Submitted in fulfillment of the requirements for the Master of Technology: Radiography degree, Durban University of Technology, Durban, South Africa, 2015. / Introduction Occupational stress has negative effects on both the organisation and individuals employed by the organisation. In the organisation it can result in high levels of absenteeism, reduced productivity and compromised levels of patient care. Furthermore individuals affected by stress may suffer from raised levels of tension, mental fatigue, insufficient sleep, anxiety, and anger. Interventions to prevent both organisational and individual effects of occupational stress may only be implemented once stressors in an occupa-tional group have been identified hence the need for the current study. Purpose The purpose of the study was to investigate occupational stress in diagnostic radiographers working in public healthcare institutions in the eThekwini District of KwaZulu-Natal using a quantitative research approach. Method A cross sectional survey using a validated questionnaire with some open and closed-ended questions was utilised. Radiographers working in public hospitals in the eThekwini District of KwaZulu-Natal were invited to parti-cipate in the study. Respondents were asked to answer 60 closed ended and four open ended questions. Open ended questions afforded the respondents an opportunity to express their opinions. Quantitative data was analysed using the Statistical Package for Social Sciences (SPSS) version 21.0. Inferential statistics included the use of reliability coefficients, correlations and chi square test at a 95% confidence level. Open ended questions were analysed using thematic analysis. Results One hundred and one questionnaires were administered and forty three were returned which resulted in a 43% response rate. The mean age of respondents was 31.7 years and 88.4% were females. The majority (67.4%) were in possession of a National Diploma in Radiography. Seventy two percent worked in regional hospitals. The majority (41.8%) were employed as chief radiographers. Most radiographers affected by stressors were those working in regional hospitals. The three main sources of stress in order of response were workload, faulty equipment and staff shortages. In addition, bullying, long and strenuous shifts as well as training of students were also found to be stressors. Physical exercises, counselling and wellness days were used to reduce stress whilst employment of more staff, attending to faulty equipment, team building, reducing workload, and improved working conditions were suggested as methods of reducing stress amongst radiographers. Conclusion Radiographers working in the eThekwini District were stressed by a number of factors in their work places. Radiographers suggested ways that can be employed to reduce stress in their departments. A close cooperation between radiographers; radiography supervisors; institutional, district and provincial managers is recommended in order to address the challenges faced by radiographers.

Submitted in fulfillment of the requirements for the Master of Technology: Radiography degree, Durban University of Technology, Durban, South Africa, 2015. / Introduction Occupational stress has negative effects on both the organisation and individuals employed by the organisation. In the organisation it can result in high levels of absenteeism, reduced productivity and compromised levels of patient care. Furthermore individuals affected by stress may suffer from raised levels of tension, mental fatigue, insufficient sleep, anxiety, and anger. Interventions to prevent both organisational and individual effects of occupational stress may only be implemented once stressors in an occupa-tional group have been identified hence the need for the current study. Purpose The purpose of the study was to investigate occupational stress in diagnostic radiographers working in public healthcare institutions in the eThekwini District of KwaZulu-Natal using a quantitative research approach. Method A cross sectional survey using a validated questionnaire with some open and closed-ended questions was utilised. Radiographers working in public hospitals in the eThekwini District of KwaZulu-Natal were invited to parti-cipate in the study. Respondents were asked to answer 60 closed ended and four open ended questions. Open ended questions afforded the respondents an opportunity to express their opinions. Quantitative data was analysed using the Statistical Package for Social Sciences (SPSS) version 21.0. Inferential statistics included the use of reliability coefficients, correlations and chi square test at a 95% confidence level. Open ended questions were analysed using thematic analysis. Results One hundred and one questionnaires were administered and forty three were returned which resulted in a 43% response rate. The mean age of respondents was 31.7 years and 88.4% were females. The majority (67.4%) were in possession of a National Diploma in Radiography. Seventy two percent worked in regional hospitals. The majority (41.8%) were employed as chief radiographers. Most radiographers affected by stressors were those working in regional hospitals. The three main sources of stress in order of response were workload, faulty equipment and staff shortages. In addition, bullying, long and strenuous shifts as well as training of students were also found to be stressors. Physical exercises, counselling and wellness days were used to reduce stress whilst employment of more staff, attending to faulty equipment, team building, reducing workload, and improved working conditions were suggested as methods of reducing stress amongst radiographers. Conclusion Radiographers working in the eThekwini District were stressed by a number of factors in their work places. Radiographers suggested ways that can be employed to reduce stress in their departments. A close cooperation between radiographers; radiography supervisors; institutional, district and provincial managers is recommended in order to address the challenges faced by radiographers. / M

