Kurdistan Regional Government Council of Ministers Ministry of Higher Education and Scientific Research University of Sulaimani The Deanery of Faculty of Medical Sciences School of Nursing
EFFECT OF JOB STRESS ON JOB SATISFACTION AMONG NURSING STAFF IN SULIMANI MENTAL HEALTH HOSPITALS
A THESIS SUBMITTED TO THE DEPARTMENT OF PSYCHIATRIC AND MENTAL HEALTH IN NURSING COLLEGE / UNIVERSTY OF SULAIMANI IN PARTIAL FULFILLMENTS OF THE REQUIREMENTS FOR THE DEGREE OF MASTER SCIENCE IN NURSING
BY KAMAL JUMMAH AMEEN B.SC. NURSING 1997
UNDER SUPERVISION OF Dr . SAMAN ANWAR. FARAJ M.B.Ch.B, F.I.B.M.S (PSYCHIATRY)
DECEMBER 2016
BAFRANBAR 2716
ﱠ ﱠ ْ ّ ْ ِﺑﺴﻢِ ﺍﻟﻠﻪِ ﺍﻟﺮﺣﻤﻦِ ﺍﻟﺮﺣِﻴﻢِ
ﱠ َ ُ ﱠ ْ َ ﱠ َ َ َ ﱠ َْ ُ َ ْ َ ْ ُ ْ َ َ ْ ُُ ﺬﻳﻦ )ﺃﻡ ﺣﺴِﺒﺘﻢ ﺃﻥ ﺗﺪﺧﻠﻮﺍ ﺍﻟﺠﻨﺔ ﻭ ْﻟﻤﺎ ﻳﺄﺗِﻜﻢ ﻣﺜﻞ ﺍﻟ ِ ﱠ ﱠ ُ َ ُ ْ ُ ﱠ ﱠ ْ ُ ُ ْ َ َ ُ َ َ ْ ُ ََ ْ ۖ ﺧﻠﻮﺍ ﻣِﻦ ﻗﺒﻠِﻜﻢ ◌ ﻣﺴﺘﻬﻢ ﺍﻟﺒﺄﺳﺎء ﻭﺍﻟﻀﺮﺍء ﻭﺯﻟﺰِﻟﻮﺍ َ َ ُ َ َ ٰ َ ْ ُ َ َ ُ ﱠ ُ ُ َ ﱠ َ ﱠ ٰ َُ َ ﺬﻳﻦ ﺁﻣﻨﻮﺍ ﻣﻌﻪ ﻣﺘﻰ ﻧﺼﺮ ﺣﺘﻰ َﻳﻘﻮﻝ ﺍﻟﺮﺳﻮﻝ ﻭﺍﻟ ِ ٌ َ ﱠ َ ْ َ ﱠ َ ﱠ ﺍﻟﻠﻪِ ۗ◌ ﺃﻻ ِﺇﻥ ﻧﺼﺮ ﺍﻟﻠﻪِ ﻗ ِﺮﻳﺐ(
َ
ﺻﺪﻕ ﺍﷲ ﺍﻟﻌﻈﻴﻢ
ﺳﻮﺭﺓ ﺍﻟﺒﻘﺮﺓ ﺍﻵﯾﺔ )(214
Dedication To Those who gave me support, assistance and prayers for the sake of my success. My family for their support and encouragement.
Acknowledgements Before all, greats thanks to God ‘Allah’ the Merciful, the compassionate, for helping us in completing this work. I would like to thank Dr. Atiya Kareem Mohammed Dean of College of Nursing / University of Sulaimani for her cooperation and assistance. I wish to express my deepest and grateful thanks to professor Dr. Salwa Shakir Alkrwi Head of Department of Psychiatric and Mental Health Nursing/ University of Sulaimani for her kind encouragement and cooperation. My gratitude and appreciation to the administrative staff and librarians in Nursing College / University of Sulaimani. My gratitude and appreciation to The General Directorate of Health and the Administration of Mental Health Hospitals in Sulaimani for granting me the opportunity to conduct the project and for making the study possible and for their valuable contributions. My great thanks to all experts in different specialists and work setting who enriched the study questionnaire through their review and scientific recommendations for validity of questionnaire. Finally, my great thanks go to all who assisted me to deliver this thesis.
I
ABSTRACT
Abstract Background: Job stress is regarded as a harmful factor for both employees and organizations, which negatively affects the effectiveness of employees and efficiency of organizational performance. Many of occupations are exposed to different types of stress in the work place environment. One of these occupations is nursing, which occupies essential role and vital parts of the effectiveness of health care system. Objective: To investigate the relationship between the effect of job stress on job satisfaction for nurses. Method: A descriptive study was conducted among nursing staff in mental health hospitals in Sulaimani. The process of the necessary data collection began from 25th May - 10th July 2016 and was obtained through self-report convenient sample of (75) nurses. They distributed in three hospitals Soz Mental Hospital, Shahid Salahi Muhandis Hospital and Mental Health Center / Teaching Hospital by using questionnaire were divided into three parts: First, socio-demographic characteristics consisted of eight items. Second, Expanded Nursing Stress Scale (ENSS). This consisted of (57) items ranged in nine sub scales. Third, Job Satisfaction Survey (JSS), which included 36 items in nine subscales. Descriptive data and inferential data were used for analysis. validity of the questionnaire was determined through panel of (11) experts in the different fields and work settings.
II
ABSTRACT Results: The analysis of the data figured out that total average job stress among nursing staff at the mental hospitals was "Occasionally stressful- frequently stressful". The subscale death and dying from job stress took the highest level. Nursing staff had job satisfaction, subscale payment (salary) from job satisfaction took the lowest level. There were significant statistical relationships between level of job stress subscales and demographic characteristics except training course dimension. There was no statistical significant correlation between total ENSS and total JSS. Conclusions: The death of the patients played an important role in perceiving job stress. The lack and delay in salary were a major factor of decreasing job satisfaction, although the level of job stress among nurses does not highly recorded. Also, most of the nurses were satisfied with their work.
III
List of Contents Subjects Acknowledgement Abstract List of Contents List of Tables List of Figures List of Abbreviation and Symbols List of Appendices Chapter One: Introduction 1.1 Introduction 1.2 Importance of Study 1.3 Statement of Problem 1.4 Objectives of the Study 1.5 Definition of Terms Chapter Two: Review of Literature 2.1 Part I :- Stress 2.1.1 Stress 2.1.2 Models of Stress 2.1.3 General Adaptation Syndrome 2.1.4 Classification of Stress 2.1.5 Type of Stress 2.2 Part Two :- Job stress 2.2.1 Job stress 2.2.2 Sources of the Job Stress at Work Place 2.2.3 Signs and Symptoms of Job Stress in the Work Place 2.2.4 Job Stress in Nursing Professions 2.2.5 Main Job Stress Consequences 2.2.6 Coping with Stress Strategies. 2.2.7 Stress Management for Nurses 2.3 Part Three: Job satisfaction 2.3.1 Job Satisfaction IV
Page No. I II IV VI VII VII
VIII
1-8 2 4 5 6 6 9-48 10 10 11 13 15 16 17 17 19 21 22 23 25 28 32 32
2.3.2 Job Satisfaction in Nursing Profession 2.4.3 Job Stress and Job Satisfaction in Psychiatric Nursing 2.4 Previous Studies Chapter Three: Method 3.1 Administrative Arrangements 3.2 Design of the Study 3.3 The Setting of the Study 3.4 The Sample and the Sampling of the Study 3.5 The Study Tool Construction 3.6 Data Collection 3.7 Validity and Reliability of the Study Instrument 3.8 Statistical Data Analysis 3.9 Limitation of the Study Chapter Four: Results See List of Tables Table (4-1) to Table(4-13)
35 36 40 49-61 50 50 51 52 53 56 57 59 61 62-78
Chapter Five: 79-98 Discussion Part One: Characteristics of the Sample Study 80 Part Two: Responses of Nursing Staff in Mental Health Hospitals 84 with Items Subscales of Expanded Nursing Stress Scale Part Three: Responses of Nurses Staff in Mental Health Hospitals 89 with Items of Job Satisfaction Survey Part Four: Associations between Level of Expanded Nursing Stress 92 Scale and Demographic Characteristics Part Five: Correlations of Expanded Nursing Stress Scale with Job 97 Satisfaction Scale Chapter Six: 99-101 Conclusion and Recommendations 5.1 Conclusion 100 5.2 Recommendations 101 102-132 References
V
List of Tables No.
Title
1.
Table(3-1): Distribution of the Nurses, Beds and Samples in Psychiatric - Mental Health Hospitals in Sulaimani 2. Table(3-2): Expanded Nursing Stress Subscales with the Number of Items 3. Table(3-3): Job Satisfaction Survey Subscales Descriptions with the Number of Items 4. Table(3-4): Reliability Coefficient of the Study Instruments 5. Table(4-1): Distribution of the Socio-demographic Characteristics of (75) mental hospitals nurses 6. Table(4-2): Level Subscales of Expanded Nursing Stress Scale(ENSS) Subscales 7. Table(4-3): Level Subscales of Job Satisfaction Survey (JSS) Subscales 8. Table(4-4): Gender Difference in Regard of Expanded Nursing Stress Scale 9. Table(4-5): Age Group Differences in Regard of Expanded Nursing Stress Scale 10. Table(4-6): Marital Status vs. Expanded Nursing Stress Scale 11. Table(4-7): Graduation vs. Expanded Nursing Stress Scale
Page No. 51 54 55 58 63 65 67 69 70 71 72
12. Table(4-8): Employment vs. Expanded Nursing Stress Scale 13. Table(4-9): Economic Status vs. Expanded Nursing Stress Scale 14. Table(4-10): Training Course vs. Expanded Nursing Stress Scale 15. Table(4-11): Interest vs. Expanded Nursing Stress Scale
73
16. Table(4-12): Correlations of Both ENSS with JSS in all Nine Subscales 17. Table(4-13): Correlations of Total ENSS with Total JSS
77
VI
74 75 76
78
List of Figures No. 1.
Title Stages of General Adaptation Syndrome with Level of Resistance Duration of Exposure to Stress.
List of Abbreviations and Symbols Abbreviation
Phrases
A.I.S ANA ANOVA APA AR ASD DOH ENSS ES et al F (%) GAS HSE JSS MMSS MOH M.S NHS No.
The American Institute of Stress American Nurses Association Analysis of Variance American Psychiatric Association Alarm Reaction Acute Stress Disorder Department of Health Expanded Nursing Stress Scale Exhaustion Stage Etalia (and Others) Frequent (Percentage) General Adaptation Syndrome Health and Safety Executive Job Satisfaction Survey Mueller and Mccloskey Satisfaction Scale Ministry of Health Means of Scores National Healthcare Services Number
r RS S.D
Correlation Coefficient Resistance Stage Standard Deviation VII
Page No. 14
SDT SES SPSS SSE SST T VS. WHO ≤ %
Self-Determination Theory Socioeconomic Status Statistical Package for Social Science Sum of Squares due to Error Sum of Squares due to Treatment Independent Samples T- Test Versus World Health Organization Less Than or Equal Percentage
x̅
Mean
∑
Summation
List of Appendices
List
Title
A
Formal Letter Concerning to the Study from Nursing School
B
Administrative Permission from General Health Directorate / Sulaimani
C
Ethical Committee Form
D1
Questionnaire in English Language
D2
Questionnaire in Kurdish Language
E
Roster of Questionnaires' Expert of Validity
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Chapter One: Introduction
CHAPTER ONE : INTRODUCTION
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Chapter One 1. Introduction 1.1 Introduction Stress is now regarded as a biggest problem in many countries around the world (Sabee, 2013). It has been recognized as a major health problem in the 20th century (Maldonado, 2014). It was took the number one of the health problem for both employees and organizations (Watson, 2013). Job stress is defined as the psychological tension or strain that arises from both employees and organizational stressors in the workplace related to the demands of the job (Finney et al., 2013). There are constant understandings that job stress described as a complex phenomenon. It is regarded as a harmful factor for employees in terms of health, well-being and job dissatisfaction as well as for organizations in terms of absenteeism and productivity which negatively affects the effectiveness of employees and efficiency of organizational performance (Shikieri and Musa, 2012). It is produced from an interaction between organizational factors and the characteristics of employees in the work place which is related to recent human resource management problems, like higher absenteeism, high rates of turnover, burnout and lower job satisfaction problems (Sullivan, 2013) and (Al Rasasi, et al., 2015). Many of occupations with totally different jobs are exposed to different types of stress in the work place environments. One of these occupations is nursing (Milutinović et al., 2012). The Nursing profession occupies essential role and vital parts of the effectiveness of health care system (Sullivan, 2013). Wen-Hsien et al., (2009) identified various sources of job stress in the nursing field. In their environment, nurses are exposed daily to a number of potent
CHAPTER ONE : INTRODUCTION
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stressors, such as conflict with physicians, discrimination, high workload, and persist dealing with death, patients and their families (Mark and Smith, 2011). They occur when nurses attempt to manage patients and provide services within the scope and field of nursing (Cang-Wong, 2009) . Numerous studies have shown when there is an imbalance or mismatch between the demands of the work place and a worker’s ability to cope (Li et al., 2014) make nursing profession a hard work and job stress would be prevalent and common among nursing staff (Al-Makhaita, et al., 2014). Job stress in the nursing profession is associated with a variety of negative trends, behavioral, physical and psychological health effects and consequences. Among attitudinal and behavioral consequences mentioned job satisfaction (Long et al., 2014) . Job dissatisfaction is one of the obvious negative outcomes of job stress among nurses with each work environment (Kawano, 2008). Job satisfaction is a subjective feeling or attitude regarding various aspects of the job which is influenced by a multitude of factors. It is highly influenced by job stress (Kumar, et al., 2015) . Recent studies in this area show that the higher levels of nurse job satisfaction are positively linked to improved quality and quantity of care, enhance work environment, increase of productivity, communication performance, self-esteem among staff, organizational citizenship, satisfaction with life and client satisfaction, client interest, mood and indelicacy (Melo, et al., 2011) . Hence, it is found necessary to assess the level of both job stress and job satisfaction, and figure out the effect of job stress on job satisfaction among the nursing staff especially at the mental health hospitals, because tragic
CHAPTER ONE : INTRODUCTION
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consequences of this relationship are serious, growing concerns for nurses, patients family, and hospitals.
1.2 Importance of the Study: This study provides knowledge and serves as a source of reference material on job stress and job satisfaction among nurses, and may help to resolve or decrease some managerial problems such as delay and absence of staff in the work place, decrease productivity and efficacy, conflict at work, workload. It is not only for assessing job stress in health sector, but also to clarify some information that may help government to adopt a better and effective planning and management policy in other hospital departments. Outcomes of the study may broaden perceptions on job stress and job satisfaction among nursing staff thereby offer deeper insights for stockholders. It may inform health planners to enable them set up genuine planning schemes for health care services. The study will serve as a basis for further studies on job stress among nurses; support nursing management to find adequate means for continuous monitoring workplace stress, and to control the stress effectively and retaining satisfied work forces. In the developed countries the job stress among nursing staff is widely studied. Several obvious studies focused on effect of job stress among nurses, because they work in high-stress environments, which have adverse effects on nurse job satisfaction (Davey et al., 2014). There is no adequate data about prevalence of stress and job satisfaction amongst mental hospital nurses in Kurdistan region. Therefore, additional studies are needed now more than ever, because of the rapid changes and the complex technology characteristics of the health care system, and persistent financial crisis impact on quality of care and nurses' life.
CHAPTER ONE : INTRODUCTION
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1.3 Statement of Problem: The statement of the problem is ‘Effect of Job Stress on Job Satisfaction among Nursing Staff in Sulaimani Mental Health Hospitals’.
1.4 Objectives of the Study: The study aims to obtain the following objectives: 1- To measure the level of job stress and job satisfaction among nursing staff at the mental health hospitals in Sulaimani city. 2- To find out
the relationship between job stress and sociodemographic
variables which are age, gender, marital status, educational level, years of employment, economic status, training course, and interest. 3- To investigate the relationship between the effect of job stress on job satisfaction for nurses.
CHAPTER ONE : INTRODUCTION
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1.5 Definition of the Terms: 1.5.1 Effect: 1.5.1.a Theoretical Definition: The result of an influence (Cambridge Dictionary, 2016). 1.5.1.b Operational Definition: Is the impact or influence of job stress on job satisfaction among nursing staff in Sulaimani Mental Health Hospitals.
1.5.2 Job Stress: 1.5.2.a Theoretical Definition: The harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker (Roberts and Grubb, 2014). 1.5.2.b Operational Definition: The physical, psychological, and social reaction that result from environmental strains arise from nurses working in Sulaimani mental health hospitals.
1.5.3 Job Satisfaction: 1.5.3.a Theoretical Definition: The pleasurable emotional state resulting from the appraisal of one’s job as achieving or facilitating the achievement of one’s job values (Liu, et al., 2015).
CHAPTER ONE : INTRODUCTION
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1.5.3.b Operational Definition: Feelings of nurses about different aspects of the job; liked and satisfied about job in Sulaimani mental hospitals and that’s created by multiple factors related to the job are measured by: Payment, promotion, supervision, fringe benefits, contingent rewards, operating conditions, coworkers, nature of work, and communications.
1.5.4 Nursing Staff: 1.5.4.a Theoretical Definition: Nursing staff are people educated and licensed in the practice of nursing. A nurse is concerned with diagnosis and treatment of human responses to actual or potential health problem (ANA, 2010 and 2014). 1.5.4.b Operational Definition: A number of persons who have nursing certifications in different level of graduation , and those are working with other medical staff in mental health hospitals in Sulaimani city.
CHAPTER TWO: REVIEW OF LITERATURE
CHAPTER TWO : REVIEW OF LITERATURE
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Chapter Two Review of Literature 2.1 Part I : Stress 2.1.1. Concept of Stress : Stress is a feeling that is generated when there is a reaction to certain environment events. It is a way for body to challenge and prepare to face the difficulties and serious situation threatening with focus, energy and stamina, making heightened alertness and caution (Kaur, et al., 2013; Helpguide, 2016). Mostly stress is defined either as a reaction with something or as a stimulus from something. As a reaction the meaning of stress is consubstantial with specific changes that human biological system is experiencing, as stimulus the definition of stress is related to environmental events that cause those changes (Papathanasiou et al., 2015). Selye defines stress as a consequence of the interaction between stimuli and the response a universal experience in our life. Stress could be a result of any demands upon the body. Stress may be present for a person to function; so not all stress is negative (The American Institute of Stress (A.I.S., 2011). Waddell et al., (2006) explained stress as an essential psychological concept that impacts health well-being and work performance in negative dimensions. They state that stress has a psychological dimension such as anxiety, irritability, and frustration as a result of the stimuli at the workplace, and has physiological dimension such as headaches, chest pain, and palpitations as a reaction of the body in an individual. These dimensions often seen as various stressful triggers at work (Viegas, 2015).
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2.1.2 Models of Stress : There are three main models of stress in addition to other models formulated to interpret the stress. The followings are models of stress: 2.1.2.a Stimulus Based Model : In this form of stress models, stress is interpreted and explained as a stimulus, a life event or a group of environment factors which may stimulate normal and / or psychological reactions those reactions may increase an individual's exposure to disease. According to this theory, both positive and negative life events are considered stressful (Vakola and Nikolaou, 2005). 2.1.2.b Response Based Model : In this model, stress is interpreted as a response as developed and described by Selye. He defines stress as a nonspecific response of the body to any kind of demands applied on it (Kalsi, 2013). 2.1.2.c Transaction Based Model : In this model the stress is explained as a transaction on the theory of Lazarus, which focuses on the fact that there are differences among people in the interpretation of stress as stimulus or as a response, depending on how the individual takes it (Papathanasiou, et al., 2015), There is a shortage of theories in explaining the factors that help some people to cope with which last longer than others in the stressful stimuli (Lazarus, 1966). Depending on this, a number of external and internal information are received daily to a neurological level of the body which are interpreted by the cognitive evaluation process (Folkman and Lazarus, 1988). This will help individuals to negotiate with potential or actual demands (Roesch, Weiner and Vaughn,2002).
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Cox’s Transactional Model of Work Stress Cox’s transactional model focuses on two dimensions: 1-Occupational health.
2- individual differences.
Cox’s framework (1987) has five stages. The First Stage: it represents the demand or job characteristics of the environment. The Second Stage: it represents the employees perceptions of these demands or job characteristics relative to their ability to cope. Stress occur when there is a mismatch between perceptions of the importance of a demand, and beliefs about employees ability to cope with it. Cox and Ferguson (1991) describe how this primary appraisal process is influenced by the internal and external demands experienced as well as coping abilities and incomes, and maintenance from others. The Third Stage : it is associated with the mental and physical changes such as mood change and emotional experience that the employees undergoe as a result of the recognition of a stress state. It also and involves secondary appraisal and coping. The Fourth Stage : it represents the outcomes or consequences of coping. The Fifth Stage : it is feedback which is proposed to occur in relation to all other stages. Cox and Ferguson (1991) state that primary assessment is a continual monitoring process. Secondary assessment is an explicit decision making process. Hence, the entire stress process is well balanced and sensible in a problem solving (Cox, et al., 2000).
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2.1.3 General Adaptation Syndrome (GAS) : Selye (1956) originated a model as a generalized response to prolonged stress called the General Adaptive Syndrome model to explain the stress phenomenon and the stress levels, which is used to describe the body's short-term and long-term reactions to stress. This model has three stage, shown in figure (1) which are based on the supposition that the body is normal level of stress resistance, as discussed by (Kaminsky, 2010): Phase 1: Alarm Reaction (AR): It involves the body’s response to or familiarizing itself with the new situation or stressor, during which the body activates its resources to cope with stress. It prepares the body for physical activities and releases adrenaline and a variety of other psychological mechanisms to combat the stress. Phase 2: Resistance Stage (RS): It involves resisting and reacting to the situation and the body’s response to long term protection. Resistance remains high until the final stages of exhaustion where it rapidly drops. Resistance will ensue if continued exposure to the stressor adaptation. Phase 3: Exhaustion Stage (ES): In this phase the body has run out of its reserve of body energy and immunity. Mental, physical and emotional resources suffer heavily. The body's resistance to the stress may gradually be reduced following long-continued exposure to the stressor. The general adaptation syndrome is also influenced by widespread human variables as overall health and nutritional status, sex, age, racial background, level of education, socioeconomic status (SES), genetic makeup. Some of these variables are biologically based and difficult or impossible to change (Mitterer and Dennis, 2013).
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(Bennett, 2016) Figure (1): Stages of General Adaptation Syndrome with Level of Resistance Duration of Exposure to Stress.
2.1.4 Classifications of Stress: Stress is classified in two different categories: 2.1.4.a Internal Stress: Originates from within the person such as inability to accept uncertainty and unrealistic expectations to determine the body's ability to respond, to keep physiological homeostasis (Greene, 2013).
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2.1.4.b External Stress: External stress comes from outside a person. It starts from the environmental influence on an individual (Health24, 2009). This can be physical and/or mental stress (Swanson, 2014). This may include family and social problems stressors such as divorce, financial conflicts such as salary, benefits, promote, and physical conditions such as poor lighting, poor seating arrangements. Work stressors arise from workplace stress such as irregular chief or frantic activity schedules and shortage of time (Cunha and Shah, 2016) and (Seltzer, 2008). 2.1.5 Type of Stress: Generally, stress is divided in to two major types:2.1.5.a Acute Stress It is the most common type of stress caused by the daily demands. It occurs as a reaction to an immediate threat or a new challenge that we know as the flight or fight response within very short period of time (short –term stress), when it occurs repeatedly, it will be episodic acute stress (American Psychological Association, 2016) and (Sincero, 2008). 2.1.5.b Chronic Stress This type of stress is brought about by long-term exposure to stressors. It is dangerous and unhealthy, such as unhappy marriage, traumatic experiences, unwanted career or job stress, poverty, relationship conflicts, political problems, and dysfunctional families. The accumulated stress that results from prolong exposure can be lifethreatening, and can even lead a person to resort to violence, suicide and selfharm (Sincero, 2008).
