A Study Of Healthcare Employees' Opinions About Stress Patterns In The UAE

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2009 Oxford Business & Economics Conference Program
ISBN : 978-0-9742114-1-1
A Study of HealthCare Employees’ Opinions about
Stress Patterns in the UAE
Belal Barhem
Abu Dhabi University, College of Business Administration
Hassan Younies*
UAE University, College of Business and Economics
This study aims to investigate workplace stress and its related patterns (sources, patient’s
interaction, and coping strategies) among health care employees in the UAE. A sample of
175 respondents from different health organizations in the public and private sectors of
health care in the UAE participated in the study. The results show significant
relationships between role ambiguity and age and between role conflict and age and
marital status. The patients as a source of workplace stress constitute the only factor
related to the nature of the job and to income. The correlation and regression analysis for
coping strategies revealed that self-knowledge as a coping strategy related significantly to
the nature of the job and the years of experience. Wide interests were affected
significantly by age, marital status and the nature of the job; and flexibility and being
active and productive similarly related significantly to the type of organization.
KEY WORDS: UAE, work stress, health care
*
Corresponding Author, hassan.younies@uaeu.ac.ae
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Introduction
Workplace stress is a continual problem facing managers at all levels in all types of
organization. It generates increasing public and media concern and its cost at work is
significantly increasing. Although stress is inherent in life (Modern Business Report,
1975) and human behavior (Auerbach and Gramling, 1998), workplace stress is not
confined to the workplace, but it is frequently brought home as well (Doby and Caplan,
1995).
Increasingly, employers, trade unions, and health and safety representatives at work are
finding guidance on the nature and causes of the problem and on the organizational
requirements relating to its prevention and control. A number of factors have to be
considered in the study of stress, for example, the multidimensionality of the nature of
workplace stress, the definition of stress, the direct relationship between stress and
behavior, coping with stress and the increasing negative effects of stress on work. The
multidimensionality of stress, according to Hogan and Joyce (1982), is evidenced by the
fact that it takes different forms and is the concern of different fields, for example,
Clinical and Applied Psychology, Anthropology, Sociology, Psychosomatic Medicine,
Industrial Relations and Epidemiology.
It is useful to clarify that stressors can derive from any component of the quality of life,
whether economic, physical, emotional, social, intellectual or spiritual, as discussed by
Girdano et al (1993). Stress can influence individual behavior either negatively or
positively. Many researchers, such as Spielberger (1979), believe that workplace stress is
one of the most important factors affecting productivity because of the direct relationship
between individual behavior and the stress experienced.
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Referring to the literature on workplace stress, some researchers have understood stress
as person-environment fit (Bhagat et al, 1995; Mass, 1981; ILO, 1984). The study by
Bhagat et al, (1995) defined stress as “a problematic level of environmental demand that
interacts with the individual to change his/her psychological or physiological condition
such that the person (mind or/and body) is forced to deviate from normal functioning”.
Arroba and James (1987), however, define stress as a result of pressure. It is first
necessary to understand the person and environmental circumstances before the cause of
stress is understood (Lazarus, 1995).
Spielberger and Sarason (1986) find that the
environment must be dealt with first, which means that multiple variables have first to be
tackled.
Another dimension in defining, according to Matteson and Ivancivich (1987), is “an
adaptive response, moderated by individual differences, that is a consequence of any
action, situation, or event that places special demands upon a person.” Similarly, Barhem
et al (2004) define stress as an extraordinary state affecting individual human functions as
an outcome of internal and external factors which differ qualitatively (having different
types of stressors) and quantitatively (having different numbers of stressors) from
individual performance, due to individual differences. Alternatively, Hendrix et al (1995)
define stress as “an uncomfortable cognitive state resulting from exposure to a stressor
that can result in psychological and physiological strain.” Fontana (1989), for his part,
defines stress in relation to personal capabilities ‘a demand made on the adaptive
capacities of the mind and body’.
The factors related to job stress and work conditions need to be defined accurately.
Among physicians, various stressors have been found in connection with job stress (Lee,
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1986; Scheiber, 1987; Butterfield;1988 Richardsen and Burke, 1991). Among the factors
causing them job stress are work demands, excessive work load, long duty hours,
financial problems, conflict between professional and personal life, problems with
patients and those related to the occurrence of death (Mawardi, 1979, Charles et al, 1987;
Richardsen and Burke, 1991). A significant relationship has also been found between
interactions with colleagues, inadequacy of perceived professional knowledge, diagnosis
and treatment process, stress in dialogues with patients and the degree of psychological
morbidity (Tattersall et al, 1999) and responsibility, (Heim, 1992). Boredom with
providing the same services over time may also help to explain workplace stress (Locke
1976) and consistent exposure to chronic and difficult clients could be another cause.
A further important aspect of workplace stress is its relationship to individual differences
(gender, age, educational level, cultural differences such as religion, experience, etc.).
Individual staff members bring their own personal characteristics to the job, which may
contribute to factors leading to work dissatisfaction and burnout (Rockwell et al, 1995).