Introduction: Amongst all public servants in Hong Kong, health care workers are one of the groups suffering from highest working pressure. They have long working hours and may have overnight shift duties, including Sundays or even public holidays. This may lead to poor job satisfaction, psychological stress and the recent high resignation rate in public hospitals. The aim of this study is to assess the prevalence of the psychological stress, psychological symptoms and job satisfaction of health care workers, the association between stress, psychological symptoms and job satisfaction; and also the factors associated with job satisfaction in a regional hospital in Hong Kong. Method: Health care workers in a large regional hospital of Hong Kong were surveyed by means of a questionnaire assessing basic demographic data, questions of the General Health Questionnaire (GHQ-12), Perceived Stress Scale (PSS), Warr-Cook and Wall job satisfaction scale (JSS). Four groups of health care workers (doctors, nurses, allied health workers and supporting staffs) were surveyed. Summary of descriptive statistics were calculated for each group to compare the prevalence of job dissatisfaction, perceived stress, and psychological symptoms. Two-stage analysis will be used. The first stage analysis will use ANOVA test to access the association between job satisfaction and different variables. The second stage analysis will use multivariate regression model to further assess the coefficient correlation of significant factors drawn from ANOVA test with job satisfaction. Results: There were 674 eligible questionnaires. About half (47%) of the health care workers reported having perceived stress and a third (33.8%) psychological symptoms. Doctors reported the (76.8%, 95% C.I = 69.43%, 84.17%) highest level of job satisfaction amongst all the health care workers surveyed. Among staff reporting a GHQ score equal to or more than three, supportive staff had significantly higher prevalence (38.7%, 95% C.I.=27.96%, 49.44%) and doctors the lowest prevalence (28.1%, 95% C.I.= 15.11%, 41.09%) of psychological symptom but proportions were compatible with their counterparts in other countries. The mean score for GHQ-12 was 2.41+/- S.D. 3.28. The overall mean perceived stress score was 18.14 with SD +/- 5.0. There was no significant difference when different subgroups were compared. The mean PSS scores of all subgroups were lower than their counterparts in other counties but were quite similar to the mean PSS reported during SARS period. Sixty eight percent of all health care workers surveyed were satisfied with their job (respondents indicating “moderately satisfied”, “very satisfied” and “extremely satisfied” on their overall job satisfaction). Values equal to or above 5 reflect being satisfied. The mean value for Job satisfaction was 4.58 +/-S.D. 1.21. The factors including shift duty, perceived stress, and psychological symptoms were negative correlated with job satisfaction. Factors such as clinical work, doctor and secondary school level were positive correlate with job satisfaction. Conclusion: Prevalence of perceived stress and psychological symptoms among health care workers were high when compared with the general population (14-17.6% for perceived stress and 28.1% for psychological symptom), but not as high as expected. In contrast to popular belief, doctors had the lowest perceived stress level, lowest prevalence of psychological symptom and the highest job satisfaction among different groups of health care workers. This may be related to higher income, social status and, education background that might help to protect them from depression and anxiety. Supportive staffs, who felt neglected by management, were found to have the highest prevalence of psychological symptom and higher stress levels. Nurses got highest prevalence of perceived stress. More attentions and resources should be devoted to these groups to cope with their psychological needs and stress. / published_or_final_version / Public Health / Master / Master of Public Health