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2.2 Part Two :- Job Stress : 2.2.1 Job Stress : Job stress is a chronic problem caused by workplace conditions that adversely affect an individual's performance and well-being of his body and mind (Mazumdar, et al., 2011). Job (occupational, work or workplace) stress has become one of the most serious health issues in the modern world (Lu et al., 2003). It is a global problem for nurses and it negatively affects job satisfaction (AbuRuz, 2014). There is no specific definition of job stress, but most of the interpretations has the meaning of perversion from the standard condition of psychological and physical state of the individual (Ali, et al., 2011). The generally accepted definition today is one of the interactions between the situation and the individual. It is the psychological and physical state that results when the resources of the individual are not sufficient to cope with the demands and strains of the situation which was caused by a perceived hazards (Michie, 2002) and (Downs and Swailes, 2013). According to Wilton (2011) and Rahman et al., (2015) it affects both the human resources and the organizational management. It is connected with physical, behavioral, or psychological responses. Kreitner and Kincki(2010) presented four levels of stressors in the individual life: - Individual level involve ( role ambiguity, role conflict, and etc ). - Group levels (lack of cohesiveness within groups' conflict with staff, and etc). - Organizational level (structure of organization, culture, technology, etc) - Additional organizational level (family, economic factors, and etc).
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According to Al-khasawneh and Moh’d Futa, (2013) regarded working conditions with unpleasant organizational climate and Frustrating regulatory environment as the rigidity of rules, instructions, and regulations are job stressors. Conflicts have an adverse effect on productivity, morale, patient care, may affect on organization skills. Role conflict in the workplace is time-consuming. It is caused by multiplicity of the inconsistent requirement and Legal processes, instructions and orders between these roles paves stress in the work (Mansoor, 2011). Rao and Borkar (2012) suppose that employees suspect their competence and abilities; if they had sufficient qualifications to achieve job requirements, lack of knowledge and expertise opposite to job demands will end in internal serious disagreement and job stress. Jaramillo et al. (2011) provide ideas and views on the interpersonal relations inside the organization, conflicts inside work teams and groups that range from hidden behaviors and lack of consensus or approval up to the physical injury. Consequently, poor communication can wreak in an organization. It encourages employees to communicate as clearly and concisely as possible to avoid confusion. According to Wilton (2011) stress at the work coincides with bad quality of life at work, low degree of autonomy and censorship on individual jobs, their decision making and the work processes in an organization. Ulrich et al. (2010) regarded lack of obligation to ethical commitment in dealing with patients and maintaining acceptable levels of their privacy and confidentiality and satisfying patients’ needs in a proper way, one of the major source of stress in the nurse’s daily duties.
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The gap between supply and demand, and the persistent reduction in workers' numbers could be the major cause of highest workload and requirements for this kind of job, in addition to the fact that nurses are managing physical and psychological parts of the patients (Dave et al. 2011). Stress and the bad results of stress have been predictable as financially costly to any health care organization. Negative outcomes of job stress include physical and mental disorder (Rita, et al., 2013). Several studies show that health care workers have higher rates of substance abuse and suicide than other professions and elevated rates of depression and anxiety linked to job stress (NIOSH, 2008). Briefly, there are several methodologies related to stress. Generally, job stress is often seen as negative consequences or non-specific response and it can distress the well-being not only of individuals, but also of organization. This study is to measure level of job stress among nurses beside job satisfaction in mental health hospitals.
2.2.2 Sources of the Job Stress at Work Place In attempts to identify the sources of job stress, we revealed many wrongs. Cooper (1983) developed a comprehensive list and brief, completed six sources of work pressure: (1) Conditions of work for example work overload, physical danger, and techno stress. (2) Role stress for example role ambiguity, sex bias and sex-role stereotypes. (3) Interpersonal factors such as poor work and social support systems, lack of management concern for the employees, political conflict.
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(4) Career development for example under promotion, over promotion, job security and frustrated ambitions. (5) Organizational structure as rigid and impersonal structure, political battles, inadequate supervision or training and non-participative decision making. (6) Home-work Interface - spillover, such as lack of support from spouse, marital conflict and dual career stress. Najimi et al. (2012) mentioned some palpable sources of stress in the work place as working hours, time, sensitive or illogical decisions, Financial and rewards aspect, colleagues relationships, level of education, mutual support, and setting of nurses. Wilson and Kirshbaum (2011) concluded that the death of a patient can have an impact on nurses mind and their activities, this could happen in their work environment and outside of work, and could affect their relationships with others, the emotional impact on staff, the culture of the work environment, personal life experiences of staff and coping strategies. Salami et al. (2010) regarded lack of stability in the organizations' policies, instructions, rules, scheduling and procedures due to persistent change or conglomerate destructive among staff could be major factor of stressors in any organization. Gray-Toft and Anderson (1981) developed expanded and comprehensive source of stress among nursing staff in domains (a) Death and dying, (b) Conflict with Physicians, (c) Inadequate emotional preparation, (e) Problems relating to peers, (f) Problems relating to supervisors, (g) Work load, (h) Uncertainty concerning treatment, (i) Patients and their families, and (j) Discrimination. These were used intensively in the nursing field.
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2.2.3 Signs and Symptoms of Job Stress in the Workplace : Health and Safety Executive (HSE) (2014) mentioned some common stress signs and symptoms in two dimensions. It tends to vary due to the type of work required and patterns of life outside of work : 2.2.3.a Symptoms of Stress in Individuals: Physical Symptoms : They usually include muscle tension, headache, backache and problems with digestion (King C., 2012). Psychological Symptoms : They include trouble concentrating, loss of motivation, loss of interest in work, and lack of commitment. There is a tendency to become more sensitive, feeling anxious, irritable or depression, and more negative (Kennard, 2012). Behaviour Symptoms : Eating and sleeping problem, increased use of alcohol or drugs, changes in attendance such as arriving later or taking more time off, the need to work longer hours, the rush to complete things, missing breaks and holiday entitlements, and spending less time with family and friends (Parnabas, 2014) (Palmer and Cooper, 2013).
2.2.3.b Signs of Stress in Staff : The followings are signs of stress in staff : Conflicts and disaffection, disturbance in time management, staff turnover and increase in sickness absence, increase in complaints and grievances, escape from work responsibilities, late arrival, early leave, difficulty in attracting new staff, low of performance and achievement, clients dissatisfaction or complaints (HSE., 2014) (Hunnur, 2014).
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2.2.4 Job Stress in Nursing Professions Stress is part of everyday life for nurses in the workplace, since their main responsibility focuses upon providing attention to patients who are usually encountering life crises. Nurses rate complex and high workloads and deal with ‘death and dying’ as their major stressful events (Hipwell et al., 1989). Huber (2006) proposed that nursing work is one of the most stressful and challenging. Nurses occupy particularly interesting positions in the provision of quality health care, which are vital element, and have a major role in the success and reforming of any health organization. Al Rasasi et al. (2015) described stress as the emotional and physical reactions resulting from the interactions between the nurse and her/his work setting where the demands of the duty exceed capabilities and resources. Various studies have focused on work related to stress in nurses because they work in high-stress environments, which have detrimental effects both on their psychological and physical health, productivity and efficacy at work, absenteeism. They have effects on patients' outcomes like increased mortality and patient dissatisfaction (Vahey et al., 2004) (Ayed et al., 2014). Job stress can be accumulated gradually. If it is not resolved or adapted, it will develop to high and far-reaching consequences. It will cause deep and extensive poor health and decrease individual productivity (Huber, 2006). In short, nursing profession are always faced with stress from work than other sectors. It occurs in mental health hospitals more than other specialists. It is because the job of nurses in those hospitals is directly related to human mental illness. The most reported job stress for staff nurses in the hospital are experiencing with stress from moderate to high level (Davey et al., 2014).
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2.2.5 Main Job Stress Consequences : Job stress produces a range of undesirable, costly, and debilitating consequences (Ross, 2005). It can be grouped into individual and organizational dimensions. On the individual level, there are three chief subcategories of stress consequence's : (Blake et al. 1996) and (Cascio, 2013) . 1) Unwanted feelings and undesirable behaviors for example anger, low motivation, low staff morale, decrease the organizational commitment, lowered the overall quality of life, work absenteeism, intention to leave the job, lower productivity, decreased quantity and quality of work, inability to make sound decisions. 2) Biological and physical diseases for example hypertension and increased pulse rate, circulatory diseases, high cholesterol, hyperglycemia, sleep disorder, headaches, skin rashes, suppressed immune system, damages, exhaustion. 3) Psychological disorder for example depression, sadness, anxiety, apathy, hostility, loss of self-confidence and self-esteem, inability to concentrate, feelings of ineffectiveness, indifference and forgetfulness of standards and social morality, lack of job satisfaction and living and losing contact with reality, emotional distress. On the organizational dimension, consequences of job stress can be grouped into two main subclasses (Jaramillo et al., 2011). Also Kreitner and Kinicki (2010) mentioned three types of stress consequences: 1- Behavioral consequences: which cover the individual behaviors and intentions . 2-Attitudes; involve satisfaction, turnover, absenteeism and performance.
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3-The cognitive consequences: such as lack of perceptive and possibilities for problem solving and weakness in making decisions, lack or lost concentration, disappointment which lead to frustration, physical and physiological problems like hypertension and other diseases related the heart and the immunity system. Occasionally job stress extends in its bad impacts. This could lead to excessive use of alcohol or drug abuse, in a way that it could affect the ability of employees to fulfill their daily jobs in an effective way (Shirazi and Rasekhnia, 2011). The consequences and outcomes of stress depends on the individuals' understanding and awareness, interpretations, the degree of reaction to the stress. Also, it depends on the capacity and capabilities to manage sensors to transfer the disadvantages into tasks to improve their performance (Sen, 2008).
2.2.6. Coping with Stress Strategies : Coping with stress is a mechanism of management problems and stressful situations. It refers to an interplay between person and the environment that occurs when an individual appraises a situation or an event as stressful (Baqutayan, 2015). Coping strategies mainly divided in to two types. One of them is problemfocused coping it improves some settings by focusing on the problem. Emotion focused coping concentrates on thoughts and actions to mitigate the feeling of stress. It might be coping strategies for long term or for short term coping strategies (McLeod, 2015 and Abdalrahim, 2013). Effective coping strategies depend on some factors as the number, duration and severity of tension, previous experiences, available support systems and personal capacity (Shahrokhi et al., 2014).
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Gill et al. (2010) noted the importance of empowerment and transformational leadership style, early retirement programs and their effectiveness in reducing and managing the bad influence of stress. Karimi and Alipour (2011) recommended that internal position control, sports and exercise, physical activity, sleep, all of these can be successful in reducing processing and dealing with the stress of work. Joy and Buvaneswari, (2016) concentrated on training courses on stress management and psychological counseling. Rajen, (1996) concentrated on four approaches for managing or reduce stress to control this fight-flight. They are : "Action-oriented approach: Appropriate changes are made to alter the situation or the environment, and thereby it reduces or eliminates stress by resolution of the problem creating the stress. Emotion-oriented approach: The individual modifies personal emotions to interpret the situation differently, and thereby, it attempts to reduce to eliminate stress. Acceptance-oriented approach : In this kind of approach, total acceptance of the stress is undergone, and the focus is only on to somehow let the time pass and survive the stress. Adaptation-oriented approach : In this kind of approach, the individual adapts to the situation, and instead of trying to fight it, tries to go along with the flow. Thereby, it becomes one of the factors causing stress." Kreitner and Kinicki (2010) recommended (3) level strategies to combat stress attacks. They are using control strategy in diagnosis solving problems, and leave
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strategy when people fail in facing their stressors. The third solution strategy deals with symptoms treatment. Health and Safety Executive (H.S.E) (2009 and 2012) has identified specific factors in the organizations support resolving problems and making decisions successful: • "Culture issues, which could include lack of positive response to stress or health concerns, lack of staff involvement, poor communication, lack of consultation and participation in decision making, and long work hours or lack of rest breaks. • Demands: such as lack of challenge and pressure, exposure to violence or aggression, work overload, poor physical environment, lack of training, lone working, and fast pace of work. • Control issues which are low levels or lack of control over task design, or nonparticipation in decision making. • Relationships with those working with them or patients. This can range from bullying and harassment, through lack of support for the employee to physical violence. • Changes: many people in the NHS would recognise change as a stress factor over the last few years. This could include changing market demands, new technology, and organizational restructuring. • The individual’s role and conflicts and ambiguity within it. • Support: training and individual factors such as lack of adequate training, mismatch between person and job, lack of support or feedback, and lack of constructive advice."
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2.2.7. Stress Management for Nurses: Steps for managing stress in nursing at the work place are as follows: A- Adopting Occupational Health and Safety Act: Adopting and depending (occupational health and safety act) are very necessary. It is composed groups of specialists and those interested in the affairs of public safety and health professionals seeking to protect the human and material resources of the dangers of accidents and injuries and environmental pollution. This group provides help especially in the workplace, ensuring the mental health and well-being for all employees who suffer from job stress. Occupational Health and safety Act
ensures some of these : safe systems of work and work
environment. This ensures that everything used at the workplace is safe when used properly. For example equipment, providing information, instruction and training, establish and maintaining effective consultation, providing supervision sufficient to ensure safety, providing adequate facilities for the welfare of employees as toilets, facilities for hand washing and meal rooms (Holmes, 2006). B- Emotion Management: This indicates implementing emotion management strategies, including understanding the nature of reaction, trying to communicate , actively listening with the nurse in order to identify sources and meaning of bad emotions and feelings (Kidwell and Hasford, 2014) and (Whitbourne, 2014). C- Taking Rest Properly: Taking a regular rest is very important. It is one of the essential elements in stress management, because while the body is resting, it is recovering and improving the desired energy levels (Looker and Gregson, 2010).
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D- Organization and Administrative Facilities: Providing facilities and management skills with regulations encourage employees’ participation in decision-making. It grants the employees greater independence, and encourages decentralization. The employees should make a “to-do” list daily, prioritize the acts in the list and plan the acts accordingly (Shukla, 2013). E- Physical Activity (Exercise): Regular physical exercises keep the body and mind fit. They also releases positive hormones which soothens the mind and the body. Psychological advantage are relieving from tension and relaxation (Helpguide, 2016) and (Underwood and Coltrera, 2011). F- Relaxation Body and Mind: The nurses use this technique when they face stressful circumstances. This included breathing exercises, massage, progressive relaxation, guiding use of images, biofeedback, therapeutic touch, music treatment, good humor and laughter and meditation to reduce stress symptoms especially anger and frustration. It also gives support and confidence. These activities can be done inside organization (hospital) (Jacobs, 2001; Stoica, 2010). G- Management of Time: Poor time management can cause a lot of stress. Employees who manage their time carefully in organizations are experiencing less stress because they feel that the whole thing is under control (Papathanasiou, et al., 2015).
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I- Communication Techniques: Ünal (2012) describes "Therapeutic Communication Techniques", these techniques include making open-ended comments, reducing conflict, distance, restating, seeking clarification, reflecting, and planning. Actively listening to someone when they are stressed can help them release frustrations and cope with their problems. Effective organizational communication can also change employee views. Managers can use better signs and symbols which are not misinterpreted by the employees. J- Change of Thinking and Outlooks: Attitudes and thoughts influence the way you see things. A healthy dose of optimism can help you make the best out of stressful circumstances. Everyone can learn to think more optimistically and reap the benefits. Improving and increases quality of thinking produces positivity and increases quality of employees interpreted environment events (Sasson, 2001) K- Knowledge: Increased knowledge and quality data about everything related to work leads to alleviate fears – clear up any misconceptions and give yourself the tools and resources to cope with sources of stress (Kirk-Brown and Wallace, 2004). L- Employee Counselling: Through counselling, employees can become aware of their strengths and how to develop those strengths and their weaknesses. They can be aware of how to eliminate them. They can also develop strategies for changing their behaviors. Employees are also given career counselling which helps in reducing their ambiguities with regard to career (Shyamala, 2014).
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M- The Organization Goals : The organization goals should be realistic, clear, measurable, achievable, they act as a regular factor for activity and employees energy in improving and strengths nurses insight and vision to avoid complexity and chaos in the work and costs in procedures. The nurses must be given feedback on how well they are heading towards these goals (Shyamala, 2014). N- Improve Work Environments : This includes creating safe working environment, having a fair distribution of incentives and salary structure, promoting job rotation and job enrichment, having effective hiring and orientation procedures, appreciating the employees on accomplishing and over-exceeding their targets (Pandey and Kaur, 2016). O- Self Management The employees should have optimistic approach about their work. They should avoid connections with negative approach employees. They do not remain preoccupied with themselves. They should turn your focus outwards, and help others. This will release some stress (Mccraty, et al., 1998).
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2.3. Part Three : Job Satisfaction : 2.3.1. Job Satisfaction: Job satisfaction is a key factor for the success of an organization. It is much studied in organizational behavior. Satisfied employee with his or her job has significant positive consequences not only for the employee, but also for coemployees, managers and the organization as a whole (Spector, 1997); (Pouramini and Fayyazi, 2015). Satisfied employees will be more productive and stay with the organization longer, while dissatisfied employees will be less productive and will have more tendency to quit the work in between (Kumari, 2013). A more recent definition of the concept of job satisfaction is from Zedeck, (2010) who
have
noted
that
job
satisfaction
includes
multidimensional psychological responses to an individual's job. These personal responses have cognitive (evaluative), affective (emotional), and behavioral components. Employee’s level or degree of job satisfaction can range from extreme satisfaction to extreme dissatisfaction (Aziri, 2011). Mueller and Kim (2008) mentioned basically two types of job satisfaction based on the level of employees' feelings regarding their jobs. This refers to employees' overall feelings about their jobs. The second type is job facet satisfaction, which refers to feelings regarding specific job aspects, such as salary, benefits, work hierarchy. Level of satisfaction with the staff's feelings about their jobs are influenced by three groups of factors: characteristics of work, social interactions, and personal disposition (Biggio and Cortese, 2013).
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Spector (1997) identified nine (9) dimensions of job satisfactions which are a multidimensional construct consisting of the followings: payment, promotions, supervision, fringe benefits, contingent rewards operating procedures (required rules and procedures), coworkers, nature of work, and communication. Adopted Spector‟s job satisfaction scales in present study for measuring job satisfaction among nursing staff. There are three important dimensions to job satisfaction which refer to: 1- Employee's feeling towards one's job. 2- Well outcomes meet or exceed expectations. 3- Effective orientations on the part of employees towards their work roles. Job satisfaction has been found to be related with various job stress consequences and behaviours such as counterproductive work behavior, organizational citizenship behaviour, and turnover intentions (Nifadkar and Dongre, 2014). There are obvious differences between
the two terms job-satisfaction and
attitudes, although are mostly used interchangeably. Attitudes in the mind refers to predisposition to respond. Job-satisfaction in behaviour relates to performance factors. Attitudes reflect one's feelings towards individuals, organizations, and objects. However satisfaction refers to one's attitude to a job. Job satisfaction is, therefore, a specific subset of attitudes (Hammer et al., 1978). Job satisfaction has been defined in various contexts by various authors are mentioned below: One of the most widely used definitions in organizational research is that of Locke (1976) a pleasurable or positive emotional state resulting from the appraisal of one's job or job experiences.
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Spector (1997) gave the meaning of job satisfaction as “how people feel about their jobs and different aspects of their jobs.” Job satisfaction is known as
favorableness or un favorableness in which
employees display their works (Uddin et al., 2016). Job satisfaction can be defined as a set of emotions that hold the individual towards his job (Walczak and Derbis, 2015). Job satisfaction is an effective attitude, feeling of relative like or dislike towards something. If job affects the person's feelings and values in positive way, then it can be said that there is a job satisfaction (Redmond, 2016). Job satisfaction is generally defined as an employee’s effective reaction to a job, based on comparing actual outcomes with desired outcomes (Bergheim et al., 2015). Job satisfaction can be an important indicator of the employees’ feeling; and a general expression of them. Positive attitudes build up about employees job and a predictor of work behavior such as organizational citizenship, absenteeism, and turnover (Atefi et al., 2014). Rain (1991) states that job satisfaction is correlated to life satisfaction which means that people who are satisfied with life will tend to be satisfied with the job, and people who are satisfied with job will tend to satisfied with their life. In general, most definitions cover the affective feeling an employee has towards his / her
job or his / her attitudes towards specific aspects of it, such as:
colleagues, payment or working conditions (Lu et al., 2012). Job satisfaction is a multifaceted construct with a variety of definitions and related concepts, which has been studied in a variety of disciplines for many years to now (Ravari et al., 2012).
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Many studies, theories and articles of interest to managers, social psychologist, and scholars, focus on job satisfaction because most people spend their life-time for their work. Understanding of the factors that increase satisfaction is important to improve the well-being of individuals in this field (Parveen and Maimani, 2015). By consistent evaluating of job satisfaction, an organization can possibly increase positive outcomes such as employee performance and satisfaction. It may also decrease absenteeism and turnover. Investigating the employee or employee's value-perception can aid in managers building and creating work environments that help them to achieve high levels of employee satisfaction. The intention of investigating employee job satisfaction is a step towards creating a healthy psychological contract for people at work (Mbah, 2012).
2.3.2 Job Satisfaction in Nursing Profession: Nurses’ job satisfaction and their consequences have always been important issues for health care administrators and regulatory authorities. Job satisfaction is a complex and multifaceted concept which can mean different things to different people. Job satisfaction is more of an attitude and an internal feeling. It could, for example, be associated with a personal feeling of achievement, either quantitative or qualitative; it is a nurse’s sense of achievement and success on the job. It is generally perceived to be directly linked to productivity as well as to personal well-being (Asegid, 2014). Therefore, it is the key ingredient that leads to recognition, income, promotion, and the achievement of other goals that lead to a feeling of fulfillment and personal satisfaction (Castaneda and Scanlan, 2014).