Vedat et al (2004) listed other factors causing stress in health care professionals, such as
marital status, age, professional career, unfairness in promotion opportunities, imbalance
between jobs and responsibilities, conflict with colleagues, responsibilities of role, long
and tiring work hours, problems experienced with patients and their relatives, and
problems of communication with team members. Other studies reported other sources of
stress, such as work conditions, low salaries and inadequate social facilities, lack of inservice training, the status of just starting work, the end of career, lack of opportunities
for promotion, and decline in the appreciation of patients and superiors (Beemsterboer
and Baum, 1984; Bram and Katz, 1989; Whippen and Canellos, 1991; Hershbach, 1992;
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Ramirez et al, 1995; Wilkinson, 1995; Isikhan et al, 1998; Fielden and Peckar, 1999;
Tattersall et al, 1999).
There are many dimensions to understanding and dealing with workplace stress. Kahn
and Cooper (1993) state that the word “stress”, as generally used, means essentially four
fundamentally different things: an environmental condition, an appraisal of an
environment situation, the response to that condition, and some form of relationship
between one’s environmental demands and the ability to meet them.
The workplace stress problem seems to do more damage in uniform jobs, due to the high
degree of responsibility for others’ lives. Health care is one of the main areas in which
workers’ main duty is to save the lives of others. Distress among healthcare professionals
can have negative effects on the well-being of these professionals and also on the quality
of care they provide to patients. The importance of keeping such workers energized,
motivated and satisfied is obvious. Stress, burnout, depression and anxiety have been
described in up to 25 per cent of practicing physicians (Agius et al, 1996). Examples of
writers on workplace stress in the health sector are: Chan and Chan (2004), Maslach and
Jackson (1982), Mowardi (1983), Arnetz (1991), Dallender et al (1999), Mechteld et al
(2003), Ramirez et al (1996), and Cronin-Stubbs and Rooks (1985).
The impact of these adverse outcomes can be considerable: worsening of doctor-patient
communication, diminished productivity, lower quality of care and turnover in physician
practices. Predictors of stress have been posited and assessed in other countries than the
UAE but research has rarely addressed the predictors of stress in UAE health care
employees.
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Rapid changes in the UAE health care system may be a good starting-place for
considering the stress on health care employees. The health care services in the UAE in
all health tasks are mostly provided by expatriates, from every country. Working overseas
may lead to additional sources of workplace stress and exhibit the multifarious nature of
coping strategies. A model with ‘therapeutic implications’ for preventing stress would be
beneficial.
The literature on coping is itself wide. Coping with workplace stress is defined as ‘the
cognitive and behavioural efforts a person makes to manage demands that tax or exceed
his/her personal resources’ (Lazarus, 1995; Lazarus and Lunier, 1987). It is also a range
of behaviours by which individuals can prevent, alleviate or respond to stressful
circumstances (Pearlin and Scholer, 1978). To cope with stress efficiently, it has to be
remembered that stress can vary within a person and from time to time (Crandall and
Perrewé, 1995). Stark (1999) believes that it is helpful to establish realistic deadlines.
Another way to minimize stress at work is to ensure that the employees clearly
understand their duties. Vagueness about their responsibilities portends big problems.
Coping strategies are the ways used by an individual, group or organization to minimize
the effects of stress. To help us cope, we must first recognize that stress is variable for
individuals and over time, as a natural part of life. As such, it cannot be avoided, but
only minimized for a better response.
It is not sufficient to detect the sources and levels of workplace stress; it is even more
important to devise coping strategies to deal with it. According to Krohe (1999), coping
with stress is the effective reduction of its negative effects.
He states that senior
managers often think it necessary to create a stressful work environment to induce the
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best performance from their staff.
ISBN : 978-0-9742114-1-1
However, stress is rather an obstacle to good
performance, innovation and creativity.
A person’s reaction to stress very much depends on his/her attitude; therefore, the stress
felt will differ between people according to their circumstances (Mclean, 1979).
Similarly, the ILO (1984) found that the effectiveness of coping techniques very much
depends on the individual. Potential predictors include gender, age, case mix, time
pressure in patient visits, workload, practice type, specialty, work control, isolation and
support in balancing work and home.
Empirical studies suggest that: nurses who report high levels of workload use more
problem-solving strategies; nurses who are subjected to stress due to patient demands and
home/work conflicts use social support strategies; and avoidance is the most reliable
symptom of stress and job dissatisfaction (Tyler and Cushway, 1992; Tyson and
Pongruengphant, 1996( .
The sources of workplace stress differ in nature; they can be psychological, workplacerelated, social, economic and personal.
Workplace-related sources include role
ambiguity (Mclean, 1979). Caplan and Jones (1975) report that role ambiguity results in
anxiety and depression. According to Froiland (1993), role conflict occurs when an
individual in a particular job is torn by conflicting job demands or doing things which
he/she does not think are part of the job see also Sutherland and Cooper (1990).
Additional sources are career development (Mclean, 1979); role overload – quantitative,
(Marglies et al, 1974); role overload-qualitative (Kahn and Cooper, 1993; Schermerhorn
et al, 2000); and responsibility for other people (McLean, 1980). Wardwell et al (1964)
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report that responsibility for people is significantly more likely to lead to coronary heart
disease (CHD) than responsibility for things.
The level of workplace stress may be determined by other moderator variables, such as:
country (Peterson et al, 1995; Brown and Cooper, 1996); gender, since men and women
differ naturally in many ways, and therefore differences in their response to stressors are
not unexpected (Russo, 1985; Stoney et al, 1985; Kerrler et al, 1985; Jick and Mitz,
1985). As stress affects age, so too does age affect stress (Matteson and Ivancivich, 1987;
Leighton, 1963; Comslock and Helsing, 1976; Kaufman, 1982; Kahn and Cooper, 1993).
