Chapter no. 2

2) A review of literature

Job stress has been recognized as a serious and chronic cause of individual suffering, irritation, strain and discomforts. As a matter of fact little research work has so far been carried out on the topic of job stress in Pakistan. On the other hand plenty of work has been done on the topic across the world particularly in the U.S.A and Europe. For the purpose of conducting review of relevant literature on the topic, the researcher was obliged to browse through Internet and to find relevant materials. The magnitude of research work done on job stress across the world and the quantum of data available on the topic on the Internet is phenomenal and is outside the scope of this chapter to incorporate it all. However an effort has been made to select a few closely related dissertations, reports and articles on the topic for review purpose.

This review examines published evidences on the causes and effects of job stress, and the implications for nurses/employees in organisations. It is worth mentioning here that in todays dynamic world the nursing profession is considered to be full of stress.

British Psychological Society, 1988 stated job stress as one of the top ten industrial diseases in the US”. Willcox (1994), reported that atleast 25% of the employees are psychlogically stressed at any one time. It has serious implications for the health of the workers in the society as a whole. The Health of The Nation (HMSO, 1992) describes that this area needs to be addressed to promote the health of the workers (government documents 1992).

‘Stress' is “one of the most inaccurate words in the scientific literature” reported by williams (1994). The term sometimes indicates stressfull events and sometime indicate the effect of these events on work performance and sometime dis ordered health remarked by Maclean (1985). Marmot Et. Al 1987 reports that job stress is “lack of understanding how work enviroment make a person ill. Job stress refer to broad class of problems indicated by Lazarus (1971) “Any demand which atax the system, whatever it is, a physiological system, a social system or a psychological system, and the response of that system.” There is greater consensus about the meaning and effect of job stress. WHO (1986) stated that stress “is a dynamic state of mind characterized by reasonable harmony between a person's abilities, needs and expectations, and environmental demands and opportunities.” Prof. Cox (1993) concentrates on the importance for general health of a state of balance between needs and demands, citing the World Health Organisation's definition of well-being:

Research study on job stress concludes;

Hans Selye (1956) is considered as the father of stress research. The Stress of Life (1956), a book by Hans Seyle introduced the concept of stress in the public domain and his General Adaptation Syndrome [GAS] is a popular one amongst the research scholor of psychology and management. Stress “a state, manifested by a specific syndrome of biological events” Selye (1974). He argued that stress is not entirely a bad event. According to him stress is the reaction of the physical body toward a situation or event, which is demanding. “Any kind of normal activity can produce considerable stress without causing any harmful effects” (Selye, 1974), Selye 1982 clearly state that the non specific implication of any demand put on the body be its effect mental or somatic.

“The uncertainty that occurs at the organizational, unit, group, and individual levels. Uncertainty exists to the extent that knowledge about an event or condition requiring action or resolution is experienced as inadequate” reported by Schuler and Jackson (1986).

Edwards (1988) view about the stress is that “A negative discrepancy between an individual's perceived state and desired state, provided that the presence of this discrepancy is considered important by the individual.”

Taylor (1992) reported about stress in the following words “Demands made upon us [internally or externally] which we perceive as exceeding our adaptive resources. If we try to cope and that is ineffective this gives rise to stress. If this stress is prolonged then lasting psychological and physical damage may occur.” Hereby demands we do mean that arise from the workload or work burden.

Cox (1993) perception of stress is from te assumption that stressor are discreat, time limited and various events of the life requiring adjustments or adaptaion are utterly associated with stress. Holmes and Rahe (1967) ranked the potential stressfull events which may be work or non work related such as death of spouse, divorce, marriage (not all negative), fired from work marital reconciliation, retirement, bussiness readjustment, change in work responsibilities trouble with boss change in work condition. (Holmes and Rahe, 1967).

“Job stress is the sum total of factors experienced in relation to work which affects the psychosocial and physiological homeostasis of the worker. The individual factor is termed a stressor and stress is the individual worker's reaction to stressors.” Suggested by Weiman (1977).

Beehr and O'Hara (1987) used ‘stressor' rather than ‘stress' to refer to causal factors because“few people misinterpret stressor to mean the person's reaction.” And uses ‘strain' to mean “the state ofbeing stressed as evidenced by physiological, psychological or medical indices,”

Hans Selye (1951) report about The General Adaptation Syndrome [GAS] states that, in response to a stressor, an initial ‘alarm reaction' is followed by a ‘stage of resistance' in which resistance to the original stressor builds up but ability to resist new stressors is lowered. Eventually a ‘stage of exhaustion' sets in which ends in catastrophic inability to cope with any form of stress.

2.1 The human face of nursing, (2001): Commented on nursing profession;

The female nurses' faces challenging situations on daily basis. They face crying and dying patients and their task is stressfull , unrewarding and frightening.

2.2 Theimportance of the nursing profession is evident from the fact that the ILO has commissioned a manual with the title job stress in nursing profession to control and prevent the stress by Professor Cox (ILO 2001)

2.3 ILO (2001) reported.

The occupation of nursing is related with challenges and demanding tasks. It is also full of overload, role conflit and role ambiguity. So, there is a great need to initiate a stress intervention and stress management program for nurses.

2.4 ILO(2001) presented that various research studies have tried to work out the effect of job stress on job performance and job satisfaction of nurses. It has been established that a negative relation exist between job stress and job performance and job satisfaction.

2.5 Health and Safety Executive (HSE 2001) research report with the title; the workplace stress epidemic; reveals that 53% of the employees have experienced a stress in the work place, International Stress Management Association (2001) found that one out of four working force have suffered due to stress related sickness. One out of five has suffered extreme stress in the work palce.

