3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The prevalence of burnout amongst registrars at the School of clinical medicine at the university of the witwatersrand, Johannesburg, South africa(2018) Zeijlemaker, CathelijnBackground: Burnout is a response to prolonged stress and consists of three elements: Emotional Exhaustion (EE); Depersonalisation (DP); and Personal Accomplishment (PA). Existence of burnout under doctors is often not acknowledged but has major consequences for personal and professional life. Only limited research done regarding prevalence of burnout amongst registrars in South Africa. Objectives: To describe the prevalence of burnout, and asses for relationships between burnout and socio-demographic factors. Methods: A cross-sectional descriptive, internet survey was conducted. Respondents were registrars within the departments of the School of Clinical Medicine at the University of the Witwatersrand. To measure burnout the Mashlach Burnout Inventory (MBI) was used. Relationships were assessed by independent samples t-test and ANOVA. Results: Of the 585 successfully delivered questionnaires, 201 registrars started the survey (response rate of 34%). 170 questionnaires were analysed. The mean age of the respondents was 33 years, the male to female ratio was 1:1.8. The average score for EE was 3,5 (SD1.2), for DP 2.7 (SD1.1) and for PA 4.1 (SD1.1). The overall level of burnout was 84%. None of the respondents scored low over all categories. No significant association between socio-demographics and MBI dimensions was found. Conclusion: The prevalence levels found in this study was higher than found in national and international literature. Extremely high levels of DP were found. This is worrisome as DP affects professionalism and engagement of doctors. In keeping with international literature no associations were found with socio-demographic factors and burnout, suggesting the cause of burnout should truly be sought out in the work environment. Efforts to improve autonomy in the workspace, development opportunities and promoting peer collaboration, are needed to prevent of burnout.Item Effects of the stress management intervention amonsgt intensive care nurses in a Gauteng public hospital(2017) Haarde, MarliseBackground: South African professional nurses, working in an Intensive Care Unit (ICU) experience many physical and psycho-social hazards and risks. Stress, provoked by failure to meet work demands, leads to illness, injury and psychological suffering. This in turn may result in absenteeism and to the nurse abandoning the profession. It is therefore necessary for healthcare administrators to address the aspects leading to nurse stress and work burnout. Setting: The study was conducted in the adult intensive care units of a public sector hospital. Purpose of the study: The purpose of the study was to develop and pilot test a stress management intervention for professional nurses practising in ICUs. Method: A quasi-experimental non-equivalent control group design was selected for this study. It comprised of pre-testing, development and implementation of the intervention and post testing. Both groups of professional nurses were recruited from the same hospital by means of convenience sampling. Each group was asked to complete the Expanded Nurses Stress Scale (ENSS). The Intervention group participated in the educational intervention on stress management. The control group received no form of any intervention. Both groups completed the ENSS, four weeks after completion of the intervention. The intervention group of participants also completed a stress management intervention assessment form in order to collect feedback for the evaluation of the workshop and the researcher. The quantitative data was analysed by means of descriptive summary statistics. Results: There was clear evidence of significant differences (p=0.000) emerging in all 9 subscale total average scores with respect to level of stress when considering the pre-test score and the post-test score. This indicates the stress management intervention had an effect on the stress levels of nurses practicing in the ICUs at the selected study sites. Evaluation of stress management intervention workshop also revealed that an overwhelming (>87%) number of nurse participants experienced all activities as meaningful, with contributory worth. Recommendations arising from the study findings are put forward for intensive care nursing practice, occupational health nursing, executive hospital management and further research. Key words: intensive care, nurses, stress management intervention.Item A description of psychosocial stressors of final year student nurses in a Private Training Facility in Gauteng(2018) Freer, Karen AnnOverall purpose of the study To identify the nature of the psychosocial stressors of final year student nurses in a private clinical training facility experience, with a view at a later stage of developing a preventive and support programme. Problem Statement Student nurses in the private training facility are subjected to many psychosocial stressors. Anecdotal evidence shows that these students are not coping with these stressors, as evidenced by attrition and mental health issues. The nature and extent of the stressors was not known. While confidential counselling service is available to students, this is a short term (maximum 6 sessions) service, and reactive in nature. By identifying common psychosocial stressors, an intervention to prevent or mitigate these stressors will, at a later stage, be developed. Research question What is the nature of psychosocial stressors that final year student nurses in the private clinical training facility experience? Research methods This was a qualitative research study using semi-structured interviews as a data collection tool. It was conducted in a private nursing education institution in Gauteng. Sixteen student nurses were interviewed and the data was analysed by means of a content analysis according to the steps of Braun and Clarke (2006). Major findings In this study, four categories of psychosocial stressors were identified viz. Academic pressure, financial constraints, work stress and social issues. The various stressors are interrelated. Academic pressure and