Research Booklet(1)

8/6/2019 Research Booklet(1)

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CONTENTS

I. Introduction & BackgroundII. ObjectivesIII. Literature ReviewIV. Study DesignV. Eligibility CriteriaVI. Sampling Size & TechniqueVII. Ethical ConsiderationsVIII. Data Collection,Methods,Instruments,MeasurementsIX. Data management & Analysis PlanX. ResultsXI. DiscussionXII. ConclusionXIII. SuggestionsXIV. ReferencesXV. AcknowledgementsXVI. SummaryXVII. TimelineXVIII. Budget


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Consequences of stress include changes of behavior and attitude of theperson.

Diarrhea, anxiety, insomnia, headache, and psychological depression are thetypical symptoms of stress.

It can also be linked to an upset stomach, back pain, and trouble sleeping. It can weaken the immune system, making it harder to fight of disease. Stress can worse the disease and lead to depression and ultimately

unsatisfactory professional performance.

The proportion of doctors and other health professionals showing above

threshold levels of stress have stayed remarkably constant at around 28%, whether

the studies are cross sectional or longitudinal, compared with around 18% in the

general working population. 1 What has changed over the years is that, contrary to

the experience of the two registrars, doctors have become used to discussing thetopic of stress and even to admitting to it in themselves. They are more aware of their

colleagues' symptoms than they were, which means that they may be more likely to

help colleagues through a difficult time or suggest they get help when they need it.

Interest in stress has broadened as organizations have finally accepted that stress

costs them vast amounts of moneythrough absence, litigation, and the fact that

unhappy, tense, tired, or anxious doctors do not produce quality care.2 Indeed,

stressed doctors may make considerably more errors than those whose sense of well

being is high.3 This is particularly true if they have insufficient hours of sleep;4

however, we now know that working long hours in itself is not the cause of problems

provided a doctor feels well supported. Stress and all its related problems come both

from the workplace and from the individual. Individual causes may be to do withpersonality or with ways of thinking, such as being particularly self critical, or having

certain types of unsupportive early family relationships; or they may come from job

related factors such as lack of sleep, poor communication, and poor teamwork.2

Better teams have less stressed staff,5 probably because they support each other,

notice when one person is performing below par, and step in to help.

Objectives

Study level of stress in Doctors Compare stress between doctors of Govt. and Private hospitals Study factors which cause stress.


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A paper attempted to compare job satisfaction and mental wellbeing of male and

female general practitioners[GPs] of England from a quastionnaire study. Female GPs

showed positive signs of mental wellbeing. Conversely, male doctors showed

significantly higher anxiety and depression score than the females. However both

genders were unhappy about rate of pay, hours of work and amount of work they do.

Analysis disclosed 3 job stressors: pressure/interruptions, working

environment/communication, career and goal acheivments.[10]

In a research it was found that main causes of stress in GPs were uncertainity and

insecurity about work, isolation, a poor relationship with other doctors,

disillusionment with role of general practice and an awareness of changing demands.

Factor analysis of work stress in GPs highlighted new contract demands such as

Organizational management changes and communicating with health service

managers, working with practice staff and non-clinical routine.[11]

Materials And MethodologyStudy Design

It was a Descriptive type of study.

Eligibility Criteria

Inclusion Criteria:

y Doctors

y Both sexes

y Doctors currently doing job in a hospital.

Exclusion Criteria:

y Persons having recent accident or mishapy Persons with nervous breakdown

y Persons having any physical disability or any other significant medical issue

y Doctors above 60 years of age.


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Sampling size and TechniqueSample size was calculated usingEpi-info software programme.

Sample Size : 60

Technique : Stratified random Technique

Ethical ConsiderationsWe should properly introduce ourselves first, inform them(the doctors) about our research

and very politely request them to help us with data collection (in our case: questionnaires),

with their full co-operation.

Data collection Methods,Instruments,

Measurements.

Data Collection Methods:-

Specifically designed Questionnaires for socio-demographic characteristics, physical and

mental health, job stress, and satisfaction are to be distributed among Doctors.

