The Development of a Theoretical Framework on Work Related Stress in Health and Social Care Professionals who Manage Behaviours that Challenge

Rippon, Daniel (2018) The Development of a Theoretical Framework on Work Related Stress in Health and Social Care Professionals who Manage Behaviours that Challenge. Doctoral thesis, Northumbria University.

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Abstract

Providing direct health and social care services to people who exhibit behaviours that challenge can be a highly stressful occupational demand. Existing literature has suggested that health/social care professionals who work in settings such as Mental Health, Dementia Care, Autism and Learning Disability services could be prone to encountering incidences where care recipients exhibit behaviours that are perceived as being challenging. There are a number of existing occupational stress theories. However, none of these theories have been developed specifically to explain the conditions under which stress occurs for frontline health/social care staff who are required to manage incidences of behaviours that challenge in their role. Thus, the primary aim of this thesis was to develop a theoretical framework that illustrated the causes of and protective factors against work related stress in frontline staff who provide care for people who exhibit behaviours that challenge.

In the current research programme, an exploratory sequential mixed methods research design was employed to enable the development and investigation of a theoretical framework on work related stress and the management of behaviours that challenge. The initial phase of this project comprised a Grounded Theory study, which led to the development of the Therapeutic Engagement Stress Theory (TEST). TEST illustrates how an interplay of organisational factors, work place environments, colleagues, service users and qualities intrinsic to health/social care professionals can impact the capacity for frontline staff to therapeutically engage with care recipients who exhibit behaviours that challenge. The core category within TEST indicated that the extent to which health/social care professionals are able to engage therapeutically with care recipients, who exhibit behaviours that challenge, can determine the levels of work related stress experienced.

The subsequent aims of this thesis was to investigate the TEST framework using appropriate Quantitative methods. This was to ascertain if the capacity to therapeutically engage with care recipients, who exhibit behaviours that challenge, could genuinely influence the levels of work related stress experienced by frontline health/social care professionals. It was also necessary to investigate if the TEST model could be used effectively in applied settings to tease out the work related factors that could either facilitate or inhibit frontline staff to therapeutically engage with care recipients who exhibit behaviours that challenge. Thus, the next phase of the mixed methods research programme involved operationalising each of the categories and core category, within the TEST model, using pre-existing quantitative measures. Quantitative studies were conducted to investigate specific components of the TEST model in a sample of mental healthcare professionals who provided direct services to people who exhibit behaviours that challenge. It was observed that factors such as work place settings, quality of professional relationships with care recipients and propensity to have repetitive negative thoughts could influence stress levels experienced by mental healthcare professionals through affecting their capacity to engage therapeutically with patients.

Further exploration of the TEST model was conducted to investigate work related stress in professional dementia carers who provided care for residents within Nursing Home settings. It was observed that the capacity to engage with residents who have Dementia fully mediated a positive correlation between the fear of being negatively evaluated by colleagues and perceived work related stress. Higher levels of perceived organisational support were also shown to correlate with lower levels of stress being reported by professional dementia carers. However, a non-significant correlation was observed between perceived organisational support and capacity to engage with residents who exhibit behaviours that challenge.

Finally, a study was conducted to demonstrate the extent to which professional dementia carers are vulnerable to the deleterious consequences of chronic biological stress as ascertained through analysis of hair cortisol concentration. It was observed that professional dementia carers, who manage behaviours that challenge, had significantly higher levels of hair cortisol concentration in comparison to people who work in University settings and students studying at undergraduate level.

This research project has provided novel contributions to existing literature through development and investigation of a theoretical framework using a robust mixed methods approach, in order to optimally understand the articulated experiences of health/social care professionals regarding stress and the management of behaviours that challenge.

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