Stressors That Negatively Affect the Health of Radiology Professionals

Article Outline

• Abstract
• Résumé
• Introduction
• Literature Review
• Discussion
• Conclusion
• References
• Biography
• Copyright

Abstract 

Stress is one of the leading causes of mental and physical health problems in our society. This subject is nothing new to radiology professionals because of the constant exposure to various stressors. These stressors include staffing shortages, physical injuries, hospital violence, and diverse types of fatigue. Stressors are unique and personal to each individual, but they can also be applied to all radiology professionals and can correlate with health deficiencies. This paper examines research available on stress, and what stressors continuously affect the health of working professionals. To eliminate the negative effects of stressors, it is imperative for all health care providers to evaluate the bounds and risks to devise the most appropriate solution.

Résumé 

Le stress constitue l'une des principales causes des problèmes de santé mentaux et physiques de notre société. Le sujet n'est pas inconnu des professionnels des soins de santé en radiologie à cause des divers agents de stress auxquels ils sont constamment exposés. Parmi ceux-ci, on compte les pénuries de personnel, les blessures physiques, la violence dans les hôpitaux, et divers types de fatigue. Les facteurs de stress sont uniques et propres à chacun, mais ils s'appliquent certainement à tous les spécialistes en radiologie et viennent s'ajouter aux faiblesses de la santé. Ce document examine la recherche portant sur le stress et plus particulièrement, les facteurs de stress qui nuisent continuellement à la santé des spécialistes du marché du travail. Pour éliminer les effets négatifs du stress, il est impératif que les fournisseurs de soins de santé en évaluent les limites et les risques afin de proposer la solution appropriée.

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Introduction 

There is no calling more honourable than the ability to take part in saving or caring for an individual's life, as in the health care industry. However, this aptitude results in many different types of stressors for workers within the health care profession. One particular occupation in the health care setting that endures many health deficiencies from stress is the radiological science professional. In the context of this literature review, stress can be defined as “physical or psychological stimulus that can produce mental tension or physiological reactions that may lead to illness [1].” Gaining a better understanding of what these stressors are, whether direct or indirect, can help reduce the effects of these agents. With regard to this topic, it must be asked, “What are the stressors that negatively affect the health of radiology professionals?” By finding the answer to this question, measurable efforts can be made to reverse or alleviate the issues arising from stressors in this type of work environment.

There are many different types of stressors related to the health care field. These stressors are unique to each individual, but in some manner can be associated with most radiologic professionals' personal situations. One effect of stress was found in research showing that constant stress causes people to enter an immunodeficiency state earlier in life than nonstressed groups [2]. In a 6-year study, researchers found that caregivers produce high levels of proinflammatory cytokines, which are soluble proteins that help control the immune system. Because this substance is out of balance, it creates a situation whereby the body and immune system is older than actual age [2]. Other threatening physical effects include heart disease, hypertension, headaches, back pain, musculoskeletal disorders (MSDs), and overall fatigue. Furthermore, negative psychological effects of stress are well recognized. The inability to control temper, insecurities about oneself, anxiety, depression, and discontentment with an occupation are all byproducts of mental stress in the health care industry [3].

Job-related stressors are not new to the work environment, especially in the health care field. There has been very little research regarding stress issues in the area of radiology professionals [3]. Occupational stressors have been shown to be at the top of the list for causing work-related health issues, and it is imperative to explore the overlooked area of radiology [3]. Identification and education about stressors in this field will allow workers to acknowledge these negative influences and to take appropriate actions to redirect or modulate the effects.

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Literature Review 

Staffing issues are one of the major contributors of stress for radiology professionals. Inadequate personnel for radiology departments are explained by Raj as being either a quantitative or a qualitative stressor [3]. When the workload is too much for a department or they have not been given ample time to complete job duties, the situation becomes stressful. This is an example of a quantitative stressor. An editorial article reports that, “staff need to feel they have some control over their workload, and can organize this to maintain an acceptable and recognized quality of care [4].” This is supported by Demmer, who stated that dissatisfaction with work role and workload may cause staff to avoid patients because of increased burnout [5]. Personnel who are not given the resources or adequate time to provide optimal patient care see results rooted in stress from inadequate management and discontentment with limited patient care.

Qualitative stressors arise when staff members believe that they do not have proper training in a particular area of placement [3]. An example of this would be if a radiology technologist were asked to perform fluoroscopy in an invasive surgery case for which that individual had never been trained. Another example would be if a radiographer not trained in computed axial tomography (CAT) or computed tomography (CT) were asked to perform a diagnostic CT scan to fill in during a staff shortage. In both cases there would be high expectations from doctors that the radiographers perform efficiently and effectively. Whether considering quantitative or qualitative failure, stress becomes an issue when role conflicts and undue working strain take place [3], [5].

Another staffing problem within radiology departments is “role ambiguity [3], [6].” Imaging personnel that do not have clear and precise direction on how they are to conduct themselves on the job can become stressed and confused. Eventually these conditions can lead to friction between an employee and employer. Landsbergis reported that lack of clear job definition, responsibilities, and roles was a major contributor to stress and burnout [7].

