PSY8 625 Capella University Week 10 Staff Working with Intellectual Disabilities Journal Article

Assignment regarding Journal Article. Must know IBM SPSS for statistical calculations.

Journal of Applied Research in Intellectual Disabilities 2004, 17, 119±126
Job Stress, Burnout and Job Satisfaction: An
Intervention Study for Staff Working with
People with Intellectual Disabilities
Siw Tone Innstrand, Geir Arild Espnesy and Reidar Mykletunz

Department of Social Work and Health Sciences, Faculty of Social Science and Technology Management, Norwegian University of
Science and Technology, Norway, yDepartment of Social Work and Health Sciences and Program for Sport Sciences, Faculty of Social
Science and Technology Management, Norwegian University of Science and Technology, Norway, zNorwegian School of Hotel
Management, Stavanger University College, Norway
Accepted for publication 10 March 2004
Background The present paper reviews staff stress, burnout and job satisfaction.
Methods A longitudinal, quasi experimental study was
carried out among staff working with people with intellectual disabilities in two municipalities in Norway. The
purpose was to measure mean differences of stress, burnout and job satisfaction after different intervention approaches were applied to staff in one of the municipalities.
Staff in the other municipality acted as a control group.
Results Using the pretest score as the covariate, by analysis
of covariance (ANCOVA), the experimental group showed a
Introduction
In Norway, the responsibility of persons with intellectual
disabilities was transferred from the county to each municipality in 1991, and most of the central institutions were
dissolved (called `the HVPU-reform’). Since then, several
studies have been carried out where the relation between
the organization of services and the interests of the recipients have been the main focus (e.g. Mùrch 1994; Sñtersdal 1994; Romùren 1995; Sundet 1995; Tùssebro 1995). Less
attention has been devoted to the consequences of the
reform on the working environment for staff working with
persons with intellectual disabilities (Moland 1997). This is
quite surprising as reducing stress and strain is important
not only to promote the individual worker’s health and
well being, but also to ensure the health and well being of
those for whom services are provided (Cherniss 1980;
Moore & Cooper 1996; Rose et al. 1998a).
The most popular and, perhaps, the most reasonable
sounding measure of the effects of stress is burnout. Both
for the uninitiated and initiated, it seems to be intertwined
# 2004 BILD Publications
signi®cant (P < 0.05) reduction in stress and exhaustion, and a strong signi®cant rise in job satisfaction after intervention. Conclusions This was a suf®ciently promising result to encourage further research, not only to promote the individual worker's health and well being, but also to ensure the health and well being of those for whom services are provided. Keywords: burnout, intervention, job satisfaction, staff stress with stress, and it is dif®cult sometimes to tell whether it is a stressor or a strain measure (Koslowsky 1998). Burnout is different from job stress in several ways: it refers more to a breakdown in adaptation as a result of prolonged stress, it is characterized by a multidimensional symptomatology, particular speci®c attitudes, and it seems partly to be the result of a high initial level of motivation (Schaufeli & Buunk 1996). The operational de®nition, and the corresponding measure Maslach Burnout Inventory (MBI), which is most widely used in burnout research, is the three-component model developed by Jackson & Maslach (Maslach 1993). They de®ne burnout as: `a psychological syndrome of emotional exhaustion, depersonalization, and reduced accomplishment that can occur among individuals who work with other people in some capacity' (Maslach 1993; p. 20). The importance of reducing stress and strain has been proved by several investigations, which link stress and strain to serious consequences for the individual (e.g. poor health, emotional problems, unhealthy lifestyle, quality of life, marital and family problems), the recipients (e.g. deterioration in the quality of care), the organization 120 Journal of Applied Research in Intellectual Disabilities (e.g. decrements in performance, low morale, and increased turnover and absenteeism/sick leave) and the society (®nancial cost); Maslach & Jackson 1981; Pines 1993; Rose 1995; Burke & Richardsen 1996; Maslach & Leiter 1997; Rose et al. 1998b; Geurts & GruÈndermann 1999; Rose 1999; Wright & Cropanzano 2000; Mitchell & Hastings 2001. While a great deal of research has been devoted to identifying the sources of workplace stress and its links to adverse health and organizational outcomes, few studies have focused on interventions which are meant to improve working environments (Kompier & Cooper 1999; Whatmore et al. 1999). In a review of burnout literature published over the last 15 years, SùndergaÊrd et al. (1998) found only 18 intervention studies. Both individual and organizational approaches like physical exercise, stress awareness training, seminars or health circles, practice of mastery, strengthening of social support, introduction of a bottom-up organizational structure or a work redesign have all proved to buffer the harmful effects of stress and strain (Pines & Aronson 1988; Himle & Jayaratne 1990; Brannon & Feist 1997; Wine®eld et al. 1998; Beerman et al. 1999; Netterstrùm 1999; Theorell & Wahlstedt 