EFFECT OF WORKPLACE STRESS ON THE PERCEIVED HEALTH OF RESIDENT DOCTORS IN NIGERIA

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A.O. Alao¹, A.M. Obimakinde², A.M. Ogunbode¹

1. Department of Family Medicine, University College Hospital, Ibadan, Nigeria.
2. Department of Family Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria.

Abstract

Background: Resident doctors’ health and wellbeing has recently become the focus of international concern, as they are very important members of the healthcare system. The medical workplace is a complex environment where the doctors respond differently.

Objective: The objective of this study was to assess workplace stress among the resident doctors, examine their perceived health status, and determine the effect of workplace stress on their perceived health status.

Method: The study was a cross-sectional study conducted among resident doctors at University College Hospital (UCH), Ibadan, Nigeria across all the specialties over a three-month period, from 1st March to 31st May, 2019. Two hundred and thirty-two eligible and consenting resident doctors were selected by stratified random sampling and data was collected using interviewer-guided self administered questionnaire. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 23.

Results: The result showed that 144 (62.1%) of the resident doctors experienced workplace stress and 108 (46.6%) resident doctors perceived their health as poor. Workplace stress, years in residency program, designation, and work hours on least busy day at work were all significantly associated with perceived health status of the resident doctors, however, only workplace stress could independently predict poor perceived health status of the resident doctors.

Conclusion: It is therefore important to prevent and manage workplace stress in order to improve the perceived health status of resident doctors.

Keywords: Workplace; Stress; Perceived health; Resident doctors.

Introduction

Residency training program is a very stressful period in medical profession.¹ The level of stress among resident doctors has been found to be high in several studies conducted both locally and internationally.^2,3,4,5 Resident doctors experience high level of stress at work largely because the medical profession is inherently stressful due to, long working hours, conflicting demands, difficult patients ethical dilemmas, among other challenges.^2,6 The residency training program is associated with frequent exposure to diseases, dying, and deaths of patients, thereby producing a great deal of anxiety and self-doubt.⁷ Consequently, the residency training can be extremely stressful and may contribute to feelings of burnout, and distress.⁷

The World Health Organisation (WHO) defines work related stress, also known as workplace stress or job stress, as “the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities, which challenges their ability to cope”.⁸ The International Labour Organization (ILO) also defines stress as the harmful physical and emotional response caused by an imbalance between the perceived demands and the perceived resources and abilities of individuals to cope with those demands.⁹

The prevalence of workplace stress among resident doctors in the literature ranges between 18% and 54.7%.^2,3,4,10 Although female doctors are more susceptible to higher stress than male doctors it is noteworthy that women and men respond to and manage stress in different ways.^9,11 They attempt to manage stress and perceive their ability to do so in distinctly different ways.⁹

Resident doctors’ health and well-being and that of other medical doctors have recently become the focus of international concern as they are important ‘citizens’ of the healthcare system, therefore, their wellness is crucial to its function.¹² The medical workplace is a complex environment where medical doctors respond differently; some are contented and inspired to work while some may experience burnout and feel stressed at work.⁶ Residency training-induced stress can endanger the health of a resident doctor’s which then negatively affects productivity, efficiency, quality of patient care and physician preservation.^2,12

Perceived health is defined as the perception of a person’s health in general, either by the persons themselves or, in the case of proxy response, by the person responding.¹³ Perceived health status reflects people’s overall perception of their health, including both physical and psychological dimensions,¹⁴ while health means not only the absence of disease or injury but also the presence of physical, mental and social wellbeing.¹⁵

Perceived health status, quality of life (QoL), and health-related quality of life (HRQoL) are often used interchangeably.¹⁶ The WHO, quality of life as “individuals’ perceptions of their positions in life within the context of their culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns”.¹⁶ Quality of life is also “the product of the interplay between social, health, economic, and environmental conditions, which affect human and social development”.¹⁶ Self perceived health is a powerful indicator of health status and it is significantly influenced by stress which could be workplace stress.^17,18 Idubor et al. in 2015 also reported a relationship between the levels of stress experienced and health status.¹⁹

Low socioeconomic status, physical disability and poor access to good healthcare services have been noted to be associated with poor perceived health status among resident doctors.^20,21 Poor sleep quality and sleep duration, either being too short or too long, are also related to a poor health status in all ages

There is a relationship between job stress and various physical and psychological diseases.²² Job stress influences health of an employee negatively in many ways like physical, psychological, emotional and behavioural.²² Most doctors work long hours and even work night shifts and both can have negative health outcomes.²² When a person is having trouble dealing with the stress, the individual may experience physical, psychosocial, cognitive and behavioural problem.²²

Job stress and lack of enabling work environment can culminate in ill-health of resident doctors,²² but how they actually perceive their health has not been well documented in the literature, especially in Nigeria. It is therefore worthwhile to study the perceived stress among resident doctors and how this affects their physical health perception, because they are a unique group of doctors responsible for the care of patients.²³ As a result of paucity of articles on workplace stress among resident doctors and how they perceived their health, this study focused on these two aspects and their association.

The Objective of this study therefore is to determine the effect of workplace stress on the perceived health status of the resident doctors.