Occupational stress, coping, burnout and work engagement of hospital pharmacists in South Africa
Malan, Agatha Madeleine
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The environment in which hospital pharmacists currently function demands more of them than did any previous period. Employees in pharmacy companies have to cope with the demands that arise from fulfilling various roles, as well as with increased pressures such as managed health care and primary health care. Tracking and addressing their effectiveness in coping with new demands and stimulating their growth in areas that could possibly impact on the standard of pharmacy services are therefore of great importance. The first step in the enhancement of the work-related well-being of hospital pharmacists is the successful diagnosis of occupational stress, burnout and work engagement. However, in order to measure these constructs, it is important to use reliable and valid instruments, and at the same time take biographical differences into account. The objectives of this study were to validate the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Utrecht Work Engagement Scale (UWES) and the Pharmacist Stress Inventory (PSI) for hospital pharmacists in South Africa, to assess the effect of biographical factors on the levels of burnout, engagement and occupational stress, and to investigate the role of job stress and coping strategies in the work-related well-being (burnout and work engagement) of hospital pharmacists in South Africa. A cross-sectional survey design was used. The study population consisted of an accidental sample (N = 187) of South African hospital pharmacists in both public and private hospital facilities on a national basis. The MBI-HSS, UWES, PSI, the Coping Orientation for Problem Experienced (COPE) as well as a biographical questionnaire were administered. Descriptive statistics, Cronbach alpha coefficients, confirmatory and exploratory factor analyses, multivariate analysis of variance (MANOVA), one-way analysis of variance (ANOVA), t-tests and multiple regression analysis were used to analyse the data Confirmatory factor analysis by means of structural equation modelling of the MBI-HSS, confirmed a three-factor model of burnout, consisting of Emotional Exhaustion, Depersonalisation and Personal Accomplishment. The scales showed acceptable reliabilities. The results indicated that 35% of the hospital pharmacists showed high levels of emotional exhaustion, while 25% showed high levels of depersonalisation. Biographical factors such as age, years in pharmacy practice, home language, average number of hours worked per week, as well as the level of job satisfaction were related to the burnout levels of hospital pharmacists. Exploratory factor analysis of the UWES resulted in two factors, namely Vigour/dedication and Absorption. These factors showed acceptable Cronbach alpha coefficients. In the same sample (but in a different analysis where the two factors were used separately), it was indicated that compared to a South African norm, 38,5% and 48,9% of the hospital pharmacists showed low levels of vigour and dedication respectively. Position, home language, and the educational level were related to work engagement of hospital pharmacists. The PSI was developed as a measuring instrument for the purposes of this study. Three internally consistent factors, namely Job Demands, Pharmacy-Specific Stressors and Lack of Resources were extracted. The level of severity of the various stressors was calculated and the unavailability of medicine proved to be the most severe stressor. Other severe stressors included frequent interruptions, co-workers not doing their jobs, workload and insufficient salaries. Finally it was investigated whether job stress and coping strategies could predict the work related well-being of hospital pharmacists in South Africa. The results showed that job stress (as a result of job demands and lack of job resources), as well as three coping strategies (approach coping, avoidance coping and turning to religion) predicted burnout and work engagement of South African hospital pharmacists. Recommendations for future research were made.