THE INFLUENCE OF CARE WORKERS’ ATTITUDE TO DEMENTIA AND COPING STYLES ON OCCUPATIONAL STRESS

Introduction
In most long-term medical facilities, care providers carry out complex jobs, providing care and support to their dementia patients, enduring psychological and emotional needs as well as meeting the needs of their family members. Sometimes, nurse Assistants and personal carers in the nursing care facilities are engaged for lengthy hours, with low salaries, and poor compensation benefits (Pitfield, Shahriyarmolki, & Livingston, 2011). With such working environments, health practitioners in nursing facilities are often subjected to a lot of stress.

Ideally, the quality of health care in the facilities lies in the ability of the care workers to deliver superior services and so the need to take care of their welfare. Further, the connection between patient and caregivers is a critical feature of quality care as it dictates the patient wellness outcomes and the care worker performances. Consequently, stressors experienced by health workers do not only affect them but also extend to service recipients (Downs & Bowers, 2008). Of interest to the current research are the stress levels that care workers working with dementia patients go through. The study investigates the influence of work related stress and attitudes to dementia of care workers on job satisfaction. The study is based on the perspective that most care givers for dementia patients undergo stressful working environments that requirement improvement of the conditions.

Background of the Study
Dementia is the term used to refer to a wide range symptoms resulting from brain disorders. Dementia has significant effects on behaviour of the patients, the patient’s daily work routine and thinking. A person’s social lifestyle and working life is altered by dementia beyond a person’s normal operation. The severity of dementia may be to the extent of incapability to cope with daily activities which result from a decrease in cognitive ability. Dementia diagnosis by doctors is based on a number of significantly dysfunctional cognitive functions. Diagnosis is administered in the cases where a patient suffers from more than one cognitive function impairment (Alzheimer’s Association, 2013). The most commonly impaired cognitive functions affected are; judgment, message understanding, memory, spatial skills, attention, and language skills. Changes in personality may also be a dementia symptom. However, changes in personality mainly depend on the section of the brain that the disease resulting from dementia has impaired.

Anybody may be a victim of dementia; however, the older people are more prone to dementia than younger people. The cause of dementia should however not be understood as a disease of the aged but is caused by brain infection. Dementia inheritance happens in rare cases where it is caused particularly by mutation of a gene that causes the disease (Alzheimer’s Association, 2013). Other factors relating to a person’s health practice and lifestyle are known to have an impact on the risk of the disease acquisition. Physically dormant people, mentally dormant people and, people suffering from untreated high blood pressure and other factors relating to vascular dangers are at high risks of being affected with dementia. Dementia affects people in many forms.
Vascular dementia is caused by the impairment of the blood vessels located in the brain, which result from either numerous gradual mini-strokes or a single stroke (Prince, Guerchet, &Prina, 2013). Alzheimer’s disease on the other hand results from systematic deterioration of cognitive abilities. These declines in the cognitive abilities in most cases begin with impairment of the memory loss. It is the most rampant infection which accounts for over 60 percent of dementia cases (Alzheimer’s Association, 2013).

In a complex setting such as dementia residential or care home, care workers need the coping resources to regulate their physical and psychological resistance to stress. This aims to improve the problems encountered by care workers and to maintain productivity in their stay in this prolonged care setting (Gottlieb & Wolfe, 2002). However, KneeboneandMartin, (2003) suggested that although care workers experience different stressors while caring for dementia patient, their ability to cope efficiently may vary due to past negative experience encountered.

Occupational stress understanding and psychological health concept have a wide historical study. Stress is a general term that refers to a condition originating from a negative physical health or psychological health or both cases that may result in a person’s discomfort within his/her environment (Johnson et al., 2005). Stress may be an external catalyst, demand or load resulting from a situation, condition or event that has potentially harmful effects on an individual’s wellbeing. Mental stress is the reaction of a person to environmental stimulus that affects his/her physiology or psychology. Stress occurs when strain reactions are generated by an organism as a reaction to a specific event, condition or situation (AbuAlRub, 2004).
The body of a human being is naturally active to demand or threat and the reaction is displayed through a chemical response. This response generates an abnormal behaviour known as the strain. The body gradually regains its initial state after the threat or demand has been withdrawn. In the workplace, the workers are overloaded with tasks exceeding their ability and even with increased effort they still cannot manage the tasks (AbuAlRub, 2004). The overload provokes an anxiety and their heartbeat is gets faster due to their incapability to manage their workloads (Johnson, et al., 2005). The overall result is strain which may include; chronic headache (insomnia) and high blood pressure.

Direct care workers are the basic providers of services to the disabled and elderly people; they help these people with a wide variety of their daily needs by giving support to them. The support services include; getting about (moving around), adhering to scheduled daily activities, bathing, preparations of meals, dressing, and medical support (Munn-Giddings, &Winter, 2013). The care workers are vital in the enhancement of the lives of the less advantaged groups. Their attitudes towards the service to their clients are of great importance as it influences their ability to deliver quality to the needy people. Their continued support makes their client’s lives significant with regard to their interaction and connection with their families, community, and with their environments.

