0

Theories of work-related stress

There are many theories of work stress and general stress theories. I have been trying to get my head around just a few, and so I thought I would share them here for future reference on work stress theory. Perhaps these will help you in your job and career?…or perhaps help you as a leader or manager to support your employees. In any case, please share your top workplace tips for working productively…. I would love to see these theories used to make your workplace a happier one ❣

worked

Transactional theories of work-related stress

The most commonly used transactional theory suggests that stress is the direct product of a transaction between an individual and their environment which may tax their resources and thus threaten their wellbeing (Lazarus 1986, Lazarus and Folkman 1987). Yet a more recent version of this theoretical model suggests that it is the appraisal of this transaction that offers a causal pathway that may better express the nature of the underlying psychological and physiological mechanisms which underpin the overall process and experience of stress (Lazarus et al. 2001).

In this sense, any aspect of the work environment can be perceived as a stressor by the appraising individual. Yet the individual appraisal of demands and capabilities can be influenced by a number of factors, including personality, situational demands, coping skills, pervious experiences, time lapse, and any current stress state already experienced (Prem et al. 2017). One multidisciplinary review provides a broad consensus that stressors really only exert their effects through how an individual perceives and evaluates them (Ganster and Rosen 2013).

As such, the experience of workplace stress according to the transactional theory, is associated with exposure to particular workplace scenarios, and a person’s appraisal of a difficulty in coping. This experience is usually accompanied by attempts to cope with the underlying problem and by changes in psychological functioning, behaviour and function (Aspinwall and Taylor 1997, Guppy and Weatherstone 1997). In order to recognise these external and internal elements of workplace stress, Cox (1993) outlined another modified transactional theory. This theory represented the sources of the stressor, the perceptions of those stressors in relation to his/her ability to cope, the psychological and physiological changes associated with the recognition of stress arising, including perceived ability to cope, the consequences of coping, and all general feedback that occurs during this process.

Yet, as with all transactional theories of work-related stress, it is the concept of appraisal that has been criticised for being too simplistic and for not always considering an individuals’ history, future, goals and identities (Harris, Daniels and Briner 2004). Additionally, in his later works, Lazarus stressed that his transactional theories of stress failed to acknowledge the outcomes associated with coping in specific social contexts and during interpersonal interactions (Lazarus 2006a).

cooperate

Interactional theories of stress

Interactional models emphasise the interaction of the environmental stimulus and the associated individual responses as a foundation of stress (Lazarus and Launier 1978). For instance, the Effort-Reward Imbalance (ERI) theory posits that effort at work is spent as part of a psychological contract, based on the norm of social reciprocity, where effort at work is remunerated with rewards and opportunities (Siegrist 1996). Here, it is the imbalance in this contract that can result in stress or distress. Yet in contrast to transactional theories of stress, this imbalance may not necessarily be subject to any appraisal, as the stressor may be an everyday constant occurrence.

The Person-Environment Fit theory is one of the earliest interactional theories of work-related psychological distress, suggesting that work-related stress arises due to a lack of fit between the individual’s skills, resources and abilities, and the demands of the work environment (Caplan 1987, French, Caplan and Van Harrison 1982). Here, interactions may occur between objective realities and subjective perceptions and between environmental variables and individual variables. In this case, it has been argued that stress can occur when there is a lack of fit between either the degree to which an employee’s attitudes and abilities meet the demands of the job or the extent to which the job environment meets the workers’ needs (French, Rodgers and Cobb 1974).

Yet the Job Demand-Control (JDC) theory supposes that work-related stress can result from the interaction between several psychological job demands relating to workload such as cognitive and emotional demands, interpersonal conflict, job control relating to decision authority (agency to make work-related decisions) and skill discretion (breadth of work-related skills used) (Karasek Jr 1979). The JDC model is concerned with predicting outcomes of psychological strain, and workers who experience high demands paired with low control are more likely to experience work-related psychological distress and strain (Beehr et al. 2001).

However, the original concept of job demand and control was expanded in 1988 to become the Demand Control Support (DCS) theory, describing how social support may also act as a buffer in high demand situations (Johnson and Hall 1988). As social support as a coping mechanism can moderate the negative impacts of job stress, another later version of the JDC theory was developed to suggest that it is those individuals who experience high demands paired with low control and poor support who are most at risk of work-related psychological distress (Van der Doef and Maes 1999). These later versions of the JDC theory were developed, as earlier versions were considered to be too simplistic and ignorant of the moderating effects of social support upon the main variables. However, the perceived job demands and decision autonomy outlined in the JDC theory have been acknowledged as being key factors in determining the effects and outcomes of work on employees’ health (Cox, Griffiths and Rial-González 2000).

Allostatic Load Model of the Stress Process

Early psychological models of stress may be suitable for describing how environmental events generate stressful appraisals for individuals. Yet another theoretical model, devised via a multidisciplinary review of Work Stress and Employee Health identifies the intervening physiological processes that link stress exposure to health outcomes (Ganster and Rosen 2013). This Allostatic load model of the stress process builds on earlier cognitive appraisal models of stress and the work of Seyle (Seyle 1983) to describe the developments of allostasis in the process of stress. Allostasis is the process of adjustment for an individual’s bodily systems that serve to cope with real, illusory, or anticipated challenges to homeostatic (stable) bodily systems. This model proposes that continued overstimulation leads to dysregulation, and then to poor tertiary health outcomes. However, the sequence of this model has proven difficult to validate empirically. Additionally, this research is concerned with the psychological rather than the physical outcomes of work-related stress.

Allostatic Load Model of the Stress Process

Allostatic Load Model of the Stress Process

Another model of work stress has been developed in response to the Health and Safety Executive’s (HSE) advice for tackling work-related stress and stress risk assessments (Cousins* et al. 2004, HSE 2001). This model, developed by Cooper and Palmer underpins the theory and practice advocated by the HSE (Palmer, Cooper and Thomas 2003). This model explores the stress-related ‘hazards’ or sources of stress facing employees in the workplace. The acute symptoms of stress are also set out, and these symptoms relate to the organisation, as well as the individual. The negative outcomes are outlined for both an individual’s physical and mental health, however beyond this, outcomes are presented as financial losses for both the individual and the organisation.