Sub-Saharan Africa has the highest number of people living with HIV and AIDS in the world. Several studies that were carried out suggest that there is a negative impact of HIV and AIDS on the health sector. This impacts directly on health care providers as they are the first point of contact for ill people. This study seeks to explore the impact of HIV and AIDS on health care provision looking at the perception of health care providers. Qualitative methods were used for collecting data from the health care providers. Two focus group discussions were conducted and ten in-depth interviews were conducted in three health care facilities in Lesotho. Audio tapes were used to record the interviews and thematic analysis was utilized to analyse the data. The results showed that the workload has increased due the increased number of people who seek health care services. There is also a shortage of staff in facilities which leads to health workers having to work extra hours. The study further indicated that there is lack of knowledge among health care providers regarding the management of HIV and AIDS. Consequently, the health care providers fear the risk of contracting HIV from their patients. In addition, the results revealed that the poor infrastructure at the facilities hinder health care providers from performing their duties effectively. The other concern was the lack of support structures from the management. Furthermore, stigma and discrimination emerged as the major problems for providers as work and home. As a result, the health care providers are stressed and suffered from burnout. There is a need for further research on the impact of HIV and AIDS on health providers. Government should take more responsibility for encouraging students to enroll at health training institutes. The curriculum should include an emphasis on HIV and AIDS and workshops on HIV and AIDS should be held. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2010.

Submitted in fulfillment of the requirements for the Master’s Degree in Health Sciences in Radiography, Durban University of Technology, Durban, South Africa, 2017. / Introduction Work related stressors are identified as the main reason for the decline in patient care in Radiography in public hospitals. Radiographers opt to leave the public sector because of stressful experiences. Research has shown that the scarcity of qualitative studies on the phenomenon makes it difficult to understand work related stress in relation to radiography as a profession. Aim of the study The aim of the study was to explore and describe work related stressors in Radiography at a public hospital in Gauteng, South Africa. Methodology This study was a qualitative, exploratory, descriptive study. An interview guide was used to elicit information from 10 participants through semi-structured interviews. All the interviews were one-on-one and were audio-recorded. The data were analysed through Tesch’s eight steps of thematic analysis. Findings The following three themes emerged during data analysis, namely: personal well-being of Radiographers; decline in quality patient care and impaired radiography service; and, environmental enablers. The findings of the study revealed that the participants’ general health was compromised by various factors pertaining to work related stress. Conclusion Interventions necessary for dealing with work related stressors are highlighted as a way of enabling improvement of the working environment conditions. The participants in the study felt that hiring more staff could alleviate their work related stressors. The study has shown that it is also imperative that staff and management are constantly communicating well. / M

M.A. / This study looks into the types of stressors specific to the Emergency Medical Services. The study was undertaken over a period of two years with the following objectives: • A literature survey regarding stress, organisational stress in general and stress in the context of Emergency Medical Services in particular. • An investigation of the personnel of the Emergency Medical Services to ascertain the stressors perceived as stressful by them. • Recommendations on how to prevent or lower stress in the Emergency Medical Services. The first part of this study is devoted to a theoretical investigation which gives an overview of stress in its broadest sense as well as stress in organisations which includes cumulative stress/burnout. Critical Incident Stress and Post Traumatic Stress are also closely examined, as well as the personality characteristics of members of the Emergency Medical Services. The point of departure for the researcher is an ecosystemic perspective where objectivity itself is questionable. Therefore, qualitative research was called for and the transactional/interactional model of Richard Lazarus was used to categorise stressors. The research results suggest that what the Emergency Medical Service personnel perceive as stressful are mainly organisational stressors but they acknowledge that in the long term the continual dealing with death and trauma starts to take its toll. Criticisms that could be levelled against the study are that the results are only generalisable to the personnel of the Johannesburg Emergency Services, whose demographic characteristics and backgrounds differ, for instance, from those who work at Bryanston, or Pretoria. As the study relied solely on personal disclosure and observation the results can be seen as somewhat subjective in nature. What was communicated as stress-related events was what was perceived as stressful by the personnel as well as the researcher's subjective perception of whether certain events were perceived as stressful for the personnel. After working on the ambulance with these personnel for over three years, the researcher is an accepted part of their system, and became subject to the same blunting of affect and depersonalisation of victims as the Emergency workers. Over an extended period in time, it became harder to divorce the researcher from the "worker" while on duty, to maintain a scientific perspective and to write objectively. However, the findings of this study concur with those done by previous researchers on this subject such as Sparrius (1992) and Du Toit & Botes (1996).