2.5 The HSE(2001) research found, a highky significant co relation between extreme stress and poor working condition. The employees have reported a wide rang of health problems and behavior problems, Professor Andy Smith have confirmed the fact that job stress is one of the most evident problem in the work enviroment.

2.6 The Bristol team(2000)has reported that 30% increase in job stress has been occurred in the work enviroment. The major problems indicated by job stress related illness are depression, anxiety, backach and musculo skeletal disorders.

2.7 Chartered Management Institute in 2001has found that long hours work load, working late at night has become a culture in the todays modern organization and as such are sources of job stress.

2.8 This study by the CMI and healthcare(2000), has reportd that 25% of the executive had gone on sick leave in the past one year due to job stress, 75% of the executive has reported that job stress was demaging their home life, health, performace at work and satisfaction level..

2.9 The Health and Safety Executive (2001); research survey stated about sorces of stress and the circumstances which result in stress. The sources of stress are work overload, repetative work, role conflict, role ambiguity, danger, harasment and bullying, poor relation ship, in flexible shedule, lack of social support, confusion, lack of communication and poor working condition etc.

2.9.1Cary Cooper(1995), has argued that the trends in the american society are the major sources of job stress, such as working for long hours, down sizing and no contact culture.

2.10 According to Elizabeth Burtney (2002),who found the organization are full of stress and therefore we should focus on the stress intervention in the organization as wel as on stressed out indivisual.

2.11 Professor Stephen Palmer(2001)reported in his research study that stress in a universal thing. Everyone can be stressed and the threshold level of every body will be different. It depend on the person how he percieves a specific situation. Stress may be the result of the interactio between the person and enviroment.

2.11.1 Professor Cary Cooper (1995) has argued that insecurity in the organization stereo type attitude of the boss may be the major sources of stress. For employees it is necessary that they should have complete control on the job because of lack of control some time result in job stress.

2.11.2 Elizabeth Burtney of HEBS research(2004) reveals that stress in this modern world too carries a stigma in the closed style of management where the employees are expected to work hard and no concern is shown for their home life. The employees too never talk about the job stress.

2.12 Elizabeth Burtney of HEBS (2002)reported.That every job has some stress and the most stressful job is that where there is the element of change. Some professions such as health care education, games, and sports are highly stressful and risky.

2.13 Professor Cary Cooper(1997) has found the most stressful jobs of todays world. These are security personnels, social organization, education the proffession of nursing, medical and dentistry, sports and games, acting, jornalism, transportation and resturants.

2.14 Professor Cooper (1997)has assessedthat 60% increase in the job stress level has been occurred. Further he has measured the intensity of job stress in various proffession.

2.15According to an article with the title, “Job stress and job satisfaction” of employees in German radiotherapy (2001), which concludes that the greatest source of job stress stemmed from underpayment, crying patients,keeping patients fit and living,long hours, role conflict etc. Physicians and nurses showed a significantly higher stress level on scales such as structural conditions and particularly compassion than radiographers and physicists. Finally, rating of job stress and satisfaction depends significantly on the age group, gender, experience and the hospital.

2.16 K. CHANDRAIAH et. al. (1990) research study with title;Occupational Stress and Job Satisfaction among Managers, states;Individuals under excessive stress tend to find their jobs less satisfying. Some of their intrinsic or extrinsic needs may be thwarted or not met sufficiently.Corroborating many studies in the literature (Hollingworth et. al. 1988; Keller, 1975), the findingsof the present study also reveal the same. The subjects with lower job satisfaction were found to experience more stress in the form of overload,role ambiguity, role conflict, under participation, powerlessness and low status compared to those with higher job satisfaction. Age, therefore, was found to be of importance in these study findings. The results of the study reiteratethe significance of demands at each career development level as pointed out by Hallingworth.And the individuals encounter crisis at each developmental stage as hypothesized by Erickson.Significantly decreasing stress and increasing job satisfaction with increasing age was found among the managers and these confirm the importance of the developmental process.

2.17 An Empirical Study (1999) with title, “Effect of Job Stress” reported that; job stress is one of the vital issues in the organisation. It has been established that a negative relation exist between job stress and job performance, job stress and job satisfaction.

2.18 This review with title factors influencing stress and job satisfaction(2001): shows that various elements effect stress level and job satisfaction. These elements are leadership, quality control, relation between doctor and nurse. It has been established that a negative relationship exists between leadership, stress and job satisfaction.

Although a positive relationship between clinical leadership and nurses' job satisfaction was found, the association between clinical leadership and quality of inter-professional collaboration is unclear. The association between these variables and job satisfaction is positive but tenuous. In addition, a positive but weak relationship was revealed between the clinical leadership and the quality of relationships amongst nurses. Organisational issues, lack of nursing staff and patient care were found to be related to ward type mental health nurses' stress emerged as mediating variables between stress and job satisfaction.

2.19 Beatrice et. al. (2002) has found that the higher is the demand on job the higher will be the stress and demanding job negatively affect the health of the nurses and result in deterioration of general health.

2.20 Center for Organizational Health and Development(2002) researched on job related stress in nursing:The research appears to support the view that, together, factors inherent in the nursing role and in the organizational culture within which the nurse works are as important a determinant of the experience of stress by nurses as the type of nursing pursued. Stress in nursing reflects the overall complexity of the nurses' role, rather than any particular aspects of their individual tasks. Different nursing groups report similar levels of stress, the profile of stressors associated with those similar levels differed somewhat between groups. However, the inter-group differences reported in those studies and others are not sufficient to argue for the separate treatment of the various nurse groups which exist in hospitals. Therefore, while strategies forstress management needs to be tailored to the generic group, hospital-based nurses, they do not need to be further tailored to distinguish between different types of hospital-based nurses.

