Posted at 12.11.2018
Problems of stress in a variety of professions have drawn the attention of psychologists of different directions for a long time. A big most classical studies have shown that extended stress exposure leads to such adverse effects as the reduction in overall mental steadiness of the organism, the emergence of dissatisfaction of its activities, the tendency to reject tasks in situations of increased requirements, setbacks and defeats. Research of the factors that cause similar symptoms in different activities implies that there's a variety of professions when a person starts to feel self emotionally drained by the inner need for continuous contact with other folks. It really is a well-known idea that the medical profession like any other is related to interpersonal connection, so timely diagnosis and correction of such violations are relevant to doctors and nurses. Thus, we will discuss stress in the medical field incorporating its effect on professional doctors' activities and personal lives.
First of all, the interest in occupational stress in doctors is provoked by basic trend for the humanization of modern science, which is shown in a wide variety of business - from the theory of management clubs, to the essential philosophical epistemology and technique of science. One manifestation of the trend is attracting the attention of experts to the subject of professional activity, specifically the effect of chosen profession on the type and identity of the person.
Another reason behind interest in this issue is the tightening of requirements for the experts of different profiles and requirements tempo and rhythm of a modern lifestyle. The requirements for representatives of the so-called 'helping professions' need additional attention, because their psycho-physiological condition directly influences the potency of their professional activities, whose importance in modern-day society can hardly be overestimated. In particular, studying of the problem in the annex to the medical staff is the question of extremely high importance, because exactly a human being life is usually the possible 'price of any mistake' in their activities. Thus, the group of observation is doctors who provide mental, urgent, or palliative care and attention and doctors in hospices.
In psychology under the word 'stress' we ought to understand the mental stress that occurs in humans consuming complicated, difficult, adverse conditions of activities and lifestyle, or in special, extreme situations. As the stressors (the factors resulting in the go up of human stress in short-term, and to the development of severe, long-lasting experience) can be adverse physical effects of environmental emergencies, physical and psychological injury, etc.
Mental stress that arises consuming stressors may be a useful adaptive value, mobilizing visitors to overcome troubles. This occurrence, for example, established fact to sports athletes or stars, 'prestarting enjoyment' which serves as a environment for the approaching activities. However, if stress is too high as a result of intensity of vulnerability or its unexpectedness, recruiting may be inadequate to handle stress, and it starts to have a destructive effect on the person until the appearance of physiological disorders and complete disorganization of individual life.
Observing stress factors among doctors in hospices we see that exactly among people of this occupation the challenge of occupational stress acutely declared itself currently, because in the modern post-industrial modern culture, people's frame of mind to work is changing at a rate that does not run into any previous generation. In developed countries, especially today, when the economical crisis continues, staff are increasingly losing self confidence in the stability of their own public and material position, warranty at work, and material well-being. Competition for the prestigious and highly paid job is quite high nowadays. On the one hand, parallel operations are going for a narrow specialization in the profession, and on the other side - the globalization of related companies is popular. Demand of the labor market is changing speedily and facing some complications, one can not completely realize the gathered energy due to physiological stress. Because of this this energy starts to destroy individuals character and spirit. In this case, rather than completely normal stress reactions the organism commences to actually "tear aside" the mechanisms of distress, when the energy can't be came to the realization in constructive activities.
As a consequence, a mental, psychological stress associated with stress at work raises. People find in their habit symptoms of revealed panic, depression, emotional burnout syndrome, psychosomatic disorders and other malfunctions. It contributes to growing reliance on psychoactive chemicals, including alcohol, tranquilizers and other psychotropic substances. Thus, the info offered in Dollard, Winefield & Winefield work shows that 81, 4 % of examined doctors, 85, 9% of nurses and 79, 8% of medical students use alcohol. Also 33, 3% of surveyed students regularly drink beer and other alcoholic beverages. (Dollard, Winefield & Winefield, 2003).
Thinking about the continuing future of medical students and relating to Levey we see that "medical students are inundated with stress from the start of these medical training as they try to adjust to changes in lifestyle and increasing inconveniences incurred by the requirements of medical education. Characteristics commonly associated with medical training and identified as situational or professional stressors include: variable hour shifts, sleep deprivation, cumbersome administrative obligations, poor administrative support, and curriculum overload" (Levey, 2001). Dollard, Winefield & Winefield stated that "Additional characteristics are: recognized lack of professional knowledge and skills, healthcare plan changes, difficult patients, patient health care, life and fatality situations, and surprising shill in academics performance. Further stressors mentioned in the literature include family obligations, incurring credit card debt, lowered chances for cultural, leisure, or physical activities, decreased support network anticipated to relocation, social and minority issues, and insufficient coping skills" (Dollard, Winefield & Winefield, 2003).