1999; Whatmore et al. 1999). But although almost every author on the subject acknowledges that a combination of both individual and workplace interventions would be most effective (e.g. Murphy 1988; Pines 1993; Kalimo & Toppinen 1999), the vast majority of burnout interventions have been conducted on the individual level (Rice 1992; Schaufeli & Buunk 1996). The ®rst step to solve any problem is to search for its causes. Therefore, to prevent burnout among health professionals, `job stress is a logical starting point' (Cherniss 1980; p. 43). A similar argument can be made on the issue of job satisfaction. By using exploratory path analysis, Hendrix et al. (1995) found increased job stress to be related to decreased job satisfaction and increased emotional exhaustion. This was also supported by a similar study conducted on the same sample as this article (Innstrand et al. 2002). Stressor reduction interventions thus remain the preferred approach to reduce employee stress problems because of the focus on the source of the problem(s), not the symptoms (Cartwright et al. 1996). The success of any intervention effort to reduce work stressors, and heighten individual satisfaction and well being will depend on accurate diagnosis as different work stressors require different actions (Burke 1988; Himle & Jayaratne 1990; Kompier & Cooper 1999). Treatment and prevention must therefore be approached from many directions and at various levels. A growing interest in stress among staff working with people with intellectual disabilities has revealed several sources for stress (see Rose 1995 for a review). However, according to Maslach & Leiter (1997), one does not have to reduce all the stressors or mismatches as they call it. The best path to take is to choose a mismatch of major concern, whose resolution has the potential to generate and allow implementation of concrete solutions. Therefore, the choice of path should rest on two key questions: `which area of mismatches is causing the greatest problems?' and `which area has the greatest potential to lead to change?' As negative effects in some mismatches will be offset by greater harmony in others, it may not be necessary to deal with all the mismatches, but just some of them. Regardless of which intervention approach might be used, the involvement and participation of workers in the process, as well as the support from top management, are critical to its success (Cartwright et al. 1996; Kompier & Cooper 1999). The purpose of the present study is to evaluate possible changes in stress, burnout and job satisfaction that might occur between pre- and postmeasurements after stressreducing interventions on both the individual and organizational levels has been applied to the experimental group. Method Participants The participants were 112 staff members working with persons with intellectual disabilities in two municipalities in Norway. Staff in one of the municipalities acted as an experimental group (pre, n ˆ 43; post, n ˆ 36) and participated in the intervention phase, while staff in the other municipality acted as a control group (pre, n ˆ 22; post, n ˆ 11) and did not participate in any of the interventions applied (see Table 1). The two municipalities were quite similar according to how the community residential care was performed. Both samples of staff had an average age of about 40 years, ranging from 21 to 65. About 90% were females. However, there were some differences in their education level as 18.2% of the control group had higher education (3 years or more with education beyond comprehensive school) as compared to 8.9% in the experimental group. The two municipalities have different locations in Norway with no formal communication with each other. Procedure The study was carried out with both a pre- and a post-test 10 months apart. During this 10-month period, different interventions were applied in the experimental group. # 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 119±126 Journal of Applied Research in Intellectual Disabilities 121 Table 1 Number of participants in the pretest only, the post-test only and participation in both pre- and post-test Pretest Post-test Total Only pretest Total Only post-test Pre- and post-test Experimental Control 43 22 21 13 36 11 14 2 22 9 ± ± Total 65 ± 47 ± ± 112 Based on relevant literature, and discussion with supervisors and workers, a questionnaire was designed. The questionnaire was intended to re¯ect descriptive statistics, stress, burnout and job satisfaction among staff working with persons with intellectual disabilities. The questionnaire was examined by a workgroup consisting of the manager of the unit for people with intellectual disabilities, two of the senior leaders, and two representatives for the workers, the human resource manager and the investigator. After approval, the questionnaire was sent out to both groups (experimental and control groups) prior to the interventions (pretest) and after a 10-month period (post-test). Participants were informed about the anonymity and the voluntary participation in the investigation. Total Both groups were requested to return the questionnaires within 1 week. After 3±4 weeks, a reminder was sent to all recipients. The ®nal sample (experimental and control groups together) had a response rate of 61.9% in the pretest (n ˆ 65) and 47% in the post-test (n ˆ 47). Interventions Possible stressors identi®ed in the pretest were presented and discussed at a meeting, where all the employees in the experimental