Introduction : To determine association between occupational stress and personality characteristics among nurses at Maternal and Child Health Clinic in the state of Malacca, emphasizing on type of personality and personal perception of stress.

Methods : A cross sectional study was conducted among 152 nurses of Maternal and Child Health Clinics in Malacca using self administered questionnaires and selected via multistage sampling.

Results : This study showed that a total of 28.3% of the nurses were found to be stressed. Almost half (41.2%) of those who perceived that they were stressed were likely to be really stressed (p = 0.004). Therefore those who perceived themselves to be stressed should be referred for stress evaluation and further management if necessary. However self-perception of stress cannot be used as a screening tool for stress due to its lack of sensitivity (56.8%) and poor Positive Predictive Value (41.2%). Majority of the nurses were of Guardians Personality Type (98%) and 72.4% of them had extrovert trait. However there were no significant associations between stress with personality type or characteristic, most probably due to the preponderance of one personality type or characteristic. Other studied variables such as socio-demographic factors (age, gender, ethnicity, religion, marital status, educational level, body mass index, type of work place, position, duration of service and poverty level) and social factors (placement, chronic medical illness, chronic care taker, smoking status and alcohol drinker) were suggestive of an association between them and stress but were not statistically significant.

Conclusion : There is no association between occupational stress and personal characteristics among nurses in Malacca