The interest for the topic of stress in the medical field was provoked by Wicks' words who wrote in the foreword for his own e book, describing the appearance of stress and hardships of medical profession, the following: "Who in our midst has not determined with the young leukemia patient who's refractory to treatment and frightened to loss of life, or the midcareer professional deeply unresponsive and too young to experienced this massive stroke, or parents hoping to absorb to their consciousness the rapid accidental death of a child? Rather than the afflicted's "Why me?" the caregiver's frightened imponderable becomes "Why not me? What spin of the dice, what action of fate, what divine intervention preserves me from any one of the circumstances?" What makes it easy for health professionals and nurses to confront these patients and circumstances day after day with caring and therapeutic fix and walk the total amount beam between the paralyzing concern with their own mortality and the numbness of emotional disengagement or indifference? Even though the hospital environment is the epicenter of personal publicity, the reminders are distributed one's day from office trips with patients to calls with distraught family. In each encounter, we see ourselves separated from our patient's circumstances by the luck of the get but believe that at a unconscious level that people are somehow shielded. It's like wearing a Red Combination arm badge in the battlefield. " (Wicks, 2006) This expression deeply effects on people who work in the medical field and we can say with confidence that the structure of specialized medical manifestations of occupational stress among specialists of the 'helping' professions (so-called 'emotional burnout') includes different features that gather this occurrence with the amount of traditional mental (such as asthenic neurosis), and psychosomatic disorders. This situation suggests the existence of etiopathogenetic framework of occupational stress in psychological level, playing almost the key role in the foundation and development of the phenomenon.
WHO Western Ministerial Meeting (2005) known that the strain associated with work, can be an important issue for about one-third of workers in the European Union. The cost of solving problems related to mental health in this context includes in average 3-4% of gross national income of developed countries (Wicks, 2006).
Observing books about stress in medical field it was discovered that among doctors (as it was mentioned previously the target group because of this task is doctors in hospices) as among other medical researchers, there is a higher incidence of mental disorders compared with the averages in the populace, which is generally considered that it is connected with the peculiarities of the medical job. In 1997, one of the issues of the journal 'Improvements in Psychiatric Treatment' was specialized in the overall theme of mental disorders among doctors with an focus on phenomenology and treatment.
Interviewing Dr. Thomas, who is the doctor in hospice it was found that stress greatly influences not only professional life, but also personal life of any doctor. Dr. Thomas mentioned that "usually the patient's life depends on the well-timed receipt of sufficient health care for high-quality making of which the doctor of hospice requires self-discipline, higher level of attentiveness and clarity of action. The necessity for quick decision-making under hard time constraints and information causes long-term psychological suspense - and, as a result, the introduction of stress. " Dr. Thomas also talked about through the interview that "among healthcare workers experts who are most recognized by an elevated sense of responsibility, determination to always come to the aid for the individual, the desire to be important, the desire to provide internal support, a higher amount of moral work to the individual and the desire to comply with certain ethical-deontological requirements, encounters about their professional competence are in the group of risk for the strain development. "
While making the research of stress in the medical field it was discovered that according to British analysts as it was mentioned by Levey, in 41% of the instances among general experts high levels of anxiety are discovered, and medically evident depression is present in 26% of instances. (Levey, 2001). The third part of doctors use medication for modification of psychological stress, and the amount of alcohol use surpasses the common level.
According to Wicks stress is provoked by three types of factors in the big majority of conditions (Wicks, 2006). In such situation personal role and organizational factors contain the leading place in the medical field.
Personal factor. It describes 'burning up' doctors as sympathetic, humane, delicate, fond, idealists, people-oriented, with the dame time unstable, introverted, obsessed by permanent ideas, "fiery" and easily identifying themselves personalities.
Role factor. The relationship between your role discord, role ambiguity and 'psychological burnout' was discovered many decades before. Wicks mentioned that employment regarding a clear department of responsibility limit the introduction of stress in the medical field (Wicks, 2006). Additionally, doctors who feel fuzzy or uneven circulation of responsibility for his or her professional actions, recognize that this factor boosts sharply, even at lower workload.
Organizational factor. The main organizational factors that donate to stress 'burnout' include: high workload, absence or absence of communal support from colleagues and management, insufficient remuneration for work, a higher degree of uncertainty in assessing the work performed; inability to affect decision-making process; ambiguous requirements for the work; the constant risk of fines, monotonous and unpromising activities, the necessity to outwardly show sentiment, that's not conform to fact, lack of holidays, vacations and pursuits outside of the own medical job. Additionally it is necessary to speak about that one of the other critical indicators in the development of stress will be the destabilizing firm of activities and unfavorable mental health atmosphere in the team.