group participated. At the end of this meeting, the participants were divided into four groups and were asked to ®nd possible solutions for reducing the stressors discussed and make priorities concerning actions to improve their working conditions (see Table 2). Based Table 2 List of priorities, interventions and the purpose/goal with these interventions Priorities Interventions Purpose/goal Agreement upon the priorities Meet the politicians Larger positions (work more hours a week) Open meeting Feel involvement Opportunity to speak up Get a better overview and promote a sense of security among the employee Receive feedback and reveal individual wishes and needs Encourage employees to take upper secondary education Acquire competence and professional input Strengthen the individual's self-esteem and competance Promote security and engagement in work Promote social support and friendship across the communities Promote a sense of security among new employees and responsibility among the others Improve fitness and thereby health and well being Prevent health problems Review the interventions and make goals for the future Receive both praise and criticism Circulating among the communities Acquire competence Better on-the-job training routines for new employees Improving the working schedule Performance appraisal Information from the Norwegian Employment Service about different educational opportunities Seminars Better health and vigour `Buddy system' Prepare a guide with on-the-job training routines Exercise at a health club Create realistic goals for the future Open meeting # 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 119±126 122 Journal of Applied Research in Intellectual Disabilities on this priority list, the workgroup agreed upon a set of intervention strategies both at the individual and at the organizational level. At the individual level, a voluntary exercise programme was offered, where the participants had to exercise at least two times a week for a period of 2 months. Besides improving physical ®tness, regular exercise has been proved to confer certain psychological bene®ts like decreasing depression, reducing anxiety, providing a buffer against the harmful effects of stress and burnout, and enhancing feelings of self-esteem (Seidman & Zager 1991; Brannon & Feist 1997; Whatmore et al. 1999). The purpose was to improve ®tness, and thereby the health and well being among the participants, and to buffer the harmful effects of stress and burnout. Five 4-h seminars were also arranged. The seminars were held at different places, and comprised different topics and lecturers like `Ethic and values', `Autism', `How are the conditions for people with intellectual disabilities after the reform?', `Motivational conditions' and `Taking care of oneself and getting the inspiration back in work'. The purpose was to strengthen the individuals' self-esteem, and to educate and promote security and engagement in work. An additional bene®t was meant to be the social aspect of these gatherings, which could provide social support and friendship across the group homes. A common problem in burnout interventions is that burned out individuals most often are too tired to participate in any intervention at all, even when the purpose is to improve their own condition. Offering to pay those who participate in such seminars in their leisure time is both expensive and makes the individuals regard the seminars as a duty imposed by their superiors. In this investigation, each participant was given a ticket at each seminar. At the end of the intervention period, one of them would win a prize on his/her ticket (a trip abroad). The purpose was to encourage voluntary participation and make the participants feel they were participating for their own sake and not for that of the organization. The whole arrangement with booking lecturers, deciding the location and the food for the lectures was all done by the workers themselves. It was hoped that this would heighten the possibility of continuing with arrangements of this kind, also after the end of the project and the withdrawal of the resources of the project leaders. At the organizational level, three interventions were planned: performance appraisals were carried out1, working schedules were reorganized promoting larger posi- tions (meaning work more hours a week)2 and stability among the staff, and the routines for new employees were improved. This was done in order to provide feedback to both the employees and the superiors, and promote job security. A small amount of data that exist indicate that the effects of job insecurity appear to be similar to that of job loss itself (Burke 1988). At the end of the intervention period, a new meeting was arranged for all the employees in the experimental group to propose further realistic goals. The control group did not participate in this process. 