Based on the particular service they provide, the direct care workers may include; nurse aides, homecare and personal aides, and home health aides. There has been a notable deficit of the care workers workforce due to the increase in the demand for their services from the recent past until now (Prince, et al., 2013). There is however a considerable growth of the care workers in the health cares setting but still not sufficient to sustain the available demand. There is therefore the need to put in place mechanisms of attracting additional direct care workers in the current situation and in the future. The qualities of services provided by the care workers are mainly dependent on the socio-demographic attributes; some of their characteristics include; Most of them are less educated and have little household incomes. In addition to that, many of them have formerly utilized public assistance programs to great extents.

Based on the economic and educational status, immigrants, females, racial, and ethnic minorities are highly recruited in the workforce. The huge part of the labour pool is represented by immigrants owing to their higher level of education in comparison to their non-immigrants counterparts and also their anticipated ability to assist in reducing the labour deficit in the health care setting. Due to language barrier, immigrant direct care workers experience difficulties in their work compared to the native-born direct care workers. Many caregivers have a huge task of uniformly addressing care giving at the workplace and in their homes. This may possibly result in increased levels of stress and frequent absence from work (Munn-Giddings, et al., 2013).

The basic care providers are obligated to offer important support to people suffering from dementia. The General Practitioners perform services which include post diagnosis follow up activities that are aimed at continued provision of care and strategic arrangement and organization of accompaniment for their clients and their carers (Schoenmakers, Buntinx, and DeLepeleire, 2010). On the other hand, community nurses specialize mainly in dementia diagnosis and rendering skills and expertise. Both the caregivers are in most cases the relied upon providers of primary services to the dementia infected clients. The caregivers are the front runners in patients’ assessment and the immediate consultants for advice relating to care giving services.

The expert functions in the profession may be badly off even though the caregiver’s ability in the field is widely accepted. There have been major disagreements between the society’s needs regarding the profession and what is readily provided by the care givers. Task doubts and opinion disagreements among the caregivers have been the major causes of stress in the profession. The expectations of family doctors of what can be offered by general practice to aged people with dementia are below the anticipated levels (Schoenmakers, et al., 2010). If the caregivers trust that dementia results in unavoidable incoherence and incontinency, they are likely to be disregarding on accomplishment of the carers and patients’ demands.

The attitudes of general practitioner to dementia handling have been ignored in the past. This has been evident basing the argument on the reaction obtained from majority of General practitioners. They claim that the training on dementia handling with regards to diagnosis and dealing with it is not adequately administered (Munn-Giddings, et al., 2013). Attaining determinate diagnosis, absence of information of support services other than medical service, and ineffective treatment techniques of dementia are some of the regions of handling in the profession that generate ill-defined anticipation among caregivers.

Patients under dementia are not given sufficient basic care which they need the most. The insufficiency in the service rendering have been said to be caused by inexact and slow diagnosis of the disease. The patients’ access to the service has been made retarded and as a consequence it has resulted in deteriorated care giving service. Carers experience difficulties in obtaining care givers service and allege that General practitioners are not sufficiently meeting the health needs of the patients (Rosness, Haugen, &Engedal, 2008). The carers claim that the GeneralPpractitioners fail to perceive the illness, precisely depression, in the carers and their clients. They report from their observations that the family doctors have pathetic skills on dementia management, most of them trust that they have limited information on the progressive and the inveterate nature of the disease. General practitioners have the tendency of disregarding the service urgency and keep deferring the action until the patient’s immediately concerned people intervene.
General Practitioners experience intense levels of occupational stress. The factors resulting to such stress include; handling complicated patients, abnormal anticipations of their task by their clients and relatives, inquiry for alternative impression, managing terminally sick patients, and emergency demands. Dealing with dementia is regarded by nurses and general practitioners as the most difficult task to undertake and consider them outside their ordinary occupational role (Borson, Frank, Bayley, Boustani, Dean, Lin, and Ashford, 2013).

General practitioners claim to undergo difficulties in; organizing support services, acquiring information on caring services, answering to behaviour related problems, and informing the patients of the diagnosis results (Rosness, et al., 2008). On the other hand, nurses encounter more difficulties in; answering to behaviour troubles, replying to patients’ with regards to their psychiatric disorders, and obtaining determinate diagnosis. These caregivers always expect these difficulties and this has negatively affected their attitude towards their roles are caregivers.