Cooper and Palmer’s model of work stress

Cooper and Palmer_s model of work stress

Another model of work stress developed by Cooper and Marshall sets out the sources of stress at work, factors which determine how an individual may respond to such stressors, go on to experience acute symptoms, and eventually go on to reach the chronic disease phase affecting one’s physical and/or mental health (Cooper and Marshall 1976). This model is concerned with the long-term consequences of work-related stress, as well as the acute symptoms of, sources of, and the individual characteristics associated with work-related stress.

Cooper and Marshall’s model of work-related stress

Cooper and Marshall_s model of work-related stress

The Conservation of Resources (COR) Model

The above models all outline potential stressors or hazards relating to the workplace. Yet work-related stressors cannot always remain separate from general life stressors. Illustrating this, the Conservation of Resources (COR) Model, an integrated model of stress looks to encompass several stress theories relating to work, life and family (Hobfoll 1989). According to this theory, stress occurs when there is a loss, or threat of loss of resources. This is because individuals ultimately seek to obtain and maintain their resources, loosely described by the authors as objects, states, conditions, and other things that people value. Some of these stressors may relate to resources such as one’s home, clothing, self-esteem, relationship status, time and/or finances. In this context, work/relationship conflicts may result in stress, because resources such as time and energy are lost in the process of managing both roles effectively (Hobfoll 2001). This may in turn result in job dissatisfaction and anxiety, although other resources such as self-esteem may moderate such conflicts and stress (Hobfoll 2002). Such a model would be useful in the development of resource-focused interventions which aim to make changes in employees’ resources and subsequent outcomes (Halbesleben et al. 2014).

Understanding the Role of Resources in Conservation of Resources Theory

Basic Tenets of Conservation of Resources Theory

Principle 1 Resource loss is more salient than resource gain.

Principle 2 People must invest resources to gain resources and protect themselves from losing resources or to recover from resource loss.

Corollary 1 Individuals with more resources are better positioned for resource gains. Individuals with fewer resources are more likely to experience resource losses.

Corollary 2 Initial resource losses lead to future resource losses.

Corollary 3 Initial resource gains lead to future resource gains.

Corollary 4 Lack of resources leads to defensive attempts to conserve remaining resources.

(Halbesleben et al. 2014)

A Sample of Psychological Resources

Objects/ Conditions: Job Security Constructive Rewards, Reinforcement Contingencies, Inducements

Constructive: Autonomy, Decision Authority, Skill Discretion, Control Participation in Decision Making Opportunities for Professional Development Resilience

Social Support: (supervisor, coworker, organization, spousal, customer, etc.)

Energies: Time Away from Work, Recovery Experiences

Key: Self-Esteem, Self-Efficacy, Locus of Control, Core Self-Evaluation Conscientiousness, Emotional Stability

Macro: Family-Friendly Workplace Policies

(Halbesleben et al. 2014)

The Revised Transactional Model of Occupational Stress and Coping

One model combines both Lazarus’ transactional theory of stress and coping (Lazarus 1986) and Karasek’s JDC theory (Karasek Jr 1979) is the revised transactional model of occupational stress and coping presented by Goh and colleagues (Goh, Sawang and Oei 2010). This model demonstrates how individuals appraise, cope with and experience occupational stress. This process involves an individual firstly encountering a potential stressor and appraising their experience of it. Subsequently, this model demonstrates how the individual then goes on to a secondary phase of risk appraisal, where coping strategies are initiated in response to the individuals experience of the initial stressor. The model also outlines how immediate outcomes and outcomes after 2 to 4 weeks are involved throughout this process of stress and coping.

In this case, the model demonstrates a direct link between the primary appraisal of the stressor and primary stress outcomes, and also a direct link between the primary and secondary stress outcomes. This process demonstrates how the appraisals of stressful events can significantly impact on an individual’s experience of stress and its associated outcomes. This model also provides support to the effect of emotions on a person’s choice of coping strategy (Ficková 2002). Notably, this model posits that the experience of stress, coping and the development of negative outcomes can occur at different points in the process of occupational stress and coping, and can be triggered by both psychological and behavioural coping factors.

The Revised Transactional Model of Occupational Stress and Coping

This model is my personal favourite as it explains the process and experience of stress and appraisal, along with the outcomes of stress. Here, we can also see how each component relates to one another. These are just a few of the stress models out there. Some can be applied to life, and some to areas of the workplace. Are the two ever really separate?…If you have any more you would like me to add then please let me know. I hope these few give us all something to think about in the field of work-related stress research and practice.

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

References

Aspinwall, L. G. and Taylor, S. E. (1997) ‘A Stitch in Time: Self-Regulation and Proactive Coping.’. Psychological Bulletin 121 (3), 417

Beehr, T. A., Glaser, K. M., Canali, K. G., and Wallwey, D. A. (2001) ‘Back to Basics: Re-Examination of Demand-Control Theory of Occupational Stress’. Work & Stress 15 (2), 115-130

Caplan, R. D. (1987) ‘Person-Environment Fit Theory and Organizations: Commensurate Dimensions, Time Perspectives, and Mechanisms’. Journal of Vocational Behavior 31 (3), 248-267

Cooper, C. L. and Marshall, J. (1976) ‘Occupational Sources of Stress: A Review of the Literature Relating to Coronary Heart Disease and Mental Ill Health’. Journal of Occupational Psychology 49 (1), 11-28

Cousins*, R., Mackay, C. J., Clarke, S. D., Kelly, C., Kelly, P. J., and McCaig, R. H. (2004) ‘‘Management Standards’ Work-Related Stress in the UK: Practical Development’. Work & Stress 18 (2), 113-136

Cox, T., Griffiths, A., and Rial-González, E. (2000) ‘Research on Work-Related Stress: European Agency for Safety and Health at Work’. Luxembourg: Office for Official Publications of the European Communities

Cox, T. (1993) Stress Research and Stress Management: Putting Theory to Work.: HSE Books Sudbury

