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118Факторы, вызывающие стресс, и методы борьбы со стрессом: на практике центра семейного здоровья эскишехира в области детского здравоохранения
Тюркан Гечер
докторант, кафедра экономики, Южный федеральный университет (УИБиП), [email protected]
В настоящее время стресс, занимающий важное место во всех сферах нашей жизни, независимо от причины и источника, находится в нашей жизни с древних времен. Сотрудники сталкиваются с организационными стрессами, такими как стрессы, вызванные пациентами и проблемами на рабочем месте, большой нагрузкой, проблемами общения с пациентами и их родственниками, отсутствием равного распределения работы, недостаточным количеством сотрудников и аналогичными ситуациями. Стресс, который значительно влияет на человеческую жизнь, приводит к чрезмерному несчастью, снижению производительности, увеличению бездействия и психологическим спадам.
С помощью этого исследования, было направлено на определение необходимых методов для повышения качества обслуживания и создания необходимых организаций для последующих этапов путем определения методов борьбы со стрессом. Использовалась шкала опроса магистреской диссертации «Факторы стресса и методы борьбы со стрессом у сотрудников здравоохранения, работающих на первом уровне» кафедры Управление больницами и учреждениями здравоохранения Института Социальных наук университета Бейкент. Вселенную исследования составил город Эскишехир, а образец - центры семейного здоровья Эскишехира. Цель состояла в том, чтобы охватить 190 медицинских работников, включая врачей, медсестер, акушерок, техников, техников, медицинских работников, но, к сожалению, достигло только до 150 человек. Каждый пункт шкалы оценивается от 1 до 5 баллов. Баллы, полученные опрошенными сотрудниками, оценивались от 10 до 50 баллов. Данные, полученные для этой цели, были статистически проанализированы. В этом исследовании были применены методы опроса, основанные на встрече с родителями в области здравоохранения детей. Ключевые слова: стресс, стрессовые факторы, методы снятия стресса, стресс и здоровье работника.
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INTRODUCTION
Stress is an important factor in any field of working life. Research (Patricia M. Buhler, D.B.A.2018), stated that this amount could change from person to person, and that as a result of extreme stress, performance could decrease and we could face irreparable errors.
What is stress with this work? Stress-generating factors and stress coping methods will be discussed and an application will be made in the main Child Health Services of Eski§ehir family health centers and the results will shed light on the studies to be made in the following years.
According to stress, we are together in our daily lives. Sometimes we even feel stress like our best friend.
Stress is one of the most important diseases of our age, although there are a lot of research on stress, which is constantly present in human life from the early ages to the present day. (Rojas and Kleiner, 2000, Qinar, 2010). The term stress comes from the Latin phrase "Stringere", meaning "pulling and stretching", rather than from its origins in French and English. (Graham, 1999, Okutan and Tengilimoglu, 2002).
Health and social services and education, as the most affected occupational groups by stress, has been stated in the work stress report prepared by the European fund for improving living and working conditions in 2007. (Lindeman 1944 and Capan 1964, UQman, 1990) according to the psychological distress (distressed) psychodynamic views, such as the most frequent stressful events in daily life trigger psychological distress, the proliferation of stress only occur in the individual's subconscious should not be connected to conflicts.
Historically, stress coping mechanisms are discussed from 5 different perspectives. These include the unconscious defense mechanisms (later called Ego mechanisms) proposed by 1.Freud mekanunpsychoanalytic theory; 2. individual sources such as self-confidence, self-efficacy or internal control, which Erikson mentions in his iQ life cycle 2. approach; 3. Evolution theory and problem solving efforts in behavioral movements; A genetically programmed reaction by humans such as Cannon and Selye, shown by both humans and animals against stress; 5. Consistently changing, cognitive, and behavioral efforts directed towards adaptation of the organism against the exhaustion of their physio-psychological resources (Compas, 1987; Folkman, 1984; Moos and
Billings, 1982, 1986; Patterson, Hamilton and McCubbin, 1987, Akt: Hisli Sahin and Durak, 1995). Methodology
The stress scale developed by the researcher was used in the study.