In terms of experience, Auerbach and Gramling (1998) find that coping ability is very
much a function of past experience, Kahn and Cooper (1993); regarding educational
level, Syme (1975) finds that stress illness rates increased as individuals climbed above
the social level commensurate with their educational level. The better educated and
endowed a person is, the less stress he feels (Sutherland and Cooper, 1990). Marital
status also affects stress levels, among the possibilities of single, married, divorced or
widowed status. Being married is less stressful and more satisfying for men than for
women (Jenkins, 1991; Crosby, 1984; Valdez and Gutek, 1987).
Model of the Study
The coping strategies proposed by many workers will be evaluated in this study. They
are: i) flexibility (Pun, 1997; Schönpflug, 1983); ii) acceptance of others’ values; iii)
self-knowledge (Pun, 1997; Powell and Enright, 1990); iv), wide interests; and v) activity
and productiveness (Mclean, 1980). All these strategies were described in detail in the
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third part of the questionnaire. Diagram 1 represents the model of the study and clarifies
which relationships between different aspects of workplace stress were investigated.
Diagram (1): The model of the study
Demographic variables
Gender, Age, Years of Experience (YEX), Educational Level (EDU), Marital Status
(MIS), Ethnicity, Income, Type of Organization, Size, Set-up, and Nature of Work
Sources of workplace stress
-Role Ambiguity (RAB)
-Role Conflict (RC)
-Career Development (CRD)
-Role Overload, Quantitative (ROQN)
-Role Overload, Qualitative (ROQL)
-Responsibility for Other People (RES)
- Patients
Coping strategies
-Flexibility (FLX)
-Acceptance of Others’ Values
(ACCV)
-Self-Knowledge (SKW)
-Wide Interests (WIT)
-Activity and Productiveness
(ACPD)
Hypothesis
The study examined the following hypotheses:
H1: there is a significant relationship between Sources of workplace stress and
Demographic variables
H2: there is a significant relationship between Coping strategies and Demographic
variables
Tool of the study
The tool of the study is a four-part questionnaire in which we examined 3 areas
considered important in relation to job stress; sources of workplace stress, coping
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strategies, patients’ response, and certain demographic variables. The measurement for
sources of workplace stress was adopted from Ivancivich and Michael (1980). It is
composed of 30 items aimed to evaluate the influence of sources of workplace stress.
The level of stress was measured by the respondents on a five-point scale (1 = strongly
disagree, to 5 = strongly agree). Questions on the following different sources of stress
were posed: role ambiguity, role conflict, role overload – quantitative, role overload –
qualitative, career development and responsibility for others
The measurement used for coping strategies is adopted from Mclean (1980) and includes
20 questions to evaluate the effects of personal traits on the ability to cope with stress.
The participants are asked to use a five-point scale (Statements 1-9: 1= Very true to 5=
Not at all true; Statements 10-18: 5= Very true, to 1=Not at all true). The personal traits
(Coping Strategies) considered were: Self-Knowledge, Wide Interests, Flexibility,
Acceptance of others’ values, and Activity and Productiveness.
The reliability test for the different parts of the questionnaire is represented in Table (1).
It reveals a Cronbach's Alpha level from 0.67 to 0.9 which is considered acceptable
according to the research criteria.
Table (1): Reliability Statistics
Cronbach's Alpha
0.912
0.674
0.754
N of Items
30
20
5
A sample of 175 respondents from different organizations in the public and private health
care sectors in the UAE participated in the study.
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The respondents’ profile is presented in Table (2); most of them worked in the public
sector, which explains the majority of Arabs (52%) among the sample members. Even
though 60% of the sample members were more than 30 years old, the category of 26-30
years is the largest single category, and we can understand why 52% of the sample had
less than 4 years’ experience. The majority had a university degree as a result of the new
standards in hiring health staff in the UAE.
Married workers constituted 75% of the sample and more than 52% of the respondents
were working in organizations where more than 300 were employed. Physicians and
nurses were the largest groups, 37% and 31% respectively. People with an income below
10,000 Dh accounted for more than 54% of the whole sample.
