TABLE OF CONTENTS
Title Page – – – – – – -i
Approval Page – – – – – – -ii
Certification – – – – – – -iii
Dedication – – – – – – -iv
Acknowledgement – – – – – – -v
Abstract – – – – – – -vi
Table of contents – – – – – – -vii
CHAPTER ONE
1.0 Introduction – – – – – – -1
1.1 Background of study – – – – – – -1
1.2 Statement of problem – – – – – – -3
1.3 Objectives of study – – – – – – -4
1.4 Significance of study – – – – – – -4
1.5 Scope of study – – – – – – -5
1.6 Operational definition of terms – – – – -5
1.7 Literature review – – – – – – -6
CHAPTER TWO
2.0 Theoretical background – – – – -11
2.1 Stress – – – – – – -11
2.2 Neuro-anatomy of stress – – – – – -12
2.3 Effects and symptoms of stress – – – – -16
2.4 Occupational stress – – – – – – -17
2.4.1 Categories of Occupational stress – – – – -18
2.5 Causes of Occupational stress – – – – – -20
2.5.1 Work Problems – – – – – – -0
2.5.2 Role ambiguity and Role conflict – – – – -21
2.6 Burnout – – – – – – – -21
2.7 The radiography working environment – – – -23
2.8 Stress management – – – – – – -24
CHAPTER THREE
3.0 Research Methodology – – – – – -27
3.1 Research Design – – – – – – -27
3.2 Location of study – – – – – – -27
3.3 Target Population – – – – – – -27
3.4 Sample Technique – – – – – – -27
3.5 Subject Description – – – – – – -27
3.6 Instrument for Data collection – – – – -28
3.7 Method of Data Collection – – – – – -28
CHAPTER FOUR
4.0 Data analysis and Presentation – – – – -29
4.1 Data analysis – – – – – – – – -29
4.2 Data presentation – – – – – – -29
CHAPTER FIVE
5.0 Discussion, Summary of findings, Recommendations, Limitations, Areas of Further Research – – – – – -49
5.1 Discussion of findings – – – – – -49
5.2 Summary of findings – – – – – – -52
5.3 Recommendations – – – – – – -52
5.4 Limitations of the study – – – – – -53
5.5 Areas of further research – – – – – -53
References
Appendix I
List of Tables
Table 1a: Sex and Age of Respondents
Table 1b: Levels of Education and Years of working experience
Table 1c: Respondents hospitals and Rank
Table 2a: Incidence of Occupational stress in the department
Table 2b: Average number of patients received in the various hospitals
Table 3: Workload pattern among radiographers in the department
Table 4: Sources of occupational stress among radiographers
Table 5: Effects of occupational stress among radiographers
Table 6: Relationship between hospitals on the rate of occurrence of occupational stress in the department
Table 7: Relationship between hospitals on the time of occurrence of occupational stress in the department
Table 8: Relationship between the workplace patterns among radiographers in the hospitals
Table 9: Relationship between sources of occupational stress among radiographers in both hospitals
List of Figures
Figure 1: Rate of Occurrence of stress among radiographers
Figure 2: Time of occurrence of occupational stress among radiographers
Figure 3: Stress management in the workplace
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF STUDY
Stress can be defined as an interference disturbing an individual’s well being physically, emotionally and mentally. It can be categorized based on its physical and physiological effects on a person, and can be a mental, physical or emotional strain1. When this stress is related to a profession it is termed Occupational Stress2. This includes thoughts, feelings and physiological reactions that can occur as a result of stressful events3, which can on the long run be detrimental to the professional in relation to his profession. Occupational stress can occur in various professions but in line with this research, the researcher is relating the incidence of occupational stress in the radiography profession.