2.21 HSE(1995) research study entitled health effects of stress in nursing” states that job stress negatively effect quality of nurses' work it results in creating minor psychiatric morbidity, physical illness and a lot of other health related diseases. It also increases the musculo skeletal disorder and depression. Nurses are amongst those groups of profession which reported a higher level of stress.

2.22 The study here is of Kaohsiung City government employees, china human resource management deptt (2000), entitled job stress relation with social support and job performance.It has been proved in the above research study that there is great relevance between job stress and job performance. job stress is inversly propotional to job performance. Further social support has a great impact on level of job stress. Greater social support results in the reduction of stress level and hence increases the perfromance of the employees. The report also indicated that female employees feel more stressed as compared to male employees (Bheer 2000).

2.23 Ms santha et. al. (2003) research report has presented that the stress level of the employees has various effects on the employees as well as on the organization. Due to stress the employee may give more absenteeism, accidents, high turnover rate and impaired descion. Upto some extent stress may be a good thing. It gives the push and motivation to the employee. But extreme stress is harmful. It may result in poor performance and yet productivity of the employees is reduced.

2.24 NIOSH (1999) reported that;

40% of workers say their job is extremely stressfull.

26% of workers report burnout during working hours.

2.25 David's and Theresa's(1999)have reported that 25% of the employees have considered there job stressful, 75% of the employees say that the task is the modern organisation is more stressful than earlier. Job stress may give a lot of problems during the work and it is attached with health problems etc.

2.26 NIOSH (2001) model of job stress is self explanatory;


(Individual/situation factor apply)

2.27 The NIOSH (1999) research study on gender and job stress finds that sex descrimination and role conflict and role ambiguity and family demand may have more severe effect on female employees. Stress can be reduced in the organisation by introducing a change in the workplace. It may result in the reduction of stress levels for both workers male and females. The organization should promote family friendly policiy, discourge sex descrimination.

2.28 The research study with the title "Women in Construction” has reported that women in the construction industry have complaints of frequent harasment isolation and abuses by her co workers. The turn over of the female workers in the construction industry is higher as compared to others. Female labours in this industry are always at higher risk due to lack of safety measures and trainings.

2.29 In the research study by NIOSH (1999) of females workers in the internal revencue service (IRS), which states that musculoskeletal discomfort can be reduced to a great extent if periodic rest is provided to the worker during working hours. It may result in higer job performance.

2.30 NIOSH (2001) has presented in a survey that 60% of the woman workers have reported that stress is a great problem for them. They have cited that the following are the major sources of stress during job for females employees, role conflict and role ambiguity, poor relationship with other workers, burden of work, rush poor working enviroment, monotonus and repetitive work, lack of control over job, demands etc.

2.31 Journal of Occupational and Environmental Medicine (2001) indicated that in the current era the stress related expenditure on employees is 50% higher than the early period.

2.32Encyclopaedia of Occupational Safety and Health(2001)states that high demanding jobs enhances the risk of cardiovascular diseases, musculoskeletal disorders, psychological problems, injuries at work, suicide, cancer, ulcer and impaired immune function.

2.33 NIOSH(2001) research report on job stress health and productivity states that job stress has inverse relation with productivity and it negatively affect the health of the employees. Stressful working condition results in poor health of the employees. Job stress increases absenteeism, tardiness, higher turnover and poor health.

2.34 Journal of Applied Psychology (2001)reseacrh report with the title “Stress Prevention and Job Performance” states that effect of intervention programe on job stress is very encouraging. The organization should educate employee on job stress, inform the employees regarding policies of the organization, how to reduce job stress and initiate employees support program. Stress prevention program encourage employees and results in enhanced production.

2.35 NIOSH (2000)has reported thaton average employees remain off the job for alost 20 days due to job stress, so job stress results in increased absenteeism.

2.36 The report by national insurance company 1992 enitiled employee burnout states that job stress directly propotional to burn out. Employees stress level should be reduced to avoid employee's burn out.

In the research study by the national insurance company that female workers feel more stressed than male workers. The chances of burnout and physical sickness related to job stress are more among female workers. The reason may be that the women are paid less than male workers.

2.37 European Agency (2001) research report has mentioned the following details which may be considered at the cost of

Each year millions of working days are lost due to job stress.

The cost of job stress in term of money is in millions of dollars.

2.38 Many studies have tried to determine the posible positive relationship between job stress and violance at work drug use. One study has established the fact that job stress creates negative indivisuals and has negative effect on the organization. The workers who experienced job stress start using drugs and alcohol and tobacco to reduce there tension, so job stress is one of the reason for drinking in the workers ILO (2001).

2.39 University of utara(2004), Malaysia, school of accounting, report on job stress among professional accountants working in selected public firms, a Malaysia case, establish and extends that job stressors faced by workers during job includes workload, role conflict, role ambiguity, lack of job autonomy and lack of job control.

2.40 A research report in Saudi Medical Journal (2003)titled“Job satisfaction and organizationalcommitment “ states that female nurses are more satisfied and contented in the public sector hospital, the study further reveals that satisfied nurses provide higher output as compared to less satisfied nurses. The other factor for higher production from nurses is there comittment toward job.

2.41 A report in journal of health (2003) with title “stress and suicide in nurses” revealed that the relation between stress and suicide remained U shaped.when the job stress and home stress are combined, five fold increase in risk of suicide among women occurs.risk of suicide among high stress women is more compare to low stress experience by women.