I Rosnah,

M.T Azmi,

English

UKM Journal Article Repository

Journal of Community Health 2008: Volume 14 Number 278ORIGINAL ARTICLEOCCUPATIONAL STRESS AND PERSONALITY CHARACTERISTICS: ARE THEY RELATED?I Rosnah,  M.T Azmi11Department of Community Medicine UKM Medical Centre.ABSTRACTIntroduction: To determine association between occupational stress and personality characteristics among nurses at Maternal and Child Health Clinic in the state of Malacca, emphasizing on type of personality and personal perception of stress.Methods      : A cross sectional study was conducted among 152 nurses of Maternal and Child Health Clinics in Malacca using self administered questionnaires and selected via multistage sampling.  Results         : This study showed that a total of 28.3% of the nurses were found to be stressed.  Almost half (41.2%) of those who perceived that they were stressed were likely to be really stressed (p = 0.004).  Therefore those who perceived themselves to be stressed should be referred for stress evaluation and further management if necessary. However self-perception of stress cannot be used as a screening tool for stress due to its lack of sensitivity (56.8%) and poor Positive Predictive Value (41.2%).  Majority of the nurses were of Guardians Personality Type (98%) and 72.4% of them had extrovert trait. However there were no significant associations between stress with personality type or characteristic, most probably due to the preponderance of one personality type or characteristic.  Other studied variables such as socio-demographic factors (age, gender, ethnicity, religion, marital status, educational level, body mass index, type of work place, position, duration of service and poverty level) and social factors (placement, chronic medical illness, chronic care taker, smoking status and alcohol drinker) were suggestive of an association between them and stress but were not statistically significant.  Conclusion  : There is no association between occupational stress and personal characteristics among nurses in Malacca.Keywords    : Occupational stress, personality typeCorrespondence to: Rosnah Ismail,Department of Community Health,UKM Medical CentreTel:  03-9145 6405, Fax: 03-91737825(e-mail: drrose@mail.hukm.ukm.my)Journal of Community Health 2008: Volume 14 Number 279INTRODUCTIONStress is part and parcel of the working environment and helps to keep the workers motivated.  But excessive stress can undermine performance and is costly to the employers.  It can also lead to increase in sickness absenteeism.  Occupational stress is defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker¹,².  However, personality characteristics should have some influence on stress appraisals and coping efforts².  Since different people react differently to stress, the effects of stress can be different for each of us. The available scientific evidence suggests that those who work in the healthcare setting, especially those with direct contact with and responsibility for patients, may be particularly at risk from work-related stress². Work-related stress has been associated with numerous negative psychological and physical responses².  The effect of such stress in those who work in healthcare are no less than those who work in other types of jobs e.g. managers and teachers³.  However, other effects of stress such as reduced productivity and sickness absenteeism are a real challenge to the quality of healthcare provision and may be a factor that determines the overall effectiveness of the healthcare systems.  Work-related stress in healthcare systems is a major challenge to the health of those who work in those systems, to the healthiness of their organizations and to the effectiveness of the health services that they deliver¹.  RESEARCH JUSTIFICATIONPerception of stress is highly subjective, and due to the complexity of nursing practice, it may result in variation in identifying the sources of stress by the nurses4.  Most studies agree that job stress resulted from the interaction of the worker and the conditions at work.  However, this study aims to demonstrate the association between personality type and job stress since the relationship between personality factor and stress was not emphasized upon in most studies.  The differences of individual characteristics such as personality and coping style enable us to predict whether certain job conditions will result in stress or not.  As stated earlier, what is considered as stressful for one may not be stressful for another. Identifying those with suitable personality characteristic and coping skills may lead to better prevention strategies that focus on the worker and identify ways to help them cope with demanding job conditions. Otherwise such chronic stress may lead to poor health or even injury.OBJECTIVEThe objective of the study is to determine the association between occupational stress and personality characteristics among nurses at Maternal and Child Health Clinic of Malacca state. The study will also determine the prevalence of occupational stress and its association with socio-demographic factors and perception of stress.METHODOLOGYThis was a cross sectional study involving a sample of 158 nurses working in Maternal and Child Health government facilities in Malacca state from 15th September to 15th November 2005.  They were taken via multistage sampling method with a required sample size of 130 respondents.  All the nurses were selected randomly from 16 Maternal and Child Health Clinics in two randomly chosen districts of Malacca.  Pregnant women and known cases of psychiatric problems already diagnosed by a certified Medical Officer or Psychiatrist were excluded from the study.  Self-administered questionnaires were used to gather the information.  There were 3 sections in the questionnaire; section A-sociodemographic,  section B- Life Stress Questionnaire5 and  section C- Personality Test: Keirsey Temperament Sorter6.  The Keirsey Temperament Sorter was used to differentiate four distinct temperament categories;  The Guardians (sensory judgment),  The Artisans (sensory perception),  The Rationals (intuitive thinking) and  The Idealist (intuitive feeling).  Journal of Community Health 2008: Volume 14 Number 280Those who scored 150 and more in Life Stress Questionnaire were defined as stressed5.  Data were analyzed by using SPSS Version 11.5.  Variables were analyzed appropriately according to the objective, type of data and its distribution.RESULTSA total of 158 questionnaires were distributed and 6 were not returned, giving a response rate of 96.2%.  