Ficková, E. (2002) ‘Impact of Negative Emotionality on Coping with Stress in Adolescents.’. Studia Psychologica

French, J. R., Caplan, R. D., and Van Harrison, R. (1982) The Mechanisms of Job Stress and Strain.: Chichester [Sussex]; New York: J. Wiley

French, J. R., Rodgers, W., and Cobb, S. (1974) ‘Adjustment as Person-Environment Fit’. Coping and Adaptation, 316-333

Ganster, D. C. and Rosen, C. C. (2013) ‘Work Stress and Employee Health A Multidisciplinary Review’. Journal of Management, 0149206313475815

Goh, Y. W., Sawang, S., and Oei, T. P. (2010) ‘The Revised Transactional Model (RTM) of Occupational Stress and Coping: An Improved Process Approach’. The Australian and New Zealand Journal of Organisational Psychology 3, 13-20

Guppy, A. and Weatherstone, L. (1997) ‘Coping Strategies, Dysfunctional Attitudes and Psychological Well-being in White Collar Public Sector Employees’. Work & Stress 11 (1), 58-67

Halbesleben, J. R., Neveu, J., Paustian-Underdahl, S. C., and Westman, M. (2014) ‘Getting to the “COR” Understanding the Role of Resources in Conservation of Resources Theory’. Journal of Management 40 (5), 1334-1364

Harris, C., Daniels, K., and Briner, R. B. (2004) ‘How do Work Stress and Coping Work? Toward a Fundamental Theoretical Reappraisal’. British Journal of Guidance & Counselling 32 (2), 223-234

Hobfoll, S. E. (2002) ‘Social and Psychological Resources and Adaptation.’. Review of General Psychology 6 (4), 307

Hobfoll, S. E. (2001) ‘The Influence of Culture, Community, and the Nested‐self in the Stress Process: Advancing Conservation of Resources Theory’. Applied Psychology 50 (3), 337-421

Hobfoll, S. E. (1989) ‘Conservation of Resources: A New Attempt at Conceptualizing Stress.’. American Psychologist 44 (3), 513

HSE (2001) ‘Tackling Work-Related Stress: A Managers’ Guide to Improving and Maintaining Employee Health and Well-Being’

Johnson, J. V. and Hall, E. M. (1988) ‘Job Strain, Work Place Social Support, and Cardiovascular Disease: A Cross-Sectional Study of a Random Sample of the Swedish Working Population’. American Journal of Public Health 78 (10), 1336-1342

Karasek Jr, R. A. (1979) ‘Job Demands, Job Decision Latitude, and Mental Strain: Implications for Job Redesign’. Administrative Science Quarterly, 285-308

Lazarus, R. S. (2006) ‘Emotions and Interpersonal Relationships: Toward a Person‐centered Conceptualization of Emotions and Coping’. Journal of Personality 74 (1), 9-46

Lazarus, R. S., Cohen-Charash, Y., Payne, R., and Cooper, C. (2001) ‘Discrete Emotions in Organizational Life’. Emotions at Work: Theory, Research and Applications for Management 4584

Lazarus, R. S. and Folkman, S. (1987) ‘Transactional Theory and Research on Emotions and Coping’. European Journal of Personality 1 (3), 141-169

Lazarus, R. S. (1986) ‘Folkman. S.(1984) Stress, Appraisal, and Coping’. New York 1

Lazarus, R. S. and Launier, R. (1978) ‘Stress-Related Transactions between Person and Environment’. in Perspectives in Interactional Psychology. ed. by Anon: Springer, 287-327

Palmer, S., Cooper, C., and Thomas, K. (2003) ‘Revised Model of Organisational Stress for use within Stress Prevention/Management and Wellbeing programmes—Brief Update’. International Journal of Health Promotion and Education 41 (2), 57-58

Prem, R., Ohly, S., Kubicek, B., and Korunka, C. (2017) ‘Thriving on Challenge Stressors? Exploring Time Pressure and Learning Demands as Antecedents of Thriving at Work’. Journal of Organizational Behavior 38 (1), 108-123

Seyle, H. (1983) ‘The Stress Concept: Past, Present and Future’. Cooper, CL, 1-20

Siegrist, J. (1996) ‘Adverse Health Effects of High-Effort/Low-Reward Conditions.’. Journal of Occupational Health Psychology 1 (1), 27

Van der Doef, M. and Maes, S. (1999) ‘The Job Demand-Control (-Support) Model and Psychological Well-being: A Review of 20 Years of Empirical Research’. Work & Stress 13 (2), 87-114

Advertisements
0

Exploring ‘obstetric violence’ and ‘birth rape’

trauma hiding.jpg

Recently, the wonderful Ibone Olza (Perinatal Psychiatrist and Childbirth Activist from Childbirth is Ours, Spain) contacted me about her work on obstetric violence, birth rape and professional trauma. After reading her papers and watching her present her work, I was compelled to document and reflect upon some of the issues raised, here.

The following points are made within the paper: Fernández, Ibone Olza. “PTSD and obstetric violence.” Midwifery today with international midwife 105 (2013): 48-9.

Birth trauma has been defined as “Actual or threatened injury or death to the mother or her baby” (Beck 2008). Yet such trauma lies in the eye of the beholder, therefore, any trauma experienced by either the mother, newborn or the birth attendant may be due to a subjective experience of stress which does not need to fit any particular criteria necessarily. This means that some traumatic events may be subjective in their nature, and as such, we cannot judge what may or may not cause another person trauma. It is a personal interpretation or perception.

A meta-ethnographic analysis of studies about women’s perceptions and experiences of a traumatic birth reported that women are often traumatized as a result of the actions or inactions of midwifery staff (Elmir et al. 2010). Whatever, such inactions or actions may be…women often use words such as ‘barbaric’, ‘intrusive’, ‘horrific’ and ‘degrading’ to describe their mistreatment (Thomson and Downe 2008).

For Hodges, drugging or cutting a pregnant woman with no medical indication is an act of violence, even when performed by a medical professional in a hospital. Inappropriate medical treatment is also clearly abusive, although few women are aware that this is deliberate mistreatment (Hodges 2009).