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Table (2): Respondents profile (n 175)
Profile
Category
Public
Private
Type
Semipublic
< 20 years
21-25
26-30 years
31-35 years
Age
36-40 years
41-50
> 50 years
Certificate/diploma
Professional
Education Bachelor’s
Master’s
PhD
<4 years
4-8 years
Experience
8-12 years
>12 years
Single
Married
Marital status
Divorced
Separated
Male
Gender
Female
Arab
Chinese
Ethnicity
Indians
Others
LESS THAN 5
5-10
Set-up
10-20
More than 20
< 100
100-200
Size
200-300
More than 300
administrative
physician
nurse
Task
technician
laboratory
other
less than 5,000
5,000-10,000
Income
10,000-15,000
More than 15,000
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Frequency
88
80
7
1
6
43
33
40
27
25
28
46
54
30
17
91
54
12
18
37
130
5
3
90
85
95
1
39
40
69
24
24
58
39
31
14
91
11
65
55
17
4
23
47
48
31
49
Percentage
50.3
45.7
4.0
.6
3.4
24.6
18.9
22.9
15.4
14.3
16.0
26.3
30.9
17.1
9.7
52.0
30.9
6.9
10.3
21.1
74.3
2.9
1.7
51.4
48.6
54.3
.6
22.3
22.9
39.4
13.7
13.7
33.1
22.3
17.7
8.0
52.0
6.3
37.1
31.4
9.7
2.3
13.1
26.9
27.4
17.7
28.0
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Analysis
The analysis relies on means, standard deviation, correlation and regression. The main
source of workplace stress for health care employees in the UAE, as reported in Table
(3), is role ambiguity. Similarly, Vedat et al (2004) and Heim (1992) report that
imbalance between jobs and responsibilities, conflict with colleagues and responsibilities
of role are the main sources of workplace stress. The medical services are usually
provided by teams and it is very important to know one’s exact role among the team
members, with clear and specific responsibilities, otherwise lack of clarity about
assignments and duties may lead to fatal errors. It is thought that stress in oncology
clinics emanates from the imbalance between the coping ability of the individual and the
demands of the work place, with the demands outweighing their ability to cope (Ullrich
and Fitzgerald, 1990). Moreover, Fagin et al (1996) attribute burnout among psychiatric
nurses to staff shortages, health service changes, poor morale and not being notified of
changes before they occurred.
Role overload – qualitative ranked as the second source, due to the high professional
skills required to perform the medical tasks. This is close to the results of the study by
Guppy and Gutteridge (1991) that 85% of stress in nurses was due to heavy workload.
Although support and good relations with colleagues are important, responsibility for
others ranked in sixth place, contradicting the study by Chan and Chan (2004). Both
doctors and nurses highlighted that attending on the badly injured or those who have been
killed is the most distressing experience for them. This is a not unexpected result of the
nature of their work. Patients, however, were the lowest causes of stress; some
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researchers did not even consider them among the major causes (Ullrich and Fitzgerald,
1990; Vedat et al, 2004; Heim, 1992).
Table (3): Sources of workplace stress for health care employees in the UAE
Mean
Std.
Deviation
RAB
3.5646
0.819
ROQL
3.3703
0.7487
- Role Ambiguity (RAB)
- Role Overload Quantitative (ROQN)
- Role Overload Qualitative (ROQL)
RC
3.2926
0.7565
ROQN
3.0377
0.8217
CR
2.96
0.8582
RES
2.7794
0.6553
Pat
2.1014
0.6206
- Career Development (CRD)
- Role Conflict (RC)
- Responsibility for Other People (RES) - Pat (Patients)
In terms of coping strategies, as revealed in Table 4, the main coping strategy for of
workplace stress by health care employees in the UAE is to be active and productive.
When dealing with people’s lives, it is very important to be careful, but at the same time
the patients need to be served as much as possible. To keep a balance, employees must be
flexible and socially intelligent; acceptance of others’ values ranked third in the list of
important qualities and this helps to minimize the level of workplace stress.
Table (4): Coping strategies for workplace stress by health care employees
Mean
Std.
Deviation
ACT
2.8829
0.6122
FLEX
2.6529
0.6716
ACV
2.6129
0.5398
WIT
2.5714
0.6064
SKW
2.38
0.4602
- Flexibility (FLX)
- Self-Knowledge (SKW)
- Wide Interests (WIT)
- Activity and Productiveness (ACPD)
- Acceptance of Others’ Values (ACCV)
Table (5) shows significant relationships between role ambiguity and age, while role
conflict related significantly to age and marital status. Role overload – quantitative, Role
overload – qualitative and career development all related significantly with age.
Responsibility for others is the only source of stress which is related to years of
experience. The study by A.R. and Gh.R. (2006) stated that significant positive
correlation was noted between age and years of experience for the psychiatric nurses. The
patients as source of workplace stress is the only factor related to number of children,
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nature of the job (according to C Renzi, et al, 2005, burnout was similar for
dermatologists and other specialists), and income.
The independent variable nature of the job related significantly with the patients, this
result complies with some previous studies such as the studies by Cronin-Stubbs and
Rooks (1985) and Yousefy and Ghassemi (2006). The latter study states that psychiatric
nurses experienced a greater degree of emotional exhaustion than do medical nurses.
Table (5): Correlation table for demographic variables and source of workplace
stress (n 175)
Gender
RAB
RC
ROQN
ROQL
CR
RES
Sig.
.002
.005
.047
.005
.001
.899
P. Corr
-.039
-.022
-.017
-.065
-.120
.017
-.085
Sig.
.608
.770
.825
.389
.113
.827
.261
.069
-.018
.064
.032
-.071
.041
.077
.366
.816
.397
.678
.353
.587
.308
P. Corr .198(**) .209(**) .205(**) .239(**) .301(**)
.052
-.165(*)
Sig.
.009
.006
.007
.001
.000
.495
.030
P. Corr
.113
.063
.085
.064
.107
.066
-.141
Sig.
.136
.406
.266
.404
.158
.383
.063
P. Corr
.033
.178(*)
.143
.128
.136
.150(*)
.007
Sig.
.663
.018
.058
.091
.072
.048
.928
P. Corr
.085
.073
.052
.107
.125
.173(*)
-.041
Sig.
.266
.339
.496
.160
.098
.022
.592
P. Corr
-.080
.060
-.027
-.094
-.130
-.056
.259(**)
Sig.