Background: Despite the prevalence of HIV/AIDS stabilizing and slightly decreasing in certain provinces, there are a number of People Living With HIV/AIDS (PLWHA) in South Africa. Many people seek help at primary health clinics and hospitals and receive chronic care at these facilities. Caring for these chronic patients and new patients entering the health system can be stressful to the health professionals who are involved. Many studies that have been conducted have focused on the clinical aspects of individual patients, while few studies have focused on the experiences and stressors of health professionals looking after PLWHA. To ensure quality of care for patients with HIV/AIDS, it is important to understand the experiences of health professionals looking after HIV/AIDS patients and how stressful experiences may influence their attitude towards these patients. Aim: The aim of this study is to report the factors health professionals perceive as occupational stressors caring for people living with HIV/AIDS in the public health sector of the Nelson Mandela Metropolitan Municipality. Research design and Methodology: A quantitative, descriptive and non-experimental research design was followed. A pilot study was conducted to determine the clarity of questions, effectiveness of the instructions, completeness of the response sets, the time required to complete the questionnaires and the success of the data collection. The primary method of data collection was self-administered questionnaires. The questionnaires were dispatched to 30 health professionals at the public health facilities in the Nelson Mandela Metropolitan Municipality. A descriptive statistical analysis was done using a Statistical Package. This revealed the following findings. Findings: The following are the findings that were perceived to be occupational stressors: organizational factors, job design factors, career and promotional factors, role-related factors and cultural factors. iv Conclusion and recommendations: There are occupational stressors that affect health care professionals working in an HIV/AIDS setting. The following are the recommendations to rectify or to improve the situation: • Improve the communication of goals and objectives; • Redesign the job; • Human-resources development ; • Improvement of salaries; • Career planning and mentoring; and • Sensitisation of employees to cultural differences.

Electronic health records (EHRs) led to improvements in patient safety, care delivery, and efficiency; however, they have also resulted in significant increases in documentation time. EHR documentation burden, defined as “added work (e.g., documentation) or extraneous actions (e.g., clicks) performed in the EHR beyond that which is required for good clinical care”, has been linked to increased medical errors, poorer patient outcomes, reduced care quality, cognitive overload, and ultimately, burnout among clinicians. Relative to other clinical practice settings where patient flows are more predictable and of lower intensity, emergency department (ED) clinicians report markedly higher workload. Furthermore, EHR implementation research in the ED indicates that incongruities between EHR design and usability and the clinical workflow may intensify clinician workflow fragmentation. In our prior work, we identified workflow fragmentation, which we define as task switching, as one potential approach for evaluating documentation burden in ED practice settings. Yet, no standardized, scalable measures of documentation burden have been developed. Despite shortcomings, there have been increasing efforts to leverage information from EHR event logs as an alternative to direct clinical observation methods in evaluating user-centric behaviors and interactions with health information technology systems. Using EHR event logs, this dissertation aims to advance the study of evaluating burden by investigating EHR-mediated workflow fragmentation as a measure of EHR documentation burden among physicians and registered nurses (hereinafter interchangeably referred to as “clinicians”) in the ED. First, I review the literature on the existing quantitative approaches employed for measuring clinician documentation burden in clinical practice settings. Next, I explore EHR factors perceived to contribute to clinician documentation burden as well as the perceived role of workflow fragmentation on clinician documentation burden in the ED. Lastly, I investigate data-driven approaches to abstract clinically relevant concepts from EHR event logs for studying EHR documentation burden—culminating into a computational framework to evaluate ED clinician documentation burden in the context of cognitive burden. Collectively, the work conducted in this dissertation contributes computational methods that are foundational for investigating clinician documentation burden measurement at scale using EHR event logs, informed by current evidence and clinician perspectives, and grounded in theory.