2.42 School of Health Science (2002),Blekinge Institute of Technology Karlskrona,Sweden entitled “job stress of nurses” concludes that stress contains amongst other the element of moral. There is shortage of nurses in the health care and organisational structure too impedes nursing performance to avoid the negative consequences of stress for nurses moral support is required. In ICU stress and complex situation are common for all nurses, the stress implication are sometime ethical issues, morbidity and burn out, the report revealed.

2.43 Queensland University of Technology(2002), thesis with the title “The influence of work stress and work support on burnout in public hospital nurses” States that female nurses with high level of stress and little support have experience high rate of burnout. Job stressors were the main predictors of Emotional Exhaustion, Conflict. Changes in the objective conditions at work have had major implications for nurses' subjective experiences of work, with increasing numbers of nurses feeling stressed and as a consequence, are opting to work part-time or leave the profession

2.44 HSJ - HEALTH SCIENCE JOURNAL(2005), REPORT CARRYING THE TITLE “job stress and job satisfaction”shows that a strong negative relationship was found between clinical leadership, inter-professional collaboration, and stress and job satisfaction. Although a positive relationship between clinical leadership and nurses' job satisfaction was found, the association between clinical leadership and quality of inter-professional collaboration is unclear. The association between these variables and job satisfaction is positive but tenuous. In addition, a positive but weak relationship was revealed between the clinical leadership and the quality of relationships amongst nurses. Organisational issues, lack of nursing staff and patient care were found to be related to ward type mental health nurses' stress emerged as mediating variables between stress and job satisfaction.

2.45 A research study by Deptt of medicine(2006). University of Ottawa, enitiled, “job stress corelation with job satisfaction and burn out”The findings are that medical staff frequently faces burn out due to high level of job stress. The turn over rate amongst the highly stressed workers are very high. The problem of burnout is common amongst the staff of cancer unit.

2.46 A research paper by School of Health Care Practice 2006, Anglia Polytechnic University, Chelmsford, Essex(2009), UK,entitled “Workplace stress in nursing” finds that workload, management style, professional conflict and emotional cost of caring and leadership style, lack of reward and shift working are the main sources of stress for nurses for many years. Stress management programe should concentrate on stress prevention as well as how organization should takle this vital issue.

2.47 The Graduate College University of Wisconsin-Stout (2005), Research Paper with title OCCUPATIONAL STRESS IN MENTAL HEALTH COUNSELORS, concludes that,The mental healthcounselors involved in completing the survey instruments scored an average of2.57 on afive point scale, with past administrations of the Weiman Occupational Stress Scalehaving yielded a baseline score of 2.25. The mental health counselors in this study scoredon average 13% higher than the calculated WOSS baseline. Employees in publiclyfunded institutions (Winnebago Mental Health) experience greater perceived work stressthan those counselors in privately funded clinics.

2.48 Research studyconducted by Carol Brewer(2000)mentioned that new comers in the profession of nursing confront enhanced stress as compared to existing lot .New nurses have reported the following are the major sources of job stress for them; complex jobs ,long hours,overtimes frequently, role conflict, role ambiguity, dangerous working conditions,abuses, inadequate resources and strain.

2.49An Exploratorystudy(2001) to dig out the job stressors conducted in Tiawan on nurses concludes that changes in the today's organizations,role conflict, role ambiguity,lack of social support,working environment in the hospital, demanding job of nurses are the main stressors for nurses.

2.50 European Journal(2005) of Social Sciences, reportentitled “Link between Job Stress and Job Satisfaction” signify that job stress and job satisfaction are invrsely corelated. According to Stamps & Piedmonte (1986) job satisfaction has been found significant relationship with job stress. One study of general practitioners in England identified four job stressors that were predictive of job dissatisfaction (Cooper, et al., 1989). In other study, Vinokur-Kaplan (1991) stated that organization factors such as workload and working condition were negatively related with job satisfaction. Fletcher & Payne (1980) identified that a lack of satisfaction can be a source of stress, while high satisfaction can alleviate the effects of stress. This study reveals that, both of job stress and job satisfaction were found to be interrelated. The study of Landsbergis (1988) and Terry et al. (1993) showed that high levels of work stress are associated with low levels of job satisfaction. Moreover, Cummins (1990) have emphasized that job stressors are predictive of job dissatisfaction and greater propensity to leave the organization. Sheena et al. (2005) studied in UK found that there are some occupations that are reporting worse than average scores on each of the factors such as physical health, psychological well-being, and job satisfaction. The relationship between variables can be very important to academician. If a definite link exists between two variables, it could be possible for a academician to provide intervention in order to increase the level of one of the variables in hope that the intervention will also improve the other variable as well (Koslowsky, et al., 1995).

2.51 A Study of Job Stress and Job Satisfaction among UniversityStaff in Malaysia, a research article(2007)investigates what corelation exists between job stress and job satisfaction? Inverse relationship exists between job stress and job satisfaction. The stressors that have been taken for research contain leadership style and interference by management, relationship with peers, work burden, role ambiguity, and role conflict.

2.52Faculty of Education (2001), University of Ibadan, article entitled“Effects of Job Stress” states that stress has negative effect on health, physical and mental, work behaviour,and performance,satisfaction level.