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Studies conducted among nurses have revealed that stress affects the level of job satisfaction and in turn influence the quality of care. Hence it was found necessary to assess the level of stress among nurses in mental health hospitals. Some of the reasons why it is so important to study the job satisfaction of nursing staff are: a) Findings of studies showed that the job satisfaction of employees in general, and more specifically nursing staff, is on the decline worldwide (Hope, 2015). b) Severe shortage of nursing staff are on the increase worldwide, in spite of causes for these nursing shortages (Amaya, 2009). This relates to work characters such as low payment, lack of support and rewards of employees, abuse by demanding patients, job stress, work environment-related factors, and lack of opportunities for advancement (Heisler, 2009). c) Large impacts of job satisfaction on patient care and staff nurses with low job satisfaction levels may find it difficult to provide high quality patient care, and create a friendly and supportive atmosphere within the health care. This impacts on nurses work responsibilities, performance and productivity (Risman et al., 2016). 2.3.3. Job Stress and Job Satisfaction in Psychiatric Nursing: As a general rule, in mental hospitals the relationship between job stress and job satisfaction according to several previous studies is negative (Cushway et al., 1996; Konstantinos, N. 2008). This is for when stress rises, job satisfaction drops. For this, higher level of job stress results in lower job satisfaction and reduced quality of care. This will certainly affect performance (Taha et al., 2014). Low level job satisfaction Inevitably leads to a negative attitude towards work and family patients and colleagues , and 2010).
ultimately self-destruction (Lapré,
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For psychiatric care employees and other staffs ,physical hazards and threat from behaviorally decontrolled patients are significant problems. These might include employees job satisfaction, incentive and motivation ,well-being and attitude toward patients life. However, the impact of threats to physical safety may be having an opposing force or effect by factors in the clinical environment. There is a growing literature on the relations between work conditions and welfare among workers in psychiatric setting. A large part of this literature is descriptively valuable in relating perceived source of stress, satisfaction in the work milieu, conditions with physical or mental collapse, and normalization in employee (Lynch et al., 2005). In recent years, the subject of job satisfaction and job stress among employee of mental health" has become a matter of focus in research especially in the case of health hospital and community care. For the employees in a psychiatric hospital, the answer of the question" How satisfied am I on the job? can have multiple meanings, and multiple determinants. That mainly depend on
effective and
degree "climate" of the work place which form meaning in the mind and feeling. The work climate may be shaped by job demand. Every day work-related responsibilities, rewards pay and benefits in inpatient setting affect safety inherent in working with behaviorally compromised patients. Other aspects can contribute to the overall climate in ways that buffer psychiatric employees from the risks of their jobs, while it provides them a sense of satisfaction in what they do (Brief and Weiss, 2002). In psychiatric settings there was concept of "autonomy" or "independence" as a basic requirement for viability of production to have a sense of initiative in ones work. It is so important for the psychiatric quality care. Also, it is important for the communion for interaction with management and authority and decision maker that's products greater job satisfaction and job commitment (Engin and Cam, 2009). It is found that lack of autonomy led to the lack of administrative
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control, lack of influence on the job, lack of input in to treatment decisions, and the lack of control in important aspects of work are all associated with job stress (Donat et al., 1991). Kamel and Hashish (2015) psychiatric nurses needs satisfaction in the workplace for autonomy, relatedness, and competence with psychiatric hospital setting. In psychiatric fields, there is "Self-Determination Theory" (SDT) that’s a theory of motivation. It is concerned with supporting our natural or intrinsic tendencies to behave in effective and healthy ways (Deci and Ryan, 2011). It is test the relations of employee outcomes such as acceptance of hospital programs, attitudes toward patients, and employee well- being and job satisfaction both with satisfaction of basic psychological needs at work and with the experience of threat to safety on the job. This theory is focused on how both extrinsic rewards and satisfaction affect people's self-regulation and well-being. Within organizational settings SDT suggests that the institutional climate, including management styles, reward, and the level of challenges and demands has important implications or functional significance in terms of need satisfaction and the outcomes associated with it. SDT stated that self-motivation and wellbeing largely dependent on opportunities for autonomy, and competence (Ryan and Deci, 2000). Miller et al, (1990) noted that the evidence also indicates the importance of the psychiatric workers of the experience of kinship within the workplace. For example appreciate lack of collegial has been associated with burnout among psychiatric workers who are reported social supported were associated with lower stress and burnt, greater job satisfaction and greater job commitment, also lack of respect from coworkers have been linked to stress and burnout among psychiatric workers. Hughes and Umeh, (2005) conclusion that psychiatric nurses are protected from stress through social support from the multi-disciplinary team.
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Lynch, et al (2005) regarding competence and capability of workers in psychiatric settings, inability to control resident behavior and working with uncooperative resident both obvious factor of which could affect the commitment and performance and predicting stress in direct care staff in a psychiatric hospital. In the psychiatric hospitals sufficient and proper training in de-escalation techniques can help substantially mental health staff when they threats and assaults, as well as effective techniques to manage violent patients lead to incidence of violent attacks against mental health professionals decreases. (Anderson and West, 2011). Regarding salaries, according to the American Psychiatrist Nurses Association, the average Salaries for nurses who work in mental health hospitals that’s depended on the type of facilities they work in, work different hours; including nights and weekends and the level of education they achieve. Those with a bachelor’s or master’s degree may earn more. Your level of experience and the type of facility you work in also plays a part in earnings (Persson, 2014).
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2.4. Part Four : Previous Studies : There are several studies that have been carried out in different countries related to the current study. These are according to the degree of relatively to study and its main headlines: In Albania, Zahaj et al. ( 2016) conducted the study on nurses chosen randomly among 264 nurses to assess the level of job satisfaction among nurses in the Public Hospital Vlora with the contributing factors on it. By using a questionnaire based on Mueller and McCloskey Satisfaction Scale (MMSS), the results indicated that the most important extrinsic factor that affected the intensity of satisfaction in the nursing profession was 'monthly payment' , while as the most important intrinsic factor was ranked "career escalation". Also the level of professional satisfaction among nurses involved in this study was below the average. Less satisfied groups from nursing profession were young people and high educated nurses. The low level of professional gratifying is expressed as well in the fact that over 70% of nurses in the study would like to practice another profession. In Iran, Esfandnia et al. ( 2016) conducted a cross-sectional study to investigate the job stress among 216 nurses of Imam Reza Hospital, Kermanshah. Data gathering tool was Expanded Nursing Stress Scale (ENSS) to measure nurses job related stressors. As a result, there was a significant relationship between job stress and its dimensions, it seems that there was a lot of stress among nurses. The patient’s suffering and death, and uncertainty concerning treatment were the most important factors for job stress. In Iraq, Abdullah and Abbass (2015) conducted a descriptive analytic study to assess job stress among (100) nurses who were working in psychiatric hospitals in Baghdad city, and its relation to socio-demographic characteristics of the nurses. The study had been done at three psychiatric hospitals in Baghdad
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city. The data were collected through the use of constructed questionnaire. Descriptive data analysis was done through frequency, percentage, mean and standard deviation. Inferential data analysis was done by independent t-test and Analysis of variance (ANOVA). The findings showed the majority of nurses were middle age male, married, graduated from nursing institutes, and had less than or equal 5 years of experience in the psychiatric hospitals, most of them participated in training courses related to psychiatric mental health care inside Iraq, while few of them participated in the courses outside Iraq. Results revealed that both nurses male and female were suffer from moderate level of stress in their work in all of the domains. There was a significant relationship between nurses stress and their training courses especially outside the country. Also, the results revealed that job stress in all domains was found moderate among nurses in psychiatric mental health hospitals. This was for the lack of participation in training courses and especially outside country. In Korea, Lee and Cho ( 2015) carried out the study among 312 nurses to measure the relationship between job stress and job satisfaction among nurses working for a general hospitals. Through self-administered questionnaires, the results showed that the level of job satisfaction of subjects was significantly lower in the high groups than low group in job demand. However, it was significantly lower in low group than high group in job control, supervisor support and coworker support. In correlations, job satisfaction was found to be in a negative correlation with job demand, whereas in positive correlation with job control, supervisor and coworker support. Job control supervisor and coworker support were significantly decreased in the high group than in low group. Also, the affecting factors to the job satisfaction was selected variables such as educational background, work station, subject satisfaction of work, career choice motives, turnover experience, job stress contents (job demand, job control,
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supervisor support and coworker support). Job stress contents was significantly increased of explanatory power of job satisfaction . In Cyprus, Skitsou et al. (2015) studied to investigate the job satisfaction level of the nursing staff in Athalassa Psychiatric Hospital. Paul E. Spector’s Job Satisfaction Survey questionnaire was employed, which included 36 question elements with Likert scale possible answers. Nine aspects of job satisfaction were measured: salary ، development opportunities, supervision, general benefits, moral rewards, functional processes, partners, nature of
work and
communication. Results indicated that the highest satisfaction average (4.71) was found in question “sympathy toward partners” with the lowest value of standard deviation (0.963), while the lowest satisfaction average (2.78) concerned question “existence of additional benefits” with a standard deviation of 1.082. In general, the staff appeared satisfied by only two aspects: “partners” and “nature of work” . In Korea , Lee and Jung (2015) carried out the descriptive study on participants who were 119 nurses working in hospitals with no guardians to investigate task performance, importance, knowledge, and level of job stress and job satisfaction of nurses working in a hospital with no family or family paid auxiliary caregivers by using the questionnaire. The results indicated that nurses' job stress was significantly associated with job satisfaction. The mean scores for nurses' job stress and job satisfaction were low. In Nigeria, Patience Edoho (2015) conducted the study on 346 nurses in Calabar, Cross River State, Nigeria through stratified random sampling, to assess the level of job satisfaction and the relationship between determinants and overall job satisfaction. By using the methods: A descriptive survey with a sample, the results revealed that majority of the respondents (82.4%) were moderately satisfied with their work. Nurses were least satisfied with their salaries. The level
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of achievement, advancement, responsibility, recognition, work itself, nursing practice environment, hospital policy, interpersonal relationship, salary, supervision and working conditions were significantly positively related to the overall job satisfaction. The study had shown that nurses in the hospital under study were not totally satisfied with their job. In Erbil city capital of Iraqi Kurdistan Region, Ali et al. (2014) conducted the study under the title ‘Job Satisfaction among Group of Nurses in GeneralHospitals - Erbil City’ attempted to find out the level of nurse job satisfaction and its association with different demographical variables among 127 nurses. From all 200 nurses by a cross section the study was conducted in Erbil city. Convenient sample was chosen. Two questionnaires were used: the first one was a closed ended questionnaire that included demographical criteria. The second type was Job Satisfaction Scale. The results were out of all 127 nurses, 63.8% were neither satisfied nor unsatisfied, 22% were satisfied while only 14.2 were not satisfied with their job. The only association was between gender and job satisfaction. Findings state a low level of overall satisfaction among nurses in major hospitals in Erbil city. This response may be due to poor environment of work, unclear future promotion, missing their real work position, attention and respect. In Jordan, AbuRuz (2014) attempted to identify the sources of stress for Jordanian nurses and to compare the effect of stress on job satisfaction between Jordanian and Saudi nurses. A descriptive cross-sectional correlational design was used . A total of 150 nurses from a private hospital in Amman Jordan and 100 nurses from a self-operated hospital in Dammam, Saudi Arabia completed the study questionnaires. The results showed that the stressful situations for Jordanian nurses were: death and dying, workload, and patients and their families. There was a significant negative relationship between stress and job satisfaction for Jordanian nurses r(148)= -0.630, p˂.05 and for Saudi nurses
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r(98)= -0.437, p˂.05. Jordanian nurses were less satisfied with their jobs compared to Saudi nurses Z = -2.09, p < .05. In conclusion, stress is a global problem for nurses and negatively affects job satisfaction . In Japan, Yoshizawa et al. ( 2014) conducted a cross-sectional study on 238 psychiatric nurses who were recruited from 7 hospitals to examine occupational stress among psychiatric nurses in Japan. The data were obtained via self-report questionnaires. The finding showed that social support reduced the effect of stress on depression among psychiatric nurses. However, the interpretation of these results was hampered by the lack of data concerning important occupational factors, such as working position, personal income, and working hours. In Indian, Gulavani and Shinde (2014) carried the Descriptive study to assess occupational stress and job satisfaction among 100 nurses working in tertiary care hospitals and to find out correlation between occupational stress and job satisfaction among nurses selected by convenient sampling technique. The results showed that maximum of nurses were working as staff nurses in age group of 21 to 30 years. They were females, were married, below 5 years of experience. As well as there was no significant association found between occupational stress, job satisfaction and age, sex, professional education and year of experience. Davey et al., (2014) conducted a study on qualified nurses to find out the degree of work-related stress among the (100) staff nurses and various determinants through predesigned and pre-tested questionnaire. The results indicated that there was a risk for professional stress due to poor and satisfactory doctor's attitude which was found about 3 and 4 times more than with excellent attitude of doctors toward the staff nurses. Nurses reported that they had no time for rest, of whom 42% were suffering from moderate-to-severe stress.
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The nurses who felt that the job was not tiring were found to be less stressed. The main nurses' occupational stressors were poor doctor's attitude, posting in busy departments (emergency/ICU), inadequate pay, too much work, and etc. In Kingdom of Saudi Arabia, Taha et al (2014) studied to investigate the presence of work related stress and its impact on nurses’ job satisfaction. One hundred female nurses were recruited; 60 of them were working in ICU of both adult and pediatrics at King Saud Medical Complex. and 40 of them were working in labor room at Al-Yamamah Maternity Hospital. Through interview and questionnaire (Job Satisfaction Survey) scale, results of this study revealed that near half of the subjects (49%) perceived frequently stress, while only 7% perceived extremely stress. Also results revealed that 47% of the subjects were ambivalent in their response to job satisfaction and 35% were satisfied. A significant positive relation between the level of perceived stress and level of job satisfaction were found in this study. In Central Kerala, Mathew, (2013) conducted their study ‘Effect of Stress on job satisfaction among nurses in central kerala’ among 100 respondents nurses in private hospitals, working in leading hospitals in Central Kerala to examine job stress and its impact on the job satisfaction. Questionnaire was used to collect the pertinent data from the selected sample respondents. Results indicated to only 7% of the nurses understudy were satisfied with the pay according to the efforts which were put in. Only 29.07% were satisfied with assistance that they get from the doctors and other staffs. Nurses are highly satisfied with the communication channel prevailing in the organizations. Less than 7% felt that their job was secured.
Only about
15.1%
were happy with
the
present
working
environment.15.1% were satisfied with social support from the peer. About 34.88% reported psychological harassment from doctors or co-workers to affect their performance .
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43
In southern Iran, Sahraian et. al (2013) carried out a study on 180 nurses who were selected to assess occupational stress in nurses working in surgical, internal and psychiatric wards in 4 teaching hospitals affiliated to Shiraz University of Medical Sciences teaching hospitals, Southern Iran. By using questionnaires containing Health and Safety Executive (HSE). The results of the study indicated that nurses of surgical and internal wards showed significantly higher level of occupational stress in most scales of occupational stress, except relationship, compared with nurses working in psychiatric wards. There was no significant correlation among scales of occupational stress and age, marital status, work shifts and experience. Also it found a significant correlation with some scales of occupational stress and sex and education level. In Slovenia, Lorber and Skela Savič (2012) carried out a study on 509 employees included in the study that represented 6% of all employees in nursing in Slovenian hospitals to determine the level of job satisfaction of nursing professionals in 4 Slovenian hospitals and factors influencing job satisfaction in nursing. By using structured survey questionnaire. They examined the correlation between independent variables (age, number of years of employment, behavior of leaders, personal characteristics of leaders, and managerial competencies of leaders) and the dependent variable (job satisfaction - satisfaction with the work, coworkers, management, pay, and etc . The finding indicated that satisfied employees played a crucial role in an organization's success. In Sulaimani city / Iraqi Kurdistan Region, Merza (2008) carried a descriptive study to assess job satisfaction among (132) hospital nurses that were selected out of (659) nurses . Five hospitals out of (9) in Sulaimani city by using questionnaire had been chosen. Data collected through interviewing. The findings revealed high mean of scores in three dimension nature of work, work condition, interpersonal relationship. While lower mean of score in other dimensions: economical; psychological; and feedback. It found that (52.27%) of nurses were
CHAPTER TWO : REVIEW OF LITERATURE
44
satisfied, and 31.13%of them were dissatisfied. While only 16.6% of nurses were highly satisfied. Gender; education; and dimensions were significant associations with the level of job satisfaction. In England, Lephalala (2008) studied factors influencing nurses’ job satisfaction in selected private hospitals in England. Herzberg’s Theory of Motivation was used to contextualize the results obtained from 85 completed questionnaires.
Quantitative
descriptive
survey
used
self-completion
questionnaires. In terms of Herzberg’s Theory of Motivation, the most important extrinsic (hygiene) factor was no satisfaction with their salaries compared to nurses’ salaries in other private hospitals in England. However, most nurses were satisfied with the other extrinsic factors (organization and administration policies, supervision and interpersonal relations). The most important intrinsic factors (motivators), influencing nurses’ job satisfaction was their lack of satisfaction with promotions (including the fact that their qualifications were reportedly not considered for promotions), lack of advancement opportunities and being in dead-end jobs, and lack of involvement in decision- and policy-making activities. This study found that nurses’ levels of job satisfaction might be enhanced if promotion policies could be consistent, advancement opportunities implemented, qualifications considered for promotions, salary issues clarified, and nurses could be involved in decision- and policy-making. In Kirkuk city/ Iraq, Sofi (2007) a descriptive design was carried out among (547) nurses to assess the level of job satisfaction for nursing staff in governmental health agencies and educational setting. The sample of study had been chosen randomly from Ministry of Health and Ministry of Higher Education and Scientific Research in the provinces of Erbil, Mosul and Kirkuk. Data was collected by questionnaire consisted of three parts and the overall items included in the questionnaire were (78). Quantitative research methods were utilized to employ the study design. The analysis of data shows that the majority of the
CHAPTER TWO : REVIEW OF LITERATURE
45
sample was dissatisfied with their job. Also, it revealed that Kirkuk's Nurses were more dissatisfied than Mosul and Erbil Nursing staff. In a Northeastern State, Flanagan (2006) focused on relationships between job stress and satisfaction among (454) nurses fulfilled to: first replicate an earlier study of correctional nurses to determine whether similar findings could be duplicated in a study of prison nurses from another state. Second, test the concepts of stress and satisfaction as represented in the anticipated turnover model by using the Index of Work Satisfaction and the Nurse Stress Index a correlational mail survey that was designed to assess job stress and satisfaction them in a Northeastern state prison system. Stress levels and the top two sources of stress were essentially the same for both groups of correctional nurses. Sources of satisfaction were ranked similarly but subscale and overall scores indicated that the nurses in the replication study were more dissatisfied. Findings validated the theoretical proposition in the anticipated turnover model that job stress was a major predictor variable in explaining job satisfaction.
CHAPTER THREE: METHODOLOGY
CHAPTER THREE : METHODOLOGY
47
Methodology This chapter deals with the procedures and methods that were used in this study. They include: design of the study, administrative arrangement, setting of the study, sample of the study, the study instrument, validity and reliability of questionnaire, data collection and statistical data analysis. 3.1 Design of the Study : A quantitative design and descriptive study was conducted among nursing staff in mental health hospitals in Sulaimani for achieving the objectives of study. 3.2 Administrative Arrangements: Prior to the data collection, formal written permission (formal approvals) which concern the Administrative Arrangements has been obtained: A- A formal letter has been sent from college of Nursing/ University of Sulaimani to Ministry of Health / General Directorate Health asking them for help and support to facilitate the process of data collection (Appendix A) to conduct the study in mental health hospitals in Sulaimani. B- A formal letter has been sent to the concerned hospitals to gain permission and access for data collection (Appendix B). These formal letters facilitated the researcher to meet the nurses in these hospitals and explain the title and objectives of the study to them after taking permission (verbal informed consent) from them to participate in the study. C- Ethical approval: ethical committee permission of college of Nursing/ University of Sulaimani (Appendix C).
CHAPTER THREE : METHODOLOGY
48
3.3 The Setting of the Study: This study was conducted on the nursing staffs at the mental health hospitals in Sulaimani city (Soz Mental Hospital, Shahid Salahi Muhandis hospital, and Mental Health Center/ Sulaimani Teaching Hospital). 1- Soz Mental Hospital was established in 2009. It consists of two floors, each one (35) beds; total (70) beds, It is in the Tasluja- Peramagroon route, for female chronic patients. 2- Shahid Salahi Muhandis Hospital was established in 2011. It consist of (42) beds, It is in the east of Sulaimani city, for male chronic patients (schizophrenia, bipolar and personality disorder). 3- Mental Health Center/ Sulaimani Teaching Hospital was established in 2007. It consist of (40) beds. The building of Center consist of two floor: ground floors (20) beds for male and other (20) beds for female. It is in the Sulaimani center. (Table :3-1). Table (3-1): Distribution of the Beds, Nurses and Samples in Mental Health Hospitals in Sulaimani Governorate No
Mental Name
1-
Soz mental hospital
2-
3-
Hospital No. of No. of Beds Nurses 70
Shahid Salahi Muhandis hospital
42
Mental Health Center/ Teaching Hospital
40
Total ( 3 ) hospitals
152
42
29
24
95
No. of No. of Female Sample and Male 32
23
20
75
32
Female
0
Male
0
Female
23
Male
4
Female
16
Male
36
Female
39
Male
CHAPTER THREE : METHODOLOGY
49
3.4 The Sample and the Sampling of the Study: Convenient sample of (75) nurses, (39) male, and (36) female, distributed in three hospitals (32) of them were from Soz Mental Hospital, (23) from Shahid Salahi Muhandis Hospital and (20) from Mental Health Center / Teaching Hospital. The study population included all staff nurses without that participated in pilot study. Also, sample of the study was chosen according to the following criteria :A- Inclusion Criteria: 1- Nurses who were working in mental health hospitals 2- Nurses who have more than one year of employment and have registered at nursing administration 3- Those who are present during period of data collection and are cooperating to participation. B- Exclusion Criteria: 1- Those who refused participation or absent during period of data collection. 2- Nurses who participated in pilot study. 3.5 The Study Tool: The data required for this study was obtained through especial questionnaire with interviewing by using a standardized instrument in second and third parts. Overall items included in the questionnaire (101) were divided in to three parts as follows: (Appendix D) The First Part is "Socio – Demographic Characteristics" composed of: age, gender, marital status, graduational level, year of employment, economic status, training course, and interest.
CHAPTER THREE : METHODOLOGY
50
The Second Part is "Expanded Nursing Stress Scale" (ENSS). It is standardized, developed by Gray-Toft and Anderson (1981) (French et al., 2000). It contained 57 items ranged in (9) subscales on 5-point Likert scale. (Table:3-2). The responses were ‘never stressful’ (1), ‘occasionally stressful’ (2), ‘frequently stressful’ (3), ‘extremely stressful’ (4), and ‘does not apply’ (0). (French et al., 2000). The higher the score, the more the respondent agreed that the situation was stressful. A total and sub-scale mean score could be derived from this instrument which ranged from "1 never stressful" to "4 extremely stressful" and " 0 does not apply". Higher scores indicated higher levels of stress (French et al., 2000; Damit, 2007; Saleh et al., 2013).
Table(3-2): Expanded Nursing Stress Subscales with the Number of Items N
Subscales
Number of items
1-
Death and dying.
7 items 1,9,17,27,37,47,53
2-
Conflict with physicians.
5 items 2,10,28,38,48,
3-
Inadequate preparation.
3 items 3,11,19,
4-
Problems with peers.
6 items 4,12,20,21,22,50
5-
Problems with supervisors.
7 items 5,30,31,40,46,49,54
6-
Workload.
9 items 13,23,32,41,42,45,51,55,57
7-
Uncertainty concerning treatment.
9 items 6,14,18,24,29,33,36,39,43
8-
Patients and their families .
8 items 7,15,25,34,35,44,52,56
9-
Discrimination.
3 items 8,16,26
TOTAL
57 items
CHAPTER THREE : METHODOLOGY
51
The Third Part is "Job Satisfaction Scale" (JSS). It is developed by Spector (1997) to measured level of job satisfaction. It has (9) facet subscales as it was shown in (Table:3-3). Each scale has 4 items, ending of a total of 36 item questionnaire. They range from "agree very much (6)" to "disagree very much (1). The score on negatively worded items was reversed before summing with the positively worded items, 18 items out of 36 (2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36) were negatively worded. That is to say scores with a Mean Item response of 4 or more represents satisfaction, whereas mean responses of 3 or less represents dissatisfaction and mean scores between 3 and 4 are ambivalence (Spector, 1985; Spector, 1997). It has been widely used in the healthcare sector (Hutton et al., 2014). JSS along with (9) facets was provided overall picture about job satisfaction. Table(3-3): Job Satisfaction Survey Subscales descriptions with the number of item No
Subscales
Description
number of items
1-
Pay
Pay and salary
4 items
1, 10, 19, 28
2-
Promotion
Promotion Opportunities
4 items
2, 11, 20, 33
3-
Supervision
Immediate Supervisor
4 items
3, 12, 21, 30
4-
Fringe Benefits
4 items
4, 13, 22, 29
5-
Contingent rewards
Monetary and Nonmonetary Fringe Benefits Appreciation, Recognition, and Rewards for Good Work
4 items
5, 14, 23, 32
6-
Operating conditions
Operating Policies and Procedures.