.292
.431
.723
.214
.086
.461
.001
P. Corr
-.023
-.008
-.050
-.057
-.030
-.228(**)
.030
Sig.
.767
.917
.509
.450
.696
.002
.697
P. Corr
-.061
-.106
-.044
-.064
.067
-.079
-.289(**)
Sig.
.423
.164
.565
.397
.377
.297
.000
Ethnicity P. Corr
Sig.
Age
EDU
MIS
Type
Job
YEX
Income
EDU: Educational level
Job: Nature of the job
Pat
MIS: Marital status
Type: Type of organization
YEX: Years of experience
Pear. Corr: Pearson correlation
Table (6) reveals several significant similar (to correlation) relationships for the sources
of workplace stress. For example, all the sources except responsibility for others, related
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significantly to the age variable. According to Schaufeli et al (1998), burnout seems to be
less prevalent among older people and among married people, and it is the same for years
of experience and for the responsibility for others. Characteristics which individual staff
members reported as related to burnout include length of time at their current job and in
their career (Maslach and Florian 1988). According to Gerits L et al (2005), female
nurses were characterized by fewer symptoms of burnout, relatively high emotional
intelligence profiles and lower social skills than male nurses.
Table (6): Regression analysis for demographic variables and source
(Constant)
Pat
Pear. Sig.
Corr
8.059
.000
RAM
Pear. Sig.
Corr
6.165 .000
ROQL
Pear. Sig.
Corr
5.461 .000
RC
Pear. Sig.
Corr
4.438 .000
ROQN
Pear. Sig.
Corr
6.542 .000
CR
Pear. Sig.
Corr
4.262 .000
RES
Pear. Sig.
Corr
6.183 .000
Gender
-2.91
0.004
.034
.973
.277
.782
.525
.600
-.156
.876
-.337
.736
.797
.426
Ethnicity
0.076
0.94
.527
.599
-.958
.340
.510
.611
-.268
.789
-1.29
.198
-.564
.573
Age
-1.28
0.202
2.397
.018
2.643
.009
2.429
.016
2.881
.004
3.267
.001
.815
.416
EDU
-0.37
0.71
1.132
.259
.598
.551
.788
.432
.110
.913
-.126
.900
.691
.491
MIS
1.3
0.196
-.689
.492
1.356
.177
.987
.325
.450
.653
.123
.902
1.960
.052
Type
-1.46
0.147
.293
.770
.231
.817
-.381
.704
.443
.658
1.581
.116
.630
.530
Job
1.445
0.15
-.793
.429
1.165
.246
.196
.845
-.779
.437
-.497
.620
-.365
.715
YEX
0.613
0.541
-.403
.688
-1.17
.244
-1.39
.166
-1.23
.222
-.796
.427
-2.98
.003
Income
-3.18
0.002
-1.60
.112
-1.81
.072
-1.10
.274
-1.80
.074
-.352
.725
-1.28
.201
R Square
0.178
.100
0.075
0.097
.125
0.111
Table (7) represents the correlation among the coping strategies and demographic
variables. Self-knowledge related significantly to the nature of the job and years of
experience. Wide interests was affected significantly by age, marital status and the nature
of the job. Flexibility, and active and productive similarly related significantly to the type
of organization but differed in relating significantly to ethnicity and the nature of the job.
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Table (7): Correlation table for demographic variables and the coping strategies for
workplace stress (n 175)
Gender
SKW
WIT
FLEX
ACV
ACT
P. Corr
-.051
-.105
-.107
-.087
-.071
Sig.
.502
.165
.160
.253
.350
P. Corr
.033
-.042
.007
.007
.020
.668
.582
.925
.932
.789
P. Corr
.060
.281(**)
.109
.136
.175(*)
Sig.
.434
.000
.151
.073
.021
P. Corr
.080
.139
.108
-.024
-.017
Sig.
.290
.067
.155
.751
.820
P. Corr
-.105
.191(*)
.006
.164(*)
-.017
Sig.
.167
.011
.935
.030
.822
P. Corr
-.070
.067
.069
.044
-.106
Sig.
.358
.382
.365
.561
.163
-.194(*)
-.070
-.240(**)
.000
.010
.358
.001
P. Corr -.163(*)
-.055
-.237(**)
-.043
-.111
Sig.
.032
.467
.002
.575
.142
P. Corr
.108
.085
.112
.021
.116
Sig.
.154
.265
.140
.787
.127
Ethnicity Sig.
Age
EDU
MIS
Type
P. Corr -.173(*) -.320(**)
Job
YEX
Income
Sig.
.022
Regression analysis in Table (8) supported the correlation results to some extent. It
revealed significant relationships among the different dependent and independent
variables. Self-knowledge correlated with years of experience; wide interests with age,
the nature of the job and income; flexibility with years of experience; activity and
productiveness with the type of the organization, nature of the job and years of
experience. Based on the theory of professionalization of Forsyth and Danisiewicz
(1985), it might be expected that staff who are more active in their profession would
perceive themselves to be more autonomous from their organization but not from their
clients. Moreover, stronger attachments to clients who are at times very difficult may
June 24-26, 2009
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contribute to burnout. Additionally, there is considerable evidence that younger
employees experience higher levels of burnout (Cordes and Dougherty 1993), possibly
because they become disillusioned by the “real world” after having held an idealistic
view which influenced their career choice and reinforced in their training programs.