A radiology professional is exposed to numerous contractible diseases from patients every day. According to the United States Department of Labor's Bureau of Labor Statistics, stress-induced injuries, or MSDs, still outnumber communicable diseases contracted by employees from encounters with patients by 40 times [8]. MSDs are epidemic injuries associated with sprains and strains to any of the 430 skeletal muscles that make up the human body; approximately 2 million Americans experience them each year [8]. Damage (in this case, known as a microfailure) usually starts with a minor tear in an overexerted muscle and, after repeated episodes of intense physical work, becomes extremely painful. Eventually inflammation, muscular microtrauma, and scar tissue will develop [8]. The stressful physical lifting of patients during procedures can cause these occupational injuries. Action should be taken to train employees regarding the proper way to lift and manipulate patients.

Obese patients are also associated with the MSD stressor. Obesity in the United States (US) is one of the major contributors to acute and chronic injuries to technologists when performing diagnostic studies [9]. During the process of manipulating patients for appropriate positions, 83% of technologists have reported painful injuries afterward [9]. This is supported by the fact that in the US 66% of adults are obese, with children comprising a similar alarming statistic [9].

MSDs are related not only to physical but also to psychological stressors. Similar to the immune system losing strength when a person is stressed, muscles lose their ability to mend after a minor injury [2], [8]. The source of this problem may be the production of a high amount of cortisol [8], a glucocorticoid stress hormone created by the body in stressful periods. Cortisol is released into the blood, causing a decrease in the ability of a muscle to repair itself [8]. With repetitive tasks resulting in these injuries, there is a buildup of stress on the muscles. The once-minor injury progresses into serious chronic damage because of the body's inability to repair and regenerate itself. In this particular situation, a physical stressor causes a psychological stressor and vice versa. Unfortunately, both complement each other, initiating a cascade effect on the health of the individual.

The perception that the hospital atmosphere is a safe place for individuals to come to seek help or for workers to be employed is far from the truth. Racette reported a radiology technologist stating that “a lot of health care workers have the attitude that nothing bad can happen to them at work because they are doing good by helping other people [10].” Statistically, it has been confirmed that violence, especially in the emergency room (ER), is an important stressor that causes lethal as well as nonlethal outcomes. Violence in the ER setting is defined by Racette as “aggression that includes behaviour with intent to harm another, whether or not harm actually occurred, or with willful blindness as to whether harm would result. Such behavior can be physical or verbal, active or passive, and may involve psychological and emotional tactics [10].

The US Bureau of Labor Statistics reported that approximately 1000 workers die annually as a result of workplace violence [10]. Health care workers constitute the majority of the nonlethal category, with a number exceeding 20,000 episodes per year [10]. More importantly, there are certain aspects of a health care facility that make it a highly stressful and dangerous working environment, as described below:

It is evident that these violent acts toward radiology professionals can be perpetrated by patients, family members, or individuals with no association with the hospital facility. In a study performed in a metropolitan hospital, 106 ER staff members were asked to complete a survey to provide a better understanding of their experiences and reflections on violence as a stressor. Violence as a stressor was defined by respondents as certain events that they had experienced. Of the respondents, 76% reported that they observed verbal abuse, and 86% were eyewitnesses to physical threats or assault [11]. Also, 92% had been verbally battered and physically assaulted, with 97% reporting physical threats [11]. These statistics are alarming, especially given the percentages of frequency. During a regular work week from the previous year, 84% of health care workers confirmed that they had experienced verbal violence every day that they worked, and 90% were verbally mistreated a minimum of 4 instances per month [11].

Although the major stressor, physical and verbal violence, is not reported in many instances, the statistics available are still unnerving. Sadly, it has been shown that violence in civilization is climbing in numbers and in severity [10], [11]. Violence, for radiology personnel, can include psychological ramifications affecting their well-being [10]. Workers who have experienced hospital violence inflicted by patients remember these incidents and usually develop a fear of reoccurrence [10]. This may result in an inability to perform normal duties because of feelings of uselessness and lack of power, possibly resulting in a career change or a long leave of absence. Racette further states that workers may have problems with sleeping habits, which could cause different types of fatigue [10].

Fatigue is another major symptom of working in the health care field. In many other professions, responsibilities and physical labour are limited and are regulated to relieve fatigue and its negative effects on society. For example, interstate truck drivers are limited to the number of hours they can drive because of the increased risk of accidents resulting from fatigue. Fatigue has also affected the field of medicine, causing patient care errors and earning the label of “the Achilles heel of the medical profession [12].”

The well-being of radiology professionals is disrupted when sleep deficiencies are caused by lengthy working shifts and the normal human biological cycle of sleep and awake time is disurbed [12]. These effects influence not only an individual's ability to work proficiently, but derails that individual's outside life and family relations. An analysis of residents in the last 30 years provided data showing that fatigue caused by long working hours aggravated mood and escalated disparity, anxiety, uncertainty, and antagonism [12]. All of these factors contribute to disruption within oneself and interaction between others.