Instruments:-

y Questionnaires

Measurements:-

y Frequency Tables (Age/Duration of job)

y Grading of stressy Sex distribution

y Number of working hours

y Proper security

y Frequency of vacations

y Family support

y Average income


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y Graphical representations of the above

y Relation of above factors with the stress level of the doctors

y Comparison of stress among doctors of Govt. and Private hospitals.

Data Management and Analysis PlanMicrosoft Excel was used for the purpose of tabulation, calculations and data management.

RESULTS

Data was collected from 60 Doctors who were currently working in hospitals. 30 doctors

from :

Government hospitals:

y Services Hospital Lahore

y Punjab Institute of Cardiology,Lahore

And 30 from Private hospitals:

y FMH,Lahore

y Umar Hospital,Lahore

y Cardiac..


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Distribution of data in Government hospitals is:

Sex Distribution:

Fig.1 Distribution of data according to sex

Above figure, shows that out of 30 doctors under study 70% i.e.21 were males and 7 werefemales.

Stress Score:

Level of stress along with its frequency was:

Table 1: Stress score with its frequency

and percentage

The table scores stress in 3 levels in which 23.3% doctors have mild stress, 50.0% have

moderate stress and 26.7% suffer from severe stress.

Given below is the graphical representation of the stress scores in the Table.1

Figure.2: Stress score

30%

70%

SEX DISTRIBUTIONfemale male

23.30%

50.00%

26.70%

mild moderate severe

stress score

Percent

stress score Frequency Percent Cum Percent

mild 7 23.3% 23.3%

moderate 15 50.0% 73.3%

severe 8 26.7% 100.0%

Total 30 100.0% 100.0%


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Headache Associated with stress:

Table.2: Headache associated with stress in males and

females

oddratio=0.6

chi-square=0.2922

Table.2 tells us the percentage of males and females who have headache associated with

stress i.e in females 66.7% of the doctors said yes,while 33.3% do not have headache

associated stress.

In male doctors, 73.3% have stress with headache while 26.7% do not have headache

associated stress.

In total 73.3% doctors(including both males and females) have headache with stress while

26.7% do not have headache with stress.

Change in attitude associated with sex:

in many cases behavior of the person is reflected by his/her profession. To study the change

in attitude the results obtained are tabulated below:

CHANGE IN ATTITUDE

sex Yes No TOTAL

female

Row %

Col %

6

66.7

28.6

3

33.3

33.3

9

100.0

30.0

male

Row %

Col %

15

71.4

71.4

6

28.6

66.7

21

100.0

70.0

TOTALRow %

Col %

21

70.0

100.0

9

30.0

100.0

30

100.0

100.0

HEADACHE / INSOMNIA

sex Yes No TOTALfemaleRow %

Col %

6

66.7

27.3

3

33.3

37.5

9

100.0

30.0

maleRow %

Col %

16

76.2

72.7

5

23.8

62.5

21

100.0

70.0

TOTAL

Row %

Col %

22

73.3

100.0

8

26.7

100.0

30

100.0

100.0


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Table.3: Percentage of change in attitude associated with sex

Odd ratio=0.800

Chi-square= 0.068

Studies have shown that in female doctors 66.7% have change in attitude due to stress

while 33.3% do not. On the other hand 71.4% male doctors have change of attitude

because of stress,and 28.6% do not have change of attitude.

FACTORS AFFECTING STRESS

SEX:

To study any effect of gender on the level and degree of stress in the doctors.According to

survey it was analysed that :

Table.4: Stress affected by gender of the doctor

Single Table Analysis

Chi-square df Probability

5.4870 2 0.0643

INCOME:

Income plays a very crucial role not only in the profession of medicine but in every

profession. According to research carried out it was observed that doctors satisfied with

STRESS SCORE

sex mild moderate severe TOTAL

femaleRow %

Col %

5

55.6

62.5

2

22.2

18.2

2

22.2

18.2

9

100.0

30.0

male

Row %

Col %

3

14.3

37.5

9

42.9

81.8

9

42.9

81.8

21

100.0

70.0

TOTAL

Row %

Col %

8

26.7

100.0

11

36.7

100.0

11

36.7

100.0

30

100.0

100.0


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their income had less severe stress while doctors not satisfied with the income were more in

stress.