2.53 Heavy workloads, difficult students and lack of resources are stressing out Australian teachers (1999). Many also experience stress from increasing violence and bullying. In one recent year, 274 teachers in Victoria were either assaulted or threatened by students and another 70 were attacked by colleagues. Over the past five years , 910 teachers in Victoria and 1150 teachers in New South Wales have filed worker compensation claims for anxiety,depression,nervous breakdown and other stress related symptom. Union leaders say these figures are just the tip of the iceberg: Teacher are very reluctant to proceed with those claims because it just adds another problem and additional stress, explains Australian education union president John Gregory Teaching in Australia may be stressful, but the profession seems to be under siege in the Uk , Janice Howell a primary school teacher in Newport (South Wales)is one of the casualties. She initially had the assistance of an English language teacher but that teacher took long-term leave with no replacement. Unable to cope with 28 kids, 11 of them with learning or behavioral difficulties, Howell had a nervous breakdown.

After recovering several months later, Howell complained to the school about the intolerable stress. Rather than providing support, the school added two more troubled kids to Howells class. One student, new to Wales, ran away one morning and was seen playing near dangerous mudflats. Although he was taken home safely, no one told Howell until the end of the day. This led to Howells second breakdown, ending her career. From being a confident, well adjusted teacher who enjoyed her job I became depressed and dysfunctional, says Howell for the first time in my life I did hate to go to work. It got to the stage that I was physically unable to enter the classroom.

2.54 Nebuo Miuro (1999)quoted in the book about stress that employees are under a lot of pressure from his employer to get a new restaurant ready for its launch. The interiors fitter from Tokyo worked late, sometimes until 4.30 in the morning. After one such marathon, Miuro caught a few hour sleep, then return for another long day. But he didn't get very far. The 47 year old suddenly took ill and keeled over while picking up his hammer and nails. He died a week later. The corners verdict was that Miuro died of Karoshi_death by overwork. Karoshi accounts for nearly 10000 deaths each year in Japan. Research indicates that long work hours cause an unhealthy lifestyle such as smoking, poor eating habits, lack of physical exercise and sleeplessness. This result in weight gain, which, along with stressful working conditions, damages the cardiovascular system and leads to strokes and heart attacks. Karoshi came to the public spotlight in the 1970s when Japans economy was booming, but the country's current recession is making matters worse.companies are laying off employees and loading the extra work onto those who remain. Performance based expectations are replacing life qtime employment guarantees, putting further pressure on employees to work long hours. Many also blame Japans samurai spirit culture which idolizes long work hours as the ultimate symbol of company loyalty and personal fortitude. Being exhausted is considered a virtue explains a Japanese psychiatrist. So far, only 17 percent of Japanese companies offer over stressed employees some form of counseling. However the Japanese Government has launched an advertising campaign encouraging people to call a Karoshi hotline for anonymous help. The families of deceased workaholics, including Nobuo Mauro's relatives are also taking action by suing the employers for lack of due care.

2.55 A report (2001) regarding working out causes of burn out among managers and nurses in Canada concluded that job stress is positively corelated to burn out.The corelation was analysed from various perspective that is emotional exhaustion, lack of accomplishment and depersonalization. Job stress was significantly correlated with overall burnout. In the nursing sample, job stress was also significantly correlated with psychosomatic health problems and organizational commitment. Moderated multiple regressions only marginally supported the role of gender as a moderator of stress-burnout relationship.

2.56 A research article (2001) relating to job stress and gender indicate that there are statistically significant differences in the stress levels of employees based on their gender. With females experience more stress then male. And physical conditions are considered as a most stressful factor for females. Male experiences less stress with physical conditions. Women were found to experience more stress then male. They are more affected by physical conditions such as noise, lightning etc.

2.57 Journal of Managerial Psychology(2006), research report on stress and various enterprizes found that workers in the private s experiernce more stress than the workers in public sector organizations.According to this study the stressors in organization are no knowledge about job, lack of appreciation, lack of evaluation.saudi workers feel extreme stress as compared to others such as arabs,asiana,Europeans,Americans.the stress level of workers is also influenced by educational levels of workers.

2.58 An article on “Occupational stress and depression in Korean employees” (2001): States that lack of social support,complex and irritating work environment are the prominent elements, which results in depression in korean employees.

2.59 Department of Psychology & Applied Psychology research study (2008) ,University of the Punjab,entitled “OCCUPATIONAL STRESS AND JOB PERFORMANCE” indicated that heavy load of work/burden,monotonous work, lack of support from co-workers are major stressors in work set up. Further,it is reported that job stress affect performance of employees.

2.60 In reseach study about “Occupational Stress and Employee Control “ (1992), psychologists has established that job stress is inversly proportional to control over work.Better control over job may results in greater productivity and inflate motivation.entire control is directly related to better health ,output morale. It enhances decision making power of employees and they can easily manage work burden. Psychologists have discovered that demanding tasks requires better control on job. Lack of control result in poor health for employeed.

2.61 Colegio Oficial de Psic.logos (2007) s ‘article has found that stressors in work set up are corelated with poor health. The study reveals that job of psychologist is very stressful. In this comparitive reseach report psychiatrist feel less stress as compared to their colleagues.

2.62 A reprt presented by European Commission (2007), states that job stress negatively affects 40 million employees in Europe alone. 20 billion annually is lost due job stress. It is now established that job stress is big hurdles in better performance and high in cost, Health related problems are also associated with job stress.

2.63AReport on how job stress affects health and output ofNurses in Public Hospitals” (2006), Department of Social Work, Faculty of Education, University of Ibadan, Nigeria, established that job stress has significant effect on physical and mental health of the nurses. It also established that there was a significantdifference in personal and work behaviour of highly stressed nurses and less stressed nurses. Based on these findings,it was recommended that the government (Federal or State) and Hospital Management Boards should improve the welfare of the nurses. It was also recommended that their morale should be boosted by involving them in policy or decision-making concerning their welfare or care of their patients. Their salary should be reviewed and that they should be promoted as at when due. (Research study by University of Ibadan, Nigeria 2006).