Factor and Reliability Analysis Results of Stress Scale
Table 1
Items Scale Mean if Item Deleted Scale Variance if Item Deleted Corrected Item-Total Correlatio n Cronbach' s Alpha if Item Deleted
1- Having a lot of work increases my stress. 39,82 106,1 1 0,52 0,86
2- Unable to communicate with the Chief increases my stress. 40,49 100,4 1 0,61 0,86
3- Excessive number of patients increases the stress. 39,74 106,3 0 0,52 0,86
4- Family problems increase my stress. 40,25 108,4 7 0,36 0,87
5- It makes me stress that I don't like my job. 41,61 109,0 6 0,43 0,86
6- I'm having trouble communicating with patients and their relatives. 40,95 109,6 0 0,34 0,87
7- The inadequacy of the number of employees is stressing. 40,57 101,3 5 0,62 0,85
8- I've got a lot of stress. 40,46 105,8 2 0,46 0,86
9- The lack of equal work distribution makes me stress. 40,30 100,1 7 0,63 0,85
10- The working environment (physical conditions, noise, light, etc.) makes me stress. 40,34 100,5 6 0,64 0,85
11- The attitudes of the patients' relatives make me stress. 39,64 107,3 1 0,48 0,86
12- Inadequate number of intermediate elements makes me stress. 40,40 100,6 4 0,68 0,85
13- The lack of understanding of the responsible supervisor makes me stress. 40,99 102,9 5 0,52 0,86
14- It makes me stress that my colleagues are unhappy. 40,01 105,7 6 0,54 0,86
When the results of the item analysis of the stress scale in Table 1 are examined, the relationship of a substance with other substances should not be less than 0.30 (Buyukozturk, 2002). The item was not removed from the scale as it was found to be not less than 0.30.
FINDINGS
In the study, the demographic distribution of the subjects was examined and 82.7% female, 17.3% male, 22% 18-25 age, 12si 26-33 age, 28%, I 34-41 age, 38% 42 and over age, 32.7% of the educational status secondary education(high school), 12.0% associate degree, 40.7% undergraduate, 14.7% postgraduate, marital status married 24%, single 72.7%, widow 1.3%, divorced 2%, Professional 24%, nurse
33.3%, midwives 28.7%, midwives 28.7%,health officer 0.7%, technician 1.3%, technician 6%, service duration less than 1 year; 8.0%, 1 year 1.3%, 2 years 4.0%, 3 years 4.7% 4 years and over 82.0%, occupation selection status, 82.0%, involuntary 18.0%, working method, continuous day, 96.7%, shift 3.3%, course, seminar, conference, etc. yes with 76.7%, 23.3% no, weekly working time, 40-45, % 81,3, 46-60, % 17,3, 61-80, % 1,3 they answered.
Table 2
Item-Total Score Correlation Values of the Stress Scale
Stress r P
Item1 0,596 0,000**
Item2 0,686 0,000**
Item3 0,593 0,000**
Item4 0,464 0,000**
Item5 0,511 0,000**
Item6 0,442 0,000**
Item7 0,694 0,000**
Item8 0,551 0,000**
Item9 0,707 0,000**
Item10 0,712 0,000**
Item11 0,560 0,000**
Item12 0,739 0,000**
Item13 0,610 0,000**
Item14 0,613 0,000**
When the Itemototal correlation values of stress scale were examined, it was determined that the Itemototal correlation values of 14 items on the scale were between 0,442 and 0,739. When item scores were examined, it was determined that there was consistency between the items.
Table 3
Results of the normal distribution of data
Kolmogorov-Smirnov
Statistic df p x Media n Skewnes s Kurtosi s
Stress 0,066 150 0,200 43,50 44 -0,211 -0,521
Table 4
Factors ItemNo Faktör Agirliklari Faktör Açiklayicilari Faktör Güvenirligi
ITEM1 0,608
ITEM2 0,686
ITEM3 0,610
ITEM4 0,429
ITEM5 0,503
ITEM6 0,415
ITEM7 0,709
ITEM8 0,531
ITEM9 0,720
Factor 1 ITEM10 0,724 37,627 0,868
ITEM11 0,559
ITEM12 0,756
ITEM13 0,597
ITEM14 0,616
Total 37,627 0,868
Kaiser-Meyer-Olkin 0,863
Bartlett - Ki kare: 715,02 5
Sd 91
P 0,000
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As a result of factor analysis, the stress scale of 14 items was grouped under one factor and this single factor explained 37.627% of total variance. (Buyukozturk, 2002) this can give us a good result when we apply factor load value at 0.45 or higher. But this does not mean that only 0.45 and higher values will be taken as a measure of this value can be reduced by up to 0.30 and emphasized that it will be suitable for a small number of items. Therefore, since the item under 0.30 was not removed, the Item was not removed from the scale. In addition, (Buyukozturk) explained that at least 30% and more of the variance may be sufficient.
One factor load values are shown in Table 5 with the phrases and expression are gathered under 14. This factor is called "stress and health worker".