Table.5: Income affecting stress levels



3.2323 2 0.1987

Working hour:

Stamina and energy levels after continuous work gradually star depleting and therefore tire

the doctor which directly causes stress. Severe form of stress has been seen in doctors

working more than 50 hours a week.

Table.6: Relation of working hours and

stress



STRESS SCORE

enough income mild moderate severe TOTAL

YesRow %

Col %

2

66.7

25.0

1

33.3

9.1

0

0.0

0.0

3

100.0

10.0

No

Row %

Col %

6

22.2

75.0

10

37.0

90.9

11

40.7

100.0

27

100.0

90.0

TOTAL

Row %

Col %

8

26.7

100.0

11

36.7

100.0

11

36.7

100.0

30

100.0

100.0

working hrs mild moderate severe TOTAL

50

Row %

Col %

3

13.6

37.5

10

45.5

90.9

9

40.9

81.8

22

100.0

73.3

TOTAL

Row %Col %

8

26.7100.0

11

36.7100.0

11

36.7100.0

30

100.0100.0


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7.3954 2 0.0248

Family support:Family support and decisions play a very important part in the performance and energy level

of the doctor both directly and indirectly.

Table.7:Family support and stress



.6676 2 0.7162

Security:

Freedom of performance and activity is also dependant upon the security and the

environment in which the doctor is working.Lack of security greatly affects the work and

causes severe forms of stress in 58.8% of the doctors under study.

family support mild moderate severe TOTAL

YesRow %

Col %

7

29.2

87.5

9

37.5

81.8

8

33.3

72.7

24

100.0

80.0

No

Row %

Col %

1

16.7

12.5

2

33.3

18.2

3

50.0

27.3

6

100.0

20.0

TOTAL

Row %

Col %

8

26.7

100.0

11

36.7

100.0

11

36.7

100.0

30

100.0

100.0


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Table.8: Security and stress



11.6279 2 0.0030

Vacations:

Some leaves and vacations for entertainment or rest is necessary in every profession

hence,less vacations lead to frequency of more stress.

Table.9: Security and stress



1.1580 2 0.5605

STRES SCORE

proper security mild moderate severe TOTAL

YesRow %

Col %

7

53.8

87.5

5

38.5

45.5

1

7.7

9.1

13

100.0

43.3

No

Row %

Col %

1

5.9

12.5

6

35.3

54.5

10

58.8

90.9

17

100.0

56.7

TOTAL

Row %

Col %

8

26.7

100.0

11

36.7

100.0

11

36.7

100.0

30

100.0

100.0

STRESS SCORE

proper vacations mild moderate severe TOTAL

YesRow %

Col %

3

33.3

37.5

4

44.4

36.4

2

22.2

18.2

9

100.0

30.0

NoRow %

Col %

5

23.8

62.5

7

33.3

63.6

9

42.9

81.8

21

100.0

70.0

TOTALRow %

Col %

8

26.7

100.0

11

36.7

100.0

11

36.7

100.0

30

100.0

100.0


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PRIVATE HOSPITALS

Sex Distribution:

Fig.3: Distribution of data according to sex

Above figure, shows that out of 30 doctors under study 70% i.e.21 were males and 30% i.e:

7 were females.

Stress Score:

Level of stress along with its frequency was:


mild 5 16.7% 16.7%

moderate 22 73.3% 90.0%

sever 3 10.0% 100.0%

Total 30 100.0% 100.0%

Table.10: Stress score with its frequency and percentage

The table scores stress in 3 levels in which 16.7% doctors have mild stress, 73.3% have

moderate stress and 10.0% suffer from severe stress.