4 items
6, 15, 24, 31
7-
Coworkers
People you Work with
4 items
7, 16, 25, 34
8-
Nature of work
Job tasks themselves
4 items
8, 17, 27, 35
9-
Communication
Communication within the Organization
4 items
9, 18, 26, 36
Total number
36 items
CHAPTER THREE : METHODOLOGY
52
3.6 Data Collection : The researcher used self-reported technique in each hospital to explain the objectives of the study, significance of research, and then collect the actual data through Kurdish version questionnaire. The process of data collection began from 25th May to 10th July 2016 and the respondent took proximately (30 mins) to fill the questionnaire.
3.7 Validity and Reliability of the Study Instrument : 3.7.1 Validity of the Study Instrument : Face validity of the questionnaire was determined through panel of (11) experts in the different fields and work settings (Psychiatry, Community Medicine, Psychiatric Health Nursing, Community Health Nursing, and Adult Nursing). (Appendix E). The majority of experts agreed upon the final draft of the first part (sociodemographic characteristics), and the other parts (two and three) are standardization. Then, the questionnaire was considered valid after looking in to considerations, suggestions and recommendations for modification. 3.7.2 Pilot Study : Before starting on the field work, a pilot study was carried out on (10) nurses through the period from the 2nd - 20th May 2016. The nurses selected randomly from mental health hospitals, in Soz Mental Hospital (4) nurses, Shahid Salah Hospital (3) nurses and (3) nurses from Mental Health Center. The purpose of the Pilot study were :1- To determine the reliability of the study instrument.
CHAPTER THREE : METHODOLOGY
53
2- To obtain the clarity of the instrument structure throughout the sample understanding. 3- To determine required modification. 4- To consider the times estimated for the data collection to show how much time is needed to answer the questions. 5- To identify the barriers that may be encountered during the collection process. The result of the pilot study revealed that the items of the questionnaire were clear and understandable to the participants and required some modification in the part one "socio-demographic characteristics". The time required to answer each questionnaire approximately was half hour (30 mins) to complete.
3.7.3 Reliability of the Study Instrument : Data were collected from 10 nurses selected randomly from mental health hospitals to measure stability and consistently of instrument. Internal consistency reliability of the instruments was assessed using Cronobach's coefficient alpha of (ENSS) which was (r = 0.888). For (JSS) it was (r = 0.78) as can be seen in the table (3-4). This means that the questionnaire was statistically acceptable proper for data collection. Table (3-4): Reliability Coefficient of the Study Instruments Study Scales
Expanded Nursing Scale (ENSS)
Stress
Job Satisfaction Scale (JSS)
Number of Items
Cronobach's alpha
Report
57 item
0.88
V. Good
36 item
0.78
Good
CHAPTER THREE : METHODOLOGY
54
3.8 Statistical Data Analysis : The obtained of the respondents responses to the questionnaire were entered in to the computer and analyzed through the use of the statistical package social science SPSS program (version 22). They consisted of: 3.8.1 Descriptive Analysis : Descriptive statistics are used to describe Socio-demographic data of the sample study, and to measure the level of job stress and job satisfaction among nursing staff. This approach includes the measurement of the following: 3.8.2 Inferential Statistics: Two-tailed t-test (independent sample test) was used to investigate the effect of Expanded Nurses Stress Scales on demographic variables (gender, marital status, training course, and interest) (Ltd, 2013). One-way ANOVA test was used to investigate the effect of the expanded nurses stress scales on other demographic variables in the sample (age, graduation level, economic status, and years of employment). (Kim, H.-Y. 2014). Pearson coefficient correlation (r=test) was used to investigate the relationship between the effect of job stress on job satisfaction. The correlation coefficient r measures the strength and direction of a linear relationship between two variables on a scatterplot. The value of r is always between +1 and –1. And 0. No linear relationship (Rumsey, 2011).
3.9. Limitation of the study : 1-The influence of external support to staffs working in mental health hospitals (distribution of land plots form on the staff) during the period of data collection in the sample.
CHAPTER FOUR: RESULTS
CHAPTER FOUR: RESULTS
56
Results
Table (4-1): Socio-demographic Characteristics of the Sample. Number of the total sample = 75 Socio-demographic
Subgroup
N (%)a
Characteristics Age Groups
Gender
Marital Status
Graduation Level
Years of Employment in Mental Health
Economic Status
Training Course Undertaken
Profession Fits with Interest a Number
(Percentage)
20-24 Years
1 (1.3)
25-29 Years
12 (16)
30-34 Years
22 (29.3)
35-39 Years
14 (18.7)
40-44 Years
13 (17.3)
45-49 Years
10 (13.3)
50-54 Years
2 (2.7)
55-59 Years Male
1 (1.3) 39 (52)
Female
36 (48)
Unmarried
13 (17.3)
Married
62 (82.7)
Nursing Preparatory School
17 (22.7)
Institute Diploma of Nursing
56 (74.7)
Bachelor of Nursing Science
2 (2.7)
1 to 5 years
26 (34.7)
6 to 10 years
28 (37.3)
11 to 15 years
9 (12)
16 to 20 years
7 (9.3)
21 to 25 years
5 (6.7)
Sufficient
8 (10.7)
Barely Sufficient
54 (72)
Insufficient NO
13 (17.3) 27 (36)
YES
48 (64)
NO
18 (24)
YES
57 (76)
CHAPTER FOUR: RESULTS
57
Table 4-1 described the socio-demographic characteristics. As evidenced by the table, the highest percentage of studied sample were (29.3%) in the age group of (30 to 34 years). While the lowest percentage (1.3%) were between (20 to 24 years ) and (55 to 59 years). In regard to the gender factor, approximately male and female had the same participation level (52%) were male, while other remaining (48%) of them were female. With relation to marital status, the majority (82.7%) were married. Regarding to graduation level, about three out of four (74.7%) of the staff nurses had diploma degree in nursing. While the lowest percentage (2.7%) had the Bachelors Degree of nursing science. Regarding years of employment in mental health, the table showed that the highest percentage (37.3%) had (6 to 10 years) of employment. While (6.7%) of nurses had (21 to 25 years) of employment. With regards to economic status, the table showed that majority (72%) of them were barely sufficient, while (10.7%) of them were Sufficient . Concerning training course undertaken, the high percentage of sample (64%) had participation in training course. Finally, the table demonstrated that the majority of nurses (76%) had profession fitting with interest.
CHAPTER FOUR: RESULTS
58
Extremely Stressful
Doesn’t Apply
N (%)a
N (%)a
N (%)a
N (%)a
N (%)a
1-
Death and dying .
6.6 (8.9)
26 (35.4)
23.4 (31.8)
17.4 (23.7)
0 (0)
2.73
2-
Conflict with physicians .
8.6 (11.5)
34.8 (46.4)
22.6 (30.1)
9
0 (0)
2.42
3-
Inadequate preparation .
10.6 (14.17)
36 (48.12)
19.6 (26.2)
8.6 (11.5)
0 (0)
2.35
4-
Problems with peers .
20.6 (27.5)
35.5 (47.4)
14.8 (19.7)
4(5.3)
0 (0)
2.02
5-
Problems with supervisors
9.7 (12.9)
32.5 (43.4)
22.4 (29.9)
10.1 (13.5)
0.1 (0.13)
2.44
6-
Workload .
10 (13.3)
30.1 (40.2)
21.5 (28.7)
13.2 (17.6)
0.1 (0.13)
2.56
7-
Uncertainty concerning treatment .
7(9.5)
28.2 (38.2)
23.3 (31.5)
15.1 (20.4)
0.2 (0.27)
2.62
8-
Patients and their families .
13.2 (17.6)
24.2 (32.3)
22.7 (30.3)
14.6 (19.5)
0.1 (0.13)
2.52
9-
Discrimination .
23.6 (31.5)
20 (26.7)
18.6 (24.8)
12.3 (16.4)
0.3 (0.4)
2.27
Overall Mean a
Frequently Stressful
Subscales
Occasionally Stressful
(ENSS)
Never Stressful
No
Mean
Table(4-2): Level of Subscales of Expanded Nursing Stress Scale (ENSS)
N (%)= Number (Percentage)
(12)
2.47
CHAPTER FOUR: RESULTS
59
Table 4-2 revealed that the overall mean of ‘Expanded Nursing Stress Scale’ (ENSS) was (2.47) indicated that total average of job stress that occurred in the workplace perceived by staff nurses in mental health hospitals was "Occasionally stressful to frequently stressful". The subscale ‘death and dying’ had highest level percentage as indicated at the Mean (2.73), while the subscale ‘Problems with peers’ had the lowest level percentage from the total as indicated at the mean (2.02).
CHAPTER FOUR: RESULTS
60
Agree Slightly
Agree Moderately
Agree Very Much
N (%)a
N (%)a
N (%)a
N (%)a
N (%)a
N (%)a
Mean
Disagree Slightly
(JSS) Subscales
Disagree Moderately
N o
Disagree Very Much
Table(4-3): Level of Subscales of Job Satisfaction Survey (JSS)
1
Pay
0.25 (0.33)
22 (29.2)
27 (35.9)
20.75 (27.5)
5 (6.6)
0.25 (0.33)
3.11
2
Promotion
1.2 (1.6)
10 (13.3)
22.2 (29.6)
24 (32.1)
13.7 (18.3)
3.7 (4.9)
3.67
3
Supervision
0.25 (0.3)
3.7 (5.1)
10.2 (14)
19.5 (26.8)
24.2 (33.2)
15 (20.6)
4.48
4
Fringe benefits
1.7 (2.2)
7.5 (10)
19.7 (26.3)
26 (34.7)
17.2 (23)
2.7 (3.6)
3.77
5
Contingent rewards
1.5 (2)
9.7 (13)
20.2 (27)
26.2 (35)
15.2 (20.3)
2 (2.7)
3.66
6
Operating conditions
0.5 (0.6)
7.5 (10)
13.7 (18.3)
22.5 (30)
21.5 (28.7)
9.2 (12.3)
4.13
7
Coworkers
0 (0)
1.7 (2.2)
6.7 (9)
18.5 (24.8)
28.7 (38.4)
19 (25.4)
4.74
8
Nature of work
0 (0 )
5.2 (7)
13 (17.3)
13.2 (17.6)
27.5 (36.7)
16 (21.3)
4.48
9
Communication
0 (0)
1.2 (1.6)
8 (10.7)
19.2 (25.6)
29.5 (39.4)
17 (22.7)
4.7
Overall Mean a
N (%)= Number (Percent)
4.08
CHAPTER FOUR: RESULTS
61
The findings in the table (4-3) revealed that the overall mean of job satisfaction was (4.08) indicating that there were the job satisfaction among nursing staff at mental health hospitals. Subscale ‘pay’ had lowest level of satisfaction as indicated by the mean (3.11). While the highest level of job satisfaction in subscale ‘Coworkers’ as indicated by the Mean (4.7).
CHAPTER FOUR: RESULTS
62
Associations Between the Level of Expanded Nursing Stress Scale in Nine Subscales and Demographic Characteristics in Eight Dimensions Table(4-4): Gender Difference in Regard of Expanded Nursing Stress Scale ENSS Items Death and dying Conflict with physicians Inadequate preparation Problems with peers
Gender
Work load Uncertainty concerning treatment Patients and their families Discrimination
Standard
t
Deviation
test
Male
2.6
0.5
Female
2.8
0.5
Male
2.3
0.4
Female
2.5
0.4
Male
2.3
0.6
Female
2.3
0.6
Male
1.9
0.3
2
0.4
Male
2.3
0.4
Female
2.5
0.4
Male
2.5
0.8
Female
2.6
0.5
Male
2.5
0.5
Female
2.7
0.4
Male
2.3
0.4
Female
2.6
0.5
Male
2.3
0.6
Female
2.2
0.6
Female Problems with supervisors
Mean
p Value
-1.14
0.2
-1.88
0.06
0.36
0.7
-1.04
0.3
-1.92
0.059
-0.64
0.5
-2.54
0.01*
-2.42
0.01*
0.88
0.3
* Significant
Table (4-4) indicate that there are statistical significant relationship between both subscales uncertainty concerning treatment and patients and their families in ENSS and gender at (P value= 0.01).
CHAPTER FOUR: RESULTS
63
Table(4-5): Age Groups Differences in Regard of Expanded Nursing Stress Scale ENSS Items Death and dying Conflict with physicians Inadequate preparation Problems with peers Problems with supervisors Work load Uncertainty concerning treatment Patients and their families Discrimination
ANOVA 1.41 1.15 0.83 1.03 2.12 1.62 2.48 2.09 0.81
p Value 0.2 0.3 0.5 0.4 0.053 0.1 0.02* 0.056 0.5
*Significant Maximum record within 30-34 age group; Mean ENSS = 2.88 Minimum record within 55-59 age group; Mean ENSS = 2.11
Table (4-5) shows that statistically significant relationship between sub scale uncertainty concerning treatment of ENSS and age group (30-34) yearold at (P value= 0.02).
CHAPTER FOUR: RESULTS
64
Table(4-6): Marital Status vs. Expanded Nursing Stress Scale ENSS Items
Marital
Mean
status Death and dying
Conflict with physicians
Inadequate preparation
Problems with peers
Standard
T
p
Deviation
test
value
Unmarried
2.7
0.5
Married
2.7
0.5
2.36
0.4
Married
2.4
0.5
Unmarried
2.3
0.7
Married
2.36
0.5
Unmarried
2.01
0.4
Married
2.03
0.4
2.3
0.5
2.47
0.4
Unmarried
Problems with supervisors
Unmarried
Work load
Unmarried
2.5
0.5
Married
2.5
0.7
Uncertainty concerning treatment
Unmarried
2.5
0.5
Married
2.6
0.4
Patients and their families
Unmarried
2.4
0.5
Married
2.5
0.5
Discrimination
Unmarried
1.9
0.6
Married
2.3
0.6
Married
-0.12
0.9
-0.45
0.6
-0.28
0.7
-0.14
0.8
-0.9
0.3
-0.2
0.8
-0.6
0.5
-0.4
0.6
-2.3
0.02*
*Significant
Table (4-6) illustrates the marital status difference in regard of ENSS. As evidenced by the table the only significant finding lies in the subscale discrimination at (P value < 0.05). Where married scored significantly more than unmarried.
CHAPTER FOUR: RESULTS
65
Table(4-7): Graduation Level vs. Expanded Nursing Stress Scale ENSS Items Death and dying
ANOVA
p Value 0.82
0.4
Conflict with physicians
0.7
0.5
Inadequate preparation
2.89
0.06
Problems with peers
0.06
0.9
Problems with supervisors
5.68
0.005**
Work load
0.84
0.4
Uncertainty concerning treatment
0.84
0.4
Patients and their families
1.04
0.3
Discrimination
0.81
0.4
**Highly Significant Maximum record within Bachelor of Nursing Science group; Mean ENSS = 3 Minimum record within Nursing Preparatory School group; Mean ENSS = 2.1
The result in table (4-7) shows highly significant relationship between subscale problems with supervisors and graduation level at (p value= 0.005).
CHAPTER FOUR: RESULTS
66
Table(4-8): Years of employment vs. Expanded Nursing Stress Scale ENSS Items
ANOVA
p Value
Death and dying
1.4
0.2
Conflict with physicians
0.9
0.4
Inadequate preparation
2.2
0.07
Problems with peers
0.2
0.9
Problems with supervisors
1.7
0.1
Work load
1.5
0.2
3.18
0.02*
Patients and their families
1.5
0.2
Discrimination
0.5
0.7
Uncertainty concerning treatment
*Significant Maximum record within 6-10 years group; Mean ENSS = 2.8 Minimum record within 16-20 years group; Mean ENSS = 2.2
Table (4-8) indicates that there is statistical significant relationship between subscale uncertainty concerning treatment in ENSS within (6-10) years of employment at (P value = 0.02).
CHAPTER FOUR: RESULTS
67
Table(4-9): Economic Status vs. Expanded Nursing Stress Scale ENSS Items
ANOVA
Death and dying
p Value 0.06
0.9
Conflict with physicians
3.2
0.04*
Inadequate preparation
1.9
0.1
Problems with peers
0.7
0.4
Problems with supervisors
0.38
0.6
Work load
1.96
0.1
0.001
0.9
0.54
0.5
2.9
0.06
Uncertainty concerning treatment Patients and their families Discrimination *Significant Maximum record within Insufficient group; Mean ENSS = 2.7 Minimum record within Sufficient group; Mean ENSS = 2.3
Table (4-9) showed that there was statistical significant relationship between subscale conflict with physicians in ENSS within insufficient group of economic status at (P value = 0.04).
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Table(4-10): Training Course vs. Expanded Nursing Stress Scale ENSS Items
Training
Mean
Course Death and dying Conflict with physicians Inadequate preparation Problems with peers Problems with supervisors
Work load Uncertainty concerning treatment Patients and their families Discrimination
Standard
t
p
Deviation
Test
Value
0.5
0.6
0.9
0.3
-0.18
0.8
0.3
0.7
0.4
0.6
-0.2
0.8
1
0.3
0.3
0.7
-0.2
0.7
No
2.7
0.5
Yes
2.7
0.5
No
2.5
0.4
Yes
2.3
0.5
No
2.3
0.7
Yes
2.3
0.5
No
2.04
0.4
Yes
2.01
0.4
No
2.48
0.4
Yes
2.42
0.4
No
2.53
0.4
Yes
2.57
0.8
No
2.7
0.4
Yes
2.58
0.5
No
2.55
0.6
Yes
2.5
0.5
No
2.24
0.6
Yes
2.3
0.6
Table ( 4-10) showed that there was no statistical significant difference between training course undertaken and all nine subscales of ENSS as can be seen from the table.
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69
Table(4-11): Interest vs. Expanded Nursing Stress Scale
ENSS Items
Profession
Mean
fit with your
Standard
t
Deviation
Test
p Value
Interest Death and dying Conflict with physicians Inadequate preparation Problems with peers Problems with supervisors Work load Uncertainty concerning treatment Patients and their families Discrimination
No
3.01
0.38
Yes
2.64
0.505
No
2.68
0.42
Yes
2.34
0.5
No
2.51
0.58
Yes
2.29
0.61
No
2.21
0.25
Yes
1.97
0.45
No
2.65
0.41
Yes
2.37
0.48
No
2.76
0.31
Yes
2.49
0.78
No
2.98
0.35
Yes
2.51
0.49
No
2.9
0.38
Yes
2.4
0.55
No
2.14
0.62
Yes
2.31
0.68
2.6
0.01*
2.6
0.01*
1.3
0.1
2.1
0.03*
2.1
0.03*
1.4
0.1
3.7
0.0001**
3.5
0.001**
-0.9
0.3
* Significant ** Highly Significant
Table (4-11) indicated four significant relations between profession interest dimension and Subscales death and dying, conflict with Physicians, problems with peers, and problems with supervisors at (P value=0.01, 0.01, 0.03, 0.03) respectively . Where two sub scales uncertainty concerning treatment and patients and their families recorded highly statistical significant with profession interest dimension at (P value= 0.0001) and (P value= 0.001) respectively.
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Table(4-12): Correlations of ENSS with JSS in all Nine sub-scales for Both ENSS 1 2 3 4 5 6 7 8 9
JSS
1
2
3
4
ra
0.04
0.06
-0.1
0.12
pb
0.7
0.5
0.1
ra
-0.02
0.1
pb
0.8
ra pb
5
6
7
8
9
-0.01
0.1
0.05
-0.3**
-0.08
0.3
0.9
0.2
0.6
0.01
0.4
0.06
0.06
-0.1
0.2
0.08
-0.23*
-0.07
0.3
0.5
0.6
0.3
0.06
0.4
0.04
0.5
-0.09
-0.05
0.08
-0.06
-0.01
0.003
-0.08
-0.14
-0.03
0.3
0.6
0.4
0.5
0.9
0.9
0.4
0.2
0.7
ra
0.007
-0.01
0.09
0.2
-0.1
0.14
-0.1
-0.17
0.01
pb
0.9
0.9
0.4
0.08
0.1
0.2
0.3
0.1
0.8
ra
0.07
0.07
0.03
0.1
0.005
0.1
0.1
-0.2
0.06
pb
0.5
0.5
0.7
0.3
0.9
0.2
0.1
0.054
0.5
ra
0.07
0.005
0.01
0.1
0.03
0.05
-0.04
-0.15
-0.1
pb
0.5
0.9
0.8
0.2
0.7
0.6
0.6
0.1
0.2
0.3**
-0.33**
-0.01
ra
-0.08
0.03
-0.03
0.04
-0.08
0.25*
pb
0.4
0.7
0.7
0.6
0.4
0.02
0.009
0.004
0.9
ra
-0.1
0.05
-0.07
0.2
0.09
0.04
0.06
-0.38**
-0.04
pb
0.3
0.6
0.5
0.06
0.44
0.7
0.5
0.001
0.6
ra
0.07
0.1
-0.1
0.04
-0.12
0.06
-0.1
0.15
0.1
pb
0.4
0.2
0.3
0.7
0.2
0.5
0.2
0.201
0.3
*Significant ** Highly Significant
Table (4-12) indicate that there were several kinds of associations among the items of both scales. Nevertheless, only item 7 of ENSS showed significant positive correlations with items 6 and 7 of JSS. On the other hand, ENSS 1, 2, 7, and 8 were negatively correlated with JSS 8.
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Table(4-13): Correlations of Total ENSS with Total JSS
Pearson Correlation Total r ENSS p r Total JSS p
Total ENSS 1 -0.064 0.585
Total JSS -0.064 0.585 1
Table (4-13) showed that there was no statistical significant correlation between total ENSS and total JSS.
CHAPTER FIVE: DISCUSSION
CHAPTER FIVE: DISCUSSION
73
5. Discussion To my knowledge, no study has been conducted in Kurdistan Region regarding "effect of job stress on job satisfaction among nurses". It is the first study of its kind that has been carried out so far in Kurdistan Regional Government. The study results among nursing staff at mental hospitals have depicted the following results:
5.1 Part One: Characteristics of the Sample Study: 5.1.1 Age Groups: The current study shows that most of responders (29.3%) of nurses from age group (30 to 34) years, while (1.3%) are between (20 to 24 years) and (55 to 59 years). This finding is consistent with result of study that has been done in Kingdom of Saudi Arabia by Saleh et al. (2013) that has reported the majority of nurses is middle age between 30 years old and 40 years old. This could be explained as a result to the need for new staff nurse to work at psychiatric hospitals and also these ages are able to bear and tolerate the burdens of working with psychiatric patients.
5.1.2 Gender: Regarding to gender factor, slightly more than half of participants (52%) were male, while (48%) of them were female. According to the policy of Ministry of Health, there were no male nurses working in the Soz Mental Hospital. Also, adversely in
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Shahid Salahi Muhandis Hospital there were no female nurses. However, in the Mental Health Center/ Sulaimani Teaching Hospital the most of them composed from male more than female in the sample study. The researcher attributes this finding to the nature of work in these settings. This is for the importance of the relation between the gender of patients and gender of the nurses specially in this field.
5.1.3 Marital Status: The majority of nurses (82.7%) were married. This finding is in line with other majority of previous studies. This finding is similar with study carried out by AlAmeri (2014) among nurses working at psychiatric wards in hospitals of Baghdad City/ Iraq. According to our culture, most of young people prepare to get married after graduation and employment. Marriage considered as a protective factor against job stress. On the other hand, married people’s responsibilities and worries with parenting, financial issues and other problems can increase their job stress (Sahraian et al. 2013).
5.1.4 Graduation Level : Concerning graduation level, the majority of the sample study (74.7%) had diploma degree in nursing, while (2.7%) of them had bachelor's degree in nursing science. In agreement with this result, a study conducted in two main hospitals in Riyadh city by Mansour et al. (2014) and Al Hosis et al. (2013). However, it is adverse to the
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study conducted by Saleh et al., (2013) because the standard level of education for nurses is the Bachelor in nursing.
