Transcript Document
THE FOLLOWING
LECTURE
HAS BEEN APPROVED FOR
ALL STUDENTS
BY BIRMINGHAM CITY UNIVERSITY
This lecture may contain information, ideas, concepts and discursive anecdotes that may be thought provoking and challenging Any issues raised in the lecture may require the viewer to engage in further thought, insight, reflection or critical evaluation
More Stress
Ten years on and it still hasn’t gone away
Dr. Craig Jackson Senior Lecturer in Health Psychology
Faculty of Health BCU
www.health.bcu.ac.uk/craigjackson
What we remember about Stress
Definition problems Not just at workplace Work-life Balance Control Demand Personality Cause of many secondary health problems
Stress Summary
Big problems about how to measure it reliably Any workplace / Any person / Any interaction Stress is a natural / healthy response Individual modifiers – personality, behaviour, coping style, perception Some responses to stress are pathological Worker intolerance is higher than ever before Impossible to predict stress reliably – easier to predict intolerance / people Legal obligation clearer than ever Psychosocial hazards unavoidable & intrinsic in some jobs
Stress provides more Questions than Answers
• Why do some people / workers become stress intolerant? • Post-Industrial society? • Who benefits from this? • Too much personal freedom? • Celebrity culture - nobody wants the bad jobs? • What happens to stress-prone workers? • Who is to blame for being stressed? • Who is to blame for being ill?
It’s not the Building – it’s the Job . . .
Air quality
Chemical pollutants Air con Ventilation Dust Tobacco
Space
Crowding Isolation
Noise
Equipment Telephones Others
Lighting
Artificial Glare Control
Equipment
Printers PC’s
Job content
vdu’s Monotony Overload
Organisation
Control, communication, feedback
Is STRESS the common link with SBS?
Kerching!!!!
Percentage of employees working less (Europe 1990)
Percentage of European employees working <16 hrs per week, and > 48 hrs per week, 1990 20 <16 >48 % 10 0 B DK F If graph was males only?
G GR NL IRL I LU P E UK AV
Employers >40hrs per week as % of labour force, 1996
100 Male Female 80 60 40 20 0 ILO Source: ILO
Potential effects
Stress Fatigue Exposure cardiovascular mental health immune system gastrointestinal musculoskeletal social effects performance impairment safety problems over-exposure
Potential Health Risks
How Widespread is it Really ?
• Mental health problems (some) • Somatic symptoms • Consumption consequences • CHD • Cancers • Infection • Immuno-suppression
Over investigated ?
Dutch truck drivers Taiwanese Casino staff Spanish fishermen Indian shoemakers Lebanese bank tellers
Work Life Balance?
Is this a reality?
More of us working from home than ever More of us working on-the-road than ever
Under Attack from all Angles
No longer “safe” in your own homes
Luke Williams
I think they do spoil relationships & cause alot of arguments. My g/f has facebook (i do 2) and she seems 2 add more bois thn gals n the otha day i was lookin at hers n thers a new boi on ther n it sez thy hooked up n she sed she dnt kno who it is, i dnt kno wot 2 think? We also argue bare bout it...so i think it does cause problems.
www.isma.org.uk
Performance effects
Accuracy
• Accuracy drops • Errors increase • Near-misses increase • Accidents increase • Inefficiency increases • Speed increase (some tasks)
Attitudes
• Risk taking increases • Reduced attention to Health & Safety of colleagues • Reduced compliance with rules
“Usefulness of Stress” Model
potential for change?
no yes no yes make changes
am i happy?
alternative plan: is my work… safe?
yes fun?
pleasant?
no valued?
infinite options infinite options should i worry about this?
should it make me ill?
no could it make me ill?
does it make me ill?
yes yes Stress!