Given below is the graphical representation of the stress scores in the Table.10

70%

30%

Sex Distribution

Male

Female


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Fig.4: Stress Score

Headache Associated with stress:

Table.11: Headache associated with stress

odd ratio=1.125

chi-square=0.0155

Table.11 tells us the percentage of males and females who have headache associated with

stress i.e in females 75.0% of the doctors said yes,while 25.0% do not have headache

associated stress.

In male doctors, 72.7% have stress with headache while 27.3% do not have headache

associated stress.

In total 73.3% doctors(including both males and females) have headache with stress while

26.7% do not have headache with stress.

16.70%

73.30%

10.00%

mild moderate sever

Percent

Percent

HEADACHE/INSOMNIA/FATIGUE

sex Yes No TOTAL

femaleRow %

Col %

6

75.0

27.3

2

25.0

25.0

8

100.0

26.7

male

Row %

Col %

16

72.7

72.7

6

27.3

75.0

22

100.0

73.3

TOTAL

Row %

Col %

22

73.3

100.0

8

26.7

100.0

30

100.0

100.0


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Change in attitude associated with sex:

Table.12: Percentage of change in attitude associated

with sex

odd ratio=0.667

chi-square=0.1705

FACTORS AFFECTING STRESS

SEX:

Table.13: Stress affected by gender of the

doctor



4.1064 2 0.1283

CHANGE IN ATTITUDE

sex Yes No TOTAL

female

Row %

Col %

6

75.0

25.0

2

25.0

33.3

8

100.0

26.7

male

Row %

Col %

18

81.8

75.0

4

18.2

66.7

22

100.0

73.3

TOTALRow %

Col %

24

80.0

100.0

6

20.0

100.0

30

100.0

100.0

sex mild moderate sever TOTAL

female

Row %

Col %

3

37.5

60.0

5

62.5

22.7

0

0.0

0.0

8

100.0

26.7

male

Row %

Col %

2

9.1

40.0

17

77.3

77.3

3

13.6

100.0

22

100.0

73.3

TOTALRow %

Col %

5

16.7

100.0

22

73.3

100.0

3

10.0

100.0

30

100.0

100.0


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INCOME:

Table.15: Income affecting stress

levels



1.5496 2 0.4608

Working Hours:

Table.16:Relation of Working Hours and

stress


STRESS SCORE

enough income mild moderate sever TOTAL

Yes

Row %

Col %

2

25.0

40.0

6

75.0

27.3

0

0.0

0.0

8

100.0

26.7

No

Row %

Col %

3

13.6

60.0

16

72.7

72.7

3

13.6

100.0

22

100.0

73.3

TOTALRow %

Col %

5

16.7

100.0

22

73.3

100.0

3

10.0

100.0

30

100.0

100.0

STRESS SCORE

Working hours mild moderate sever TOTAL

50Row %

Col %

0

0.0

0.0

12

80.0

54.5

3

20.0

100.0

15

100.0

50.0

TOTAL

Row %

Col %

5

16.7

100.0

22

73.3

100.0

3

10.0

100.0

30

100.0

100.0


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8.1818 2 0.0167

Family Support:

Table.17:Family support and stress



1.6364 2 0.4412

Security:

Table.18:Security and stress

STRESS SCORE

family support mild moderate sever TOTAL

YesRow %

Col %

5

20.0

100.0

18

72.0

81.8

2

8.0

66.7

25

100.0

83.3

NoRow %

Col %

0

0.0

0.0

4

80.0

18.2

1

20.0

33.3

5

100.0

16.7

TOTAL

Row %

Col %

5

16.7

100.0

22

73.3

100.0

3

10.0

100.0

30

100.0

100.0

STRESS SCORE

Proper security mild moderate sever TOTAL

Yes

Row %

Col %

4

23.5

80.0

13

76.5

59.1

0

0.0

0.0

17

100.0

56.7

No

Row %

Col %

1

7.7

20.0

9

69.2

40.9

3

23.1

100.0

13

100.0

43.3

TOTALRow %

Col %

5

16.7

100.0

22

73.3

100.0

3

10.0

100.0

30

100.0

100.0


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5.0843 2 0.0787

Vacations:

Table.19:Vacations and stress



2.0455 2 0.3596

..