5.1.5 Years of Employment: Regarding the years of employment in mental health, it has been noted that (37.3%) of nurses had (6 to 10 years), while (6.7%) of nurses had (21 to 25 years). This finding was reported by Mansour et al. (2014) carried out in two main hospitals in Riyadh city at King Saud. However, this disagreed with the findings of Al-Ameri (2014) at psychiatric wards in hospitals of Baghdad City/ Iraq. Also different studies carried out by Mohite et al. (2014) which showed 51%were had below 5 years of experience. The researcher notes that according to the Ministry of health / General Directorate Health document's, mental hospitals has been established in Sulaimani recently.
5.1.6 Economic Status : With regard to the economic status, majority of the nurses (72%) of them were "Barely Sufficient". They did not cover sufficiently their daily needs, while (10.7%) of them were sufficient. This result was similar to the study conducted by Mohamed, and Al-Juboori, (2010) in Baghdad psychiatric hospitals. It was considered normal for employees specially in the organization if it is compared with the nature of work and critical status of the workers in these settings. Also, this explanation was similar to the researcher of this study, in addition to considering current financial crisis in Kurdistan Region.
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5.1.7 Training Course : Relative to training courses undertaken, less than two thirds of the sample study (64%) had participated in training courses. that's forming a positive consequence to elevate performance and quality care(Khodadadi, et al., 2013).
5.1.8 Interests: It was delightful find that a high percentage of nurses (76%) had interest in their jobs and participants responded positively. So they had profession fits with interest. This issue influenced increase tolerance, capability, incentive and motivation to increase quality work with less fatigue (Allen and Robbins, 2010).
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5.2 Part Two: Responses of Nursing Staff in Mental Health Hospitals with Items of ENSS to Determine Level of Job Stress: Expanded Nursing Stress Scale (ENSS) items have mean (2.47). This indicates that total average of stressful events that occurr in the workplace perceived by nursing staff in mental health hospitals ranged by “Occasionally Stressful to Frequently Stressful”. This finding of the study is similar to other studies conducted by Saleh et al. (2013) in Kingdom of Saudi Arabia which ENSS Mean =(2.51), AbuRuz, (2014) in Jordan which ENSS Mean=(2.8), and Hamaideh et al. (2008) in Jordan too. We noted similar study results by Al Rasasi et al. (2015) studied among nurses in different hospitals in Dubai – UAE. They revealed that the majority of the study sample 88.5% experienced mild to moderate amounts of stress due to their work. Also, Mansour et al. ( 2014) carried out the study under the title "Nurses’ perceived job related stress and job satisfaction in two main hospitals in Riyadh city". This revealed that "35% were "Occasionally Stressful", (49%) "Frequently Stressful", 7% "extremely stressful". In disagreement with the results of present study, the following studies have been done : In Baghdad-Iraq, Abdullah and Abbas (2015) conducted a study under the title "Assessment of Job Stress for Nurses in Psychiatric Hospitals at Baghdad City". They revealed that both male and female nurses were suffering from moderate level of stress in their work in all of domains. In Saudi Arabia a study conducted by Saleh (2015) recorded that frequently stressful for staff nurses as indicated by ENSS mean (3.08) "frequently stressful".
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In Isfahan, Iran, a study by Mosadeghrad, (2013) was done. He explored the status of occupational stress among hospital nurses. The results indicated that a one-third of hospital nurses rated their occupational stress high. In Kingdom of Saudi Arabia a study had been conducted by Kamal et al. (2012) in Taif Governmental Hospitals. The ENSS Mean= 3.17 "Frequently stressful to extremely stressful". In Urban Health centers in Hamadan, Iran, a study had been done by Hamidi and Eivazi (2010) to determine the levels of employees job stress on nurses. The result showed that the participants were at moderate level of stress. In Greece, a study had been conducted by Christina and Konstantin’s (2009) who registered mental health and assistant nurses working in six acute psychiatric wards. She reported that nurses experienced moderate level of stress. It can be explained that different results of level of job stress is normal, because every study has its own conditions and different tools (Bartram, Joiner, and Stanton), (2004). So many changes give different results. The result of current study reflexes the reality of mental health hospitals in Sulaimani, and they related to some other factors as number of the patients and hospitals, number of city population, and the level, kind, time and quality of support from Ministry of Health and philanthropic and charitable organizations. In addition to these factors, there were job interest among nursing staff (Ito, et al., 2001). In current study; subscale ‘death and dying’ takes the first order in the rank, has obtained the highest mean (2.73), which is related to all these meaning of items "Performing procedures that patients experience as painful", "Feeling helpless in the case of a patient who fails to improve", "Listening or talking to a patient about his or her approaching death", "The death of a patient", "The death of a patient with whom
CHAPTER FIVE: DISCUSSION
79
you developed a close relationship", "Physician(s) not being present when a patient die", and "Watching a patient suffer". Item "Physician(s) not being present when a patient die" take the highest order in domain Death and dying have (40%) which is highly stressful events that frequently occurred in the workplace perceived by staff nurses at the mean= 3.19 . The findings agree with the study conducted by AbuRuz, (2014) in Jordan, Saleh et al., (2013) in Kingdom of Saudi Arabia, and Hamaideh et al., (2008) in Jordan who reported that the most stressful subscale for nursing staff is Death and dying of the patient. Also, the current finding is similar the study conducted by Dagget et al. (2016) under the title "Job Related Stress among Nurses Working in Jimma Zone Public Hospitals" in South West Ethiopia. It has indicated that higher overall job related stress from dealing with death and dying subscale at the mean (2.87). Also, a study was done in Gaza-Palestine by Alhajjar et al (2013) stated that death and dying and workload were the most frequent and severe occupational stressors. On the other hand, there were some studies whose findings was in-congruent A study conducted by Damit (2007) identified that the new registered nurses rated their ‘uncertainty concerning treatment’ as highly stressful events that frequently occurred in the workplace. Also findings that conducted by Kamal et al. ( 2012) stated that most stressful subscale for nurses was dealing with 'Patients and their families' as "Frequently Stressful". In a study Yau et al. (2012) stated that a high level of occupational stress was related to workload, responsibility and time. Wang et al. (2011) added that workload, lack of support, inadequate preparation, and conflict with other nurses were the most frequent stressors experienced by Hong Kong surgical nurses. And Mosadeghrad (2013) conducted study among hospital nurses in Isfahan, Iran. He indicated that the major sources of stress were inadequate
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payment, inequality at work, too much work, staff shortage, lack of promotion, job insecurity and lack of management support. It is acknowledged that direct contact with somebody who is pending death within the scope of legal responsibility has an impact on the psychological well-being (Kubler-Ross, 1971). Nurses are identified as having a wide and more extensive contact with patients than any other healthcare professionals (Costello, 2001). In some parts of acute care as mental health hospitals, patients will have several episodes of hospital admissions or prolonged stays in hospital. This will enable them and their families to become known to both nursing staff and other healthcare staff (Caldas and Killaspy,2011). The results of current study may be due to deep and direct contacts of nurses with patients for a long time (Kieft et al., 2014). Death by its nature is stressful and a source of suffering. It can affect them both in their work environment and outside of work. This is associated with poorer mental and physical health problem(Wilson and Kirshbaum, 2011). Therefore, nurses show more symptoms of stress when they are in close relation dealing with death and dying and physicians not being present. While the subscales ‘problems with peers’ from ENSS in the current study has the lowest level percentage from the total as indicated in the mean ( 2.02 ) was least stressful subscale. It is related to all these items "Lack of opportunity to talk openly with other personal about problems in the work setting", "Lack of opportunity to share experiences and feelings", "Difficulty in working with a particular nurse (or nurses) in my immediate work setting", "Difficulty in working with a particular nurse (or nurses) in my outside work setting", "Lack of an opportunity to express to
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81
other personnel on the unit my negative feeling towards patients", have occasional stressful event perceived by staff nurses" and" Difficulty in working with nurses of the opposite sex". Within these last item "Difficulty in working with nurses of the opposite sex" takes the lowest order in domain problems with peers. This finding disagree with findings of study conducted by Kamal et al. (2012) which indicated that the least stressful subscale was "Inadequate preparation". The study done by Dagget et al. (2016) in South West Ethiopia indicated that lowest job related with stress was from sexual harassment mean score of (46.19%). The current study findings may be as a result of adoption tolerance, openness culture and effective communications among nurses in work place. Besides there is satisfaction from organization’s management, and respect of work rules, despite nurses reported suffering some stress in different mean score (Gifford, et al., 2002)..
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5.3 Part Three : Responses of Nursing Staff in Mental Health Hospitals with Items of JSS to Determine Level of Job Satisfaction. The job satisfaction scale items mean (4.08) indicates that total average are “satisfaction” because the mean score is greater than 4.00 slightly. The majority of the nurses have expressed the lowest level of satisfaction regarding subscales ‘pay’ (salary) mean= 3.11. This rated the lowest level of all subscales JSS. Items "I feel I am being paid a fair amount for the work I do", "Raises are too few and far between", "I feel unappreciated by the organization when I think about what they pay me" and "I feel satisfied with my chances for salary increases". Included item "Raises are too few and far between" take the lowest level of satisfaction from the subscale pay at the means = 3.04. In agreement with this study, there are many studies conducted in Sweden; by Holmberg, et al. (2015) among Swedish psychiatric nursing staff in an inpatient psychiatric clinic. Results indicated that overall job satisfaction was rated relatively high, and salary was rated the lowest of all factors investigated. In Cyprus similar findings were noted in the study by Skitsou et al. (2015) to investigate the job satisfaction level of the nursing staff in Athalassa psychiatric hospital of Cyprus, by using the same instrument "Paul E. Spector’s JSS Questionnaire". Results indicated that the highest satisfaction average Mean = 4.71. On the other hand, the current study differs from that conducted by Ali, Sabir, and Bakir, (2014) in Erbil City/ Kurdistan Region under the title "Job Satisfaction among Group of Nurses in General-Hospitals-Erbil City". Results indicated that out of all 127 nurses, 63.8% were neither satisfied nor unsatisfied, 22% were satisfied while only 14.2% were not satisfied with their job. A study conducted by Mohamed and Al- Juboori (2010) in Baghdad psychiatric hospitals who found that the nurses in
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83
their study had moderate level of job satisfaction. This result was attributed to the satisfaction of nurses staff in the study about some domains more than others. This result strongly disagreed with the study conducted in South Africa by Khunou and Davhana-Maselesele, (2016). Amongst the nurses in the Republic of South Africa (RSA), the nurses were highly dissatisfied about the working conditions and salary. In contrary, a study conducted by AbuRuz, (2014) under the title "In a Comparative Study about the Impact of Stress on Job Satisfaction between Jordanian and Saudi Nurses" results showed mean job satisfaction score of (3.28), but subscale pay took the number one from ENSS subscales at mean (2.85). This was is similar to the result of the present study. Mansour et al. (2014) carried the study on female nurses in King Saud hospitals. Results revealed that 47% of the subjects were ambivalent in their response to job satisfaction and 35% were satisfied. Rosales et al (2013) carried the study on (48) nurses in three Government Hospitals of Western Samar, Philippines. They used Pul E. Spector JSS instrument. Findings indicated that respondents experienced a moderate level of burnout and claimed to be slightly unsatisfied with their job. The highest scored subscale on the JSS was the nature of the work. Payment has a major impact on job satisfaction. Low paid employees showed a low level of job satisfaction. Financial aspects especially salary was the most important aspect among all domains, because each employee needed livelihood to support his/ her family (Usman, 2013). Nursing staff intend to more salary and without lack and delay. Most of them feel unsatisfied with their chances for salary increases.
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While the subscale ‘coworkers’ from the current study take the highest level from the total of satisfaction mean= (4.74), concerning all these items "I like the people I work with", "I find I have to work harder at my job because of the incompetence of people I work with", "I enjoy my coworkers", and" There is too much bickering and fighting at work". Last item "There is too much bickering and fighting at work" takes the highest order in subscale coworkers mean= 5.13. It is regarded as one of the strengths of nurses staff in Sulaimani mental hospitals. It seemed that results of a research conducted by Rosales et al (2013) in Philippines used the same instruments. The results indicated that the lowest scored subscale was the fringe benefit. The researcher thinks about coworkers subscale noted that there were good relationships and cooperation among nursing staff without bickering or fighting at work (Rosales et al., 2013).
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5.4 Part Four: Associations between level of ENSS and demographic characteristics. 5.4.1 Dimension One: The Gender Difference in Regard of ENSS: The significant difference lies in the domains uncertainty concerning treatment and patients and their families, where females scored significantly more than males. Whereas the least scoring mean recorded in gender in the domain of ‘Inadequate preparation’ at P value= 0.7 and Mean ENSS = 2.1 This indicated that there was statistical significant relationship between both domains uncertainty concerning treatment and patients and their families in ENSS and gender at P value= 0.01. This finding was near to the finding of study conducted by Kamal et al., (2012) in Taif governmental hospitals in Kingdom of Saudi Arabia that showed there were significant statistical differences in perceived job related stress due to gender as indicated by P = 0.038 With regard to the findings of the aforementioned, female nurses were stressed and exhausted more than the male in the work place. This was when there were, inadequate information from a physician, inappropriate treatment for a patient, fear of making a mistake in treating patients, physician not being present during medical emergency, being exposed to health and safety hazards, and inadequate experience (Andal, 2006). Also who stressed more due to sensitivity against something as when patients or his / her families making unreasonable demands, blaming her for anything that goes wrong, deal with violent and abusive patients, and when patients families will report for inadequate care. In addition to these, she had multiple and complex roles that these women have to perform: wife, mother, employee and housekeeper (Michael et
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86
al., 2009). These reasons might restrict the physical and psychological abilities in female workers. So, with increasing workload and demand, they would experience more stress. 5.4.2 Dimension Two: Age Groups Differences in Regard of ENSS: There was statistically significant relationship between subscale uncertainty concerning treatment of ENSS and age group (30-34) years old at P value= 0.02. 5.4.3 Dimension Three : Marital Status Difference in Regard of ENSS: The only significant difference lies in the discrimination domain where the married participates scored significantly more than unmarried at (P value < 0.05). There was significant statistical association between the only subscale discrimination of job stress and marital status, where married scored =2.3. Significantly it was more than unmarried mean score=1.9 at (P value= 0.02). These were due to responsibilities and expanded financial obligations of married, which affected in inter-relationship with others in work place bringing more stress (Sumra and Schillaci, 2015). 5.4.4 Dimension Four: Graduation Level Difference in Regard of ENSS: The graduation level bachelors in nursing science group exhibited the maximum mean score at P value = 0.005 on the subscale problems with supervisors. Whereas the least scoring graduation level of nursing preparatory school group on the sub scale problems with peers. This indicates that there was highly statistical significant relationship between domain problems with supervisors in ENSS and graduation level bachelor of nursing science group at (P value= 0.005) at mean ENSS = 3 Nurses with bachelor’s degree experienced more stress. This was due to conflict with supervisor and criticism or lack of support from immediate supervisor and nursing administration (Moreland and Apker, 2016).
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5.4.5 Dimension Five : Years of Employment Vs. (ENSS) : Years of employment within (6-10) years group exhibited the maximum mean score at P value < 0.05 on the domain of uncertainty concerning treatment. Whereas the least scoring mean recorded within (16-20) years group on the domain of problems with peers at P value= 0.9. This indicated that there was statistical significant relationship between uncertainty concerning treatment domain in ENSS within (6-10) years group employment. This result was incongruent with the results in a study carried by Sahraian et al. (2013). They founded no significant relationship between work experience and occupational stress. They also concluded that more years of employment nurses had better adaptation with the adversity of working environments, and had a greater ability to deal with stress and tension in their profession. So they had less job stress (Sahraian et al. 2013). 5.4.6 Dimension Six : Economic Status Vs. (ENSS) : Insufficient group of economic status exhibited the maximum mean score on the domain of conflict with physicians at mean ENSS = 2.7 . Whereas the least scoring within sufficient group in the domain death and dying at mean ENSS = 2.3 . This indicated that there was statistical significant relationship between subscale conflict with physicians in ENSS within insufficient group about economic status at P value < 0.05. Insufficient group of economic status from the nurses staff had constant and persist suffering. That’s increase hardship in the life and privation of families making them do not bear the more stress in the work place when receiving criticism by a physician, conflict with a physician, making decision concerning a patient's life or having to organize doctors work.
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5.4.7 Dimension Seven: Training Course Vs. (ENSS): There was no statistical significant difference between training course undertaken and all nine subscales of ENSS. This finding differed from the study conducted in psychiatric hospitals at Baghdad City among 100 nurses by Abdullah (2015). The results revealed that there was a significant relationship between nurses, stress and their training courses especially outside the country. The main purpose of the training course about stress management in workplace are to find the resolution for gap of defect and control of their daily activities. These activities increase work effectiveness and productivity through more effective communication. They reduced stress levels, increased confidence handling difficult behaviors with others. They enabled the nurses to manage colleagues and friends effectively, and enjoy a more balanced lifestyle (Larkins, 2016). 5.4.8 Dimension Eight : Interest Vs. (ENSS): There was a highly statistical significant relationship in both domains uncertainty concerning treatment and patients and their families with interest at P value= 0.0001, where response NO scored significantly more than Yes. Also, there were four statistical significant relationships in the domains death and dying, conflict with physicians, problems with peers and problems with supervisors with interest dimension at P value < 0.05, where response NO scored significantly more than Yes. This meant that the desire and interest to nursing profession spontaneously acted to relieve and reduce the job stress and bear a hard work (Adib-ajbaghery, et al., 2012).
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5.5 Part five: Correlations of Expanded Nursing Stress Scale (ENSS) with Job Satisfaction Scale (JSS): In an attempt to figure out the direction of associations of the nine items of both ENSS and JSS, a correlation matrix adopting Pearson Correlation Coefficient (r), was carried out. There were several kinds of associations among the items of both scales. Nevertheless, only item 7 of ENSS showed significant positive correlations with items 6 and 7 of JSS. On the other hand, ENSS 1, 2, 7, and 8 were negatively correlated with JSS 8. In other words, increased nurses’ stress in the subscale of ‘uncertainty concerning treatment’ was associated with significantly more job satisfaction in regards of ‘operating conditions’ and ‘coworkers’. Whereas more nurse’s stress in regards of ‘death and dying’, ‘conflict with physicians’, ‘uncertainty concerning treatment’, and ‘patients and their families’ was associated with significantly less job satisfaction in regard of the ‘nature of work’. There was no statistical significant correlation between total ENSS and total JSS. In conclusion total ENSS and total JSS were not significantly correlated to each other, as it can be seen from the results of table (4-13). In agreement with present study, there was a study done by Kang and Kim, (2014) on male nurses who worked in hospitals located in B and S City in South Korea. The results showed that job stress was not correlated with job satisfaction. Also, another study conducted by Gulavani and Shinde (2014), under the title "Occupational Stress and Job Satisfaction among Nurses" revealed there was no significant correlation found between occupational stress and job satisfaction (r = 0.006).
CHAPTER FIVE: DISCUSSION
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In a comparative study about the impact of stress on job satisfaction between jordanian and saudi nurses, AbuRuz (2014) founded that there was a significant negative relationship between stress and job satisfaction for Jordanian nurses r (148) = -0.630, p˂.05 and for Saudi nurses r (98)= -0.437, p˂.05. Another study conducted by Saleh et al. (2013) and Kamal et al. (2012) in Kingdom of Saudi Arabia in agreement goes with resulting this study "negative significant relationship between stress and job satisfaction among staff nurses" as indicated by (Pearson correlation = - .437, P < 0.05) for both. Another study conducted by Mansour et al. (2014) at King Saud revealed that a significant positive relation between level of perceived stress and level of job satisfaction was found in this study p=0,009. These similarities and differences between the study results may be contributed to some reasons as: deference in place of study, size of the sample, environment influences, psychological condition of respondent, and etc. Relating to this study, most of the nursing staff were satisfied with their jobs. However, they were slightly stressed from their job environment especially in death and dying that led to a negative impact on the level of job stress (Edoho, et al.,2015). Also, regarding the domain salary which led to negative impacts on nurses job satisfaction, satisfied nurses did not correlate to nurses job stress in mental hospital. This referred to the fact that there was others factors slightly effected the satisfied nurses (Lorber and Skela, 2012).
CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS
CHAPTER SIX : CONCLUSION AND RECOMMENDATION
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Chapter Six 6. Conclusions and Recommendations
6.1. Conclusions: According to the present study findings, the researcher can conclude that :-
1. Approximately (1/4) of participated nurses have not profession fits with interest. 2. Nurses had satisfied with their work. No bickering and fighting at work. 3. The lack and delay in payment (salary) are a major cause of increasing job stress and decreasing job satisfaction, although the level of job stress among nurses is not recorded high and most of them satisfied with their job. 4. There were a good relationship and effective communication among nurses staff.
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6.2. Recommendations : The study recommends :
1. Employing Bachelor and Master degree in Nursing Sciences with achieving their desire in working at mental health hospitals. 2. Improving the payment and incentives for nurses working in mental hospitals to keep nurses from turnover or change the setting of work, and to encourage the newly graduate nurses to join in these places. 3. Implementing excessive training courses inside and outside country for nurses working in psychiatric hospitals. This is to increase or at least maintain their skills which increases satisfaction and decreases job stress. 4. Deepening coordination between the Ministry of Health and Higher Education to achieve hospitals requirements about Master and Bachelor degrees in nursing, and number of nurses in psychiatric nursing. 5. Adding stress management programmes in syllabus of nursing education to make them manage their own stress in the future. 6. Adopting effective relaxation programs and strategies to reduce amount of job stress. Thus, this will increase job satisfaction which will be reflected on patient care quality. 7. Documenting the source and the extent of stress in any health care unit or organization is essential for successful interventions.
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APPENDICES
APPENDICES – D1
Questionnaire Part one :- Socio - demographical characteristics . 1- Gender Male Female 2- Age
Years
3- Marital status Married
Unmarried
4- Graduation level : Nursing Preparatory School Diploma in Nursing
Bachelor in Nursing Science Master in Nursing Science
5- Number of Years of employment in psychiatric – mental health nursing . 1 to 5 years 6 to 10 years 11 to 15 years 16 to 20 years 21 to 25 years
6- Economic state Sufficient Barely Sufficient Insufficient 7- Training course Participation in training courses
yes
No
8- Interest Does your Profession fit with your interest ? yes No Part two : - Job stress questionnaire (Expanded Nursing stress scale) NEVER STRESSFUL 1
OCCAUSIONALLY STRESSFUL 2
FERQUENTLY STRESSFUL 3
EXTREMELY STRESSFUL 4
DOES NOT APPLY 5
1-Performing procedures that patients experience as painful ..…….…………………………….. 2-Criticism by physician…………………………………………………………………….......... 3-Feeling inadequately prepared to help with the emotional needs of the patients family............... 4-Lack of opportunity to talk openly with other personal about problems in the work setting...... 5-Conflict with supervisor ……………..………………………………………………………….. 6- Inadequate information from a physician regarding the medical condition of a patient ………..