2.64 Leo Sin and Danny Cheng (2004) identified six sources of job stress; job-assigned (overload) responsibility (role clarity) work/organizational climates; career; job value conflict; and role ambiguity. These not only overlap with the sources of stress, but also lead to many of the same consequences. Managers, who reported high jobs-assigned stress, role ambiguity stress and work organizational culture stress, also reported higher levels of psychological symptoms such as restlessness and forgetfulness. Those reporting high job-assigned and job value conflict stress reported higher level of psychosomatic symptoms such as headaches, poor appetite and trouble in getting to sleep.

Continuing the theme of interrole conflict, research by Aryee at the university of Singapore suggest that family and work roles and stressors impact on perceived work-family conflict and several outcome; job and life satisfaction, turnover intent and perceived work quality. He fond that for a group of married, professional Asian women, work-home conflict increase when they experience overload, high work load , low autonomy and high commitment to family roles. Following through to the consequences of role stress, Aryee found that, in all cases, individual reported lower levels of job satisfaction. (212)

More and more we are seeing dual career couples in the work place. As their number increases, so we must ask what the impact of juggling several roles is on their work and home lives. Do problems at work spill over into home life? Do family problems affect our working life? In recent years, the issue of role and mood-spill over has received a lot of researches attention. Research shows that work affects our home lives far more frequently then our home lives impact on work. When work-family conflict exist, individual report more depression, job dissatisfaction, higher cholesterol levels and more somatic complaints (e.g. headaches, insomnia and sweaty palms).

What impact does spill over have? When we feel bad do we carry those negative feelings between home and work? Is the same true for pleasant feelings? And how does our involvement either with home or work influence the spill-over process? First research shows that negative mood all spill over far more then positive moods. If we leave work feeling distress, we will carry that mood home with us; however if we leave work feeling elated or calm, it will have little impact on how we feel at home. And this affect is far stronger for women then men. Interestingly the more involved individual are in their jobs, the less mood spill over we see.

Over all research shows that work interferes with family far more than family interfere with work, Micheal O Driscoll, at Waikato Universities, together with Cary cooper used a critical incident analysis to determine what stressors are faced by New Zeeland workers and how they respond. According to their survey, the three most important sources of stress are organizational conflict, work over load and a lack of resources.

2.65 Fiona (2003) desribes in her book about a training co found that one in three people complained that technology at work contributes directly to rising stress levels. Referring to this as digital depression the managing director noted how he had recently come across a person who had 19400 emails in his inbox (hilpern 2003)

Work stress is thought to contribute to nightmares about killing the boss. Stress at work is contributing to regular nightmares for one in two adults (Womack 2003). Research in Britain found that 51 per cent of respondents suffered work related nightmares at least once a week with the figure rising to 61 percent among Londoners. A row with the boss was the most common dream followed by arriving late for meeting. Worryingly 7 per cent confessed to dreams where they wanted to murder the boss.

Over work can lead to death. There have been reports in the newspaper recently of deaths due to over work in Japan. Death due to this rose to 317 in 203 doubling the previous record of 147 cent in 2002. Doctors, factory workers, and taxi driver are the worst affected. (Fiona m.wilson)

2.66 According to a recent study by NIOSH,(2002) reported by Stephen which ‘states that more than half the working people in the united state comsider stress as an irritant in their lives. This is more than double the percentage reported the early 1990s. The people who have experienced stress related illness tripled between 1999 and 2002. In an annual survey released in 2002, 29 per cent of respondents faced severe stress during job in 6 year history. The American institute of stress estimates that stress related- absenteeism, burnout, mental health problems-cost American business approximately $300 bilion a year. The European Community officially dubbed stresses the second biggest occupational health problem facing employers in Europe. (Stephen 2002).

2.67 Murraybruce, (1983, 1990), a specialist in occupational medicine described the today's reaction to stress in the following terms: the heart and breathing rates increased, blood pressure goes up, sweating increases, muscles get tense, the eyes widen, and there is heightened alertness. Tense muscles caused headache, backaches, shoulder and back pain. Clenched hands, clenched jaws, and hunched shoulders along with frowning and fidgeting, figure `tremor, and the mopping of a sweaty brow. An anxious person has “butterflies” or churning in the stomach, a dry mouth, weak legs, nausea, a thumping heart, breathlessness and a feeling of light-headedness.

Course participation at a management college reported on symptoms of stress that they had previously experienced. These included dim or fizzy vision, some chest pain, unusual heart beats, occasional sleep difficulties, frequent episodes of irritability, tiredness, or depression (this was by far the most frequent), and periods in which their work performance was impaired for a few days(melhuish, 1977)

Eugene Mckenna (2000), the following is what a 37-years old teacher and head of department at a large comprehensive school, who is also a mother of two children, was reported as having said about her plight.

I am exhausted all the time; I do not sleep very well and when I wake up at night I panic about work; I am losing weight; eczema flares up when the pressure increased; frequently I feel guilty because I do not see enough of my children; I over-react when little things go wrong; recently I would not stop crying at weekends; and my marriage would have collapsed by now if I had not such an understanding husband. I cannot go to senior management because it would sound like I cannot cope, and with a new head in the school I feel under even more pressure to perform. I realize that for th sake of my health and marriage, something will have to change.

In this case the acute pressure or distress stems from trying to cope with a demanding job coupled with work in the home.