1 In Norway, performance appraisal is not only an appraisal of your performance in work, but a broader approach including career plans, training needs, satisfaction, etc. 2 Only 12.5% of the employees in the experimental group had a permanent position of 100%, the rest were ranging from 17% and up. Mean permanent position was 58%. Measures Stress A measure for stress was developed speci®cally for this study following a format developed by Cooper, and translated to Norwegian by Bru et al. (1997). Respondents were asked to express the degree to which 23 statements were a source of felt `stress'. The stress measure included statements concerning the supervisors (e.g. `Relationship with superior'), colleagues (e.g. `Relationship with colleagues'), recipients (e.g. `Relationship with recipients'), and home± work interface (e.g. `Bringing your work back home'). Internal consistency reliability of alpha (a) was 0.89. Stress ratings were scored from 0 (no stress) to 5 (very much stress). Burnout Burnout was measured with the `General Burnout Questionnaire' (GBQ; later renamed Maslach Burnout Inventory ± General Survey (MBI±GS)) developed by Schaufeli et al. (1995) and adapted to Norwegian conditions (Mykletun & Mykletun 1999). GBQ is inspired by the MBI but can be used outside the human service as well. Like the MBI, the GBQ includes three scales: exhaustion, cynicism and (reduced) professional self-ef®cacy (Schaufeli et al. 1995). The exhaustion and cynicism scales consisted of ®ve items each, and had an internal consistency reliability of aˆ 0.85 and 0.62, respectively. Exhaustion included negative statements like `working all day is really a strain for me', and cynicism included negative statements like `I doubt the signi®cance of my work'. Professional self-ef®cacy consisted of six items, including positive statements like `I have accomplished many worthwhile things in this job'. The # 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 119±126 Journal of Applied Research in Intellectual Disabilities 123 internal consistency reliability of alpha in professional selfef®cacy was 0.63. A seven-point response scale, ranking from never to always/every day, was used on all the burnout subscales. Job satisfaction Workers' satisfaction with their jobs was assessed using an 18-item scale developed by Warr et al. (1979, in Nytrù 1995) and translated into Norwegian by Nytrù (1995). A sumscore was calculated for job satisfaction, ranging between 18 and 136, and with an internal consistency reliability of aˆ 0.91. At the workgroup's request, one small adjustment was made by changing `bedrift' (company) to `bofellesskap' (group home) in one of the questions. Respondents rated their degree of satisfaction with 18 aspects of their job using a seven-point response scale, ranging from `Very dissatis®ed' to `Very satis®ed'. Aspects rated included `Your work-mates', `Possibility for progress/advancement' and `The feeling of having a safe and sure job in the future'. Data analysis The intervention effects on stress, burnout and job satisfaction were analysed for a group (experimental vs. control) effect by using analysis of covariance (ANCOVA) to compare postintervention with preintervention values as covariates. ANCOVA is a well-established statistical procedure that has received a lot of attention and scrutiny in the literature (see GarcõÂa-Berthou 2001 for a discussion of the advantages of using ANCOVA). SPSSWin (ver. 8.0) was used in the statistical analyses of the data. Results Stress Using the pretest score as the covariate, by ANCOVA, the experimental and control groups showed a signi®cant difference in stress after the intervention period (F1,28 ˆ 10.493; P < 0.05). Burnout Covarying the pretest score, by ANCOVA, the experimental and control groups showed a signi®cant difference in exhaustion after the intervention period (F1,28 ˆ 4.989; P < 0.05), while no signi®cant difference in cynicism (F1,26 ˆ 3.185; P < 0.05) or in professional self-ef®cacy (F1,26 ˆ 2.135; P < 0.05) emerged. Job satisfaction Using the pretest score as the covariate, by ANCOVA, the experimental and control groups showed a signi®cant difference in job satisfaction after the intervention period (F1,27 ˆ 4.347; P < 0.05). Discussion The purpose of the present study was to evaluate possible changes in stress, burnout and job satisfaction after stressreducing interventions were applied to the experimental group. Using the pretest score as the covariate, by ANCOVA, the experimental group showed a signi®cant reduction in stress and exhaustion, and a strong signi®cant rise in job satisfaction. There were no signi®cant effects in cynicism and professional self-ef®cacy. This seems reminiscent of previous ®ndings (Hendrix et al. 1995; Innstrand et al. 2002) of a causal relationship between stress and exhaustion, and stress and job satisfaction. The lack of signi®cant effects on cynicism and professional self-ef®cacy might be explained by the short time span between the intervention and the post-test measurement. Burnout is believed to be a process developing over time, starting with exhaustion (e.g. Leiter 1993; Maslach 1993). The reduction in the exhaustion level might therefore affect the other two components over time. A follow-up study would therefore be interesting. Another possible explanation is that cynicism and professional selfef®cacy are more serious and constant conditions than exhaustion and job satisfaction. This is consistent with Schaufeli & Buunk's conclusion after reviewing several burnout interventions. They found both personal accomplishment and depersonalization to be rather resistant to change (Schaufeli & Buunk 1996). It is also possible that cynicism and professional self-ef®cacy have other antecedents than the ones investigated here. However, some caution must be taken in the interpretation of these results. In the present study, the control group moved in an opposite and negative direction from the experimental group; in other words, they got worse (see Figures 1±5). This can be explained by regarding stress, burnout and lessened job satisfaction as a process worsening over