The term ‘birth rape’ has been used by women who feel that their bodies have been violated. Kitzinger highlighted that many women who have experienced a traumatic birth display similar symptoms to rape survivors (Kitzinger 2006). The video below explores these issues in greater detail, as we can hear the lovely  Ibone Olza  sharing this work.

 

One of the things I was most encouraged about, was that  Ibone Olza  considers the wellbeing of the midwifery staff in her work. Birth attendants are often also traumatized by these acts, and may feel powerless to intervene. In a recent study by Beck, 26% of obstetric nurses met all the diagnostic criteria for screening positive for PTSD due to exposure to their patients who were traumatized (Beck and Gable 2012). Being present at  abusive deliveries can magnify staffs’ exposure to birth trauma.

staff use phrases such as…

“the physician violated her”

“a perfect delivery turned violent”

“unnecessary roughness with her perineum”

“felt like an accomplice to a crime”

“I felt like I was watching a rape.”

….to describe the guilt that ensued when they felt like they had failed women or they did not speak up and challenge/question…

Article 51 establishes that: The following acts implemented by health personnel are considered acts of obstetric violence:

  1. Untimely and ineffective attention of obstetric emergencies
  2. Forcing the woman to give birth in a supine position, with legs raised, when the necessary means to perform a vertical delivery are available
  3. Impeding the early attachment of the child with his/her mother without a medical cause thus preventing the early attachment and blocking the possibility of holding, nursing or breastfeeding immediately after birth
  4. Altering the natural process of low-risk delivery by using acceleration
    techniques, without obtaining voluntary, expressed and informed consent of the woman
  5. Performing delivery via cesarean section, when natural childbirth is possible, without obtaining voluntary, expressed, and informed consent from the woman

(D’Gregorio 2010)

trauma

Yet whilst people do bad things, it is important to remember that they are not necessarily bad people…

This work explains how professionals may exert obstetric violence due to:

  • Lack of technical skills to deal with emotional and sexual aspects of childbirth.
  • Unsolved trauma. The medicalization of childbirth produces more severe iatrogenic
    complications (Johanson, Newburn and Macfarlane 2002; Belghiti et al. 2011). If the
    professionals do not have a supportive space to reflect or to deal with this aspect of iatrogenic care, they may fall into a spiral of continuously increased medicalization as a defensive strategy. Childbirth is then perceived as a very dangerous event, “a bomb ready to explode,” without realizing that interventions cause more unnecessary interventions and pain.
  • Professional burnout in birth attendants will lead to increased dehumanized care and therefore never-ending figures of women experiencing childbirth as very traumatic.

..and so the challenge will be to identify and address these root causes to ensure that maternity staff are able to provide excellence in midwifery care. My work explores how we might support the psychological wellbeing of health care staff may increase levels of humanity and compassion in care. I hope to keep in touch with Ibone Olza and many others around the world who share the same passion for this work. Together we may collectively work towards a time where maternity workers are psychologically safer, and therefore better able to provide the excellence in care they strive to give.

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

References and further reading

  • Soet JE, Brack GA, DiIorio C. Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth 2003 Mar;30(1):36-46.
  • Creedy DK, Shochet IM, Horsfall J. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth 2000 Jun;27(2):104-111.
  • Ayers S, Pickering AD. Do women get post traumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth 2001 Jun;28(2):111-118.
  • Beck CT, Gable RK, Sakala C, Declercq ER. Post traumatic stress disorder in new mothers: results from a two stage U.S. national survey. Birth 2011 Sep;38(3):216-227.
  • Allen S. A qualitative analysis of the process, mediating variables and impact of traumatic childbirth. Journal of Reproductive and Infant Psychology 1998;16(2-3):107-131.
  • Beck CT, Watson S. Impact of birth trauma on breast-feeding: a tale of two pathways. Nurs Res 2008 Jul-Aug;57(4):228-236.
  • Beck CT. Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res 2004 Jul-Aug;53(4):216-224.
  • Beck CT. Birth trauma: in the eye of the beholder. Nurs Res 2004 Jan-Feb;53(1):28-35.
  • Ayers S. Delivery as a traumatic event: prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder. Clin Obstet Gynecol 2004 Sep;47(3):552-567.
  • Olde E, van der Hart O, Kleber R, van Son M. Posttraumatic stress following childbirth: a review. Clin Psychol Rev 2006 Jan;26(1):1-16.
  • Elmir R, Schmied V, Wilkes L, Jackson D. Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. J Adv Nurs 2010 Oct;66(10):2142-2153.
  • Nicholls K, Ayers S. Childbirth-related post-traumatic stress disorder in couples: a qualitative study. Br J Health Psychol 2007 Nov;12(Pt 4):491-509.
  • Ayers S. Thoughts and emotions during traumatic birth: a qualitative study. Birth 2007 Sep;34(3):253-263.
  • Thomson G, Downe S. Widening the trauma discourse: the link between childbirth and experiences of abuse. J Psychosom Obstet Gynaecol 2008 Dec;29(4):268-273.
  • Goldbort JG. Women’s lived experience of their unexpected birthing process. MCN Am J Matern Child Nurs 2009 Jan-Feb;34(1):57-62.
  • Sawyer A, Ayers S. Post-traumatic growth in women after childbirth. Psychol Health 2009 Apr;24(4):457-471.
  • Hodges S. Abuse in hospital-based birth settings? J Perinat Educ 2009 Fall;18(4):8-11.
  • Kitzinger S. Birth as rape: There must be an end to ‘just in case’ obstetrics. British Journal of Midwifery 2006;14(9):544-545.
  • Beck CT. The anniversary of birth trauma: failure to rescue. Nurs Res 2006 Nov-Dec;55(6):381-390.
  • Beck CT, Gable RK. A Mixed Methods Study of Secondary Traumatic Stress in Labor and Delivery Nurses. J Obstet Gynecol Neonatal Nurs 2012 Jul 12.
  • Perez D’Gregorio R. Obstetric violence: a new legal term introduced in Venezuela. Int J Gynaecol Obstet 2010 Dec;111(3):201-202.
  • Callister LC. Making meaning: women’s birth narratives. J Obstet Gynecol Neonatal Nurs 2004 Jul-Aug;33(4):508-518.
  • Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far? BMJ 2002 Apr 13;324(7342):892-895.
  • Belghiti J, Kayem G, Dupont C, Rudigoz RC, Bouvier-Colle MH, Deneux-Tharaux C. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based, cohort-nested case-control study. BMJ Open 2011 Dec 21;1(2):e000514.