someone must act on this
Performance Indicators
Objective Physical health Quality control Performance Accidents Errors Near misses - recording problems Mental health problems Erratic / out of character behaviour – subjective Disputes Short term absence Staff turnover Trivial complaints Poor timekeeping Subjective
Methods of Assessing Stress
Questionnaire Assessment Performance: Typical vs Maximum Checklist approach “Normal” and “Abnormal” behaviours Systematic scoring principles Qualitative classification cases stressed dysfunctional stress-prone healthy
Psychological tests
Occupational & clinical odd mix Testing standards blasé attitudes over familiar
There is too much pressure to get everything done on time If I have a personal problem, I talk to people about it I often feel drained and tired I get headaches at the end of the day I feel much better at weekends My partner asks me how my day has been
Administration types open controlled supervised managed Provides… consequences perceptions perceived sources of stress agree not sure disagree
Rights of test takers #1
ITC Guidelines BPS is only recourse at present www.bps.org.uk
State purpose outcomes?
specific tests used?
evidence of relevance & appropriateness?
Clarity of procedure administration method?
competence of administrator?
locations suitable?
Inquiries and complaints handled by?
competence of handler?
what actions will result?
fair treatment?
Rights of test takers #2
Test information scoring interpretation evidence of competence communication of scores accurate and meaningful communication of scores confidentiality of scores who can access scores and why?
storage of scores / data Competence certificates of competence in testing monitor competence awareness of personal limitations
Management Prevention & Control for Nurses
Three possible stress-related situations (may co-exist) Avoidable Psychosocial Hazards long-term Intrinsic Psychosocial Hazards short term intermittent unpredictable External Psychosocial Hazards domestic issues susceptibility modification process
Avoidable psychosocial hazards
Eliminate exposure Reduce exposure Control exposure
Change physical environment Change work organisation Provide extra resources Management / employee training Career development systems Increase participation Increase control Policies to identify and address future problem issues
Intrinsic & External Psychosocial Hazards
INTRINSIC HAZARDS
• Safe systems of working • Training and education – Does this Work though? ? ? • PTSD counselling / debriefing – Does this Work though? ? ?
EXTERNAL HAZARDS
• Provide protection and rehabilitation where necessary • Counselling services • Stress management training • Health promotion activities • Information relating to specific problems
(gambling, alcohol, substance abuse, domestic)
Court of Appeal Guidelines (16 points)
Individuals who do not notify their employer of any problems are less likely to to succeed in claiming compensation
Employers entitled to assume employee can withstand normal job-pressure unless any vulnerability or problem is known
No occupations should be regarded as intrinsically dangerous to mental health
Employers offering counselling and access to treatment unlikely to be found in breach of duty
Employers not in breach of duty if only option is to demote or fire employee, if a willing worker continues in same job
Necessary to identify all steps employers (could) have taken before finding them in breach
Evaluate effectiveness of control measures
Perceptions of employees Mental health of employees Physical health of employees Performance Absenteeism Behaviour Turnover
Post Traumatic Stress Disorder (PTSD)
Response to specific traumatic / extreme event DSM IV Diagnostic condition & ICD-10 Diagnostic condition 1. Experience intense fear 2. Persistent re-experience 3. Avoidance of associations 4. Persistent increased arousal since event 5. Flashbacks Associated most with Disasters and Warfare Not new - 6th Century BC Every conflict since American Civil War in 1863 A COMPLETELY POLITICALLY MOTIVATED DIAGNOSIS “Shell-Shock” “Battle fatigue” “Combat Syndrome” NOT GULF WAR SYNDROME
Stress as a source of Entertainment
Does any other human problem get this attention?
Psychosocial Hazards
• Commonplace consideration in last 9 years • Not straightforward • All workplaces have potential to expose workers to psychosocial hazards • All social relationships have potential for stress • Little relation between stress incidents and occupational status • Stress-Boom in last 7 years – VERY BIG INDUSTRY • Intolerance of work in environments deemed psychologically stressful
“suffering from” & “recognising stress” rapidly increasing issues
Recommended Reading
Carroll D, Davey Smith G, Sheffield D, Shipley MJ, and Marmot MG. Pressor
reactions to psychological stress and prediction of future blood pressure:
data from the Whitehall II study. BMJ 1995;310:771-775.
Chen C, David AS, Nunnerley H, Michell M, Dawson JL, Berry H, Dobbs J, and Fahy T. Adverse life events and breast cancer: case-control study. BMJ 1995; 311: 1527-1530.