All respondents were female.  Mean age was 36.4 ± 9.8 years old.  The youngest respondent was 21.8 years old and the oldest respondent was 55.1 years old.  The mean of the Body Mass Index (BMI) was 25.5 ± 4.8 kg/m². The lowest BMI was 16.9kg/m²; the highest BMI was 49.5 kg/m².    Table 1 showed that majority of respondents were Malays (93.4%), were Islam (94.7%), married (88.8%) and certified nurse (78.3%).  The respondents was comprised of Community Nurse (62.5%) and stationed at Health Clinic (80.3%).  Most of them (65.1%) were in service of less than 10 years and like their placement (95.4%).  94.7% of them were non care taker and had no chronic medical illnesses (87.5%).  Majority of them were not taking alcohol (98.7%) and non smoker (99.3%).  A total of 28.3% of the nurses were found to be stressed in comparison of 33.5% of them had self perception of stress. However cross tabulation of socio-demographic factors (such as age, ethnicity, religion, marital status, educational level, body mass index, type of workplace, position, duration of service, placement, chronic care taker, alcohol drinker, smoking status and chronic medical illness) by presence of stress were not statistically significant.  Further information can be found on the following tables.Journal of Community Health 2008: Volume 14 Number 281Table 1 Socio-demographic factors and stress among respondentsDemographic Factors Frequency Percents (%)Age 16 - 25.9 19 12.526 - 35.9 70 46.136 – 45.9 25 16.446 – 55.9 38 25.0Ethnicity Malay 142 93.4ReligionMarital StatusEducational LevelBody Mass IndexType of Work PlacePositionDuration of ServicePlacementChronic Care TakerSmoking StatusAlcohol DrinkerSelf perception of stressStressChineseIndianIslamOthersSingleMarriedPreviously marriedCertificateDiplomaDegreeUnderweightNormalPre obeseObeseHealth ClinicRural Health ClinicCommunity NursePublic Health NurseLess than 10 years10 years and aboveLikeDislikeYesNoSmokerNon smokerYesNoStressNo StressDo not knowStress PresentStress Absent611448131354119321844554512230955799531447814411512150518615431093.90.794.75.38.688.82.678.3210.75.328.936.229.680.319.762.537.565.134.995.44.65.394.70.799.31.398.733.556.69.928.371.7Journal of Community Health 2008: Volume 14 Number 282Table 2 Cross tabulation of Self Perception of Stress by Presence of StressStressPresent                AbsentTotal Test pSelf Perception of StressYesNo Total2141.2%1618.6%37           30      58.8%             70        81.4%      1005186137χ² = 8.27 0.004Sensitivity = 56%, specificity = 70%, PPV = 41.2%, NPV = 81.4%Table 3 Type of Personality among RespondentsType of Personality Frequency Percent (%)Keirsey TemperamentsGuardiansArtisansRationalsIdealistESTJ - The SupervisorsISTJ - The InspectorsESFJ - The ProvidersISFJ - The ProtectorsESTP - The PromotersESFP- The PerformersISTP & ISFP - The Crafters & The Composers692838142100045.418.425.09.21.30.70.00.00.0Traits       110 72.4ExtrovertIntrovert         42 27.6Table 4 Cross Tabulation of Personality Type by Presence of StressStressPresent              AbsentTotal Test pKeirseyTemperamentsGuardiansArtisans4228.2%133.4%10771.8%266.6%1493Yates Correction = 0.200.652Traits ExtrovertIntrovert3229.1%1126.2%7870.9%3173.8%11042χ² = 0.13 0.732Journal of Community Health 2008: Volume 14 Number 283DISCUSSIONPrevalence of stress among nurses (28.3%) in Table 1 was lower in comparison to the other studies7,8,9 which were 42.5%, 49.3% and 48.8% respectively but the prevalence of stress was more or less the same with another study on stress among paramedics in Pahang10 which had a prevalence of 29.2%.  Only the association between self-perception of stress and presence of stress was statistically significant (p=0.004).  Among those felt stressed, only 41.2% of them were truly stressed.  Those who didn’t felt stressed, 81.4% of them were truly not stressed.  It was noted that prevalence of stress absence was higher in all categories of self perception.  May be the instruments used were not sensitive enough to detect the stress among the respondents.  Moreover,  the variation between individual perception is most likely to arise from differences in personal factors, as personal ‘hardiness’ influences ability to cope, as do the levels of companionship and social interaction at work and also other contributing factors from outside of the workplace4.  We were unable to determine any common source of stress from the study as it did not look for other sources of stress such as workload/time pressure, inter- and intra-professional conflicts, discriminations, lack of reward/amount of pay, dealing with patients/their family and emotional pressure.  One possible explanation for the source of stress is that during the time of the study, the Alor Gajah and Melaka Tengah Health District Office were undergoing MS ISO certification; compliance audit and surveillance audit respectively.  Therefore, most of the staffs were under pressure to comply with the requirements and were unduly stressed.  Even if an attempt was made to identify the common source of stress, chances are we cannot since there would be a lack of commonality between nurses’ perception for the source of the stress 4.There had been many studies done on occupational stress in health care workers especially nurses focusing on relationship between occupational stress and variety of ailments / work characteristics / demographic and personal characteristics; but very little were done on personality type or temperaments in relation with occupational stress. Table 3 showed only two temperaments were identified among respondents.  Majority of respondents were of Guardians Temperament (98%).  The Guardians have security seeking personality.  Common values amongst Guardians are concrete in communicating and cooperative in implementing goal11.  They also can become highly skilled in logistics11.  The Supervisors (ESTJ) subtype consist 45.4% of them.  For this subtype of personality, they are practical, traditional, loyal, hardworking and exceptionally capable in organizing and running activities11.  On the other hand, the Artisans Temperament (0.02%) havesensation seeking personality, the common values are concrete in communicating and utilitarian in implementing goals11.  They also can become highly skilled in tactical variation11.  However, no significant association could be found between personality type and presence of stress due to the preponderance of one type of personality temperament in this population. It is not surprising since nursing, would attract certain types of personality resulting in lack of variability of temperaments.  