2.68 Stress in different occupations by Eugene Mckenna (2000) analysis of mortality due to atherosclerotic heart disease among U.S males by occupational classification in the age range 20-64 shows that teachers fare better than lawyers, medical practitioners, estate agents, and insurance agents (guralnick, 1963a, 1963b, 1963c). However, general practitioners are more vulnerable to heart disease than are other physicians (morris, heady, and barley, 1952)

As to suicide rates, those connected with law enforcement had higher mortality rates then those that administering the law, though individual who exposed to life-threatening situation suffer less stress hen those who are not. Among medical and related personnel, practitioners with above average suicide rates are dentists and psychiatrists.

Dentists are said to experience significant preside form the demands of developing their practice. The dentist prone to stress tends to be anxiety prone and more easily upset when confronted with excessive administrative duties and when faced with too little work because of a preoccupation with building and sustaining the practice. Dentists with raised blood pressure perceived, to some extent, their image as inflictions of pain. They also experienced stress from their job interfering with their personal life.

2.69 "The Epidemic of the Eighties” reported in Time Magazine (1983) considered job stress in the organization is a big problem for workers it negatively effect the health of the workers. The magazine further reported that the situation has become worsened and the workers in the modern America experience more stress than the earlier workers.


The below model clearly exhibit the relation between job stress & productivity.


2.71 stress and productivity (NIOSH 2004)about job stress and productivity NIOSH (2004) presented the folowing model,


The above model is self explanatory

2.72 The article titled, Job Stress among Teachers Engaged in Nursing(2006) concludesthat job stressors among teachers of nurses are work load and job control,lack of reward, conflict,inter personal relations and qualitative load of work among women.

2.72.1 Asurvey in 2002,titled “Occupational Stress in Australian Universities” by Anthoy H.(2002) reveals psychological strain, in addition to various work place factors such as job insecurity, job satisfaction, work pressure, and work-home conflict, was highly significantly corelated with a number of stress related health symptoms experienced by staff (eg backache and difficulties in sleeping, headaches, neck pain, viral and cold infections etc). These symptoms were in turn found to be significantly correlated with the number of stress-related medical conditions reported by staff, such as , hypertension , migraines and coronary heart disease.

2.73 Research findings of WHO(2005), research paper indicate the most stress ful type of work is that where demands and pressure are not matched with skill of employees and where there is no oppurtunity, control and support from others.

2.73.1 WHO (2005) report etitled ‘Stress experienced at work' can be divided into two groups, work content and work context. The research report of WHO (2005) entitled “stress and work hazards” states that the hazard at work can be divided into two groups Work contents and Work context, work contents consist of job monotony, workload, work pace, time pressure, working hours, strict or inflexible time un social system badly designd shift system, control process and participation. Work context contain carier development, job status, compensation, insecurity, lack of promtion, low social values, piece rate payment system, unclear and unfair perofmance evalutaion system, over or under skilled for job, role in organisation, interpersonal relationship, organisational culture, work life balance etc.

2.74 According to a research study (2001) on nurses in Ankara Turkey entitled effect of pyhsical enviroment on the stress levels of nurses, states and identify that education level and employment of the nurses are significantly related with the stress levels of hemodylsis nurses. Nurses marital status, occupational seniority, years of working, number of children, age, employment status, husbands occupation and husband educational level are highly significantly co related with their stress level.

According to Hans Selye GAS model;

Selye (1982) model represent that “The General Adaptation Syndrome assumes that each individual will react to a stressful situation in a certain way. It fails to take into account the individual's ability to interpret a threat as a source of pressure and act to change his situation.” This ability is considered as coping or adaptation.

Model by Williams (1994) exhibits;


Stress process

In this model, the individual's personality attributes, has a very significant influence on the potentiality both of the sources of stress and of the coping behaviours.

Cox (1993) emphasises the importance of the feedback loop in models of this kind:

“If person realise that they are failing to cope with the demands of a task, and experience concern about that failure because it is important, then this is a ‘stress' scenario. Stress reduces the performance and as well ability of the person.

Cox (1993) indicated two important sources of stress arising from the role pf person in the enterprise that is role ambiguity and role conflict. When a worker has insufficient information about his work, role ambiguity occurs and when indivisual is compell to perform a task in conflict with the values role conflict occurs. Role conflict and ambiguity positively co related with absenteeism, leaving the job, psychological and physiological strain, tension and fatigue. Role conflict and ambiguity is negatively co related with organizational commitment, job involvment, performance, descion making, tolerance, satisfaction, physical with drawal and reported influence.

“Poorrelations with colleagues, supervisors and subordinates at work have been identified as important risk factors” for stress-related problems indicated by Sauter, Murphy and Hurrell (1992). Cox and Griffiths (1995) identify the characteristics of situations experienced as stressful, one of which is “individuals are relatively isolated and receive little support from colleagues, supervisors, friends or family” (Cox and Griffiths 1995).

Ganster (1986) research study found a strong correlation between a lack of social support, especially from a supervisor, and dissatisfaction with work. It clearly show that social support is a significant element in the organization which de enhance the level of stress and increase the level of satisfaction.

Lazarus and Folkman (1984) reported in there research study that employees will have better health and moral and satisfaction and performace if they get social support when required.

French, Caplan and van Harrison's (1982) research study indicate that some job is assignement characteristics are associated with stress. These characteristics may be too little or too much work, too complex job, more little responsibilities, work burden, long hour's survices and greater education needed for that specific job. These characteristics produce discrepancies between indivisual and his assignment so here it means that job stress may be the co relation between job and person (French, Caplan and van Harrison, 1982).