COMPARISON BETWEEN GOVERNMENT

AND PRIVATE

STRESS:


mild 7 23.3% 23.3%

moderate 15 50.0% 73.3%

severe 8 26.7% 100.0%

STRESS SCORE

prpoper vacations mild moderate sever TOTAL

Yes

Row %

Col %

2

33.3

40.0

4

66.7

18.2

0

0.0

0.0

6

100.0

20.0No

Row %

Col %

3

12.5

60.0

18

75.0

81.8

3

12.5

100.0

24

100.0

80.0

TOTALRow %

Col %

5

16.7

100.0

22

73.3

100.0

3

10.0

100.0

30

100.0

100.0


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Total 30 100.0% 100.0%


mild 5 16.7% 16.7%

moderate 22 73.3% 90.0%sever 3 10.0% 100.0%

Total 30 100.0% 100.0%

stress

score

private govt

mild 5 7

moderate 22 15

severe 3 8

total 30 30

Chi-square=3.93

According to the above graphical representation, it is seen that stress levels vary among

doctors working in Govt and private hospitals. Doctors of private hospitals have less mild

stress ,while more moderate form of stress than doctors of Govt.hospitals. On the other

hand severe stress is seen in doctors of government hospitals rather than private ones.

23.30%

50.00%

26.70%16.70%

73.30%

10.00%

Mild Moderate Severe

stress score

Stress Score Govt. Percent Stress Score Private Percent


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Headache:

headache /

insomnia/fatigue

Frequency Percent Cum

Percent

Yes 22 73.3% 73.3%

No 8 26.7% 100.0%

Total 30 100.0% 100.0%

headache/insomnia/fatigue Frequency Percent Cum Percent

Yes 22 73.3% 73.3%

No 8 26.7% 100.0%

Total 30 100.0% 100.0%

headache private govt

yes 22 22no 8 8

Frequency of headache is seen equally in doctors of both government and private hospitals.

Attitude

change inattitude Frequency Percent Cum Percent

Yes 21 70.0% 70.0%

No 9 30.0% 100.0%

Total 30 100.0% 100.0%

73.30%

26.70%

73.30%

26.70%

Yes No

headache/insomnia/fatigue

Chart Title

Govt. Private


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change in attitude Frequency Percent Cum Percent

Yes 24 80.0% 80.0%

No 6 20.0% 100.0%

Total 30 100.0% 100.0%

change in

attitude

private govt

yes 24 21

no 6 9

Oddratio=0.58

Chi-square=0.8

FACTORS AFFECTING STRESS:

Income

enough income Frequency Percent Cum Percent

Yes 3 10.0% 10.0%

No 27 90.0% 100.0%

Total 30 100.0% 100.0%

enough income Frequency Percent Cum Percent

Yes 8 26.7% 26.7%

No 22 73.3% 100.0%

70.00%

30.00%

80.00%

20.00%

yes No

Change in attitude

Govt. Private


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no 13 18

Odd ratio=0.51

Chi-square=1.67

Vacations:

proper vacations Frequency Percent Cum Percent

Yes 9 30.0% 30.0%

No 21 70.0% 100.0%

Total 30 100.0% 100.0%

proper vacations Frequency Percent Cum Percent

Yes 6 20.0% 20.0%

No 24 80.0% 100.0%

Total 30 100.0% 100.0%

vacations private govt

yes 6 9

no 24 21

40.00%

60.00%56.70%

43.30%

yes No

Proper security

Chart Title

Govt. Private


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Odd ratio = 0.58

Chi-square= 0.80

DISCUSSIONA lot of previous researches have been done on topic of 'Stress level in doctors' but we could'vt

find any research on topic of 'Comparison of stress level among doctors of Government andPrivate Hospitals'

A research was conducted at teaching hospitals of Karachi by Community Department ofAga

Khan Medical University. According to this research 68% doctors were not satisfied their jobs

anr among them 65% were males and 72% were males.[1]

According to a research conducted at Bahawal-Victorea Hospital/Quaid-e-Azam Medical College

Bahawalpur, 56% doctors were not satisfied with their jobs.[2]

According to our research: in government hospitals, 23.3% doctors had mild stress, 50.0% had

moderate stress and 26.7% had severe stress. In private hospitals: 16.7% doctors had mildstress, 73.3% had moderate stress and 10.0% had severe stress.