Jackson CA. Psychosocial Hazards. In Smedley, J et al. (eds) Oxford Handbook of Occupational Health. Oxford. Oxford University Press; 2007. Jackson CA. Psychosocial Aspects of the Workplace. In Aw, T.C et al. (eds) Occupational Health Pocket Consultant (fifth edition). Oxford: Blackwell Scientific Publishing; 2006. 191-201 Jackson CA and Cox T. Health and well-being of working age people. ESRC Seminar Series. ESRC. London. 2006
Recommended Reading
Kivimäki M, Leino-Arjas P, Luukkonen R, Riihimäki H, Vahtera J, and Kirjonen J. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ 2002; 325: 857.
Levenstein S. Stress and peptic ulcer: life beyond helicobacter. BMJ 1998; 316: 538-541.
Shain M and Kramer DM. Health Promotion in the Workplace: Framing the Concept; Reviewing the Evidence. Occupational and Environmental Medicine 2004;61:643-648.
Work Stress: The Making of a Modern Epidemic. Michael Fitzpatrick. Open University Press, 2002.
Brief Stress Test . . . Hmmmm
1.
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8.
I do not have time for many interests or hobbies outside of work. I frequently bring my work home and work on it at night. I am unable to perform work or tasks as well as I used to. Sometimes, I feel my judgement is clouded or not as good as it used to be. It seems that there are not enough hours in the working day to do all of the things that I must do. I frequently feel impatient with the speed that events take place. Sometimes, I have an extreme reluctance to go to work. I try to fit more and more tasks into less and less time. This sometimes results in me not allowing time for any unforeseen problems that may come up. My appetite has changed. Sometimes I desire to go on a binge, especially on sweet, sugary foods, or sometimes I have a loss of appetite.
Brief Stress Test . . . Hmmmm
9.
It seems that there are too many deadlines in my work and/or life that are difficult to meet. 10. Sometimes, I feel anger and resentment at nothing in particular or a feeling that something is missing, but I don't know what the something is. 11. My self confidence-self esteem is lower than it used to be. 12. I frequently have a slight guilty feeling if I relax and do nothing, even if it is for short periods of time 13. I often think about problems to do with my personal, business, or professional life. These problems often invade my thoughts when I am supposed to be engaged in recreational activities. 14. Sometimes, I have a feeling of intense fatigue. I also feel this fatigue when I awake after sleep. 15. I try to get other people to hurry up or get on with it. Others seem to move too slowly. 16. Sometimes I finish other people's sentences for them.
Brief Stress Test . . . Hmmmm
17. I may seem to be listening to other people's conversation but I am actually be preoccupied with my own thoughts. 18. I have a tendency to eat, talk, move, walk and do most everything rather quickly. 19. I have an increase in aches and pains, especially in the neck, head, chest, lower back, shoulders and jaw. (Women: Menstrual cycles are often missed and erratic.) 20. I get irritated or angry if the car or traffic in front of me is going too slowly. I am frustrated when waiting in line. 21. Sometimes, I feel depressed, irritable, tearful, short tempered, all-over tension, unusual clumsiness, memory or concentration is impaired. Sometimes, I have excessive perspiration. 22. My sex drive is less than it used to be, or I feel sexually unsatisfied. 23. When I do repetitive tasks, I become impatient. 24. I grind my teeth, especially if I am stressed or feeling impatient. 25. I have a greater dependency on alcohol, nicotine, caffeine, or drugs (prescription or not).
Brief Stress Test . . . Hmmmm
4 points or less You are not prone to stress and are not likely to suffer from a stress-related illness.
You are also not likely to have a stress-related illness.
5 – 13 points You are prone to stress and are likely to suffer from the negative effects of stress.
You may possibly be open to stress-related illnesses.
You should consider stress control management and/or counseling.
14 points or more You are very prone to the negative effects of stress and may be open to stress-related illness. You must not delay in doing something about it.
Seek professional stress management counselling and consult your medical doctor.
© Suicide and Mental Health Association International 2004-2006