 

 

1

10 Tips for Success & Self-Care for Academics

cozy-dog

Another guilt trip about the importance of self care and being successful? That is why many people will read blog posts like this. We know we should be practising self care and succeeding, but do we really know how to thrive?

(I could not find a concept analysis for either success or self care – please let me know if you do)

We must presume that both success and self-care mean something different to each and every one of us. I am no expert on these topics…. is anyone?…But I think I am pretty good at caring for myself now and working towards success…having learnt the hard way. So I thought I would share some of my hints and tips. Feel free to adapt them, use them, completely ignore them, or ridicule them as ‘poppycock’.

Most people will expect to hear things like:

  • Take a bubble bath
  • Watch your favorite film
  • Curl up with a good book
  • Work hard
  • Network

But I am sure that you know about this kind of stuff already. So let’s look at self care and success for the academic, firstly by identifying the issues that some of us may face.

As an early career researcher, I am frequently told about the stereotyping and inequalities experienced by women in academia. I myself frequently worry about the insecurity of, and problems associated with being an early career researcher, especially a female one.…I worry about where I will find my next job, funding or co-author. I worry about whether I am making any impact at all and whether I will be able to reach my true potential as an academic in the current climate. Academic pressures are in no way restricted to those earlier in their career, many more established researchers are also feeling the strain. These experiences will undoubtedly result in some psychological distress for many academics. So what can we do both proactively and preventatively to improve the lives of ourselves and each other.

Research can seem like a lot of hard work for little reward.

Tip One: Keep your eye on the goal. Visualize yourself being happy, frequently. How would it feel to publish that paper? Get that fellowship? Collaborate on that project? Create your own self-fulfilling prophecy rather than focus on a possible spiral of doom.

How to do this? – Identify what makes you happy, or what will make you happy. Then do more of what makes you happy, or have a real go at getting what will make you happy. I personally love my research work. I know that many other academics feel the same way. Happiness to me is succeeding, making a difference  and making a real impact through my work. The stress I feel is associated with this not happening.

This stress and negative thinking serves no purpose unless it positively drives me towards my goal. Yet who wants to be whipped to the goal posts?  I use visualization as a driver for success. I see myself feeling and being the way I want to be…and I allow myself to believe that this vision will come true. This makes me much happier than thinking about the alternative. So I stick with it.

The practice of meditation may also assist you to work through your thoughts, direct them towards a more positive outlook and allow your goals to become meaningful and achievable.

As these tips continue, think about your own goals for happiness…whatever they may be…think about achieving them in relation to these tips and your own experiences.

I behave in the way I want to feel or be… Surely if I continue in this direction. Good things will come…

Tip Two: The problem of job insecurity for early career academics baffles me as Job security for early career researchers is a significant factor in helping research make an impact. Yet this seems to play on my mind recurrently. It is always a worry. However, worry really does nothing to resolve this issue, and only seeks to get in the way of my progress. In order to progress, I will need to ‘work smarter’ and embrace confidence in my own abilities. Worry and negative thinking has no place in this strategy.

Negative thoughts often lie, and so I swipe them away one by one by placing them on a train that is passing the station (Visualization) – I then sit for a little longer, and imagine the way I will feel and be once I reach my goals. My mood and stress instantly lifts once I do this. I am more confident and feel much stronger. I am ready to be happy.

 

Tip 3: Say No and be proactive – We need to look at what successful academics do. From my observations, they often say ‘No’ to anything that doesn’t suit their own focused agenda (they remove the ‘noise’ and toxicity), they ooze positivity, they are confident, they are assertive, they tell people what they need to succeed and they hang around with the most inspiring people. Therefore, the most obvious strategy is for us to do the same. Say ‘No’ to negativity, and to the people and things which do not enrich us as people. Let people know what you need in order to thrive. Embrace those you feel drawn towards as positive people.

Activity: Making the best of me…

1: Ask yourself how others can get the best out of you

2: Offer what you can realistically do

3: Communicate what inhibits your productivity with others

4: Actively describe what you need from others in order to thrive

Getting the best of me

Tip 4: Express gratitude and forgiveness for enhanced wellbeing. Not always easy, but worth investing in. This task not only unburdens your mind, but allows you to see all of the good things currently going on in your life. Regularly write down 5 things that you are grateful for. Also…try to forgive yourself, and others…often.

 

Tip 5: Address your work life balance as a fluid entity. I believe that the idea of a separate home and work life is changing. This is a good thing. It takes the pressure off and allows you to be a whole person, rather than one split in two…See yourself as a whole being, a working, living and family centred being. You cannot slice yourself into pieces.

See this blog -> ‘Work’ is a verb rather than a noun…it is something we do…not always somewhere we go…

Living in the ‘now’ rather than being at either home or work also allows us to enjoy more of ourselves and our lives. Notice where you are, what you are doing…Smell the flowers, look around you as you move, work, play and just allow yourself to ‘be’.

smell-the-flowers

Tip 6: Eat Sleep move, repeat. It really is that simple, but utterly essential for optimum productivity, stress reduction, health and wellbeing. Eat nutritious food regularly, sleep 7-8 hours a night and move…Exercise, walk, swim, run, cycle…Be outdoors as often as possible.

float

Tip 7: Write. Write your thoughts, your feelings, your ‘to do’ lists, your ideas, your goals down regularly. This not only means that they are out of your head, allowing your mind to be quieter, they are also made real…They are good to share..and worth addressing (when you feel able).