Vedat et al (2004, 1) reveals that the level of stress indicates signs of both physical and
psychological stress. They also claim that health care professionals use similar strategies
in order to cope with stress. The most common strategy used by physicians and nurses
was a self-confident approach, while the strategy least used was a submissive approach.
Results, Recommendations and Managerial Implications
The main source of workplace stress among health care employees in the UAE, as shown
in Table (3) is role ambiguity, while the main coping strategy is to be active and
productive. The correlation and regression analysis shows significant relationships
between role ambiguity and age and between role conflict and age and marital status.
Role overload – quantitative, role overload – qualitative and career development related
significantly to age. Responsibility for others is the only source of stress that is related to
years of experience. The patients as a source of workplace stress constitute the only
factor related to the nature of the job and to income. The correlation and regression
analysis for coping strategies revealed that self-knowledge related significantly with the
nature of the job and years of experience. Wide interests was affected significantly by
age, marital status, and the nature of the job, while flexibility and being active and
productive similarly related significantly to the type of organization but differed between
in relating significantly to ethnicity and to the nature of the job. The cross tabulation
June 24-26, 2009
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2009 Oxford Business & Economics Conference Program
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analysis showed other significant results between the sources of workplace stress and
ethnicity and gender.
The health care managers in the UAE health organizations can minimize costs by taking
into consideration the negative effects of workplace stress level in the workplace, such as
turnover, which is costly in the UAE, absenteeism and dissatisfaction. Most of the public
hospitals in the UAE are managed now by international outsourcing, for example, the
JOHNS HOPKINS foundation, which calls for additional concern for employee
satisfaction if high quality services are to be provided. Diversity in the nationalities or
races employed may require role problems to be minimizing and increasing importance
being given to creativity.
References
Agius, R.M., Blerkin, H., Deary, I.J., Zealley, H.E. and Wood, R.A. (1996), Survey of
Perceived Stress and Work Demands of Consultant, Physicians, Occup Environ Med; 53:
217–224.
Arnetz, B. (1991), White Collar Stress: What Studies of Physicians can Teach us,
Psychother Psychosom; 55:2–4.
Auerbach, Stephen M. and Gramling, Sandra (1998), Stress Management: Psychological
Foundations, Prentice Hall, New Jersey.
Barhem, Belal, Samsinar, Md. Sidin., Abdullah, Iskandar and Alsagoff , Syed Kadir
(2004), New Model for Workplace Stress Patterns, Asian Academy of Management
Journal, Vol. 9, no.1, pp 53-77.
Beemsterboer, J. and Baum, H.B. (1984), Burnout Definition and Health Care
Management, Social Work in Health Care 10, .107–97.
Bhagat, Rabi S, Allie, Stephen M, Jr. and Ford, David L, (1995), Coping with Stressful
Life Events: An Empirical Analysis, In Rick Crandall and Pamela L. Perrewé (Eds.)
Occupational Stress, Taylor and Francis, pp: 93-112
June 24-26, 2009
St. Hugh’s College, Oxford University, Oxford, UK
19
2009 Oxford Business & Economics Conference Program
ISBN : 978-0-9742114-1-1
Bram, P.J. and Katz, L.F. (1989), A Study of Burnout in Nurses Working in Hospice and
Hospital Oncology Settings. Oncology Nursing Forum 16 (4), 555–560.
Brown, Jennifer and Campbell, Elizabeth (1994), Stress and Policing: Sources and
Strategies, John Wiley, p. 25.
Butterfield, P.S. (1988), The Stress of Residency: A Review of Literature, Archives of
Internal Medicine, 148, 1428–1433.
Caplan, R. D. and Jones K. W. (1975), Effects of Work Load, Role Ambiguity, and Type
A Personality on, Anxiety, Depression, and Heart Rate, Journal of Applied Psychology,
60, pp: 713-719.
Chan, Angelina O. M. and Chan, Yiong Huak (2004), Influence of Work Environment
on Emotional Health in A Health Care Setting, Occupational Medicine; 54:207–212 DOI:
10.1093/occmed/kqh062
Charles, S.C., Warnecke, R.B., Wilbert, J.R., et al (1987), Sued and Non-Sued
Physicians: Satisfaction, Dissatisfaction, and Sources of Stress, Psychosomatics, 28, 462–
468.
Cooper, Cary L. and Payne, Roye (1988), Causes, Coping and Consequences of Stress at
Work, John Wiley and Sons, New York, pp: 234-240.
Cordes, Cynthia L. and Dougherty, Thomas W. (1993), “A Review and an Integration of
Research on Job Burnout.” Academy of Management Review 18:621-56.
Crandall, Rick, and Perrewé, Pamela L. (Eds.) (1995), Occupational Stress, Taylor and
Francis, p. 45.
Cronin-Stubbs, D. and Rooks, C.A. (1985), The Stress, Social Support, and Burnout of
Critical Care Nurses, Heart & lung, 14(1): 31–9.
Dallender, J., Nolan P., Soares, J., Thomsen, S. and Arnetz, B. (1999), A Comparative
Study of the Perceptions of British Mental Health Nurses and Psychiatrists of their Work
Environment, Journal of Advanced Nursing, 29 (1), 36-43.
Doby, Victoria J. and Caplan, Robert D. (1995), Organisational Stress as Threat to
Reputation: Effects on Anxiety at Work and at Home, Academy of Management Journal,
38 (4), pp: 1105-1123.