Table 5
Stress and health worker
Factor 1: Stress and health worker Factor Load
1- Having a lot of work increases my stress. 0,608
2- Unable to communicate with the Chief increases my stress. 0,686
3- Excessive number of patients increases the stress. 0,610
4- Family problems increase my stress. 0,429
5- It makes me stress that I don't like my job. 0,503
6- I'm having trouble communicating with patients and their relatives. 0,415
7- The inadequacy of the number of employees is stressing. 0,709
8- I've got a lot of stress. 0,531
9- The lack of equal work distribution makes me stress. 0,720
10- The working environment (physical conditions, noise, light, etc.) makes me stress. 0,724
11- The attitudes of the patients' relatives make me stress. 0,559
12- Inadequate number of intermediate elements makes me stress. 0,756
13- The lack of understanding of the responsible supervisor makes me stress. 0,597
14- It makes me stress that my colleagues are unhappy. 0,616
Stress and factor load of health workers were found to be between 0.415 and -0.756.
Table 6
Analysis Results on The Differences of Participants' Participation In The Scale According to Their Gender __
Scale Gende r Levene
Test
n x Sd. F P T P
Femal e 124 43,77 10,8 0,571 0,451 0,632 0,528
Stress male 26 42,27 11,8
p>0,05
Hypotesis
Ho: stress perceptions of participants do not differ significantly from gender. FT H1: stress perceptions of participants differ signif-< icantly from gender.
® It was determined that the differences in the ? "stress" levels of the participants compared to their S gender were not statistically significant at 95% confi-^ dence level.
Ho: the stress perceptions of participants do not differ significantly from the marital status.
H1: stress perceptions of participants differ significantly from the marital status.
Table 7
Results of Analysis of Variance of Stress Levels of Participants According to Marital Status Variables _
Leven| e]Test F
Scale Marital Status n x Sd. Statisti cs P P
Stress Married 109 45,0 8 10,90
Single 36 38,7 5 9,57 0,596 0,61 8 4,56 2 0,004 *
Widow 2 55,0 0 7,07
Divorce d 3 35,6 7 11,96
*p<0,05
According to the one-way Anova test to determine whether the stress levels of the participants differ according to the marital status; the difference of the "stress" levels of the participants according to the marital status was statistically significant at 95% confidence level. (F=4,562 p=0,004, p<0,05). In order to determine which group of significant differences were related, Scheffe test was performed as a result of homogenization of variance from post hoc tests. According to the Scheffe test, the stress levels of the participants were I.Group 2.it was determined that there was a significant difference between the groups. Those who have been divorced marital status (X=35,67), single marital status (x=38,75), married marital status (x=45,08), marital status widow (=x 55,00) than those with lower.
Table 8
Results of The Participants' Differences in Gender Levels According to the Profession Selection Status___
Gender What's Your Job Preference?
Willingl y Involunta ry P
Female n 100 24
% 80,6 19,4 0,415
Male n 23 3
% 88,5 11,5
p>0,05
Ho: the answers to the question of choosing a profession among gender groups are not meaningful.
H1: the answers to the question of choosing a job among gender groups are important.
Chi-square analysis was performed to examine the relationship between the answers given to the question of what is your situation in choosing the profession according to the gender of the participants. According to the chi-square analysis, the relationship between sex and job selection is not statistically significant at 95% confidence level. (p=0.415;p>0.05). There is a low correlation between the participants ' gender and their choice of occupation (Cramer's v-0.077).
CONFIRMATORY FACTOR ANALYSIS (CFA) While the CFA analysis of the stress level scale was carried out, the subscale of the scale was F1= stress and health worker level, and the standard load values were below 0.50, Item4 and Item 6 questions were taken. As bardakoglu, Akgunduz and Alkan (2014)
stated in the study; the standard loads should be preferred for the validity of the scale. Stress and health workers' factors were changed from item 3 to Item 1 and Item 7 to Item 3 and Item 12 to Item 7.
Chl-tqun*!
Fig. 1: Stress CFA Path Diagrami Table 9
Measurement Models of Stress Scale
Item Standardized Loads t-value R2
Stres
Item1 0,50 6,20 0,250
Item 2 0,66 8,66 0,433
Item 3 0,57 7,20 0,322
Item 5 0,50 6,19 0,249
Item 7 0,68 9,07 0,469
Item 8 0,52 6,45 0,267
Item 9 0,76 10,59 0,582
Item 10 0,75 10,26 0,557
Item 11 0,54 6,84 0,295
Item 12 0,79 11,16 0,627
Item 13 0,62 8,04 0,385
Item 14 0,62 8,10 0,390
Stress and health workers (F1) with a coefficient of 0.79 on the lower dimensions of the stress scale and item 12 "lack of intermediate number of stress in me" variable was determined as the most effective variable.