Research of teaching hospitals of Karachi showed that 45% of doctors reported that job stress

affects their physical health and 53% said that it affects their mental health however these

results were not different in different sex.[1]

According to a research conducted at German Hospital Institute, physicians with exessively

30.00%

70.00%

20.00%

80.00%

yes No

Proper Vacations

Chart Title

Govt. Private


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long working hours had significantly high sum score of health complaints and significantly

increased mental and physical fatigue symptoms [feeling faint,languor,uneasiness,heavy

legs,insomnia,mood changes], GI [nausea,weight loss], heart disorders, chest pain.[3]

According to our research: in government hospitals, 73.3% doctors were having

headache/insomnia/fatigue at the end of working hours. In private hospitals, 75% doctors were

having headache/insomnia/fatigue at the end of working hours.

According to our research: in government hospitals, 66.7% of total females and 71.4%of total

males were having change in their attitude at the end of their working hours. In private sector,

75% of total females and 81.8% of total males were having change in their attitude at the end

of working hours.

According to a study at Karachi overall 56% doctors were not satisfied with level of their

income. It was found that 92% of all the doctors were neither satisfied with the present servicestructure nor with the career prospects in Pakistan.

[1]

According to our research: in government hospitals,90% doctors were not satisfied with their

monthly income. In private hospitals, 73.3% doctors were not satisfied with their monthly

income.

Work has to be done to compare stress level of Government and Private Hospitals so that

better facilities can be given to doctors.

CONCLUSIONBoth the doctors working in Government and Private hospitals are facing a lot of stress. More

doctors of Government Hospitals were suffering from severe stress as compared to doctors of

Private Hospitals. The factors causing stress were different. Lack of proper income, long

working hours, lack of proper security at workplace are causing more stress in doctors of

Government hospitals whereas inadequate number of vacation is causing more stress in

doctors of Private Hospitals. Level of headache at the end of working hours is equal in bothwhereas doctors of Private hospitals feel more change in their attitude at the end of working

hours.


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SUGGESTIONSFollowing measures should be taken to reduce stress level in doctors:

y Working hours should be reduced.

y Income of doctors should be raised so that they can fulfill their necessities of life.

y Families of doctors should support them in terms of their professional life.

y Doctors should be given proper security at workplace.

y Proper vacations should be given.

y Patients should encourage doctors.

y Proper working environment should be given.

y Doctors should be given opportunities for professional growth.

y Work should be done on Government level to reduce stress in doctors.

REFERENCES

1. Wall TD, Bolden RI, Borrill CS, Carter AJ, Golya DA, Hardy GE, et al

. Minor psychiatric disorders in NHS trust staff: occupational and gender

2. Firth-Cozens J

. Interventions to improve physicians' wellbeing and patient care. Soc Sci Med 2001; 52: 215222

[CrossRef][Medline][Web of Science]

3. Jones JW, Barge BN, Steffy BD, Fay LM, Kunz LK, et al

. Stress and medical malpractice: Organizational risk assessment and intervention. J Applied Psychol 1988;

4: 727735


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ACKNOWLEDGEMENTSWe are thankful to all doctors who participated whole heartidely in our research and

encouraged us for highlighting their job stress issues.

Prof. Dr.Shahid Mahmood

Professor / Head of Department of Community Medicine

SIMS/Lahore

Dr. Abdul Rauf

Demonstrator Department of Community Medicine

SIMS/Lahore.

ANNEXURE

Research Booklet(1)

Documents

Transcript of Research Booklet(1)