Physical and environmental factors causing stress.

Physical and environmental factors can have an effect on the stress experienced by a person in the workplace. Examples are lighting, ventilation, noise, vibration, chemicals, dust, badly designed machinery and equipment, and badly designed premises.(The London Hazards Centre 1994). Burke (1988) reports the “most frequently mentioned environmental stressors” as including density and crowding, lack of privacy, high noise levels, vibrations and/or sound waves, temperature extremes, air movement and background colour and illumination.

Stress may affect health

Teasdale and McKeown, (1994) reports that “Stress itself is not an illness, rather it is a state. However it is a very powerful cause of illness. Long-term excessive stress is known to lead to serious health problems”

The relationship between stress/strain and a variety of adverse physical and psychological health conditions is well-established. “Stress may affect health. At the same time, however, a state of ill health can act as a significant source of stress, and may also sensitise individuals to other sources of stress by reducing their ability to cope. Within these limits, the common assumption of a relationship between the experience of stress and poor health appears justified.”

Russek and Zohman (1958) compared young [25-40] CHD patients with a healthy control group and found that whilst only 20% of the control group reported prolonged stress related to work, 91% of the CHD patients did so. The patients also reported heavy workloads, with 46% working more than 60 hours per week and 20% doing two jobs. 20% reported frustration, discontent, insecurity or inadequacies in relation to their jobs. Breslau and Buell (1960) also found a correlation between long working hours and CHD. In a study of younger [under 45] workers in light industry those working more than 48 hours per week had double the risk of death from CHD than similar workers working less than 40 hours per week.

Weiman (1977) reports a study [carried out in 1974] of 1540 officers of a “large financial institution” who were subjects of periodic health checks, including a questionnaire on occupational stress. Weiman found that: “There is a significantly higher incidence of disease when particular stressors are operating. It is also evident that disease/risk occurs more frequently when workers are either under-stimulated or over-stimulated,

In review of the research on the associations between occupational stress and CHD, Landsbergis (1993) found that twelve out of fourteen studies reviewed showed a clear link. He estimated that 23% of CHD deaths in the US were potentially preventable if the stress levels in the “worst” jobs were reduced to average levels.

An investigation by the Post Office occupational health service (IRS, 1994) found that “psychological problems” were the second most common reason for early retirement on health grounds [after orthopaedic injury]. The pressure group The London Hazards Centre (LHC, 1994) list an array of outcomes of working excessive hours, including physical and psychological fatigue, increased risk of heart disease, sleep difficulties, sexual disorders, gastric disturbances, headaches, backaches, dizziness, weight loss, apathy, depression, disorganisation, feelings of incapability, irritability, intolerance, boredom and cynicism. The “most extreme consequence” is sudden death. Cranwell-Ward (1995) reports that death from overwork [karoshi in Japanese] has been officially registered as a fatal illness in Japan since 1989, and goes on“in 1990 the labour ministry received 777 applications for compensation because of karoshi.”

A more common outcome of stress/strain is an increase in accident rates at work (LHC, 1994). Carter and Corlett (1981), in a review of the literature on mental health and involvement in accidents, reported that “the mental state of the operator, whether he is fatigued or over-aroused, alert or distracted, has been the most frequently suggested reason for accident-causation during shiftwork.” Cartwright et al (1993) studied accidents involving company car drivers from three subsidiaries of a major company, and related them to stress levels. They found the highest rates in the subsidiary which also returned higher levels of occupational stress, poorer physical health, poorer mental health and lower job satisfaction. They concluded that“the significantly higher levels of occupational stress within [the subsidiary with the highest accident rate] indicate that stress is playing a major role in predicting accident rates.”

Prolonged exposure to stress can result in the phenomenon of ‘burnout', defined as “exhaustion, underachievement, and the inability to handle personal relationships” (LHC, 1994),

Cox (1993) identifies from the literature several effects of stress which he believes may be of “direct concern to organisations.” Some of these, such as “reduced availability for work involving high turnover, absenteeism and poor time keeping” he classifies as “essentially ‘escape' strategies.” Others involve what is described as ‘presenteeism' - people continue to report for work but their performance and involvement is poor. Cox suggests that this may result in impaired work performance and productivity, with consequent increases in client complaints. Fingret (1994) also emphasises the damage caused to organisations by presenteeism, claiming that “occupational health practitioners and psychologists are well aware of significant levels of stress and psychological maladjustment which have not resulted in significant sickness absence.” Fingret argues that this may be even more damaging to business efficiency that the absences which “though carrying physical illness labels, are in fact related to lack of mental well-being.” Cooper (1994) refers to the “huge costs ... of people turning up to work who are so distressed by their jobs or some aspect of the organizational climate that they contribute little, if anything, to their work.”

Where employees are required to exercise creativity and initiative these effects may be even more pronounced. Talbot, Cooper and Barrow (1992) studied 202 managers [a sub-set of a wider study involving 1083 respondents, all from one organisation]. They found significant negative correlations between stress and the potential for creativity, although they were unable to ascribe a causal relationship between stress and creativity because “both may be an outcome of something else.” Karasek and Theorell (1990) hypothesise that “accumulated level of unresolved strain [or anxiety level] appears to restrict a person's ability to learn solutions to new problems. The literature on burnout has also demonstrated that prolonged job stress is associated with decline in initiatives at work.”

Task performance is also found to be impaired when stress exceeds an individual's tolerance level. Selye (1982) maintains that “under stress people often perform at higher levels, but if the stress continues exhaustion sets in and leads to a range of problems [‘diseases of adaptation'].” (Selye 1982)