Psychosocial Stressors at Work and Stress Prevention Methods among Medical Staff of Psychiatric and Addiction Treatment Wards
According to European Agency for Safety and Health at Work (EU-OSHA), 25% of European workers experience work-related stress all, or most of the working time, and a similar proportion believe that work has a negative impact on their health [EU-OSHA 2014a]. Work-related stress is experienced when the demands of the working environment exceed the worker’s ability to cope with those requirements [EU-OSHA 2002]. Occupational stress is closely related to psychosocial risk factors, which include excessive workload and work pace, job insecurity, inflexible shift system, irregular working hours, poor social relations and communication, weak job control, lack of role clarity, poor career development opportunities and work-family conflict [Cox 1993].
The effects of work-related stress experiences have various consequences, including in particular, an adverse impact on employee physical and mental health such as depression, cardiovascular diseases, musculoskeletal disorders and diabetes. Attention has been drawn to significant financial costs associated with the treatment of stress-related health outcomes, which in Europe in 2012 amounted to 9% of stress-related and cardiovascular diseases healthcare expenditure, and 1% in 2004 and 2% in 2011 of the European GDP on depression and musculoskeletal disorders expenditure, respectively. Poland, along with Latvia and Estonia, has been at the forefront of healthcare spending on cardiovascular diseases (17%) [EU-OSHA 2014b]. There have also been observed significant business costs resulting from non-health consequences of work-related stress, namely increased absenteeism, staff turnover, and productivity losses.
This chapter presents psychosocial sources of occupational stress among medical staff of psychiatric and addiction treatment wards working in direct contact with patients, in Poland. It also proposes occupational stress prevention methods addressed to this occupational group.
Medical staff in psychiatric health care
In accordance with Article 3 of the Act of 30 August 1991 on Health Care Institutions [Dz.U. 2007], medical personnel of psychiatric and addiction treatment wards providing direct patient care in Poland include not only persons performing medical professions, such as doctors and nurses, but also persons entitled to provide health services, i.e. psychologists conducting psychological research, and occupational therapists conducting psychological therapy. In addition, medical staff may include ward nurses and paramedics who participate in the treatment process by performing direct patient care work, including personal care services (patient hygiene procedures, providing assistance to patients in meeting their physiological needs, transporting patients, delivering and serving meals), assisting doctors and nurses in carrying out the examination (e.g. placing and keeping the patient in an appropriate position), and assisting in all activities where the assistance of a third person is required. In special cases, ward nurses and paramedics may use direct coercive measures against the patient (e.g. restraint, compulsory administration of medication or immobilization of the patient).
The specificity of the work performed by medical staff of psychiatric and addiction treatment wards is based on intensive and direct contact with other people (patients, patients’ family members, co-workers), resulting from the requirement to provide assistance in various forms: from saving lives, protecting health, and providing constant care for the sick, to cooperation with medical staff members and patients’ families. The character of these relations makes the emotional labor an integral feature of the profession, whereby emotional regulation is required to display organizationally desired emotions by the employee [Zapf and Holz 2006], or behaviors performed for the benefit of the performer’s relationships with others [Pisaniello, Winefield, and Delfabbro 2012] or behaviors improving the emotional well-being of others and creating cooperative and positive social relationships [Strazdins 2000].
Medical personnel of psychiatric healthcare constitute one of the 24 special character professions in Poland. These are occupations “requiring particular responsibilities and psychophysical fitness, the ability of which to be properly performed without endangering public safety, including the health or life of others, is reduced before reaching the retirement age as a result of deteriorating psychophysical fitness associated with the ageing process” [Dz.U. 2007]. According to Polish law [ibid], performance of special character work duties entitles the employee - while meeting additional conditions, such as age and length of service - to an early retirement.
The World Health Organization has drawn attention to the global changes in the area of psychiatric care, where there has been a shortage of staff and a related problem of a large number of patients per medical staff, and poor working conditions [WHO 2007]. Case studies of doctors who report on their feelings after several years of working with psychiatric patients show that the reason for the experienced professional burnout are excessive job demands, which involve a wide scope of responsibilities, and a lack of support and assistance due to medical staff shortages. This results in fatigue and exhaustion, both physical (including headaches, gastric problems, and sleep disorders) and mental (lack of energy at work, a sense of a lack of purpose in the work, poor job satisfaction, frequent feelings of irritation and difficult interpersonal relations) [Wilczek-Ruzyczka 2014]. A report on the mental health care in Poland [Wciorka 2014] provides data on the number of psychiatrists and psychiatric nurses per 100,000 inhabitants, which is lower than the European average, and amounts to 6 doctors and 18.6 nurses, while in the Czech Republic, for example, the respective numbers are 12 doctors and 33 nurses, and in Finland, 22 doctors and 180 nurses.