Making the accent on the introduction of stress among doctors of hospice we ought to point out that high medical pressure, twenty-four-hour program with the required obligation, the expectation of difficulties in the health of patients require a high efficient activity of the organism and can be trained as the key professional pathogenic factors. In addition, an aggravating influence on the health of workers has the contact with dying patients when medical worker does not see the excellent results of the own attempts to save the individual and often feels his own weakness. As a result there may be mentioned developing brain disorders by means of neurosis, hypertension, stenocardia, ulcers of the gastrointestinal tract and other health issues. It is clear that professional activities often have an adverse effect on individuals that leads to depression.
The higher medical workload lead to the fact that healthcare worker experience less pleasure from the procedure of his own work. Exceeding regulatory quantity of patients, a huge amount of clerical work-design, low specialized equipment of the office and the long term shortage of drugs also donate to the manifestations of fatigue and nervousness. From the ergonomic factors doctors in the hospice often monitor eye tension, overload of the musculoskeletal system.
Thinking about the way how stress in the medical field pertains to culture you'll be able to say that the recent radical changes in population have yet another psychological burden on the medical staff, since contemporary society needs the bigger quality workers in a much shorter time since financial restrictions are providing health services. Invention activities of health care institutions is targeted on the useful use of technological and technical results and intellectual capacity to increase the number of services, options for their production, to improve quality of treatment and meet patients' needs for high quality medical services, and ultimately - to optimize the amount of health among inhabitants. One of the most part of health professionals who work within an progressive environment, have long working time, overtime, associated with merging positions or additional training workload (training, development of new methods of diagnosis and treatment). Intensification of professional activities impacts the health, assisting to increase the degree of overall incidence and prevalence of long-term diseases.
In addition to the aforementioned observed facts Dr. Thomas explained that "people employed in health care facilities are often subjected to appreciable personal stress. . . They have problems in the private life because they cannot show their emotions to other folks and have the predominant feature of the medical profession - to deny the problems related to personal health. " Because of the research work in the medical field we can state that among doctors in hospice there's a widespread proven fact that the stress at work is like failing and doctor's own weakness. That is why stress telephone calls denials predicated on the feeling of guilt and leads to the actual fact that doctors have many challenges in admitting of the existence of these problems, respectively, it is difficult to talk about and solve them timely.
Thinking about the negative impact of pressure on the work of any doctor we should pay the specific attention to the actual fact that development of this state contributes to certain personality attributes - a high level of psychological lability (neuroticism), high self applied control, particularly when expressing negative emotions with the desire to reduce them, the rationalization of the motives of personal patterns, a trend to increased stress and anxiety and depressive reactions associated with unattainability of 'inner standard' and blocking negative feelings, rigid personality structure. The paradox is the fact that the power of healthcare workers to deny their own negative thoughts can often be a power in their hands, but often it becomes their weakness. Therefore it is useful to understand that we are always a part of our problem, or part of these solutions is always in our mind.
Thus, the fieldwork shows that the symptoms of "burnout" is combined with the daily, regular professional work, often requiring from medical professionals a sufficiently powerful, not spontaneous, unimportantly issue, but for different reasons psychologically extreme communication with patients, and therefore it is not associated using its extreme conditions. So, it becomes clear why frequency and depth of this syndrome are higher among oncologists and doctors in hospice than among doctors or traumatologists.
It is impossible to leave without attention the fact that the limitation of the likelihood of using existing personal potential, the monotony of work, a higher degree of uncertainty in the evaluation of the task, dissatisfaction with social status are observed among the characteristics of communicative professions that have a substantial impact on the introduction of stress. In support of after the above numerated factors doctors emphasized that they considered low pay and poor working conditions as stress factors, considering them important, but not leading, as it often seems to be the resources of occupational stress in health care workers.
Conformity / fail capacities of professional in the medical field and sociable conditions of his activities lay in the concentrate of the challenge of occupational stress. Therefore, this matter was explored in intricate of specialist communication job and its interpersonal environment. Emotional infectiousness 'burnout' syndrome, which also emphasizes its communal nature plays also an important role in the talk of the info in this task.
In conclusion, stress in the medical field and occupational stress in its vast sense are not the challenge of 'difficult' people, but the challenge of 'difficult' (unsolved) conditions in the relationship and framework of interpersonal relations, fuzzy symbols of social roles and responsibilities, lack of emotional support from counterparts and leaders.