Tip 8: Talk about who you are. There is a tendency to talk about work first. What we do, what we are working on and what we are planning to work on. Start new conversations with how you enjoy your hobbies or your favourite music. This lets other people know that you are indeed human, and it also gives you an identity other than your work persona. Be authentic. It is healthy for you, and others to know the real and whole you. You are fab 🙂

Tip 9: Help other people and accept help yourself. Lift one another up, support colleagues, show gratitude, offer support and guidance where you can. Be a mentor. Be a positive role model. Be the change you want to see in the workplace and accept all of this in return. This will not only make you feel good, it will change the culture of your workplace, and bring about reciprocity for everyone’s success.

LiftEachotherUp_libbyvanderploeg

(Image via http://www.libbyvanderploeg.com/#/lifteachotherup/)

Tip 10: Celebrate the successes of yourself and others. Yes. Focus on the great things that you and your colleagues have achieved. However big or small, these feelings of success will snowball into a self fulfilling prophecy, where you feel valued, supported and part of a team that cares. Some people will feel uncomfortable about doing this, and feel icky when they see others wallow in their own brilliance. But what is the alternative? We all talk about how rubbish we all are? How will that make us feel?…

Spend time reflecting on what you have achieved. Write them down…use these achievements to inform your own vision of yourself…This is who you are. You are great.

As long as the feelings of celebration and success are reciprocated and directed towards others as well as yourself….Let the high fives roll.

Image result for the highest of fives gif

I do hope that these tips will resonate with some academics looking for something new to try. In the spirit of sharing, please feel free to add more tips below.

You deserve to be happy – Until next time, look after yourselves and each other ❤💙💜

 

1

Why the health, wellbeing & engagement of #NHS staff matters..financially, practically & morally speaking…

wellbeing-of-nhs-staff-a-benefit-evaluation-model
I spend a lot of my time talking to clinicians, managers, commissioners, those outside of healthcare and leaders about the importance of promoting and supporting staff wellbeing within the #NHS workplace. Some are already on board with the reality that excellence in healthcare simply cannot happen in the absence of a workforce that is cared for and nurtured to thrive. Others feel discomfort at the thought of caring for staff when the ‘patient comes first’ and some simply don’t know what to do for the best. In any case, nobody seems to want to destroy the NHS workforce (correct me if I am wrong)!… and everyone seems to want to learn more.

A good staff experience where staff feel ‘engaged’ is critical to  achieving excellence in healthcare…What do we mean by ‘Staff Engagement’?

‘Institute for Employment Studies (IES), defined staff engagement as a positive attitude held by the employee towards the organisation and its values. An engaged employee is aware of business context and works with colleagues to improve performance within the job for the benefit of the organisation. The organisation must work to develop and nurture engagement which requires a two-way relationship between employer and employee (Robinson et al 2004, p 4).’
Recently, I was asked to provide some evidence as to why the wellbeing of NHS staff matters by someone else who was keen to make a difference in this area. They needed to make the case to others in order to make change happen. I imagine that lots of other change makers will be needing to provide evidence too, and so I have set out some arguments for the case below. I hope many of you will find it useful to have some of the arguments in one place.
Image result for staff engagement nhs employers

Please feel free to share this evidence widely with others…. If you have other evidence to add to this, please feel free to comment below…

(There can never be too much to share)!

Financial reasons to care for NHS staff:

Over 2014/2015, the NHS Litigation authority (NHSLA) paid over £1.1 billion to patients who suffered harm and their legal representatives, this coming year it will be c £1.4 billion and with accumulated provisions in our balance sheet of over £28 billion further significant increases are already in the pipeline. When staff are unwell, in psychological distress, communication is hampered by poor working cultures and there is a lack of staff engagement, NHS staff are more likely to make medical errors (Hall et al, 2016).

Good staff health, wellbeing & engagement = reduced medical errors = reduced litigation costs

Estimates suggest that recruiting a nurse from overseas costs between £2,000 and £12,000 and return-to-practice costs some £2,000 per nurse, while training a new nurse costs around £79,000. Additionally, recruitment costs to replace staff who leave owing to work-related stress and/or poor job satisfaction is estimated to be £4500 (More for senior posts). As such, in order to get best value for money, the NHS will need to work hard to retain and recruit a high quality workforce.

Good staff health, wellbeing & engagement

= Increased recruitment and retention = Best value for money

Staff sickness absence rates cost an estimated £3.3million annually per NHS organisation. When staff are absent, there is the added cost of agency staff to fill in gaps (The NHS Improvement team now expect the NHS to spend a total of £3.7 billion on agency staff by the end of the 2015/16 financial year).The Francis inquiry into Mid Staffordshire also exposed the consequences for patients and staff of not addressing this issue of staff morale and sickness. Typically, if an NHS organisation reduced staff sickness rates by a third,it would provide an additional 3.4 million working days a year for NHS staff, equivalent to 14,900 full-time staff, saving an estimated £555 million.

Good staff health, wellbeing & engagement = Decrease in sickness absence = reduced agency/sickness spend & therefore, improved patient care

Image result for staff engagement nhs healthcare
(Image source :http://www.slicedbread.co.uk/solutions/employee-engagement/)

Practical reasons to care for NHS staff:

Ultimately and practically, the NHS exists to provide high quality and safe care to patients. Evidence so far shows that better staff health and wellbeing is associated with improved patient outcomes.
Some of the many benefits to improved NHS wellbeing is that better staff health results in lower infection rates and lower standardised mortality figures. The Keogh review of 14 hospital trusts with high patient mortality rates found all these trusts also had higher levels of staff sickness, compared to national average.

Good staff health, wellbeing & engagement = Safer and higher quality patient care

When an NHS organisation invests in staff health, wellbeing and engagement, they improve their ‘Brand’. Branding is one of the most important aspects of any business, large or small, and its impact shouldn’t be underestimated when it comes to engaging staff with health and wellbeing initiatives.

Good staff health, wellbeing & engagement = Your NHS organisation looks good & therefore attracts more staff

A report from the Kingsfund suggests that job satisfaction, organisational commitment, turnover intentions, and physical and mental wellbeing of employees are predictors of key organisational outcomes such as effectiveness, productivity and innovation. Everyone wants more of these things..right? They all have the potential to save money and improve the safety and quality of care.