Fagin, L. et al (1996), Stress, Coping and Burnout in Mental Health Nurses: Findings
From Three Research Studies, International journal of social psychiatry, 42(2):102–10.
Fielden, S.L. and, Peckar, J. (1999), Workplace Stress and Hospital Doctors: A
Comparative Study, Stress Medicine 15, 137–141.
June 24-26, 2009
St. Hugh’s College, Oxford University, Oxford, UK
20
2009 Oxford Business & Economics Conference Program
ISBN : 978-0-9742114-1-1
Fontana, David (1989), Managing Stress, The British Psychological Society and
Routledge Ltd, Guilford, p. 2.
Forsyth, Patrick B. and Danisiewicz, Thomas J. (1985), Toward a Theory of
Professionalization, Work and Occupations 159-76.
Froiland, Paul (1993), What Cures Job Stress, Training, DEC, p. 34.
Gerits, L. et al (2005), Emotional intelligence profiles of nurses caring for people with
severe behaviour problems, Personality and individual differences, 38(1):33–43.
Girdano, Daniel. A., Everly, George S., Everly, Dorothy E. and Dusek, E. (1993),
Controlling Stress and Tension: A holistic Approach, Prentice Hall, New Jersey.
Guppy A. and Gutteridge, T. (1991), Job satisfaction and occupational stress in UK
general hospitals nursing staff, Workplace stress; 5:315–323.
Heim, E. (1992), Stressors in health occupations: do females have a greater health risk,
Zeitschrift fur Psychosomatische Medizin und Psychoanalyse, 38 (3), 207–226.
Hendrix, William H, Summers, Timothy P., Leap, Terry L. and Steel, Robert P. (1995),
Antecedents and Organizational Effectiveness: Outcomes of Employee Stress and Health,
in, Organization. In, K. Rowland and G. Ferris (Eds.), Personal Management (pp 390419), Boston: Allyn and Bacon, p. 75.
Hershbach, P. (1992), Work-related stress specific to physicians and nurses working with
cancer patients, Journal of Psychosocial Oncology 10 (2), 79–99.
Hogan, Robert and Hogan, Joyce C. (1982), Subjective Correlates of Stress and Human
Performance. In, Earl A. Alluisi and Edwin A. Fleishman (Eds.), Human Performance
and Productivity, Lawrence Erlbaum Associates, Vol. 3, New Jersey, p. 141.
ILO (International Labor Office) (1984): Automation, Work Organization and
Occupational Stress, International Labor Office, Geneva, p. 171.
Isikhan, V., et al (1998), Kanser hastalar”yyla -cal”y-san sa&gl”yk personelinin t
.ukenmi-slik durumlar”y (Burnout states of health personnel working with cancer
patients, Turkish Journal of Hemotology-Oncology), Turk. Hematoloji-Onkoloji Dergisi
8 .152–146 ,)3(
Ivancivich, JM and Matteson, MT (1980), Stress and Work: A Managerial Perspective,
Scot Foresman and Company, pp: 118-120.
Jick, T. D, and Mitz, L. F. (1985), Sex Differences in Workplace stress, Academy of
Management Review, 10, pp: 408-420.
Kahn, Haward, and Cooper, Cary L. (1993), Stress in the Dealing Room, Routledge,
London, p. 33.
June 24-26, 2009
St. Hugh’s College, Oxford University, Oxford, UK
21
2009 Oxford Business & Economics Conference Program
ISBN : 978-0-9742114-1-1
Kahn, R. L. (1978), Job Burnout: Prevention and Remedies, Public Welfare, 16, pp: 6163.
Kahn, R. L., Quinn, D.M., Snock, R.P. and Rosenthal, R.N (1964), Organisational Stress:
Studies in Role Conflict and Ambiguity. New York, Wiley.
Kaufman, H. G. (1982), Professionals in Search of Work: Coping With the Stress of Job
Loss and Underemployment, John Wiley and Sons, New York, p. 62.
Kivisto, J. and Couture, R.T. (1997), Stress management for nurses: controlling the
whirlwind. Nursing Forum 32 (1), 25–33.
Krohe, James Jr., (1999), Workplace Stress, Across the Board, 36 (2), p. 36.
Lee, C. (1986), Professionals in medical settings: the research evidence in the 1980s.
Journal of Organizational Behavior, Management 8, 195–213.
Locke, Edwin A. (1976), “The Nature and Causes of Job Satisfaction.” The Handbook of
Industrial and Organizational Psychology, edited by M.D. Dunnette. Chicago, IL: Rand
McNally College Publishing Company, London, p. 4, pp. 1297-1347.
Maslach, Christina and Florian, Victor (1988), Burnout, Job Setting, and Self-Evaluation
Among Rehabilitation Counselors, Rehabilitation Psychology 33:85-93.
Mawardi, B.H. (1979), Satisfactions, dissatisfactions, and causes of stress in medical
practice, Journal of the American Medical Association, 241, 1483–1486.
Mclean, Albert (1980), Workplace Stress, Reading Mass: Addison-Wesley, pp: 126-127.
Mclean, Alan A. (1979), Workplace Stress, Addison-Wesley, Philippines, p. 34.
Mechteld, R.M., Visser, Ellen M.A., Smets, Frans J., Oort, Hanneke and de Haes, C.J.M.