The radiographer also known as a medical radiation technologist and a medical imaging scientist is someone who performs imaging of the human body for diagnosis and treatment of medical problems. His field of work varies from hospitals to clinics, medical laboratories and private practice4, and sometimes in the industry (when it comes to industrial radiography). Along the line in his field of work he undergoes some stress by various factors like role ambiguity which can be due to the unavailability of enough staff in the medical centre he is working in, work related problems based on the challenges he undergoes when carrying out medical investigations and diagnosis due to the type of equipments he is using to carry them out, role conflict, perceived stress, and social support3. Other factors are negative work load, isolation, extensive hours worked, toxic work environments, lack of autonomy, difficult relationships among coworkers and management, management bullying, harassment and lack of opportunities or motivation to advancement in one’s skill level5. These factors cause stress that has a lot of negative effect on the radiographer as it tends to affect his relationship with the patient, his family, his efficiency in the department and most times the stress affects his health. Occasionally stress experienced by radiographers can adversely affect patient care and may possibly trigger psychological conflicts in the radiographer, which concomitantly grinds efficiency in service delivery6.
Occupational stress among radiographers can also occur when there is a discrepancy between the demands of the environment or workplace and an individual’s ability to carry out and complete these demands and this is known as Cognitive Appraisal2. Occupational stress among radiographers can be divided into Biomechanical stress e.g musculoskeletal symptoms which occurs due to constant stress and strain of the upper and lower back in the course of manipulation of old x-ray units2, these symptoms cause pain, disability and could lead to loss of employment of workers7; and Psychosocial Stress which is stress involving psychological processes and social processes8.
Daugtherly observed that occupational stress can be caused by tension, a situation or a factor which can lead to burnout9. Duquette et al also observed that in an environment where radiographers are very few, there’s a tremendous increase in workload, which in theoretical terms predisposes the individual to increased occupational stress and if this is not checked, burnout ensures and this can lead to a state of extreme tiredness combined with feelings of failure and frustration10.
These are some factors that have been noticed by the researcher among radiographers especially those working in the Port Harcourt metropolis. Based on the Association of Radiographers Registration Board of Nigeria, there are only about 500 registered radiographers in Nigeria11, with about only 70 registered radiographers in Port Harcourt Metropolis which translates to increased patient to radiographer ratio. In addition to this, the current health sector reform in Nigeria has laid an emphasis on efficiency and increased service delivery to patient’s satisfaction. Therefore this has led to more pressure on the radiographers in trying to increase their services in the department and thus creating a link between high workload and notable stress among radiographers in the nation especially in this region.
There has been a lot of research carried out on occupational stress in the world and also in various aspects of Nigeria as a nation but to the best of the researcher’s knowledge there has been no published study carried out on the Incidence of Occupational Stress among radiographers in this region and this led to the researcher’s objective of evaluating the incidence of occupational stress among radiographers in this region.
1.2 STATEMENT OF PROBLEM
- Occupational stress among radiographers is a study that is researchable in the world today but a well published and documented research on the incidence of occupational stress among radiographers in Port Harcourt metropolis has not been observed by the researcher.
- The researcher has observed various factors that leads to occupational stress among radiographers in other regions, but whether those factor leads to occupational stress in Port Harcourt metropolis has not been observed.
1.3 OBJECTIVES OF THE STUDY
General Objective
- To evaluate the incidence of occupational stress among radiographers in Port Harcourt metropolis.
Specific Objectives
- To determine the work load pattern among radiographers in Port Harcourt metropolis
- To identify the various factors that can lead to occupational stress among radiographers in the Port Harcourt metropolis.
- To determine the effects of occupational stress on the radiographers in Port Harcourt metropolis
1.4 SIGNIFICANCE OF STUDY
This study has a lot of significance which are enumerated below:
- It would give the prevalence of stress in port Harcourt radiographers
- Test, compare and show the level of stress in federal government and state government practicing radiographers
- Help to guide the higher authorities on the employment of staff and the provision of the necessary efficient equipments needed in the radiology department and show how much the equipments would reduce stress among radiographers
- Enlighten radiographers on the necessary skills in stress reduction.