Table 10
Fit Criteria Perfect Fit Acceptable Fit Values of the Developed Scale
x2/sd <3 <5 2,281
RMSEA 0 < RMSEA <0.05 0.05 < RMSEA < 0.10 0,092
SRMR 0 < SRMR <0.05 0.05 < SRMR < 0.10 0,06
NFI 0.95 < NFI < 1 0.90 < NFI < 0.95 0,866
NNFI 0.95s NNFI < 1 0.90< NNFI < 0.95 0,894
CFI 0.95s CFI < 1 0.90< CFI < 0.95 0,918
GFI 0.95 < GFI < 1 0.90 <GFI < 0.95 0,890
AGFI 0.90 < AGFI < 1 0.85 < AGFI < 0.90 0,831
IFI 0.95< IFI< 1 0.90< IFI< 0.95 0,920
RFI 0.95< RFI< 1 0.90< RFI< 0.95 0,826
(Source: Schermelleh-Engel and Moosbrugger, 2003). (RMSEA: Root Mean Square Error of Approximation, SRMR: Standardized Root Mean Square Residual, GFI: Goodness of Fit Index, AGFI: Adjusted Goodness of Fit Index).
As a result of the CFA analysis, it was determined that the items confirmed the related factors at a confidence level of 95% (p <0.05 p = 0.000) and that the compatibility of the model was the perfect fit value (X2 / df = 2,281 <3). Conclusion
The necessary literature survey was carried out in order to get feedback on the "stress" of the employees in the main child health care centers. In this study, it was aimed to develop a scale for evaluating the views of "stress" which is a subject that has been studied extensively in the literature. First, reliability and validity analysis were performed. Since the data were distributed normally, normal distribution analysis was applied. When the total correlation values of the stress scale were examined, the total correlation values of the 14 items on the scale were found to be between 0,442 and 0,739 because of the total correlation values of the 14 items on the scale were p<0.01. When the substance scores were examined, it was determined that there was consistency between the substances. In this study, reliability analysis, factor analysis, normality and homogeneity tests, t-test, chi - square analysis, oneway ANOVA and the frequency distribution is reviewed as a result of confirmatory factor analysis of the compatibility is the only factor worth it for the perfect fit (X2/df=2,281<3) was detected.
• -When analyzing the results of the analysis of the differences between the participants ' participation levels in the scale according to their gender, it was determined that the stress perceptions of the participants did not differ significantly compared to the gender.
• The results of the analysis of the differences between the participants ' stress levels according to the marital status variables were analyzed.
• When analyzing the results of the differences between the gender levels of the participants according to the Occupational selection status, 100 female participants responded voluntarily with 80.6 and 23 male participants responded voluntarily with 88.5. 24 female participants responded involuntary with 19.4 and 3 male participants responded involuntary with 11.5.
Factors causing stress and methods of dealing with stress: in practice, the center of family health of Eskishehir in the field of children's health Turkan Gecher
Southern University (IMBL)
Today, whatever the cause and source of stress, which occupies an important place in every aspect of our lives, has been in our lives since ancient times. Employees are facing organizational stresses such as stress caused by patients and problems in the workplace, heavy work load, communication problems with patient and patient relatives, lack of equal work distribution, lack of number of employees and so on. Stress, which affects human life significantly, causes extreme unhappiness, low productivity, increased absenteeism and psychological breakdown. In this study, it was aimed to determine the necessary actions to improve the quality of service by determining the methods of coping with stress of the staff working in the main Child Health Services of Eski^ehir family health centers and to establish the organizations necessary for the next stages. The stress factors and coping methods of the primary health care personnel, the Department of Business Administration of the beykent University Institute of Social Sciences, the Department of management of hospitals and Health Institutions, The Master's thesis survey
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scale were used. The family health centers in Eskisehir and in Eskisehir have formed the main Child Health Services. (Doctor, Nurse, Midwife, Technician, Technician, health officer) it was aimed to reach 190 health personnel and 150 people were reached. Each item of the scale is scored between 1 and 5 points. The scores of the employees who participated in the survey were evaluated between 10 and 50 points. The data obtained for this purpose were analyzed statistically. In this study, family health centers conducted a face-to-face interview based survey technique in the main Child Health Services. Keywords: Stress, factors that cause stress, coping methods,
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