Good staff health, wellbeing & engagement = Higher productivity, staff effectiveness and innovation = Cash savings and better services

Image result for staff engagement nhs healthcare

Moral reasons to care for NHS staff:

Staff are entitled to a psychologically and physically safe professional journey. Caring for them is not an optional issue, it is an ethical one.

 

When staff are well cared for, they experience greater job satisfaction, improved morale and general wellbeing. Few aspire to be ill, and many feel great shame in letting others down or asking for help.
Where the emotionality of distressing work  remains unrecognised and void of support, distorted thinking, emotional distress, reduced productivity, increased sickness rates, poor decision making, and maladaptive patterns of behaviour may present. Physical symptoms can also result, where severe job stress evokes irregular menstrual bleeding patterns for female healthcare workers, poor sleep quality and bodily exhaustion.
The NHS workforce is one of the largest work forces in the world. They are patients, they are the public, as are their friends and families. As such, by caring for this group, we are also caring for a large part of society. Moreover, there is also a strong statistical link between the wellbeing of staff and patient satisfaction. This means that if we are failing to care for staff, we are also missing an opportunity to improve patient satisfaction.

Good staff health, wellbeing & engagement = A nice and decent thing to do for all.

Image result for staff engagement nhs employers

There are many more reasons for NHS organisations to care about the the health, wellbeing & engagement of their staff..Financially, practically & morally speaking… Please feel free to add these below.
I hope that these few facts and figures can be shared and used to convince everyone throughout the NHS of these facts. Many will say that it is the patient that must come first. However, I argue that excellence in health and social care may only be achieved if both the staff and patients are cared for equally, as they work in partnership to achieve the best outcomes.

Looking for ways to turn this vision into practice? See my blog on 20 ways to create a thriving NHS workforce here

Until next time, look after yourselves and each other 💛💙💜💚.
2

Partnering with the Colombo Institute of Research and Psychology – Sri Lanka…

colombo institute of research and psychology

colombo institute of research and psychology

I apologize for the lack of posts over the last 2 weeks. I have been to visit the wonderful people in the Colombo Institute of Research and Psychology and the National Institute of Mental Health, Angoda.Then of course I had to deal with copious amounts of work/emails upon my return, which I am sure will fill exciting posts to come.

When I embarked upon this research journey, I also signed up for the Global Leaders Programme at Coventry University. I did this to become a part of the global healthcare community and reach key opinion leaders with the same directive goals as myself…Starting the conversation has always been the most productive way to make change happen. Indeed, it has already put me in touch with some inspiring people, and this trip proved to be no different.

I have always had a keen interest in getting to know how the various healthcare systems across our globe work. We are all human… so what works best? I have already visited the Royal Victoria Teaching Hospital in Banjul, The Gambia and the Gimbie Adventist Hospital, Ethiopia. With the help of Maternity Worldwide and clinical work placements, I was privileged to have the opportunity to see how our health care systems contrast and compare to other healthcare systems around the globe. I was excited to take part in this visit, which promised to enlighten us all to the mental healthcare provisions and psychology research in Sri Lanka.

National Institute of Mental Health, Angoda Colombo, Sri Lanka

National Institute of Mental Health, Angoda Colombo, Sri Lanka

Speaking with the researchers in the Colombo Institute of Research and Psychology, it was clear that their research shared the same concerns as western research. Healthy debates generated interesting insights into the work they were forming in breaking stigma and securing new funding for the people of Sri Lanka. However, their population base faces some new and very real challenges:

-Less than 1% of Sri Lankas healthcare budget is spent on the mental health care of the nation.

-Sri Lankan communities often use astrology and homeopathic remedies to treat mental ill health rather than access medical facilities.

– There are only 2 psychiatric consultants for the whole of Colombo and surrounding areas.

-Limited facilities for mother and baby units, which need more space for mentally unwell mothers and their families. (In Sri Lanka, reported maternal death due to suicide is notably high) – See Puerperal Psychosis.

– The stigma around mental health issues remains great in Sri Lanka, therefore many of those who may be ready to re-enter their communities following treatment have no where to return to. They become rejected by their families.

– This stigma creates a culture where those in need are reluctant to seek help.

– Families are keen not to disclose the mental ill health of loved ones and may isolate problems.

-Mental health facilities are used as holding places for those on remand following the identification of the antisocial behavioral symptoms of ill mental health.

Speaking to one of the consultant psychiatrists about these issues was so valuable to my research. Comparing the etiologies of psychological distress with the cultures and social norms of both populations highlighted how our UK populations may face triggers for distress which are entirely unique to the UK. Although some of these factors will also translate to other populations, it may be that specific factors correlate only with our own health care professionals, within western society.

From the point of view of research, this leaves much to be explored. How do we breakdown the populations into completely homogeneous samples? Is it ever possible to?

After speaking with Dr Shavindra Dias from the University of Peradeniya, (which by the way is the most beautiful university campus I have ever seen!) it is clear that the connections I have made throughout this research trip will last throughout my career as I continue to network with and learn from some of the most outstanding and inspirational leaders who take pride in making changes to ensure a brighter future for all. The struggle to improve the overall well being of society by authenticating and placing value upon the needs of those in psychological distress is hard. Yet I still believe that is the most noble and kind thing we can do for humanity. The connections I have made throughout this trip will forever remain a part of my professional journey going forward, and I would like to thank @PsychColombo again for hosting such an amazing trip of discovery in partnership with @covcampus.

In addition to this wonderful experience we also visited:

-Galle Face Green

-Galle Fort

-The National Museum of Colombo

-International Maritime Museum in Colombo

– The National Elephant Orphanage

-The Temple of the Tooth

-Anuradhapura

-Botanical Gardens

-Tea Factories

View from the World Trade Centre in Colombo

View from the World Trade Centre in Colombo

Sri Lankan Elephant Orphanage

Sri Lankan Elephant Orphanage

I hope to reunite with the amazing people I met here soon…. Perhaps for my up and coming Delphi Study?