Josten et al conducted a study of 134 nurses, which revealed that longer shifts cause more fatigue, health problems, job dissatisfaction, and amount of time away from work [13]. With just a 1-hour increase in the workday, nurses working 9-hour shifts typically experienced a higher percentage of the common side effects noted previously [13]. Of the participants, 80% favoured no more than an 8-hour working shift [13]. Typically, other health care workers along with radiology staff have workdays comprising prolonged hours. Most often, there is a period of time when these medical workforces have to be on call [12]. This contributes to a routine that is much longer than the more favourable 8-hour workday. With an addition of on-call schedules, the worker is unable to experience sleep that is undisturbed. This can cause an individual to simulate a state of alcohol intoxication comparable to a blood alcohol concentration of .10 percent [12]. Since 1980, the workload in the health care field has increased tremendously, and, as a result, protracted working shifts are not as feasible as they once were [13]. In the beginning of the 8- and 9-hour workday study, the researchers proposed a hypothesis that longer working hours would result in a positive outcome of more days off for the nurses. However, it was found that the approval rating was low, because lengthy shifts inevitably meant more fatigue for the workers, and, therefore, recuperation was the focus of the extra time off [13].

Evening and night employment is also a significant cause of fatigue. It is similar to the extended shift outcomes, in that there is a disturbance of the sleep cycle of workers [14]. In the US, approximately 6 million people work an evening shift, and 5%-10% have “shift-work sleep disorder [14].” This ailment is characterized by difficulty staying awake during the working night and restlessness throughout the day when sleep is needed [14]. The radiology professionals that are included in this group of workers miss experiences with their families, causing them to feel grief and isolation. Eventually this disorder can lead to numerous absent days from work, resulting in termination. Physical effects include increased ulcers, accidents caused by falling asleep, lethargy, and melancholy [14].

Wright explains that lengthy and late night shifts limit an individual's participation in social and relaxing events outside of their work. This lack of social interaction may lead to frustration [15]. The inability to vent and escape from the emotional affects of working in the hospital environment can result in “compassion fatigue,” defined as an outcome of mental exhaustion that is not resolved with sleep [15].

There are many emotions that have to be expressed or even suppressed in the health care service to supply the finest care. A good example is health care workers empathizing with patients to instill confidence and trust. This can be described as emotion work, which can cause fatigue, despair, and psychological issues [16]. The job of controlling one's emotions while having to orchestrate them with another's results in emotional fatigue. An example of this is the radiology professional's duty to evaluate and to be receptive to patients' feelings during sensitive situations [16].

The stressor most influential on emotional fatigue is workers misrepresenting their true states of mind during tasks between themselves and patients. This situation is called emotional dissonance, and, with heavy repetition—as in radiology departmental interactions—it can cause estrangement of their thoughts and consequently be the basis of becoming emotionally distraught [16]. Often a problem, repression of emotions will be detrimental to the psychological health of these workers.

From this literature review, it is clear that multiple stressors exist that affect the well-being and performance of radiology professionals. Staffing issues, lack of training, and role ambiguity can seriously affect patient care. Stress arising from exposure to infectious diseases, difficult patients, physical injuries, and workplace safety can shorten job tenure and negatively affect interpersonal relationships. Emotional and physical fatigue can erode relationships and the ability to maintain professional standards.

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Discussion 

All of the stressors discussed here can be interconnected from many different perspectives. Emotional work can be heightened by mismanagement. For instance, if a radiology technologist is required to perform a heavy workload because of staffing setbacks, that individual's ability to display appropriate professionalism and to handle intricate interactions with patients becomes difficult, and a higher level of emotional dissonance is demonstrated. According to Raj [3], Demmer [5], Clark and Goetz [6], and Landsbergis [7], staffing issues are a major contributor to increased employee burnout. Their findings suggest that employers should give considerable attention to employee roles and workload. If any given stressor discussed affects someone, it can cause chemical irregularities and subject the body to taxing physical injury and illnesses. Important effects of employee stress are MSDs, with their high incidence rates and increased costs to employers [8]. Relatively simple training of staff to avoid these injuries could prevent health care institutions from unnecessary spending, and employers might also consider implementing employee health programs to deal with stress-related obesity and mental health issues. In the event, or risk, of a violent act toward radiology personnel, the creation of an overwhelming mental stressor can cause the inability to sleep, work competently, enjoy time away from work, and thereby enhance susceptibility to other stressors. One stressor can instigate a disastrous landslide of other stressors, resulting in diverse negative effects on an individual such as a radiology professional.

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Conclusion 

Currently there are continuous, important studies being conducted on stressors and their physical and psychological effects on workers. Although some of the material used for the preparation of this paper is now dated, a comparison with more current studies show that there are few data on the subject of radiology professionals, and the existing data and similarities in other health care professions contained in this research make it clear that these health care professionals experience considerable stress. Many of these stressors may go unnoticed, because they are viewed simply as part of the chosen career. Management problems, staffing issues, physical or mental damage, hospital violence (verbal or physical), and fatigue are all stressors that need to, and can, be acknowledged. Through this research, the capability to recognize these stressors will allow radiology professionals to make the appropriate adjustments to lessen the ill effects that such stressors can cause. After all, the first step to solving a problem is knowing and acknowledging that there is one.

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References 

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