In comparison to a recent study, the schizoid temperament display significant robustness in facing most job stressors and the melancholic type showed a similar pattern to a lesser degree12.  That study also showed that temperaments influences job stress significantly, it impact on stress with greater magnitude than age, gender, workload related stressors and job rank12.  SUGGESTIONSThis study confirmed that there is a significant association between perceived stress among nurses and presence of stress. Therefore thosewho perceived that they are stressed should be further evaluated for stress. If proven to be so, then they can be sent for stress management interventions to improve coping strategies, reduce personal difficulties and prevent family disharmony.  However self-perception of stress cannot be used as a screening tool for stress due to its lack of sensitivity (56.8%) and poor Positive Predictive Value (41.2%). Instead it could be used as a symptom for further evaluation prior to intervention. Available data, although sparse, suggest that the effectiveness of stress interventions at the organizational level is beneficial to both individual and organizational health14.  Work stress is current and future health and safety issue, and, as such, should be dealt with in the same logical and systematic way as other health and safety issue, as most people spend 25% of their adult lives working1. While stress at work will remain a major challenge to Journal of Community Health 2008: Volume 14 Number 284occupational health, our ability to understand and manage the stress is improving.  STUDY LIMITATIONSCross tabulation of socio-demographic factors and factors known to induce stress by presence of stress were statistically not significant even though there were differences in prevalence of stress.  It is probably due to small sample size.  The study design is cross sectional thus the possibility of reversed causality cannot be ruled out.  Weight, height, duration of service, income, personality questionnaires and stress scores were self reported – which can cause bias, due tounderestimation of stress and of the studied variables.CONCLUSIONNursing, like all professions, is based on the idea of service to humanity.  The practice of nursing involves altruistic behavior, guided by medical research and governed by a code of ethics.  They are also exposed to stress from various multi factorial stressors.  A total of 28.3% of the nurses were found to be stressed.  Socio-demographic factors and personality types were not associated with stress at workplace among the nurses.  Some of the results were suggestive of an association but they were not statistically significant.  Therefore a bigger study with a larger sample size and more comprehensive approach should be considered.  The only significant association is with perception of stress among nurses.  It showed that 41.2% of those who perceived that they are stressed were truly stressed.  Majority of the nurses were Guardian Personality Type (98%) and 72.4% of the sample were extrovert traits but there were no significant association between these personality type and traits with stress.  In conclusion, there is no association between occupational stress and personal characteristics among nurses in Malacca. ACKNOWLEDGEMENTWe wish to thank everyone who were directly and indirectly involved in the study especially Melaka State Health Department.REFERENCES1. National Institute for Occupational Safety and Health.  1999.  Stress … at work (internet) http://www.cdc.gov/NIOSH/html  (16 June 2006)2. Hall, D. S. 2004. Work-related Stress of Registered Nurse in Hospital Setting.  Journal for Nurses in Staff Development-JNSD20(1): 6-14. (internet) http://gateway.ut.ovid.com/gw2/ovidweb.cgi (14 July 2006)3. Smith, A., Brice, C., Collins, A., Matthews, V. & McNamara, R.  2000.  The scale of occupational stress: A further analysis of the impact of demographic factors and type of job.  HSE Contract Research Report311/2000(1): 1-72. (internet) http://www.hse.gov.uk/stress (24 June 2006)4. Mc Vicar, A.  2003.  Workplace stress in nursing: a literature review.  Journal of  Advanced Nursing 44(6): 633-642 (internet) http://gateway.ut.ovid.com/gw2/ovidweb.cgi (16 June 2006)5. Wisconsin Job Center. 2007. Life Stress Questionnaire. (internet) http://www.wisconsinjobcenter.org   (24 June 2006)6. David, Keirsey. 1998. Keirsey Temperament Sorter®-II (KTSII)(internet) http://www.keirsey.com (14 July 2006)7. Mazlan Razali & Noor Hassim Ismail.  2002.  Prevalence of stress among Registered Nurses in Hospital Tengku Ampuan Afzan Kuantan Pahang.   Thesis Master.  Universiti Kebangsaan Malaysia.8. Emilia Zainal Abidin & Noor Hassim Ismail.  2006.  A study on Occupational Stress and Coping Strategies among Medical and Surgical Ward Nurses in Hospital Universiti Kebangsaan Malaysia.  Thesis Master.  Universiti Kebangsaan Malaysia.9. Anza Elias & Noor Hassim Ismail.  2007.  Relationship between Stress and Burnout among Nurses in Hospital Universiti Kebangsaan Malaysia.  Journal of Community Health 2008: Volume 14 Number 285Thesis Master.  Universiti Kebangsaan Malaysia.10. Mohd Fikri Ujang & K.G. Rampal. 2002. Mental Health Knowledge and Stress Prevalence among Malaysia Ministry of Health paramedic in West Pahang. Thesis Master.  Universiti Kebangsaan Malaysia.11. Reinhold, C.R. 1997. MBTI & Myers-Briggs Personality Type Introduction –Personality Pathways (internet) http://www.personalitypathways.com/type_inventory.html (14 July 2006)12. Sakai, Y., Akiyama, T., Mikaye, Y., Kawamura, Y., Tsuda, H., Kurabayashi, L., Tominaga, M., Noda, T., Akiskal, K., Akiskal, H. 2005.  Temperament and Job Stress in Japanese Company Employees.  Journal of Affective Disorder 85(1-2): 101-112. (internet)http://gateway.ut.ovid.com/gw1/ovidweb.cgi (24 June 2006)13. Edwards, D., Burnard, P., Coyle, D., Fothergill, A. & Hannigan, B. 2000.  A stepwise multivariate analysis of factors that contribute to stress for mental health nurses working in the community.  Journal of Advanced Nursing 36(6): 805-813 (internet) http://gateway.ut.ovid.com/gw2/ovidweb.cgi (14 July 2006)14. Cox, T., Griffiths, A. & Gonzalez, E.R. 2000. Research on Work Related Stress.  European Agency for Safety and Health at Work (internet) http://osha.europa.eu  (24 February 2007)

Occupational stress and personality characteristics: are they related?

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