time, when no improvements are made in their working conditions. But this can also be explained by resentful demoralization, where the control group learnt that others are receiving special treatment and thus they may become less productive, ef®cient or motivated than they would have been because of feelings of resentment (Neal & Liebert 1986). A common problem in non-equivalent control group designs is also the threat of the internal validity by selection-maturation and local history. Another # 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 119±126 Journal of Applied Research in Intellectual Disabilities Stress 80 Job satisfaction 95 Exp. group Mean 60 40 Control group 20 0 1 Pre-Post Exhaustion 20 Mean 15 Exp. group 10 Control group 5 0 2 Pre-Post Figure 2 Observed pre- and post-test mean exhaustion score for experimental and control groups. Cynicism Mean 15 Exp. group 10 Control group 5 0 1 2 Pre-Post Figure 3 Observed pre- and post-test mean cynicism score for experimental and control groups. 20 Professional self efficacy Mean 15 Exp. group 10 Control group 5 0 1 80 Control group 75 1 2 Pre-Post Figure 1 Observed pre- and post-test mean stress score for experimental and control groups. 20 Exp. group 85 70 2 1 90 Mean 124 2 Pre-Post Figure 4 Observed pre- and post-test mean professional self-ef®cacy score for experimental and control groups. Figure 5 Observed pre- and post-test mean job satisfaction score for experimental and control groups. problem is caused by the sample size. Such a small sample suggests caution in generalizing from these results. Despite the fact that the interventions used in this study were ®tted to the speci®c problems and needs in one institution, there is reason to believe that this study could be used as a guideline for similar work institutions. A common problem of both experimental and control groups was the gap between means and ends. The difference seemed to be in what caused this gap. While bureaucratic interference is likely to have prevented staff in the experimental group from the effective delivery of services, time pressure and the need for more staff caused the gap in the control group (Thun et al. 2000; Innstrand et al. 2002). This is consistent with Leiter & Harvie (1996) who reviewed studies of burnout relating to mental health workers from 1985 to 1995, and concluded that burnout is most evident in work situations that inhibit mental health workers' capacity to realize their values through work. Such problems arise through excessive demands associated with caseloads or personal con¯ict that interfere with opportunities to attend thoroughly to the needs of service recipients. They are exacerbated by insuf®cient support from colleagues, family or the work itself, which diminish the resources available to mental health workers to work effectively. This is also supported by several staff stress studies conducted among staff working with people with intellectual disability (Rose 1995; Rose et al. 1998a, 2000; Hatton et al. 1999a,b). An accurate diagnosis is therefore required as different work stressors require different actions. In the present investigation, we chose to deal with just some of the most prominent problems whose resolution had the most potential to change. The involvement and participation of workers, as well as the support from the top management, were therefore critical to its success. The advantages of the investigation are the appropriate use of a control group and the longitudinal design with both a pre- and post-test. Despite the problem of separating the effect of each intervention, the study has the # 2004 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 17, 119±126 Journal of Applied Research in Intellectual Disabilities 125 advantage of using both an individual and an organizational approach in the preparation of interventions. In further investigations, another measure of the effect could have been a pre- and post-test of the satisfaction among the recipients, given that the best care is expected from those who feel satis®ed themselves. All in all, the project can be called a success. A decrease in the stress and exhaustion levels, and an increase in job satisfaction were observed in the experimental group. Furthermore, as some of the interventions have yet to be implemented and some of the existing interventions will continue, a further decrease in the stress and exhaustion level and an increase in job satisfaction are expected in the near future. Acknowledgements The authors would like to express our gratitude to all the participants who took part in this research and workshops and on whose experience this article is based. This article is based on results from a large project, funded by the National Insurance Administration in Norway. Correspondence Any correspondence should be directed to Siw Tone Innstrand, Department of Social Work and Health Sciences, Faculty of Social Science and Technology Management, Norwegian University of Science and Technology, 7094 Trondheim, Norway (Telefax: ‡47 73 59 18 85; e-mail: siw.tone.innstrand@svt.ntnu.no). References Beerman B., Khun K. & Kompier M. (1999) Germany: reduction of stress by health circles. In: Preventing Stress, Improving Productivity: European Case Studies in the Workplace (eds M. Kompier & C. Cooper), pp. 222±241. Routledge, London. Brannon L. & Feist J. (1997) Health Psychology. An Introduction to Behaviour and Health. Brooks/Cole, Paci®c Grove, California. 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