financial constraints were the two most stressful issues for the student nurses. Conclusion Despite their obvious high levels of stress, the student nurses seem to be driven to complete their training despite overwhelming odds.Item The relationship between stressful life events, personality profile, dissociative experiences, attachment styles and types of crimes committed among mentally ill offenders and criminal offenders in the South African context(2015-04-21) Radebe, Zama KhanyisileThe current study investigates the relationship between stressful life events, personality profile, dissociative experiences, attachment styles and the types of crimes committed among 100 mentally ill offenders and 100 criminal offenders in the South African context. It is motivated by the fact that there are no studies in South Africa comparing forensic patients and criminal offenders and the various factors that may lead to criminal behaviour, and how these may present in terms of the type and/or nature of offences committed. Instead, there is a growing emphasis on observation of patients and assessments for fitness and competence to stand trial with very little focus on understanding the mentally ill offenders and criminal offenders. This study aims to improve the understanding and knowledge with regards to the presentation of each of these groups under study and also to investigate possible differences in the types of crimes committed. It aims to assess possible correlations between the variables of the study (stressful life events, personality profiles, dissociative experiences, attachment styles and the types of crimes). It further aims to inform future treatment interventions in the forensic setting and to offer possible prevention models for the community setting. The study hypothesises that there are no differences between the mentally ill offenders and criminal offenders with regards to stressful life events, personality profile, dissociative experiences, attachment styles and the types of crimes committed. Ethical clearance was obtained from the Committee for Research on Human Subjects of the University of Witwatersrand‟s medical school. The sample size of this study consists of 200 participants (156 males and 54 females). Convenience sampling was used, where 100 mentally ill offenders admitted at the Sterkfontein Psychiatric Hospital and 100 criminal offenders, incarcerated at the Johannesburg Correctional Services in the Johannesburg area at the time of data collection, were involved in the study. The mentally ill offenders from Sterkfontein Psychiatric Hospital were interviewed at the hospital and the criminal offenders from Correctional Services were interviewed in their respective prisons without the presence of a prison guard. Participants‟ ages ranged from 18 years to 60 years. Those people who were not willing to participate were not included in the study. The Biographical details questionnaire, Social Readjustment Rating Scale (SRRS), Stressful Life Events Screening Questionnaire (SLESQ), Multiphasic Minnesota Personality Inventory – II (MMPI-II), Dissociative Experience Scale (DES) and Attachment Styles Questionnaire (ASQ) were administered to the participants of the study as a means of gathering information regarding the variables under study. The types of crimes and diagnoses were obtained from the records. The study attempted to ascertain whether there were any associations, and whether predictions could be made for possible future assessments and treatment strategies. It is a quasi-experimental design with “diagnosis” as the between-participants factor. Independent variables of the study were the type of offender, i.e. mentally ill/clinical/forensic patient offender and criminal offenders, as well as the types of crimes, i.e. violent or non-violent crime. The dependent variables were stressful life events. These variables were measured in terms of low risk to illness, moderate risk and high risk to illness; personality profile; dissociative experiences, measured as either low levels or high levels of dissociation and attachment styles (secure, fearful avoidant, ambivalent and preoccupied attachment styles). The confounding variables were substance abuse, medication and comorbid diagnoses. Descriptive statistics and the discriminant function analysis were performed. Box M was also performed to test the null hypothesis that the covariance matrices did not differ between groups formed by the dependent variables. The Chi Square test for independence was also used to determine whether associations existed between two nominally categorical variables. The results of the study indicated that there were only four female participants in the clinical offender group. A high number of research participants were single in both the criminal (72%) and clinical (80%) offender groups. Furthermore, the majority of the participants in the study were Black, where 93% in the criminal offender group and 75% in the clinical offender group. 65% of the participants in the criminal offender group and 85% in the clinical offender group had no tertiary education. There was evidence that clinical offenders tended to commit more violent crimes (83%), while criminal offenders committed more non-violent (61%) and “other” crimes (21%). 91% of criminal offenders reported homelessness compared to clinical offenders (22%). The Dissociative Experience Scale was statistically significant, suggesting that dissociative experiences were a strong determinant of whether one is deemed a criminal or clinical offender. High levels of stress were correlated with higher incidents of criminal behaviour. In contrast to the literature review, past childhood trauma was not statistically significant in the current study. Clinical offenders reported more psychological problems. When ANOVA‟s were performed, psychological difficulties such as depression, anger, antisocial practices, low self-esteem, psychasthenia and family problems were statistically significant, suggesting that these variables were strong determinants for the likelihood of criminal offending. Dismissive and Fearful attachment styles were statistically significant. In conclusion, dissociative experiences, social re-adjustment, psychological pathology and both dismissive and