The shortage of skilled professionals in the health sector has been an ongoing problem. This has resulted in poor service delivery and ultimately increased patient deaths. The primary objective of this study was to develop a conceptual model to retain scarce skilled professional workers in the health sector. An exploratory study was conducted which included both professionals and non-professionals in the pathology sector. Recruitment was done from a population of 207 employees. In total 188 employees responded, of which 116 were professionals and a comparator group of 72 being the non-professionals. The study was conducted in three phases. In the first phase, quantitative data collection methods such as the job diagnostic survey, career orientation inventory, organisational commitment questionnaire and intention to quit questionnaire were used to assess the characteristics of the groups of interest. The relationship between the independent and dependent variables were calculated. The results revealed that only a few of the traditional predictors influenced retention in the professional group. The predictors worked much better for the non-professional group. It was concluded that traditional retention strategies are not suitable to retain professionals in the health sector. The second and third phases utilised qualitative methods. The second part of the study related to identifying factors which retain professional staff. Following interviews with 15 professionals, ten themes were identified which relate to the retention of professionals. The third phase of the study consisted of interviews with 3 managers, and this was to determine what the managers can do to influence retention. A retention model for the professionals was then developed. This model not only contributes to the body of knowledge, but is also a useful managerial tool to manage professionals in the health sector / Graduate School of Business Leadership (SBL) / D.B.L. (Business Leadership)

While the mental health impacts of the COVID-19 pandemic on the general U.S. public health workforce have been well described, the effects of the COVID-19 response on Black, Indigenous, and People of Color (BIPOC) working in public health have not been adequately characterized. BIPOC public health professionals may have suffered, potentially, greater stress and more negative health impacts during the pandemic due to being part of communities experiencing severe COVID-19 health inequities and the potential for racism-related stress in the workplace. This study utilized a cross-sectional design to investigate the associations between risk factors/predictors and higher levels of burnout among BIPOC public health professionals working during the COVID-19 pandemic. Survey data was collected using the Qualtrics survey platform and SPSS was used for data analysis. Survey items measured multiple domains including professional experience (i.e., years of experience, job functions, hours worked, volunteer work), mental and physical health status (i.e., co-morbidities, BMI, COVID-19 diagnosis, insomnia, anxiety, depression, trauma, burnout), professional and personal stress (before and during the pandemic), and racism-related stress (i.e., discrimination, harassment, heightened vigilance, cultural taxation). Of the total respondents (n = 486), 80% experienced insomnia, 68.5% experienced depression, 81.7% experienced anxiety and 61.3% experienced trauma. BIPOC public health professionals suffered a moderately high overall level of burnout (mean = 2.578, SD = 0.486, min = 1, max = 3.9) and a high level of exhaustion (mean = 2.744, SD = 0.532, min = 1, max = 4). Paired t-tests found respondents’ physical and mental health status were each significantly worse during the pandemic (p < .000). Respondents also had significantly worse professional and personal stress during the pandemic (p < .000). Backward stepwise regression found higher burnout significantly predicted by: not having sought counseling; lower rating of mental health during COVID-19; higher past year mental distress (i.e., depression, anxiety, insomnia and trauma); higher past month perceived stress; and higher vigilance. These findings emerge as important in informing the public health field regarding the current and future needs of BIPOC public health professionals during the pandemic and beyond.