751
62
Pearson Chi-Square
Likelihood Ratio
N of Valid Cases
Value dfAsymp. Sig.
(2-sided)
0 cells (.0%) have expected count less than 5. Theminimum expected count is 8.89.
a.
Gender and stress level during outbreak
experience * postvas1 Crosstabulation
Count
13 3 4 20
3 14 8 25
3 5 8 16
19 22 20 61
junior
senior
very senior
experience
Total
gred 1 gred 2 gred 3
postvas1
Total
Chi-Square Tests
18.857a 4 .001
18.391 4 .001
9.640 1 .002
61
Pearson Chi-Square
Likelihood Ratio
Linear-by-LinearAssociation
N of Valid Cases
Value dfAsymp. Sig.
(2-sided)
1 cells (11.1%) have expected count less than 5. Theminimum expected count is 4.98.
a.
Experience and stress level during outbreak
Summary
The median VAS score prior to the outbreak is 2.4 (grade 1)
The median VAS score during the outbreak is 6.5 (grade 3)
Significance mean difference between pre and during outbreak
Significant association between years of experience in health services and the level of stress during the outbreak
Discussion
STRESS is a biological term which refers to the consequences of the failure of a human to respond appropriately to emotional or physical threats.
It includes a state of alarm and adrenaline production, short-term resistance as a coping mechanism, and exhaustion
The Stress of Life, Hans Selye, New York: McGraw-Hill, 1956
Job stress
is caused by conditions in the workplace that negatively affect an individual's performance and/or overall well-being of his body and mind.
One or more of a host of physical and
mental illnesses manifests job stress.
Signs of stress
May be cognitive, emotional, physical or behavioral.
Poor judgment A general negative outlook Excessive worrying Moodiness Irritability Agitation Inability to relax Feeling lonely or isolated Depressed Aches and pains
Diarrhea or constipation Nausea Dizziness Chest pain Rapid heartbeat Eating too much Sleeping too much Withdrawing from others Neglecting responsibilities Using alcohol, cigarettes,
or drugs to relax Nervous habits
Causes of work stress in government sectors
High Demand for Performance - Increased workload, long working hours for the same pay, excessive travel and too much time away from family
The expansion of technology Workplace Culture Personal or Family Problems Mental and physical harassment
Disadvantages of being ED HCW
Daily contact with ILI patients Risk of infection and & quarantine Risk of death and hospitalization Over work Over stress Under appreciated Community avoidance
Conclusion and recommendations
Infectious disease outbreak is a distressing event Preparedness and readiness are vital and it
reduce tension Buddy system enhances quality of care and
reduce stress level Involvement of occupational health experts,
appropriate communication system, token of appreciation and counseling and follow up reduce stresses among HCWs