(2003), Stress, satisfaction and burnout among Dutch medical specialists, Canadian
Medical Association or its licensors, CMAJ, FEB. 4, 2003; 168 (3)
Modern Business Reports (1975), Health in Business: How it Affects Executives, Their
Employees and their Productivity, Hamilton, Alexander, English Edition, No E-020, p.
12.
Mowardi, B.H. (1983), Aspects of the impaired physician. In: B. Farber (EB, ed. ) Stress
and Burnout in the Human Service Professions. New York: Pergamon Press.
Pearlin L. , Scholer C. (1978). The Stress Process. Journal of Health and Social Behavior,
22, 337-356.
Peterson, M.F., Smith, P.B., Akande, A., Ayestaran, S., Bochner, S., Callan, V., Cho,
June 24-26, 2009
St. Hugh’s College, Oxford University, Oxford, UK
22
2009 Oxford Business & Economics Conference Program
ISBN : 978-0-9742114-1-1
N., Iscte, J., D'amorim, M., Francois, P., Hofmann, K., Leung, K., Lim, T., Mortazavi, S.,
Munene, J., Radford, M., Ropo, A., Savage, G., Setiadi, B., Sinha, T., Sorenson, R., &
Viedge, C.(1995), Role Conflict, Ambiguity, and Overload: A 21 Nations Study,
Academy of Management Journal, 38 (2), pp: 429-452.
Ramirez, A.J., Graham, J., Richards, M.A., Cull, A. and Gregory, W.M. (1996), Mental
Health of Hospital Consultants: The Effects of Stress and Satisfaction at Work, Lancet;
347:724-8
Ramirez, A.J., Graham, J., Richards, M.A., et al (1995), Burnout and Psychiatric
Disorder among Cancer Clinicians, British Journal Cancer 71, 1263–1269.
Renzi, C., Tabolli, S., Ianni, A., di Pietro, C. and Pudd, P. (2005), Burnout and Job
Satisfaction Comparing Healthcare Staff of a Dermatological Hospital and a General
Hospital, JEADV, 19, 153–157
Richardsen, M.A. and Burke, J.R. (1991), Occupational Stress and Job Satisfaction
among Canadian Physicians, Work and Stress 5 .313–301 ,)4(
Rockwell, Schulz, Greenley, James R. and Brown, Roger (1995), Organization
Management, and Client Effects on Staff Burnout, Journal of Health and Social
Behavior, Vol. 36 (December): 333-345
Schaufeli, W.B. and Enzmann, D. (1998), The burnout companion to study & practice; a
critical analysis. London: Taylor and Francis, p. 77-8.
Scheiber, S.C. (1987), Stress in physicians. In: R. Payne and J.R. Firth-Cozen (Eds.),
Stress in the Health Professions. Wiley, New York, pp. 23–44.
Schermerhorn, Hunt J., Jr, and Osborn, R. (2003), Organizational Behavior, John Whiley,
New York.
Spielberger, Charles (1979), Understanding Stress and Anxiety, Harper and Row
Publishers,
Stark, Nancy (1999), How Do You Reduce Stress in The Workplace? Baltimore Business
Journal, 16 (42), p. 19.
Syme, S. L. (1975), Social and Psychological Risk Factors in Coronary Heart Disease,
Journal of American Heart Association, 44, pp: 17-21.
Tattersall, J.A., Paul, B. and Stirling, P. (1999), Stress and coping in hospital doctors,
Stress Medicine, 15, 109–113.
Tyler, P. and Cushway, D. (1992), Stress, coping and mental wellbeing in hospital nurses,
Stress Medicine, 8, 91–98.
June 24-26, 2009
St. Hugh’s College, Oxford University, Oxford, UK
23
2009 Oxford Business & Economics Conference Program
ISBN : 978-0-9742114-1-1
Tyson, P.D. and Pongruengphant, R., (1996), Avoidance as a coping strategy for nurses
in Thailand, Psychological Reports, 79, .594–592
Ullrich, A. and, Fitzgerald, P. (1990), Stress experienced by physicians and nurses in the
cancer ward, Social Science & Medicine, 31 .1022–1013 ,)9(
Vedat, Isikhana, Turhan, Comezb, Zafer, M. and Danis, M. (2004), Job stress and coping
strategies in health care professionals working with cancer patients, European Oncology
Nursing Society, 234–244
Wardwell, W. I, Hayman, M.M. and Bahnson, C.B. (1964), Stress and Coronary Disease
in Three Field Studies, Journal of Chronic Disease, New York, 17, pp: 73-84.
Whippen, D.A. and Canellos, G.P. (1991), Burnout syndrome in the practice of oncology:
results of a random survey of 1,000 oncologists, Journal of Clinical Oncology, 9 (10),
1916–1920.
Wilkinson, S.M. (1995), The Changing Pressures for Cancer Nurses. European Journal
of Cancer Care 4, 69–74.
Williams, Eric S. and Konrad, Thomas R. Physician stress: results from the physician
work life study, Stress and Health, 18: 37–42, 38-42
Yousefy, A.R. and Ghassemi, G.R. (2006), Job Burnout in Psychiatric and Medical
Nurses in Isfahan, Islamic Republic of Iran, La Revue de Santé de la Méditerranée
orientale, Vol. 12, No 5, 2006, 662- 669
June 24-26, 2009
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