7-Patients making unreasonable demands ………..……………………………………………….. 8-Being sexually harassed ………….…………………………………………………………….. 9-Feeling helpless in the case of a patient who fails to improve ……………….…………………. 10-Conflict with a physician ………………………………………………………………………. 11-Being asked a question by a patient for which I do not have a satisfactory answer ….….......... 12-Lack of opportunity to share experiences and feelings with other personnel in the work setting…………………………………………………..………. 13-Unpredictable staffing and scheduling ………………..………………………………………. 14-A physician ordering what appears to be in appropriate treatment for a patient ….…………... 15- Patients families making unreasonable demands ………….……………………………......... 16- experiencing discrimination because of race or ethnicity ………………………………….......... 17-Listining or talking to a patient about his or her approaching death ……………..…..………... 18-Fear of taking mistake in treating a patient ………………………………………….……….... 19-Feeling inadequate prepared to help with the emotional needs of a patient …….……………... 20-Lack of an opportunity to express to other personnel on the unit my negative feeling towards patients……………………………………………………………… 21- Difficulty in working with a particular nurse (or nurses) in my immediate work setting......... 22- Difficulty in working with a particular nurse (or nurses) in my outside work setting ………. 23-Not enough time to provide emotional support to the patient………………………………….. 24- A physician not being present in a medical emergency .………………………………........... 25-Being blamed for anything that goes wrong …………………………………………………… 26- Experiencing discrimination on the basis of sex ……………………………….…………….. 27-The death of a patient ……………………………………………………………………........... 28-Disagreement concerning the treatment of a patient …………………………………………… 29- Feeling inadequately trained for what I have to do …………………………………………… 30-Lack of support of my immediate supervisor …………………………………………………... 31- criticism by a supervisor ……………………………………………………………………….. 32-Not enough time to complete all of my nursing tasks ……………………………………….…. 33- Not knowing what a patient or patients family ought to be told about the patient's condition and its treatment…………………………………………………..... 34- Being the one that has to deal with the patients families …………………………….……….... 35- Having to deal with violent patients ………………………………………………………….. 36- Being exposed to health and safety hazards …………………………………………………… 37-The death of a patient with whom you developed a close relationship ……………………….… 38-Making decision concerning a patient when the physician is unavailable …………………….. 39-Being in charge with inadequate experience ………………………………………………….... 40-Lack of support by nursing administration ………………………………………………......... 41-Too many non – nursing tasks required , such as clerical work ……………………………..… 42-Not enough staff to adequately cover the unit …………………………………………………. 43-Uncertainly regarding the operation and functioning of specialized equipment ………………. 44-Having to deal with abusive patients …………………………..………………………………. 45-Not enough time to respond to the needs of patients families…………………..……………… 46-Being held accountable for things over which I have no control ……………………………… 47-Physician(s) not being present when a patient die …………………………………………….. 48-Having to organize doctors work ……………………..………………………………………… 49- Lack of support from other health care administrators ………………………………….......... 50-Difficulty in working with nurses of the opposite sex………………………………………….. 51-Demands of patient classifications system …………………………………………………..… 52- Having to deal with abuse from patients families ………………..……………………………. 53-Watching a patient suffer ……………………….………………………………………………. 54- Criticism from nursing administration ……………………………………………………........ 55-Having to work through breaks………………………………………………………………….. 56-Not knowing whether patients families will report you for inadequate care………….……….. 57-Having to making decision under pressure ……………………………………………………..
Part three : - Job satisfaction questionnaire .
JOB SATISFACTION SURVEY PLEASE CIRCLE THE ONE NUMBER FOR EACH QUESTION THAT COMES CLOSEST TO REFLECTING YOUR OPINION ABOUT IT.
Disagree very much Disagree moderately Disagree slightly Agree slightly Agree moderately Agree very much
Paul E. Spector 1994/ Department of Psychology /University of South Florida
1
I feel I am being paid a fair amount for the work I do.
1
2
3
4
5 6
2
There is really too little chance for promotion on my job.
1
2
3
4
5
6
3
My supervisor is quite competent in doing his/her job.
1
2
3
4
5
6
4
I am not satisfied with the benefits I receive.
1
2
3
4
5
6
5
When I do a good job, I receive the recognition for it that I should
1
2
3
4
5
6
receive. 6
Many of our rules and procedures make doing a good job difficult.
1
2
3
4
5
6
7
I like the people I work with.
1
2
3
4
5
6
8
I sometimes feel my job is meaningless.
1
2
3
4
5
6
9
Communications seem good within this organization.
1
2
3
4
5
6
10
Raises are too few and far between.
1
2
3
4
5
6
11
Those who do well on the job stand a fair chance of being promoted.
1
2
3
4
5
6
12
My supervisor is unfair to me.
1
2
3
4
5
6
13
The benefits we receive are as good as most other organizations offer.
1
2
3
4
5
6
14
I do not feel that the work I do is appreciated.
1
2
3
4
5
6
15
My efforts to do a good job are seldom blocked by red tape.
1
2
3
4
5
6
16
I find I have to work harder at my job because of the incompetence of
1
2
3
4
5
6
people I work with. 17
I like doing the things I do at work.
1
2
3
4
5
6
18
The goals of this organization are not clear to me.
1
2
3
4
5
6
19
I feel unappreciated by the organization when I think about what they pay me.
1
2
3
4
5
6
20
People get ahead as fast here as they do in other places.
1
2
3
4
5
6
21
My supervisor shows too little interest in the feelings of subordinates.
1
2
3
4
5
6
22
The benefit package we have is equitable.
1
2
3
4
5
6
23
There are few rewards for those who work here.
1
2
3
4
5
6
24
I have too much to do at work.
1
2
3
4
5
6
25
I enjoy my coworkers.
1
2
3
4
5
6
26
I often feel that I do not know what is going on with the organization.
1
2
3
4
5
6
27
I feel a sense of pride in doing my job.
1
2
3
4
5
6
28
I feel satisfied with my chances for salary increases.
1
2
3
4
5
6
29
There are benefits we do not have which we should have.
1
2
3
4
5
6
30
I like my supervisor.
1
2
3
4
5
6
31
I have too much paperwork.
1
2
3
4
5
6
32
I don't feel my efforts are rewarded the way they should be.
1
2
3
4
5
6
33
I am satisfied with my chances for promotion.
1
2
3
4
5
6
34
There is too much bickering and fighting at work.
1
2
3
4
5
6
35
My job is enjoyable.
1
2
3
4
5
6
1
2
3
4
5
6
36 Work assignments are not fully explained. Thank you for completing the questionnaire.
APPENDICES – D2 ﺭﺍﭘﺭﺳﯽ "ﮐﺎﺭﻳﮕﻪﺭی ﺳﺗﺭ ﺱ )ﻓﺷﺎﺭ( ﻟﻪﺳﻪﺭ ﺭﺍﺯی ﺑﻭﻭﻥ ﻟﻪ ﮐﺎﺭ ﻟﻪ ﻧﺎﻭ ﺳﺗﺎﻓﯽ ﭘﻪﺭﺳﺗﺎﺭی ﻧﻪﺧۆﺷﺧﺎﻧﻪﮐﺎﻧﯽ ﺗﻪﻧﺩﺭﻭﺳﺗﯽ ﺩﻩﺭﻭﻭﻧﯽ ﻟﻪ ﺳﻠ ﻣﺎﻧﯽ".
ﺑﻪﺷﯽ ﻳﻪﮐﻪﻡ :ﺗﺎﻳﺑﻪﺗﻣﻪﻧﺩی ﻳﻪ ﮐۆﻣﻪ"ﻳﻪﺗﯽ ﻭ ﺩﻳﻣۆﮔﺭﺍﻓﻳﻪﮐﺎﻥ -1ﺭﻩﮔﻪﺯ:
ﻧﺭ
-2ﺗﻪﻣﻪﻥ:
ﺳﺎڵ
-3ﺑﺎﺭی ﺧ ﺯﺍﻧﯽ:
:
ﻣ
ﺧ ﺯﺍﻧﺩﺍﺭ
ﺳﻪ ﺕ
-4ﺑڕﻭﺍﻧﺎﻣﻪ: ﻗﻭﺗﺎﺑﺧﺎﻧﻪی ﺋﺎﻣﺎﺩﻩﻳﯽ ﭘﻪﺭﺳﺗﺎﺭی ﺩﺑﻠۆﻣﯽ ﭘﻪﻳﻣﺎﻧﮕﺎ ﻟﻪ ﭘﻪﺭﺳﺗﺎﺭﻳﺩﺍ ﺑﻪﮐﺎﻟۆﺭﻳۆﺱ ﻟﻪ ﺯﺍﻧﺳﺗﯽ ﭘﻪﺭﺳﺗﺎﺭﻳﺩﺍ ﻣﺎﺳﺗﻪﺭ ﻟﻪ ﺯﺍﻧﺳﺗﯽ ﭘﻪﺭﺳﺗﺎﺭﻳﺩﺍ -5ژﻣﺎﺭﻩی ﺳﺎ"ﻧﯽ ﺧﺯﻣﻪﺗﮑﺭﺩﻥ ﻟﻪ ﭘﻪﺭﺳﺗﺎﺭی ﺗﻪﻧﺩﺭﻭﺳﺗﯽ ﺩﻩﺭﻭﻧﯽ
-6ﺑﺎﺭی ﺋﺎﺑﻭﻭﺭی:
1ﺑۆ 5ﺳﺎڵ
6ﺑۆ 10ﺳﺎڵ
11ﺑۆ 15ﺳﺎڵ
16ﺑۆ 20ﺳﺎڵ
21ﺑۆ 25ﺳﺎڵ
26ﺳﺎڵ ﻭ ﺯﻳﺎﺗﺭ
ﺑﺎﺵ
ﻧﺎﻭﻩﻧﺩ
ﺧﺭﺍپ
-7ﺧﻭﻟﯽ ﺭﺍﻫ ﻧﺎﻥ: ﺑﻪﺷﺩﺍﺭی ﺧﻭﻟﯽ ﺭﺍﻫ ﻧﺎﻧﺕ ﮐﺭﺩﻭﻭﻩ؟
-8ﺧﻭﻟﻳﺎ :ﺋﺎﻳﺎ ﮐﺎﺭﻩﮐﻪﺕ ﺋﻪﮔﻭﻧﺟ ﺕ ﻟﻪﮔﻪڵ ﺣﻪﺯﻭ ﺧﻭﻟﻳﺎی ﺧۆﺕ ﺩﺍ؟
ﻧﻪﺧ ﺭ
ﺑﻪ
ﺑﻪ
ﻧﻪﺧ ﺭ
ﺑﻪﺷﯽ ﺩﻭﻭﻩﻡ :ﭘﺭﺳﻳﺎﺭﻩﮐﺎﻧﯽ ﺗﺎﻳﺑﻪﺕ ﺑﻪ ﺳﺗﺭ ﺱ )ﻓﺷﺎﺭ( ﻟﻪ ﮐﺎﺭﺩﺍ ﻫﻪﺭﮔﻳﺯ ﻓﺷﺎﺭﻡ ﺑۆ ﺩﺭﻭﺳﺕ ﻧﺎﮐﺎﺕ )(1
ﺩﺭ ژﻩی ﭘ ﻭﻩﺭی ﻓﺷﺎﺭ ﻟﻪ ﭘﻪﺭﺳﺗﺎﺭﻳﺩﺍ ﻓﺷﺎﺭ ﻧﺎﻳﮕﺭ ﺗﻪﻭﻩ ﺯۆﺭ ﺯۆﺭ )ﺋﻪﻭﭘﻪڕی( ﻫﻪﻧﺩ ﮏ ﺟﺎﺭ ﻓﺷﺎﺭﻡ -3ﺯۆﺭﺟﺎﺭ ﻓﺷﺎﺭﻡ ﻓﺷﺎﺭﻡ ﺑۆ ﺩﺭﻭﺳﺕ ﺩﻩﮐﺎﺕ )ﺟ +ﺑﻪﺟ +ﻧﺎﺑ ﺕ( ﺑۆ ﺩﺭﻭﺳﺕ ﺩﻩﮐﺎﺕ ﺑۆ ﺩﺭﻭﺳﺕ ﺩﻩﮐﺎﺕ )(5 )(4 )(3 )(2
.1ﮐﺎﺗﯽ ﺋﻪﻧﺠﺎﻡ ﺩﺍﻧﯽ ﺋﻪﻭ ﮐﺎﺭﺍﻧﻪی ﮐﻪ ﺑﻪﻻی ﻧﻪﺧﯚﺷﻪﮐﺎﻧﻪﻭﻩ ﺋﺎﺯﺍﺭﺑﻪﺧﺸﻪ ---------------------------------------- . .2ﮐﺎﺗﯽ ﺭﻩﺧﻨﻪﮔﺮﺗﻦ ﻟﻪﻻﻳﻪﻥ ﭘﺰﻳﺸﮑﻪﻭﻩ ------------------------------------------------------------------ . .3ﮐﺎﺗ ﮏ ﻫﻪﺳﺖ ﺩﻩﮐﻪﻳﺖ ﺑﻪ ﺗﻪﻭﺍﻭی ﺋﺎﻣﺎﺩﻩﻧﻴﺖ ﻭ ﻧﺎﺗﻮﺍﻧﻴﺖ ﻟﻪ ﺭﻭﻭی ﻫﻪﺳﺖ ﻭ ﺳﯚﺯﻩﻭﻩ ﻫﺎﻭﮐﺎﺭی ﺧ(ﺰﺍﻥ ﻭ ﮐﻪﺳﻮﮐﺎﺭی ﻧﻪﺧﯚﺷﻪﮐﺎﻥ ﺑﮑﻪﻳﺖ--------------------------------------------------------------------- . .4ﻟﻪ ﮐﺎﺗﯽ ﻧﻪﺑﻮﻭﻧﯽ ﺩﻩﺭﻓﻪﺕ ﺑﯚ ﻗﺴﻪﮐﺮﺩﻥ ﺩﻩﺭﺑﺎﺭﻩی ﮐ(ﺸﻪﮐﺎﻥ ﺑﻪ ﺭﺍﺷﮑﺎﻭی ﻟﻪﮔﻪڵ ﺋﻪﻧﺪﺍﻣﺎﻧﯽ ﺗﺮی ﺳﺘﺎﻓﻪﮐﻪﺩﺍ ﻟﻪ ﺷﻮ(ﻨﯽ ﮐﺎﺭﺩﺍ ----------------------------------------------------------------------------------------- . .5ﻟﻪ ﮐﺎﺗﯽ ﺑﻮﻭﻧﯽ ﮐ(ﺸﻪ ﻟﻪﮔﻪڵ ﺳﻪﺭﭘﻪﺭﺷﺘﻴﺎﺭﺩﺍ ------------------------------------------------------------ . .6ﮐﺎﺗ(ﮏ ﭘﺰﻳﺸﮏ ﺯﺍﻧﻴﺎﺭی ﻫﻪ2ﻪﻭ ﻧﺎﻭﻭﺭﺩ ﺩﻩﺩﺍﺕ ﺩﻩﺭﺑﺎﺭﻩی ﺑﺎﺭی ﺗﻪﻧﺪﺭﻭﺳﺘﯽ ﻧﻪﺧﯚﺵ------------------------- . .7ﮐﺎﺗ(ﮏ ﻧﻪﺧﯚﺵ ﺩﺍﻭﺍﮐﺎﺭی ﻧﻪﮔﻮﻧﺠﺎﻭ ﺩﻩﮐﺎﺕ---------------------------------------------------------------. .8ﮐﺎﺗﯽ ﺑ(ﺰﺍﺭﮐﺮﺩﻥ ﻭ ﮔ(ﭽﻪ2ﯽ ﺳ(ﮑﺴﯽ ----------------------------------------------------------------- . .9ﮐﺎﺗ(ﮏ ﻧﺎﺗﻮﺍﻧﻴﺖ ﻳﺎﺭﻣﻪﺗﯽ ﺋﻪﻭ ﻧﻪﺧﯚﺷﺎﻧﻪ ﺑﺪﻩﻳﺖ ﮐﻪ ﻫﻴﭻ ﺑﻪﺭﻩﻭﭘ(ﺶ ﭼﻮﻭﻧ(ﮏ ﻟﻪ ﺗﻪﻧﺪﺭﻭﺳﺘﻴﺎﻧﺪﺍ ﺭﻭﻭﻧﺎﺩﺍﺕ -----. .10ﻟﻪ ﮐﺎﺗﯽ ﺑﻮﻭﻧﯽ ﮐ(ﺸﻪﺩﺍ ﻟﻪﮔﻪڵ ﭘﺰﻳﺸﮑﺪﺍ -------------------------------------------------------------- . .11ﮐﺎﺗ(ﮏ ﻧﻪﺧﯚﺵ ﭘﺮﺳﻴﺎﺭ(ﮏ ﺩﻩﮐﺎﺕ ﻭ ﻫﻴﭻ ﻭﻩ8ﻣ(ﮑﯽ ﮔﻮﻧﺠﺎﻭ ﻭ ﺑﺎﻭﻩڕﭘ(ﮑﻪﺭﻡ ﭘ :ﻧﻴﻪ ﺑﯚی------------------ . .12ﻟﻪ ﮐﺎﺗﯽ ﻧﻪﺑﻮﻭﻧﯽ ﺩﻩﺭﻓﻪﺕ ﺑﯚ ﮔﻮﺍﺳﺘﻨﻪﻭﻩﻭ ﺋﺎ2ﻮﮔﯚﺭﮐﺮﺩﻧﯽ ﺋﻪﺯﻣﻮﻭﻧﻪﮐﺎﻥ ﻭ ﻫﻪﺳﺘﻪﮐﺎﻧﺖ ﻟﻪﮔﻪڵ ﺋﻪﻧﺪﺍﻣﺎﻧﯽ ﺗﺮی ﺳﺘﺎﻓﻪﮐﻪﺩﺍ ﻟﻪ ﺷﻮ(ﻨﯽ ﮐﺎﺭﺩﺍ --------------------------------------------------------------------- . .13ﮐﺎﺗﯽ ﺩﺍﻧﺎﻧﯽ ﺳﺘﺎﻑ ﻭ ﺧﺸﺘﻪی ﮐﺎﺭی ﭼﺎﻭﻩڕﻭﺍﻧﻨﻪﮐﺮﺍﻭ ------------------------------------------------- . .14ﮐﺎﺗ(ﮏ ﭘﺰﻳﺸﮏ ﺩﺍﻭﺍی ﺷﺘ(ﮏ ﺩﻩﮐﺎﺕ ﮐﻪ ﻭﻩک ﭼﺎﺭﻩﺳﻪﺭ(ﮑﯽ ﻧﻪﮔﻮﻧﺠﺎﻭ ﺩﻩﺭﺩﻩﮐﻪﻭ(ﺖ ﺑﯚ ﻧﻪﺧﯚﺵ ------------- . .15ﮐﺎﺗ(ﮏ ﮐﻪﺱ ﻭ ﮐﺎﺭﻭ ﺧ(ﺰﺍﻧﯽ ﻧﻪﺧﯚﺵ ﺩﺍﻭﺍﮐﺎﺭی ﻧﻪﮔﻮﻧﺠﺎﻭ ﻭ ﻧﺎﺑﻪﺟ :ﺩﻩﮐﻪﻥ----------------------------- . .16ﻟﻪ ﮐﺎﺗﯽ ﺭﻭﻭﺑﻪﺭﻭﻭﺑﻮﻭﻧﻪﻭﻩی ﻣﺎﻣﻪ2ﻪی ﺟﻴﺎﻭ ﺟﻴﺎﻭﺍﺯی ﮐﺮﺩﻥ ﻟﻪﺑﻪﺭ ﻫﯚﮐﺎﺭی ﻧﻪژﺍﺩ ﻳﺎﻥ ﻧﻪﺗﻪﻭﻩ ---------------. .17ﮐﺎﺗﯽ ﮔﻮێ ﮔﺮﺗﻨﺖ ﻳﺎﻥ ﻗﺴﻪﮐﺮﺩﻧﺖ ﻟﻪﮔﻪڵ ﻧﻪﺧﯚﺷ(ﮏ ﺩﺍ ﮐﻪ ﺑﺎﺳﯽ ﻧﺰﻳﮏ ﺑﻮﻭﻧﻪﻭﻩی ﻣﺮﺩﻧﯽ ﺋﻪﮐﺎﺕ------------. .18ﮐﺎﺗﯽ ﺑﻮﻭﻧﯽ ﺗﺮﺱ ﻟﻪ ﻫﻪ2ﻪ ﮐﺮﺩﻥ ﻟﻪ ﭼﺎﺭﻩﺳﻪﺭﮐﺮﺩﻧﯽ ﻧﻪﺧﯚﺵ ﺩﺍ------------------------------------------- . .19ﮐﺎﺗ ﮏ ﻫﻪﺳﺖ ﺩﻩﮐﻪﻳﺖ ﺑﻪ ﺗﻪﻭﺍﻭی ﺋﺎﻣﺎﺩﻩﻧﻴﺖ ﻭ ﻧﺎﺗﻮﺍﻧﻴﺖ ﻟﻪ ﺭﻭﻭی ﻫﻪﺳﺖ ﻭ ﺳﯚﺯﻩﻭﻩ ﻫﺎﻭﮐﺎﺭی ﻧﻪﺧﯚﺷﻪﮐﺎﻥ ﺑﮑﻪﻳﺖ ---------------------------------------------------------------------------------- .20ﻟﻪ ﮐﺎﺗﯽ ﻧﻪﺑﻮﻭﻧﯽ ﺩﻩﺭﻓﻪﺕ ﻭ ﻫﻪﻝ ﺑﯚ ﮔﻮﺯﺍﺭﺷﺖ ﮐﺮﺩﻥ ﻟﻪ ﺗ(ﺮﻭﺍﻧﻴﻨﻪ ﻧﻪﺭ(ﻨﻴﻪﮐﺎﻧﺖ ﺳﻪﺑﺎﺭﻩﺕ ﺑﻪ ﻧﻪﺧﯚﺷﻪﮐﺎﻥ ﻻی ﺋﻪﻧﺪﺍﻣﺎﻧﯽ ﺗﺮی ﺳﺘﺎﻓﻪﮐﻪ ------------------------------------------------------------------. .21ﮐﺎﺗ ﮏ ﮐﺎﺭﮐﺮﺩﻥ ﻟﻪﮔﻪڵ ﭘﻪﺭﺳﺘﺎﺭ ﮑﯽ ﺩﻳﺎﺭی ﮐﺮﺍﻭ ﻳﺎﻥ ﺯﻳﺎﺗﺮﺩﺍ ﺑﻪ ﻗﻮﺭﺱ ﺩﻩﺯﺍﻧﻴﺖ ﻟﻪ ﺷﻮ ﻨﯽ ﮐﺎﺭی ﺋ ﺴﺘﺎﺕ ﺩﺍ----. .22ﮐﺎﺗ ﮏ ﮐﺎﺭﮐﺮﺩﻥ ﻟﻪﮔﻪڵ ﭘﻪﺭﺳﺘﺎﺭ ﮑﯽ ﺩﻳﺎﺭی ﮐﺮﺍﻭ ﻳﺎﻥ ﺯﻳﺎﺗﺮﺩﺍ ﺑﻪ ﻗﻮﺭﺱ ﺩﻩﺯﺍﻧﻴﺖ ﻟﻪ ﺩﻩﺭﻩﻭﻩی ﺷﻮ ﻨﯽ ﮐﺎﺭﻩﮐﻪﺕ------.