1.5 SCOPE OF THE STUDY
Based on the study to test the levels of stress among private and government radiographers, this study is going to be carried out in a major private hospital in Port Harcourt, Image Diagnostics and two government hospitals; Bright Memorial Hospital (BMH) and University of Port Harcourt Teaching Hospital (UPTH).
1.6 OPERATIONAL DEFINITION OF TERMS
According to the Wikipedia free dictionary Evaluation is a systematic determination of a subject’s merit, worth and significance, using criteria governed by a set of standards. It can assist an organization to assess any aim, realizable concept/proposal, or any alternative, to help in decision-making; or to ascertain the degree of achievement or value in regard to the aim and objectives and results of any such action that has been completed.
Incidence is the act of something happening, it is also the extent of something happening
Occupational stress is any stress involving an occupation or work. Stress is defined in terms of its physical and physiological effects on a person, and can be a mental, physical or emotional strain. Occupational stress can occur when there is a discrepancy between the demands of the environment/workplace and an individual’s ability to carry out and complete these demands.
A Radiographer also known as a radiologic technologist and as a medical radiation technologist performs imaging of the human body for diagnosis or treating medical problems. Radiologic technologists work in hospitals, clinics, medical laboratories and private practice.
Port Harcourt Metropolis is a large city that is a significant economic, political and cultural center for the country Nigeria, and also serves as an important hub for regional or international connections and communication.
1.7 LITERATURE REVIEW
Occupational stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker12. It is not necessarily considered as a detrimental thing as in the early stages because it can actually stimulate the body and enhance work performance6.
However, only when it is continuously stimulated and left unchecked that it would begin to affect a person’s productivity13.
Ugwu et al reported that emotional experience of stress is accompanied by an organized set of responses aimed at reducing stress such as both psychological and social processes. He went ahead to say that stress can emanate either from the work environment or domestic which can impair their ability to function effectively. Their aim was to identify the major predictors and levels of psychosocial stress among radiographers in south eastern Nigeria. They made use of 50 radiographers, 10 from each south eastern state, to conduct the research. 60 questionnaires were compiled based on demographic data, job related measures and job satisfaction, predictors of stress such as role ambiguity, role conflict, work problems, perceived stress and social support. From their results perceived stress was observed to correlate highly with other predictors of stress; role ambiguity correlated with job satisfaction. The study recommends employment of more radiographers by hospital managers, improved ultra-modern equipments, clear role definition and provision of stress intervention programs for radiographers as ways of stress reduction14
In another research byUgwu et althey found out that Occupational stress can be divided into Biomechanical stress and Psychosocial stress which are capable of destabilizing any health care professional. Their aim was to investigate the incidence of occupational stress among radiographers in south eastern Nigeria. 32 questionnaires were used to obtain information on demographic data, biomechanical and psychosocial components; and ways to reduce occupational stress among radiographers. Biomechanical stress symptoms was observed with upper back musculoskeletal symptoms of pain being the most prevalent with 37.5%; Psychosocial stress symptoms were observed with job satisfaction being greater with 61.3% and anxiety level as 45.75%. Their study serves as a baseline for occupational stress and as such more studies should be carried out to advert the setting in of degenerating psychosocial and biomechanical stress conditions.
Ugwu et al also carried out another study andthey concluded that due to the reduced level of Job satisfaction in the south – east, most radiographers embark on role extension into ultrasound to have job satisfaction level ad improve financial status. Therefore the aim of their study was to find out if sonography responsibilities on radiographers, has led to occupational stress. Questionnaires were used as their method of data collection. 48 questionnaires based on demographic data, knowledge of occupational stress and how it affects the duty of radiographers and sonography in terms of Job satisfaction and duty induced anxiety level; and open ended questions on how occupational stress can be reduced were used to analyse their data giving the results of upper back and middle back pain (55.6%) being more prevalent in sonographers while hand/finger pain (42.9%) more prevalent in radiographers as biomechanical symptoms. In terms of Job satisfaction and anxiety level, radiographers showed 64.29% and 42.86% respectively. Their study therefore showed that sonographers had increased biomechanical stress symptoms and anxiety level, therefore sonography responsibility among radiographers does not improve stress management nor suppress stress itself, but may increase the occurrence of psychosocial and biomechanical stress levels.