fearful attachment styles were strong determinants of offending behaviour.Item Occupational stress in a South African workforce: instrument testing, prevalence measurement and risk factor analysis(2015-03-27) Volmink, Heinrich CyrilBackground Occupational stress represents a substantial public health challenge. Although there has been an extensive focus on this form of stress within the international setting, there appears to be a paucity of relevant evidence within South Africa. Specifically, within the local context, there are relatively few: (1) reliability testing studies of screening and assessment instruments, (2) prevalence analyses of occupational stress and (3) work-related stress management intervention designs. Methods A cross-sectional descriptive and analytical study was undertaken in a large tertiary hospital in Johannesburg. Primary data were collected between February 2013 and September 2013 using the Copenhagen Psychosocial Questionnaire (COPSOQ). A sample (n=166) of administrative staff was selected, stratified into front line staff (n=54), back office staff (n=90) and managers (n=22). Data analysis included reliability testing of the COPSOQ using the Cronbach‘s alpha statistic. Prevalence measurement was also undertaken to describe the distribution of stress and other variables across the study sample. Finally, logistic regression was used to estimate associations between the exposure variables and the stress outcome (at the p < 0.05 level of significance). Results The Cronbach‘s alpha range for the COPSOQ was 0.31 to 0.85. Two out of 24 scales of the instrument fell below the unacceptability threshold of 0.5. In terms of prevalence, the stress mean for the study sample (on a scale from 0 to 100) was 38.8 (SD 19.8). Furthermore, 68.1% (n=113) of the study sample had a stress value above the reference mean. There were also significant differences in the stress values by job category, with managers having the highest mean at 51.2 (SD 24.2). Adjusting for job category, risk factors significantly associated with occupational stress in the main logistic model were offensive behaviour (OR 3.38, 95% CI: 1.54 – 7.43), quantitative demands (OR 2.83, 95% CI: 1.35 – 5.92) and emotional demands (OR 2.32, 95% CI: 1.08 – 4.96), while quality of leadership (OR 0.32, 95% CI: 0.15 – 0.67) was a protective factor. Further analysis showed that the most harmful risk factor for females was work-family conflict (OR 4.03; 95% CI: 1.45 - 11.21), and for males was exposure to offensive behaviour (OR 4.63; 95% CI: 1.15 - 18.63). Finally, ordinal regression found offensive behaviour (OR 3.60; 95% CI: 1.92 - 6.75) and quantitative demands (OR: 2.38; 95% CI: 1.27 - 4.46) to be significant risks for moving from low stress to high stress, while a commitment to workplace (OR 0.46; 95% CI: 0.24 - 0.86) could help to prevent this. Conclusions The level of occupational stress in the study sample was high relative to reference values. An occupational stress intervention is recommended, which should include primary, secondary and tertiary prevention strategies (according to identified risks). Further development of the instrument is also recommended, so as to improve its reliability in the local context. Finally, future research into occupational stress should explore the impact of factors such as resource constraints and HIV/AIDS, and should include an expansion into other settings and occupational categories. Key words Occupational stress, questionnaire reliability, psychosocial risks, intervention design.Item A programme to reduce burnout among hospital nurses in Gaza-Palestine.(2014-04-24) Alhajjar, Bashir IbrahimBackground: This thesis concerns an investigation into burnout among hospital nurses in the Gaza Strip-Palestine. The purpose of this study was to explore the prevalence and nature of burnout in a population of nurses in Gaza-Palestine and then to develop a strategy for reducing burnout and test its effectiveness. From this purpose a number of research objectives were set and from those objectives, a number of research questions were established. Method: A quantitative survey design was employed as the method for data collection, with a self-administered questionnaire pack being the data collection technique. Data were collected on burnout using Maslach Burnout Inventory (MBI). Demographic data were also collected. Data were analysed using a variety of descriptive and inferential statistical methods using the SPSS system version 17. In particular, parametric and non-parametric tests of comparison were employed. The burnout assessment was stratified into three levels (high, moderate, and low). Thirty participants of each level of burnout (15 interventions, and 15 controls) were randomly chosen on the base of 1:1 assignation, provided that they agreed to participate in part two of study. The control groups were assured that they would receive the same burnout reduction programme if found to be effective. The intervention programme consisted of 9 sessions and was provided for each intervention group separately. After completing the programme, the same questionnaire (MBI) was applied for intervention and control groups to check the effectiveness of the programme. Sample: The study population in this study is the entire cohort of nurses who are working in 16 hospitals in Gaza (n=1801). Only 1500 nurses were asked to complete a questionnaire pack, and 1330 packs were returned and used in analysis with response rate=88.7%. Results: The results of this study revealed a high prevalence of burnout (EE=44.9%, DP=53.6%, Low PA=58.4%). Emotional exhaustion (EE) was significantly associated with gender, hospital type, night shifts, and specialisation. Depersonalisation (DP) was significantly associated with hospital type extra time, night shifts, experience and specialisation. Low personal accomplishment (LPA) was significantly associated with hospital type, night shifts, and experience. The burnout reduction programme was effective with moderate and severe burnout but not with low levels of burnout. Conclusion: Being a nurse in Gaza hospitals appears to be a stressful experience. Continuation of this burnout reduction programme or a similar process is recommended to reduce burnout among Palestinian nurses in Gaza.