.23ﻟﻪ ﮐﺎﺗﯽ ﻧﻪﺑﻮﻭﻧﯽ ﮐﺎﺗﯽ ﭘ(ﻮﻳﺴﺖ ﺩﺍ ﺑﯚ ﺋﻪﻭﻩی ﻟﻪ ﺭﻭﻭی ﺩﻩﺭﻭﻭﻧﻴﻪﻭﻩ ﻫﺎﻭﮐﺎﺭی ﻧﻪﺧﯚﺵ ﺑﮑﻪﻳﺖ------------ . .24ﮐﺎﺗ(ﮏ ﭘﺰﻳﺸﮏ ﻟﻪﻭێ ﻧﻴﻪ ﻟﻪ ﮐﺎﺗﯽ ﺑﺎﺭﻭﺩۆﺧ(ﮑﯽ ﻟﻪ ﻧﺎﮐﺎﻭﺩﺍ )ﺣﺎﻟﺔ ﺍﻟﻄﺎﺭﺋﺔ( --------------------------------. .25ﮐﺎﺗ(ﮏ ﺳﻪﺭﺯﻩﻧﺸﺖ ﺩﻩﮐﺮ(ﻴﺖ ﺑﯚ ﻫﻪﺭ ﻫﻪ2ﻪﻳﻪک ﮐﻪ ﺭﻭﻭﺩﻩﺩﺍﺕ----------------------------------------- . .26ﮐﺎﺗ(ﮏ ﻟﻪﺳﻪﺭ ﺑﻨﻪﻣﺎی ﺭﻩﮔﻪﺯ ﺟﻴﺎﮐﺎﺭی ﺑﻪﺭﺍﻣﺒﻪﺭﺕ ﺋﻪﮐﺮ(ﺖ------------------------------------------- . .27ﻟﻪ ﮐﺎﺗﯽ ﮔﻴﺎﻥ ﻟﻪﺩﻩﺳﺖ ﺩﺍﻧﯽ ﻧﻪﺧﯚﺵ ﺩﺍ-------------------------------------------------------------------- . .28ﻟﻪﮐﺎﺗﯽ ﺑﻮﻭﻧﯽ ﻧﺎﮐﯚﮐﯽ ﻭ ﺟﻴﺎﻭﺍﺯی ﻟﻪﮔﻪڵ ﭘﺰﻳﺸﮑﺪﺍ ﺳﻪﺑﺎﺭﻩﺕ ﺑﻪ ﭼﺎﺭﻩﺳﻪﺭی ﻧﻪﺧﯚﺵ ------------------------. .29ﮐﺎﺗ(ﮏ ﻫﻪﺳﺖ ﺩﻩﮐﻪﻳﺖ ﻭﻩک ﭘ(ﻮﻳﺴﺖ ﺭﺍﻫ(ﻨﺎﻧﺖ ﭘ(ﻨﻪﮐﺮﺍﻭﻩ ﮐﻪ ﭘ(ﻮﻳﺴﺘﻪ ﭼﯽ ﺑﮑﻪﻳﺖ ----------------------. .30ﮐﺎﺗ(ﮏ ﺳﻪﺭﭘﻪﺭﺷﺘﻴﺎﺭﻩﮐﻪﻡ ﻫﺎﻭﮐﺎﺭﻡ ﻧﻴﻪ ---------------------------------------------------------------. .31ﮐﺎﺗ(ﮏ ﺳﻪﺭﭘﻪﺭﺷﺘﻴﺎﺭ ﺭﻩﺧﻨﻪﺕ ﻟ :ﺩﻩﮔﺮ(ﺖ----------------------------------------------------------. .32ﻟﻪ ﮐﺎﺗﯽ ﻧﻪﺑﻮﻭﻧﯽ ﮐﺎﺗﯽ ﭘ(ﻮﻳﺴﺖ ﺑﯚ ﺗﻪﻭﺍﻭﮐﺮﺩﻧﯽ ﺋﻪﺭﮐﻪ ﭘﻪﺭﺳﺘﺎﺭﻳﻪﮐﺎﻧﻢ--------------------------------------. .33ﮐﺎﺗ(ﮏ ﻧﺎﺯﺍﻧﻢ ﺩﻩﺑ(ﺖ ﭼﯽ ﺑ(Jﻢ ﺑﻪ ﻧﻪﺧﯚﺵ ﻳﺎﻥ ﮐﻪﺳﻮﮐﺎﺭی ﻧﻪﺧﯚﺵ ﺩﻩﺭﺑﺎﺭﻩی ﺑﺎﺭﻭﺩۆﺧﯽ ﻧﻪﺧﯚﺷﻪﮐﻪ ﻭ ﭼﺎﺭﻩﺳﻪﺭﻩﮐﺎﻧﯽ--------------------------------------------------------------------------------------. .34ﮐﺎﺗ(ﮏ ﺩﻩﺑ(ﺖ ﻣﻦ ﻟﻪﮔﻪڵ ﮐﻪﺳﻮﮐﺎﺭی ﻧﻪﺧﯚﺵ ﺩﺍ ﻣﺎﻣﻪ2ﻪ ﺑﮑﻪﻡ--------------------------------------------. .35ﮐﺎﺗ(ﮏ ﺩﻩﺑ(ﺖ ﻣﺎﻣﻪ2ﻪ ﻟﻪﮔﻪڵ ﻧﻪﺧﯚﺷﯽ ﺗﻮﻧﺪﻭﺗﻴﮋﺩﺍ ﺑﮑﻪﻡ-------------------------------------------------- . .36ﮐﺎﺗ(ﮏ ﺩﻩﮐﻪﻭﻣﻪ ﺑﻪﺭﻣﻪﺗﺮﺳﯽ ﺗﻪﻧﺪﺭﻭﺳﺘﯽ ﻭ ﺳﻪﻻﻣﻪﺗﯽ --------------------------------------------------. .37ﮐﺎﺗ(ﮏ ﻧﻪﺧﯚﺷ(ﮏ ﺩﻩﻣﺮ(ﺖ ﮐﻪ ﭘﻪﻳﻮﻩﻧﺪﻳﻪﮐﯽ ﺑﺎﺷﺘﺎﻥ ﻟﻪ ﻧ(ﻮﺍﻥ ﺩﺍ ﺩﺭﻭﺳﺖ ﺑﻮﻭﻩ------------------------------ . .38ﮐﺎﺗ(ﮏ ﻣﻦ ﺑﺮﻳﺎﺭﺩﻩﺩﻩﻡ ﻟﻪﺳﻪﺭ ﻧﻪﺧﯚﺵ ﻟﻪ ﺣﺎﻟﻪﺗ(ﮑﺪﺍ ﮐﻪ ﭘﺰﻳﺸﮏ ﻟﻪﻭێ ﻧﻴﻪ-------------------------------- . .39ﻟ(ﭙﺮﺳﺮﺍﻭﻳﻪﮐﺖ ﭘﯽ ﺑﺪﺭ(ﺖ ﻟﻪ ﭼﺎﺭﻩﺳﻪﺭی ﻧﻪﺧﯚﺵ ﺑ :ﺑﻮﻭﻧﯽ ﺋﻪﺯﻣﻮﻭﻧﯽ ﭘ(ﻮﻳﺴﺖ---------------------------. .40ﮐﺎﺗ(ﮏ ﻳﻪﮐﻪی ﮐﺎﺭﮔ(Mی ﭘﻪﺭﺳﺘﺎﺭی ﻭﻩک ﭘ(ﻮﻳﺴﺖ ﻫﺎﻭﮐﺎﺭﻳﺖ ﻧﺎﮐﻪﻥ--------------------------------------. .41ﮐﺎﺗ ﮏ ﮐﯚﻣﻪ( ﮏ ﺋﻪﺭﮐﯽ ﺯۆﺭﺕ ﻟ* ﺩﺍﻭﺍﺩﻩﮐﺮ ﺖ ﮐﻪ ﭘﻪﻳﻮﻩﻧﺪﻳﺎﻥ ﺑﻪ ﭘﻪﺭﺳﺘﺎﺭﻳﻪﻭﻩ ﻧﻴﻪ ﻭﻩک ﮐﺎﺭﻭﺑﺎﺭی ﻓﻪﺭﻣﺎﻧﺒﻪﺭﺍﻥ
.42ﻟﻪ ﮐﺎﺗﯽ ﻧﻪﺑﻮﻭﻧﯽ ﺳﺘﺎﻓﯽ ﺗﻪﻭﺍﻭ ﺑﯚ ﺭﺍﭘﻪﺭﺍﻧﺪﻧﯽ ﮐﺎﺭﻩﮐﺎﻥ ﻭﻩک ﭘ(ﻮﻳﺴﺖ-----------------------------------------. .43ﮐﺎﺗ(ﮏ ﺑﻪ ﻧﺎﺩ2ﻨﻴﺎﻳﯽ ﻫﻪﻭڵ ﺩﻩﺩﻩﻡ ﻟﻪ ﮐﺎﺭﮐﺮﺩﻥ ﻭ ﺋﻪﺭﮐﯽ ﺋﺎﻣ(ﺮﻩ ﺗﺎﻳﺒﻪﺗﻪﮐﺎﻥ ﺑﮑﯚ2ﻤﻪﻭﻩ ﻭ ﺑﻴﺎﻥ ﺯﺍﻧﻢ----------------. .44ﮐﺎﺗ(ﮏ ﮐﻪ ﺩﻩﺑ(ﺖ ﻣﺎﻣﻪ2ﻪ ﻟﻪﮔﻪڵ ﺋﻪﻭ ﻧﻪﺧﯚﺷﺎﻧﻪﺩﺍ ﺑﮑﻪﻳﺖ ﮐﻪ ﺳﻮﻭﮐﺎﻳﻪﺗﯽ ﺩﻩﮐﻪﻥ--------------------------------. .45ﻟﻪ ﮐﺎﺗﯽ ﻧﻪﺑﻮﻭﻧﯽ ﮐﺎﺗﯽ ﺗﻪﻭﺍﻭﺩﺍ ﺑﯚ ﻭﻩ8ﻡ ﺩﺍﻧﻪﻭﻩﻭ ﺑﻪﺩﻩﻣﻪﻭﻩﭼﻮﻭﻧﯽ ﭘ(ﻮﻳﺴﺘﻴﻪﮐﺎﻧﯽ ﺧ(ﺰﺍﻧﯽ ﻧﻪﺧﯚﺷﻪﮐﺎﻥ------. .46ﮐﺎﺗ(ﮏ ﺩﻩﮐﺮ(ﻴﺘﻪ ﻟ(ﭙﺮﺳﺮﺍﻭی ﺷﺘ(ﮏ ﮐﻪ ﻟﻪ ﺩﻩﺭﻩﻭﻩی ﮐﯚﻧﺘﺮۆ2ﯽ ﺗﯚﺩﺍﻳﻪ--------------------------------------. .47ﮐﺎﺗ(ﮏ ﻧﻪﺧﯚﺷ(ﮏ ﮔﻴﺎﻥ ﻟﻪﺩﻩﺳﺖ ﺩﻩﺩﺍﺕ ﻭ ﭘﺰﻳﺸﮑﻪﮐﺎﻥ ﺑﻪﺭﺩﻩﺳﺖ ﻧﻴﻦ ﻭ ﻟﻪﻭێ ﻧﻴﻦ-----------------------. .48ﮐﺎﺗ(ﮏ ﮐﻪ ﺩﻩﺑ(ﺖ ﮐﺎﺭﻭﺑﺎﺭی ﭘﺰﻳﺸﮑﻪﮐﺎﻥ ﺭ(ﮑﺒﺨﻪﻳﺖ---------------------------------------------------- . .49ﮐﺎﺗ(ﮏ ﮐﺎﺭﮔ(ﺮﺍﻧﯽ ﭼﺎﻭﺩ(ﺮی ﺗﻪﻧﺪﺭﻭﺳﺘﯽ ﻭﻩک ﭘ(ﻮﻳﺴﺖ ﻫﺎﻭﮐﺎﺭی ﻭ ﭘﺸﺘﮕﻴﺮﻳﺖ ﻧﺎﮐﻪﻥ--------------------. .50ﮐﺎﺗ(ﮏ ﮐﻪ ﮐﺎﺭﮐﺮﺩﻥ ﻟﻪﮔﻪڵ ﭘﻪﺭﺳﺘﺎﺭی ﺭﻩﮔﻪﺯی ﺑﻪﺭﺍﻣﺒﻪﺭ ﺑﻪ ﻗﻮﺭﺱ ﺩﻩﺯﺍﻧﻴﺖ---------------------------- . .51ﺩﺍﻭﺍﮐﺎﺭﻳﻪﮐﺎﻧﯽ ﺳﻴﺴﺘﻪﻣﯽ ﭘﯚﻟ(ﻦ ﮐﺮﺩﻧﯽ ﻧﻪﺧﯚﺵ--------------------------------------------------------. .52ﮐﺎﺗ(ﮏ ﮐﻪ ﺩﻩﺑ(ﺖ ﻣﺎﻣﻪ2ﻪ ﺑﮑﻪﻳﺖ ﻟﻪﮔﻪڵ ﺋﻪﻭ ﺳﻮﮐﺎﻳﻪﺗﻴﻪی ﮐﻪ ﭘ(ﺖ ﺩﻩﮐﺮ(ﺖ ﻟﻪﻻﻳﻪﻥ ﮐﻪﺳﻮﮐﺎﺭی ﻧﻪﺧﯚﺷﻪﻭﻩ---. .53ﮐﺎﺗ(ﮏ ﮐﻪ ﺩﻩﺑﻴﻨﻴﺖ ﻧﻪﺧﯚﺷ(ﮏ ﺋﺎﺯﺍﺭ ﺩﻩﭼ(ﮋ(ﺖ--------------------------------------------------------.
.54ﺭﻩﺧﻨﻪﮔﺮﺗﻦ ﻟﻪﻻﻳﻪﻥ ﻳﻪﮐﻪی ﮐﺎﺭﮔ(ﺮی ﭘﻪﺭﺳﺘﺎﺭﻳﻪﻭﻩ-----------------------------------------------------. .55ﮐﺎﺗ(ﮏ ﮐﻪ ﺩﺍﻭﺍﺕ ﻟ(ﺪﻩﮐﺮ(ﺖ ﻟﻪ ﮐﺎﺗﯽ ﺋﻴﺴﺮﺍﺣﻪﺗﻴﺶ ﺩﺍ ﺋﻴﺶ ﺑﮑﻪﻳﺖ-----------------------------------------. .56ﮐﺎﺗ(ﮏ ﮐﻪ ﻧﺎﺯﺍﻧﻴﺖ ﺋﺎﻳﺎ ﺧ(ﺰﺍﻥ ﻭ ﮐﻪﺳﻮﮐﺎﺭی ﻧﻪﺧﯚﺷﻪﮐﺎﻥ ﺳﮑﺎ 8ﻟﻪﺩژﺕ ﺗﯚﻣﺎﺭﺩﻩﮐﻪﻥ ﻟﻪﺳﻪﺭ ﮐﻪﻣﺘﻪﺭﺧﻪﻣﯽ ﻟﻪ ﭼﺎﻭﺩ(ﺮی ﮐﺮﺩﻥ ﻭ ﭘ(ﺸﮑﻪﺵ ﮐﺮﺩﻧﯽ ﺧﺰﻣﻪﺗﮕﻮﺯﺍﺭی ﺩﺍ---------------------------------------------- . .57ﮐﺎﺗ(ﮏ ﮐﻪ ﻧﺎﭼﺎﺭﻳﺖ ﻟﻪ ژ(ﺮ ﻓﺸﺎﺭﺩﺍ ﺑﺮﻳﺎﺭﺑﺪﻩﻳﺖ----------------------------------------------------------. ﺑﻪﺷﯽ ﺳ ﻬﻪﻡ :ﭘﺮﺳﻴﺎﺭﻩﮐﺎﻧﯽ ﺗﺎﻳﺒﻪﺕ ﺑﻪ ﺭﺍﺯی ﺑﻮﻭﻥ ﻟﻪﮐﺎﺭ ﺭﺍﭘﺮﺳﯽ ﻟﻪﺳﻪﺭ ﺭﺍﺯی ﺑﻮﻭﻥ ﻟﻪ ﮐﺎﺭ ﺗﺎﺭﺍﺩﻩﻳﻪﮐﯽ ﺯۆﺭ ﭘ ﻢ ﻭﺍﻧﻴﻪ
ﺗﺎ ﺭﺍﺩﺍﻩﻳﻪک ﭘ ﻢ ﻭﺍﻧﻴﻪ
ﺑﻪ ﺋﻪﻧﺪﺍﺯﻩﻳﻪﮐﯽ ﮐﻪﻡ ﭘ ﻢ ﻭﺍﻧﻴﻪ
ﺑﻪ ﺋﻪﻧﺪﺍﺯﻩﻳﻪﮐﯽ ﮐﻪﻡ ﭘ ﻢ ﻭﺍﻳﻪ
ﺗﺎ ﺭﺍﺩﺍﻩﻳﻪک ﭘ ﻢ ﻭﺍﻳﻪ
ﺗﺎﺭﺍﺩﻩﻳﻪﮐﯽ ﺯۆﺭ ﭘ ﻢ ﻭﺍﻳﻪ
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ﭘ(ﻢ ﻭﺍﻳﻪ ﺑMﻩ ﭘﺎﺭﻩﻳﻪﮐﯽ ﺷﺎﻳﺴﺘﻪ ﻭﻩﺭﺩﻩﮔﺮﻡ ﺑﻪﺭﺍﻣﺒﻪﺭ ﺋﻪﻭ ﮐﺎﺭﻩی ﮐﻪ ﺩﻩﻳﮑﻪﻡ
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ﻫﻪﻟﯽ ﭘﻠﻪ ﺑﻪﺭﺯﺑﻮﻭﻧﻪ ﻟﻪ ﮐﺎﺭﻩﮐﻪﻣﺪﺍ ﺯۆﺭ ﮐﻪﻣﻪ
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ﺳﻪﺭﭘﻪﺭﺷﺘﻴﺎﺭﻩﮐﻪﻡ ﮐﻪﺳ(ﮑﯽ ﺯۆﺭ ﻟ(ﻬﺎﺗﻮﻭﻩ ﻟﻪ ﮐﺎﺭﻩﮐﻪﻳﺪﺍ
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ﺭﺍﺯی ﻧﻴﻢ ﻟﻪﻭ ﺳﻮﻭﺩﺍﻧﻪی ﻭﻩﺭی ﺩﻩﮔﺮﻡ
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ﻛﺂﺗ(ﮏ ﮐﺎﺭ(ﮑﯽ ﺑﺎﺵ ﺩﻩﮐﻪﻡ ،ﺳﻮﭘﺎﺱ ﺩﻩﮐﺮ(ﻢ ﺑﻪﻭ ﺷ(ﻮﺍﺯﻩی ﮐﻪ ﭘ(ﻮﻳﺴﺘﻪ
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ﺯۆﺭﺑﻪی ﻳﺎﺳﺎﻭ ﺭ(ﮑﺎﺭﻩﮐﺎﻧﻤﺎﻥ ﻭﺍ ﺩﻩﮐﻪﻥ ﺋﻪﻧﺠﺎﻡ ﺩﺍﻧﯽ ﮐﺎﺭ(ﮑﯽ ﺑﺎﺵ ﻗﻮﺭﺱ ﺑ(ﺖ
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ﺋﻪﻭ ﮐﻪﺳﺎﻧﻪﻡ ﺑﻪ ﺩ2ﻪ ﮐﻪ ﮐﺎﺭﻳﺎﻥ ﻟﻪﮔﻪڵ ﺩﻩﮐﻪﻡ
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ﻫﻪﻧﺪ(ﮏ ﺟﺎﺭ ﻭﺍ ﻫﻪﺳﺖ ﺩﻩﮐﻪﻡ ﮐﺎﺭﻩﮐﻪﻡ ﺑ :ﻣﺎﻧﺎﻳﻪ
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ﭘﻪﻳﻮﻩﻧﺪﻳﻪﮐﺎﻥ ﺑﺎﺵ ﺩﻳﺎﺭﻥ ﻟﻪ ﻧﺎﻭ ﺋﻪﻡ ﺭ(ﮑﺨﺮﺍﻭﻩ )ﺋﻪﻡ ﻧﻪﺧﯚﺷﺨﺎﻧﻪﻳﻪ(
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ﺗﮑﺎﻳﻪ ﺑﯚ ﻫﻪﺭ ﭘﺮﺳﻴﺎﺭ ﮏ ﺋﻪﻭ ژﻣﺎﺭﻩﻳﻪ ﺑﺨﻪﺭﻩ ﻧﺎﻭ ﺑﺎﺯﻧﻪﻭﻩ ﮐﻪ ﻧﺰﻳﮑﺘﺮﻳﻨﻪ ﻟﻪ ﺑﯚﭼﻮﻭﻧﯽ ﺗﯚﻭﻩ
ﺑﻪﺭﺯﺑﻮﻭﻧﻪﻭﻩی ﻣﻮﻭﭼﻪﮐﻪﻡ ﺯۆﺭ ﮐﻪﻣﻪ ﻭ ﻧ(ﻮﺍﻥ ﺑﻪﺭﺯﺑﻮﻭﻧﻪﻭﻩﻳﻪک ﻭ ﺩﺍﻧﻪﻳﻪﮐﯽ ﺗﺮ 10
ﺯۆﺭﻩ ﺋﻪﻭ ﮐﻪﺳﺎﻧﻪی ﮐﻪ ﺑﻪ ﺑﺎﺷﯽ ﮐﺎﺭﻩﮐﺎﻧﻴﺎﻥ ﺩﻩﮐﻪﻥ ﺩﻩﺭﻓﻪﺗ(ﮑﯽ ﺑﺎﺷﻴﺎﻥ ﻫﻪﻳﻪ ﺑﯚ ﺋﻪﻭﻩی
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ﭘﻠﻪﻳﺎﻥ ﺑﻪﺭﺯﺑﮑﺮ(ﺘﻪﻭﻩ
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ﺳﻪﺭﭘﻪﺭﺷﺘﻴﺎﺭﻩﮐﻪﻡ ﺩﺍﺩﭘﻪﺭﻭﻩﺭ ﻧﻴﻪ ﻟﻪﮔﻪ2ﻢ ﺩﺍ
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ﺋﻪﻭ ﺳﻮﺩﺍﻧﻪی ﻭﻩﺭی ﺩﻩﮔﺮﻳﻦ ﺑﻪﻫﻪﻣﺎﻥ ﺷ(ﻮﻩی ﺋﻪﻭ ﺳﻮﻭﺩﺍﻧﻪ ﺑﺎﺷﻦ ﮐﻪ ﺯۆﺭﺑﻪی 13
ﺭ(ﮑﺨﺮﺍﻭﻩﮐﺎﻧﯽ ﺗﺮ ﭘ(ﺸﮑﻪﺷﯽ ﺩﻩﮐﻪﻥ
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14
ﻭﺍ ﻫﻪﺳﺖ ﻧﺎﮐﻪﻡ ﺋﻪﻭ ﮐﺎﺭﻩی ﺩﻩﻳﮑﻪﻡ ﺑﻨﺮﺧ(ﻨﺮ(ﺖ ﻭ ﺟ(ﮕﺎی ڕ(ﺰﺑ(ﺖ.
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ﻫﻪﻭڵ ﻭ ﻣﺎﻧﺪﻭﻭﺑﻮﻧﻪﮐﺎﻧﻢ ﺑﯚ ﺋﻪﻧﺠﺎﻡ ﺩﺍﻧﯽ ﮐﺎﺭی ﺑﺎﺵ ﺑﻪﺩﻩﮔﻤﻪﻥ ﺭ(ﮕﺮی ﻟ(ﺪﻩﮐﺮ(ﺖ ﺑﻪ 15
ﺭ(ﻨﻤﺎﻳﯽ ﻭ ﺭ(ﮑﺎﺭﻩ ﺭۆﺗﻴﻨﻴﻪﮐﺎﻥ
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16
ﭘ ﻢ ﻭﺍﻳﻪ ﺩﻩﺑ ﺖ ﺟﺪﺩی ﺗﺮ ﮐﺎﺭﺑﮑﻪﻡ ﻟﻪﺑﻪﺭ ﻟ ﻨﻪﻫﺎﺗﻮﻭﻳﯽ ﺋﻪﻭ ﮐﻪﺳﺎﻧﻪی ﮐﺎﺭﻳﺎﻥ ﻟﻪﮔﻪڵ ﺩﻩﮐﻪﻡ
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17
ﺣﻪﺯﻡ ﻟﻪ ﺋﻪﻧﺠﺎﻡ ﺩﺍﻧﯽ ﺋﻪﻭ ﺷﺘﺎﻧﻪﻳﻪ ﮐﻪ ﻟﻪ ﮐﺎﺗﯽ ﮐﺎﺭﺩﺍ ﺩﻩﻳﮑﻪﻡ
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18
ﺋﺎﻣﺎﻧﺠﻪﮐﺎﻧﯽ ﺋﻪﻡ ﺭ(ﮑﺨﺮﺍﻭﻩ )ﺋﻪﻡ ﻧﻪﺧﯚﺷﺨﺎﻧﻪﻳﻪ( ﻻی ﻣﻦ ﺭﻭﻭﻥ ﻧﻴﻦ
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ﻫﻪﺳﺖ ﺩﻩﮐﻪﻡ ﺭ(ﺰی ﮐﺎﺭﻩﮐﻪﻡ ﻧﺎﮔﻴﺮ(ﺖ ﻟﻪ ﻻﻳﻪﻥ ڕ(ﻜﺨﺮﺍﻭ )ﻧﻪﺧﯚﺷﺨﺎﻧﻪ( ﮐﻪﻭﻩ ﮐﺎﺗ(ﮏ 19
ﺑﻴﺮ ﻟﻪﻭ ﭘﺎﺭﻩﻳﻪ ﺩﻩﮐﻪﻣﻪﻭﻩ ﮐﻪ ﭘ(ﻢ ﺩﻩﺩﻩﻥ
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20
ﮐﻪﺳﻪﮐﺎﻥ ﻟ(ﺮﻩ ﭘﻠﻪﻳﺎﻥ ﺑﻪﺭﺯﺩﻩﮐﺮ(ﺘﻪﻭﻩ ﺑﻪ ﺧ(ﺮﺍﻳﯽ ﺑﻪﻫﻪﻣﺎﻥ ﺷ(ﻮﻩی ﺷﻮ(ﻨﻪﮐﺎﻧﯽ ﺗﺮ
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ﺳﻪﺭﭘﻪﺭﺷﺘﻴﺎﺭﻩﮐﻪﻡ ﺯۆﺭ ﮔﺮﻧﮕﯽ ﻧﺎﺩﺍﺕ ﺑﻪ ﻫﻪﺳﺖ ﻭ ﺷﻌﻮﺭی ﺋﻪﻭ ﮐﻪﺳﺎﻧﻪی 21
ﻟﻪژ(ﺮﺩﻩﺳﺘﯽ ﺩﺍ ﮐﺎﺭﺩﻩﮐﻪﻥ.