According to EronduOkechukwu et al in their research, burnout among health care workers has implications on their overall productivity. Using 65 Maslach Burn-out Inventory Questionnaires to analyse their data, they observed that Radiographers had high levels of first stage Burnout (Emotional exhaustion), low levels of the second stage of Burnout (Depersonalization) and moderate levels of the third stage of burnout (personal accomplishment) with workload, job satisfaction and years of working experience as the major predictors of burnout for radiographers in South eastern Nigeria15.
Lua’s study informed the researcher that health workers have long been known to be a highly stressful group and they were worryingly associated with higher rate of psychosocial distress than many other workers of different sectors. Their aim in carrying out their study was to compare job stress levels of health care employees based on occupational sector (government versus private), category (professional versus supportive) and specialisation (specific job descriptions) in peninsular malaysia. A sample of 223 health care providers enrolled from 7 health care institutions (East coast = 55%, mean age = 30yrs; female = 78.9%, <2yrs experience = 35.9%; government based = 48%; supportive = 62.8%, private = 46.6%) completed a respondent bio data form and a 9 point scale Job stress survey (Job stress, Job pressure, Lack of support). They observed no significant difference between government and private based sectors in term of stress severity, frequency and index, but according to the mean rank government health care providers were experiencing more occupational stress. Meanwhile supportive workers (radiographers mostly) and research based professionals were frequently stressed, and professionals were more stressed severely. The overall level of work related stress among malaysian health care employees was within management but certain job category and specialisation particularly radiographers require closer attention due to their comparatively higher level of stress16.
A review on Joe et al’s studyindicates that stress is the adverse reaction people have to excessive pressures or other types of demand placed on them. Work related stress is caused when there is a mismatch between job requirements and the individual’s abilities, resources or needs and it can affect individuals physiologically, psychologically and behaviourally and their outcomes include lower levels of self esteem, job satisfaction and motivation as well as higher blood and cholesterol levels, depression, anxiety, ulcers and heart disease. Stress management interventions is any activity, program or opportunity initiated by an organization, which focuses on reducing the presence of work related stressors or on assisting individuals to minimize the negative outcome of exposure to these stressors. Stress management interventions consists of primary, secondary and tertiary prevention strategies where primary interventions attempt to eliminate the source of stress in organization by focusing on changing the physical or socio-political environment to match individual needs and granting them more control over their work situation; secondary interventions help individuals manage stress without trying to eliminate or modify work place stressors. Tertiary prevention strategies seek to assist individuals who are expecting on-going problems emanating either from the work environment or their work lives17.
Based on another study, stress management techniques are designed to help employees modify their appraisal of stress situation or deal more effectively with the symptoms of stress e.g muscle relaxation, meditation, biofeedback, and cognitive behavioural skills which can lead to improved employee retention, improved stress coping skills and reduced stress. Interventions for work related stress appear to have some positive impact. Cognitive behavioural interventions, proves to be more effective as they focus on complaints, psychological resources and responses and perceived quality of work life18.
Following the review of related literature, the researcher observed that no work has been carried out to evaluate the incidence of occupational stress among radiographers in Port Harcourt metropolis. Furthermore there is no documented literature on stress management skills to help reduce stress among radiographers. Therefore, this work is to identify the workload experienced by the radiographers due to the increased ratio of patient to radiographers, and relate the findings with government and private hospitals, and also to determine the occurrence of stress management skills in reducing stress, in the workplace among the radiographers.
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