0

Naming Mental Health as the Cause for Disaster means a Reversal of Gains to Reduce Stigma

I am almost at a loss for words when I see the headlines in relation to Andreas Lubitz and the tragedy of Germanwings 4U9525. The horror is unbearable, but the press coverage surrounding the story has been abhorrent. I am scared to write this post as I do not want my words to detract from the pain that the families involved must be feeling…and I am sure I will not cover this issue as well as @MentalHealthCop or @BlurtAlerts… but I must share my thoughts.

Relating this story back to my own PhD research in supporting health professionals in psychological distress, this story should remind us all that high profile jobs in high pressure environments placed in the public eye can produce adverse health problems. Many people have been questioning what ‘Burnout’ actually is. For clarity I will define this as follows:

Burnout is a syndrome of emotional exhaustion. Burnout has been defined by Maslach as a syndrome consisting of emotional exhaustion, depersonalization, negative thinking towards others and a reduced sense of personal accomplishment (Maslach, 1986, Maslach, 1996).

Moving on to depression:

“Depression is a common, disabling disorder characterized by a period of at least two weeks in which a person loses pleasure in nearly all activities and/or exhibits a depressed mood“(Stewart et al, 2004;19).

Symptoms of major depression include feelings of sadness and hopelessness, diminished pleasure, changes in weight, changes in sleep patterns, lack of interest in life, chronic fatigue, a sense of worthlessness or guilt, muddled thinking and poor decision making (APA, 2013).

Sadly depression can affect all areas of a persons life, and yes some of those with depression will die by suicide. However, the headlines seemingly suggest that depression is the cause of this ‘Murder’. It will not be the only cause of this tragedy, and nothing is confirmed as yet. It frightens me to think that these assumptions are coming up so thick and fast before the facts are known. This highlights to me the stigma still apparent and surfacing in the wake of fear.

We do not know all of the facts, perhaps Andreas dissociated from everything around him and any decisions he may have been making, perhaps this is something completely unrelated. Whatever happened, the headlines of this story are damaging and risk the reversal of any progress we have made in reducing stigma.

Some news companies are scaremongering and stating that nobody with depression should be allowed to fly a plane. This at least makes a change from them saying that all those with depression are ‘fit to work and lazy’ – but I digress.

This idea is ridiculous as those with mental health issues can achieve great things… remember 1 in 4??? Do we get rid of 1/4 of our pilots?

What if our pilots have a headache? what if they have a brain tumor? what if they have a seizure whilst in flight? – the ridiculous parodies may continue…

I was hoping this would get people talking about what can be done to support those in *potential* psychological distress in order to improve overall services, instead it has led to an immediate reaction of fear. I am hoping the long term story will be a different one.

American Psychological Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders (V) American Psychiatric Association, Washington, DC (2013)

Maslach C, Jackson SE. Maslach Burnout Inventory Manual, 2nd edn. Palo Alto (CA): Consulting Psychologists Press Inc; 1986.

Maslach, C Jackson, S Leiter, M, Schaufeli, W, Schwab, R (1996) MBI: The Maslach Burnout Inventory: Manual. Consulting Psychologists Press, Palo Alto (1996)

Stewart Donna ; Gucciardi Enza ; Grace Sherry (2004) Depression BMC Women’s Health, 2004, Vol.4(Suppl+1), p.S19

0

Health Professionals who Die by Suicide – 5 Tips for Change


If the content of this post has affected you in any way, please visit the support page of this blog….

Yesterday was #NHSChangeDay, and I pledged to #StartTheConversation and raise awareness about health professionals who are in psychological distress. As it happens, @WeDocs conveniently hosted a  #WeDocs Tweetchat on preventing suicide in health care professional populations. It was great to see an issue I feel so passionate about being discussed, shared and given some much needed attention. This kind of innovative Twitter usage is one of the things I love about our NHS radicals!

Throughout the conversation, there were seemingly many people concerned and wanting to prevent clinician suicide, but not many solutions to prevention were put forward. -> See the chat summary here

A recent situational analysis into Suicide by clinicians involved in serious incidents in the NHS has identified the current support services available clinical staff, yet there is no consensus on how to effectively support clinical staff, and nobody has yet taken responsibility for the well being of NHS staff (Strobl et al, 2014). This has been further complicated by the fact that Clinicians often have difficulty in recognising symptoms and risk factors associated with their own suicidal behaviour (Goldney et al, 2002). Clinicians are at a higher risk of suicide than the general population, can be misunderstood and left unsupported whilst under immense pressure (Chan et al, 2014). The GMC have recently published a report in regards to a high rate of professionals dying by suicide whilst under investigation. A tragedy for all.

Psychological safety for NHS staff is critical for patient safety and every shiny new white paper will tell you this. But it is also critical for the NHS’s ‘ethical well being’ to care for it’s staff. If the NHS as an organization lets its staff suffer, how will it ever live with itself? The trauma will inevitably become endemic.

So what changes can we make to prevent suicide?

1. We could treat NHS staff as ‘innocent until proven guilty’ & eradicate ‘Name Blame and Shame’ Cultures.

2. Consider that poor behaviour may actually be ‘ill’ behaviour in need of medical treatment before disciplinary action takes place (Brooks et al, 2014).

3. Consider alternatives to discipline & create psychologically safe work cultures.

4.Expose investigation staff to front line clinical practice to understand organizational cultures and pressures.

5. Develop a tailor made national support programme for NHS staff which is confidential, anonymous and provides professional amnesty (The aim of my entire PhD research project)

Also… please keep the conversation going 🙂

Brooks, S, Del Busso, L, Chalder, T, Harvey, S ,Hatch, S, Hotopf, M, MadanHenderson, M (2014) ‘You feel you’ve been bad, not ill’: Sick doctors’ experiences of interactions with the General Medical Council BMJ Open 2014;Vol.4 (7) :e005537 doi:10.1136/bmjopen-2014-005537.

Chan, W., Batterham, P., Christensen, H., Galletly, C (2014) Suicide literacy, suicide stigma and help-seeking intentions in Australian medical students. Australas Psychiatry April 2014 vol. 22 no. 2 132-139

Goldney RD, Fisher LJ, Wilson DH (2002). Mental health literacy of those with major depression and suicidal ideation: an impediment to help seeking. Suicide Life Threat Behav 2002; 32: 394–403.