1
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22
ﺳﻮﻭﺩﻩﮐﺎﻥ ﺑﯚ ﻫﻪﻣﻮﻭﺍﻥ ﻭﻩک ﻳﻪﮐﻪﻭ ﺟﻴﺎﮐﺎﺭی ﻧﺎﮐﺮ(ﺖ
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23
ﺋﻪﻭ ﮐﻪﺳﺎﻧﻪی ﻟ(ﺮﻩ ﮐﺎﺭﺩﻩﮐﻪﻥ ﺯۆﺭ ﺑﻪ ﮐﻪﻣﯽ ﺧﻪ8ﺕ ﺩﻩﮐﺮ(ﻦ
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24
ﻟﻪ ﮐﺎﺭﻩﮐﻪﻣﺪﺍ ﮐﯚﻣﻪ(2ﮏ ﺷﺘﯽ ﺯۆﺭ ﻫﻪﻥ ﮐﻪ ﺩﻩﺑ(ﺖ ﺋﻪﻧﺠﺎﻣﻴﺎﻥ ﺑﺪﻩﻡ
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25
ﻟﻪﮔﻪڵ ﻫﺎﻭﭘﻴﺸﻪﮐﺎﻧﻢ ﺧﯚﺷﺤﺎ2ﻢ
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ﺯۆﺭﺟﺎﺭ ﻭﺍ ﻫﻪﺳﺖ ﺩﻩﮐﻪﻡ ﻧﺎﺯﺍﻧﻢ ﺭ(ﮑﺨﺮﺍﻭ )ﻧﻪﺧﯚﺷﺨﺎﻧﻪ( ﺗﻮﻭﺷﯽ ﭼﯽ ﺩﻩﺑ(ﺖ ﻭ ﭼﯽ 26
ﺭﻭﻭﺩﻩﺩﺍﺕ
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27
ﺷﺎﻧﺎﺯی ﺩﻩﮐﻪﻡ ﺑﻪ ﺋﻪﻧﺠﺎﻡ ﺩﺍﻧﯽ ﮐﺎﺭﻩﮐﻪﻣﻪﻭﻩ
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28
ﺭﺍﺯﻳﻢ ﻟﻪﻭ ﺩﻩﺭﻓﻪﺗﺎﻧﻪی ﮐﻪ ﻫﻪﻣﻪ ﺑﯚ ﺯﻳﺎﺩﮐﺮﺩﻧﯽ ﻣﻮﻭﭼﻪﮐﻪﻡ
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ﻫﻪﻧﺪ(ﮏ ﺳﻮﻭﺩ ﻫﻪﻥ ﮐﻪ ﭘ(ﻮﻳﺴﺘﻪ ﻫﻪﻣﺎﻥ ﺑ(ﺖ ﻭ ﻧﻴﻤﺎﻧﻪ
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ﻟﻪ ﺳﻪﺭﭘﻪﺭﺷﺘﻴﺎﺭﻩﮐﻪﻡ ﺭﺍﺯﻳﻢ
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ﮐﯚﻣﻪ(2ﮑﯽ ﺯۆﺭ ﺋﻴﺶ ﻭ ﮐﺎﺭی ﺋﻪﻭﺭﺍﻕ ﻭ ﮐﺘﺎﺑﺎﺗﻢ ﻫﻪﻳﻪ
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ﻫﻪﺳﺖ ﻧﺎﮐﻪﻡ ﻫﻪﻭڵ ﻭ ﻣﺎﻧﺪﻭﺑﻮﻧﻪﮐﺎﻧﻢ ﻭﻩک ﭘ(ﻮﻳﺴﺖ ﺑﻨﺮﺧ(ﻨﺪﺭ(ﻦ ﻭ ﭘﺎﺩﺍﺷﺖ ﺑﺪﺭ(ﻨﻪﻭﻩ
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ﺭﺍﺯﻳﻢ ﻟﻪﻭ ﺩﻩﺭﻓﻪﺗﺎﻧﻪی ﮐﻪ ﻫﻪﻣﻪ ﺑﯚ ﭘﻠﻪ ﺑﻪﺭﺯﺑﻮﻭﻧﻪﻭﻩ
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ﺩﻩﻧﮕﻪ ﺩﻩﻧﮓ ﻭ ﺷﻪڕ ﺯۆﺭﻥ ﻟﻪ ﮐﺎﺗﯽ ﮐﺎﺭﺩﺍ ﻟﻪﮔﻪڵ ﻫﺎﻭﭘﻴﺸﻪﮐﺎﻧﻢ
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ﮐﺎﺭﻩﮐﻪﻡ ﭼ(ﮋﺑﻪﺧﺸﻪ
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36
ﺋﻪﺭک ﻭ ﻭﺍﺟﺒﻪﮐﺎﻧﯽ ﮐﺎﺭﻩﮐﻪﻡ ﺑﻪ ﺗﻪﻭﺍﻭی ﺭﻭﻭﻥ ﻧﺎﮐﺮ(ﻨﻪﻭﻩ
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ﺳﻮﭘﺎﺱ ﺑﯚ ﻭﻩﻻﻡ ﺩﺍﻧﻪﻭﻩی ﭘﺮﺳﻴﺎﺭﻩﮐﺎﻥ
APPENDICES – E
(1) Roster of Questionnaires' expert
No
Name of expert
. 1-
Academic
3-
Dr. Nazar M.
Professor
M.B.Ch.B.F.I.B.M.S,
Sulaimani University /
CME Ch. Psych.
College of Medicine.
Dr. Salwa S. Alkhuri
Ph.D. in Psychiatric-
Sulaimani University /
Mental Health Nursing .
College of Nursing.
Dr. Saadoun Dawood
M.B.Ch.,B,F.I.C.M.S-
University of Kirkuk /
psychiatry
College of Medicine.
Ph.D. in Community
University of Mosal /
Health Nursing .
College of Nursing
Consultant
M.B.Ch.B. F.I.C.M.S -
Kirkuk Azadi teaching
psychiatrist
consulter psychiatric
hospital.
Lecturer
MB,Ch,B, FIBMS,
Sulaimani University /
Professor
Assist Prof.
Ahmed 4-
5-
6-
Workplace
titles Muhammad Ameen
2-
Scientific Degree
Dr. Radhwan Hussien
Dr. Jasim M. Alshindi
Dr. Rebwar Gh. Hama
Assist Prof.
College of Medicine 7-
Dr. Atiya k. Mohamead
Lecturer
Ph.D. in Adult Nursing
Sulaimani University / College of Nursing.
8-
9-
Dr. Hewa Sittar Salih
Dr. Jenan A. Shakoor
Lecturer
Lecturer
Ph.D. in Community
University of Kirkuk /
Health Nursing .
College of Nursing.
Ph.D. in Community
University of Kirkuk /
health/ maternal fetal
College of Nursing.
health. 10- Dr. Saad A. Mahmood
Lecturer
Ph.D. in Adult Nursing
Higher Health Professions Institute in Kirkuk.
11- Dr. Muhammad R. Amen
Lecturer
Ph.D. in Community
University of Sulaimani
Health Nursing-
/ College of Nursing.
Rehabilitation.
2 @ @×a‹ŽïÈ@ðäbn†ŠíØ@ôáŽîŠóè @ @ça‹îŒòì@ðäóàí−ó÷@ðmóîbØûŠó @ @ äaŒ@ñòìóåîím@ì@$ýbi@ðä‡åŽîí‚@ðmòŠaŒòì @ @ðäbáŽïÝ@ñüÙäaŒ@ðmóîbØûŠó @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ñŠbnŠóq@@ô$ÜíÙ
Kurdistan Regional Government-Iraq Presidency of Ministerial Council Ministry of higher education University of Sulaimani School of Nursing
@@ Respected Dr. / sir :…………………………………………………………
I am ( Kamal Jummah Ameen ) a postgraduate nursing student in School of Nursing / University of Sulaimani . given to your high scientific experiences , kindly check the research questionnaire under the title ( Effect Of Job Stress On Job Satisfaction Among Nursing Stuff In Sulaimani Mental Health Hospitals ) , and provide your valuable comments for questionnaire. your participation is voluntary and your effort is appreciated . With the best regards
Supervised by : Dr . Saman Anwar Faraj
Students name: Kamal Jummah Ameen Mobile : 07701248833 07511077524
[email protected]
Name of expert: Qualification: Specialty: Location: Post: Years of experience: (
)
Recommendations and Suggestions: (expert) ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………
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ﭘﻮﺧﺘ ﭘﺸﺘﮕ ﻪ :ﻓﺸﺎﺭی ﮐﺎﺭ ﮐ ﺑ ﯾ ﮐ ﮏ ﻟ ﻫﯚﮐﺎﺭە ﺋﺎﺯﺍﺭﺑ ﺧﺸ ﮐﺎﻥ ﺩﺍﺩەﻧﺮ ﺖ ﺑﯚ ﻫ ﺭﺩﻭﻭ ﮐﺎﺭﻣ ﻧﺪﺍﻥ ﻭ ڕ ﺨﺮﺍﻭەﮐﺎﻥ ﮐ ﺑ ﺷ ﻮەﯾ ﮐﯽ ﻧ ﺭ ﻴﻴﺎﻧ ﮐﺎﺭﯾﮕ ﺭی ﻟ ﺳ ﺭ ﭼﺎﻻﮐﯽ ﮐﺎﺭی ﮐﺎﺭﻣ ﻧﺪﺍﻥ ﻭ ﭼﻮﺳﺘﯽ ﺟ -ﺑ ﺟ -ﮐﺮﺩﻧﯽ ﮐﺎﺭەﮐﺎﻧﻴﺎﻥ ﺩەﺑ ﺖ. ﺯۆﺭﺑ ی ﭘﻴﺸ ﮐﺎﻥ ڕﻭﻭﺑ ﺭﻭی ﭼ ﻧﺪﯾﻦ ﺟﯚﺭی ﺟﻴﺎﻭﺍﺯی ﻓﺸﺎﺭ ﺩەﺑﻨ ﻭە ﻟ ژﯾﻨﮕ ی ﺷﻮ ﻨﯽ ﮐﺎﺭﮐﺮﺩﻧﻴﺎﻥ .ﯾ ﮐ ﮏ ﻟ ﻭ ﭘﻴﺸﺎﻧ ﮐﺎﺭی ﭘ ﺭﺳﺘﺎﺭە ﮐ ڕۆ ﮑﯽ ﺑﻨﭽﻴﻨ ﯾﯽ ﻭ ﮔﺮﻧﮓ ﻟ ﭼﺎﻻﮐﯽ ﺳﻴﺴﺘ ﻣﯽ ﭼﺎﻭﺩ ﺮی ﺗ ﻧﺪﺭﻭﺳﺘﯽ ﺩەﺑﻴﻨ ﺖ. ﺋﺎﻣﺎﻧﺞ :ﺩۆﺯﻳﻨ ﻭەﻯ ﭘ ﯾﻮەﻧﺪی ﻟ ﻧ ﻮﺍﻥ ﮐﺎﺭﯾﮕ ﺭی ﻓﺸﺎﺭی ﮐﺎﺭ ﻟﻪﺳﻪﺭ ﺭﺍﺯی ﺑﻮﻭﻥ ﻟﻪ ﮐﺎﺭ ﻟﻪ ﻧﺎﻭ ﺳﺘﺎﻓﯽ ﭘ ﺭﺳﺘﺎﺭﺍﻥ. ﺭ ﺒﺎﺯی ﻟ ﻜﯚ ﻴﻨ ﻭە )ﺷ ﻮﺍﺯ( :ﺗﻮ ﮋﯾﻨ ﻭەﯾ ﮐﯽ ڕﻭﻭﻧﮑﺮﺍﻭەﯾﯽ ﻟ ﻧ ﻮ ﺳﺘﺎﻓﯽ ﭘ ﺭﺳﺘﺎﺭﺍﻥ ﺋ ﻧﺠﺎﻡ ﺩﺭﺍ ﻟ ﻧ ﺧﯚﺷﺨﺎﻧ ﻛﺎﻧﯽ ﺩەﺭﻭﻭﻧﯽ ﺳﻠ ﻤﺎﻧﯽ .ﭘﺮۆﺳ ی ﮐﯚﮐﺮﺩﻧ ﻭەی ﺯﺍﻧﻴﺎﺭﯾﻴ ﭘ ﻮﯾﺴﺘﻴ ﮐﺎﻥ ﻟ ﺑ ﺭﻭﺍﺭی ٢٥ی ﻣﺎﻧﮕﯽ ﭘ ﻨﺞ)ﻣﺎﻳﻮ( ﺩەﺳﺘﯽ ﭘ ﮑﺮﺩ ﺗﺎ ١٠ی ﻣﺎﻧﮕﯽ ﺣ ﻭﺗﯽ)ﻳﻮﻟﻴﻮ( ﺳﺎ ﯽ ٢٠١٦ﻭە ﺯﺍﻧﻴﺎﺭﯾ ﮐﺎﻥ ﻭەﺭﮔﻴﺮﺍﻥ ﻟ ڕ ﮕ ی ﭼﺎﻭﭘ ﮑ ﻭﺗﻨﯽ ٧٥ﻧﻤﻮﻧ ی ﮔﻮﻧﺠﺎﻭ ﻟ ﭘ ﺭﺳﺘﺎﺭﺍﻥ .ﭘ ﺭﺳﺘﺎﺭﺍﻥ ﺩﺍﺑ ﺷﺒﻮﻭﻥ ﺑ ﺳ ﺭ ﺳ -ﻧ ﺧﯚﺷﺨﺎﻧ ﺩﺍ ﮐ ﺋ ﻭﺍﻧﻴﺶ ﻧ ﺧﯚﺷﺨﺎﻧ ی ﺳﯚﺯی ﺩەﺭﻭﻭﻧﯽ ،ﻧ ﺧﯚﺷﺨﺎﻧ ی ﺷ ﻫﻴﺪ ﺻ ﻻﺣﯽ ﻣﻮﻫ ﻧﺪﯾﺲ ﻭە ﺳ ﻧﺘ ﺭی ﺗ ﻧﺪﺭﻭﺳﺘﯽ ﺩەﺭﻭﻭﻧﯽ /ﻧ ﺧﯚﺷﺨﺎﻧ ی ﻓ ﺮﮐﺎﺭی ﻟ ڕ ﮕ ی ﺑ ﮐﺎﺭﻫ ﻨﺎﻧﯽ ڕﺍﭘﺮﺳﯽ ﮐ ﺋ ﻭﯾﺶ ﺩﺍﺑ ﺷﮑﺮﺍﻭە ﺑﯚ ﺳ -ﺑ ﺵ : ﯾ ﮐ ﻡ ،ﺗﺎﯾﺒﻪﺗﻤﻪﻧﺪی ﯾﻪ ﮐﯚﻣﻪ ﯾﻪﺗﯽ ﻭ ﺩﯾﻤﯚﮔﺮﺍﻓﻴﻪﮐﺎﻥ ﮐ ﭘ ﮑﻬﺎﺗﻮﻭە ﻟ ) (٨ﺑVﮔ . ﺩﻭﻭەﻡ ،ﭘ ﻮەﺭی ﻓﺮﺍﻭﺍﻧﯽ ﻓﺸﺎﺭی ﮐﺎﺭی ﭘ ﺭﺳﺘﺎﺭی) .(ENSSﮐ ﺋ ﻣ ﺵ ﭘ ﮑﻬﺎﺗﻮﻭە ﻟ ) (٥٧ﺑVﮔ ﻣ ﻭﺩﺍﮐﺮﺍﻭە ﻟ ٩ﭘ ﻮەﺭی ﻻﻭەﮐﻴﺪﺍ .ﺳ ﻴ ﻡ ،ﺳ ﺭژﻣ ﺮی ڕەﺯﺍﻣ ﻧﺪی ﮐﺎﺭ )(JSS ﮐ ) (٣٦ﺑVﮔ ﺩەﮔﺮ ﺘ ﻭە ﻟ ٩ﭘ ﻮەﺭی ﻻﻭەﮐﻴﺪﺍ .ﺯﺍﻧﻴﺎﺭی ڕﻭﻭﻧﮑﺮﺍﻭەﯾﯽ ﻭ ﺩەﺭﮐ ﻭﺗﻮﻭی ﺩﺭﻭﺳﺖ ﺑﯚ ﺷﻴﮑﺮﺩﻧ ﻭە ﺑ ﮐﺎﺭﻫ ﻨﺮﺍﻭە .ﺩﺭﻭﺳﺘﯽ ڕﺍﭘﺮﺳﻴﻴ ﮐ ﻟ ڕ ﮕ ی ﭘﺎﻧ ] ﮑﯽ ﺷﺎﺭەﺯﺍ ﺩﯾﺎﺭﯾﮑﺮﺍﻭە ﮐ ﭘ ﮑﻬﺎﺗﻮﻭە ﻟ ) (١١ﮐ ﺱ ﻟ ﭼ ﻧﺪ ﺑﻮﺍﺭﻭ ﺷﻮ ﻨﯽ ﮐﺎﺭی ﺟﻴﺎﻭﺍﺯﺩﺍﻥ. ﺋ ﻧﺠﺎﻡ :ﺷﻴﮑﺮﺩﻧ ﻭەی ﺯﺍﻧﻴﺎﺭﯾ ﮐﺎﻥ ﺋ ﻭەی ﺑ ﺩەﺭﺧ ﺴﺖ ﮐ ﺗ ﮑVﺍی ﮔﺸﺘﯽ ﻓﺸﺎﺭی ﮐﺎﺭ ﻟ ﻧ ﻮ ﺳﺘﺎﻓﯽ ﭘ ﺭﺳﺘﺎﺭﺍﻥ ﻟ ﻧ ﺧﯚﺷﺨﺎﻧ ی ﺩەﺭﻭﻭﻧﯽ ﺑﺮﯾﺘﻴ ﻟ ﻓﺸﺎﺭی )ﺟﺎﺭﺟﺎﺭ – ﺯۆﺭ ﺟﺎﺭ( .ﭘ ﻮەﺭی ﻻﻭەﮐﯽ ﻣﺮﺩﻥ ﺑ ﺭﺯﺗﺮﯾﻦ ﺋﺎﺳﺘﯽ ﮔﺮﺗﻮﻭە .ﺳﺘﺎﻓﯽ ﭘ ﺭﺳﺘﺎﺭﺍﻥ ڕەﺯﺍﻣ ﻧﺪﻥ ﻟ ﮐﺎﺭەﮐﺎﻧﻴﺎﻥ .ﭘ ﻮەﺭی ﻻﻭەﮐﯽ ﻣﻮﻭﭼ ﻧﺰﻣﺘﺮﯾﻦ ﺋﺎﺳﺘﯽ ﮔﺮﺗﻮﻭە .ﭘ ﯾﻮەﻧﺪﯾﻴ ﮐﯽ ﺋﺎﻣﺎﺭی ﮔﺮﻧﮓ ﻫ ﯾ ﻟ ﻧ ﻮﺍﻥ ﭘ ﻮەﺭی ﻻﻭەﮐﯽ ﺋﺎﺳﺘﯽ ﻓﺸﺎﺭی ﮐﺎﺭ ﻭە ﺗﺎﯾﺒﻪﺗﻤﻪﻧﺪی ﯾﻪ ﮐﯚﻣﻪ ﯾﻪﺗﯽ ﻭ ﺩﯾﻤﯚﮔﺮﺍﻓﻴﻪﮐﺎﻥ ﺑ ﺠﮕ ﻟ ﺭەﻫ ﻧﺪی ﮐﯚﺭﺳﯽ ڕﺍﻫ ﻨﺎﻥ .ﻫﻴﭻ ﭘ ﯾﻮەﻧﺪﯾﻴ ﮐﯽ ﺋﺎﻣﺎﺭی ﮔﺮﻧﮓ ﻧﻴ ﻟ ﻧ ﻮﺍﻥ ﺗ ﮑVﺍی ﻓﺮﺍﻭﺍﻧﯽ ﻓﺸﺎﺭی ﮐﺎﺭی ﭘ ﺭﺳﺘﺎﺭی) (ENSSﻭە ﺗ ﮑVﺍی ﺳ ﺭژﻣ ﺮی ڕەﺯﺍﻣ ﻧﺪی ﮐﺎﺭ ).(JSS ﺩەﺭﺋ ﻧﺠﺎﻡ :ﻣﺮﺩﻧﯽ ﻧ ﺧﯚﺷ ﮐﺎﻥ ڕۆ ﮑﯽ ﮔﺮﻧﮓ ﺩەﺑﻴﻨ ﺖ ﻟ ﻫ ﺳﺘﭙ ﮑﺮﺩﻧﯽ ﻓﺸﺎﺭی ﮐﺎﺭ. ﮐ ﻣﯽ ﻭ ﺩﻭﺍﮐ ﻭﺗﻨﯽ ﻣﻮﻭﭼ ﮔﺮﻧﮕﺘﺮﯾﻦ ﻫﯚﯾ ﺑﯚ ﮐ ﻣﮑﺮﺩﻧ ﻭەی ڕەﺯﺍﻣ ﻧﺪی ﮐﺎﺭ ، ﻫ ﺭﭼ ﻧﺪە ﺋﺎﺳﺘﯽ ﻓﺸﺎﺭی ﮐﺎﺭ ﻟ ﻧ ﻮ ﭘ ﺭﺳﺘﺎﺭﺍﻥ ﺑ ﺷ ﻮەﯾ ﮐﯽ ﺑ ﺭﺯ ﺗﯚﻣﺎﺭﻧ ﮐﺮﺍﻭە ﻭە ﻫ ﺭﻭەﻫﺎ ﺯۆﺭﺑ ی ﺯۆﺭی ﭘ ﺭﺳﺘﺎﺭﺍﻥ ڕەﺯﺍﻣ ﻧﺪﻥ ﻟ ﮐﺎﺭەﮐﺎﻧﻴﺎﻥ.
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xòŠóÐ@Šòíäa@çbàb@Šín؆ ﻣﻴﻼﺩﻯ2016
ﻛﻮﺭﺩﻯ2716