Majority of the medical caregivers have always experienced difficulties in handling patients with dementia and this has made them anticipate the same perception each time they encounter the task. The above elaboration suggests that dementia taming stimulates anxiety among the caregivers and is probably leading to some negative attitudes towards dementia by basic caregivers (Suchitra, 2007). This is a clear suggestion that there is need for extra backing for caregivers in attending such patients. The main sections that the caregivers undergo difficulties are those that are outside their ‘normal’ role, and this way, it is the source of doubts and disagreements. Limits of tasks for health practitioners are becoming modified with time; however, there is need for much more training to instil adaptability and sureness in the tasks of caregivers of people with dementia (Borson, et al., 2013).

Negative attitudes results mainly from the sense of the extent of the support caregivers administer to the carer or the patient. It may be brought on by the irregularities experienced by caregivers while attending to their patients; the attitudes have adverse effects on the concerned patients, the effects may include; taking a longtime to give the diagnosis or not giving them at all until the ignorance is clear to the carer and/or the client, failing to give the result of the diagnosis once they give the diagnosis, and conducting assessment procedures for depression in ways other than the standardized one (Suchitra, 2007).
Coping with occupational stress by employees is important regardless of the field in which one is based. In the context of Dementia, an individual’s coping with the role of care giving is key since it enables one to be capable of managing pressures that are associated with provision of care to dementia patients. In an effort to deal with the pressures attributed to managing dementia, primary providers of care for individuals with dementia depend on a number of services and supports. Dementia caregivers should be informed about dementia diagnosis and even about assistance resulting after diagnosis. Caregivers need to be viewed as being significant partners in the process of giving care (Samples et al, 1991). In addition, there is need to assist caregivers to deal and cope with most of the symptoms that are attributed to dementia such as behaviours that are challenging. Services like peer support, medical and emotional support, legal advice and fiscal support can have tremendous effects on the caregiver and their capability to cope well with the role of care giving.

Literature reveals that there is no strategy that has been realized which has the ability of dealing with all the complications and stresses attributed to care giving. Most of the strategies that have been developed have experienced fluctuating successes and failures. Caregiver support systems and resources can be divided into either formal or informal systems (Brown, 2000). The use of the formal and the informal systems are varied and they achieve varied levels of effectiveness. Support groups are programs of the formal groups whose main aim is to reduce demand on people who are involved with the enterprise of care giving to families. Support groups are the most usual kind of intervention for givers of care. Most of these support groups give emphasis on education and support. In the support groups, colleagues encourage and support each other emotionally. In addition, associates give each other insights into effective ways of dealing with varied aspects of their role as caregivers.

Counselling is also among the formal interventions. Conflicts that are witnessed in the families of caregivers expose need for therapists and physicians to improve and support family joint work given that family is a likely care giving unit. At each stage of the process of dementia, caregivers require help in coming up with strategies for self-care that will reduce stressors of caregiving (Wagner et al, 1994). This is the main function of counselling.

Additionally, counselling may also entail training of skill and techniques of managing stress. There are a number of different types of services for counselling that exists. For instance, a caregiver may pursue treatment services that are individual focused; these can include sessions with a psychiatrist. A study conducted in Canada revealed problem solving nurse counselling that was individualized was of great help to caregivers as it significantly reduced their psychological distress and improved their adjustments psychosocially (Roberts et al, 1999).

Interventions for education for caregivers can emanate in various forms and emphasis on varied areas. Education can focus on sessions of sharing information with other professionals and physicians on the condition of dementia, its nature, symptoms and causes. Education can also focus on sessions that are aimed at identifying resources which are accessible for support. Lastly, education can come in the form of sessions that focus on active strategies of management for agitation and problems associated with behaviour, skills of communication, and on the development of structure in day to day routine. Provision of education about dementia to caregivers enables them to attain a sense of being in control of the situations they are faced with and goes a long way to improve their abilities to cope (McFarland et al, 1999).

Aims and Rational
The main aim of the study is to explore the influence of care workers attitudes to dementia patients and the coping styles on the occupational stresses encountered. The study will be aligned to the following specific research objectives;
1. To understand factors that influences the attitudes of care workers working with dementia patients in residential and care home facilities.
2. To explore how the length of working hours, levels of compensation, management approaches, discrimination and hostility by dementia patients influences care workers attitudes towards job satisfaction.
3. To discuss stress coping styles for patients working with dementia patients in care setting.

Hypothesis 1: It will be predicted that the relationship between attitude to dementia and coping style will increase care workers job satisfaction. This means that job satisfaction can be influenced, for example, by management actions, whereas occupational stress is the result of low job satisfaction.
Hypothesis 2:There will be significant difference on care workers job satisfaction if all other coping styles (demographic factors) are considered in personal circumstances such as age, years of experience, ethnic background.
Research Design
According to the research proposal, the variables that will be used for this study arepersonal factors (state), attitude to dementia, coping styles and occupational stress. All the variables will be measured using self-Questionnaires for each participant and will be tested using multiple regression. The target variable will be occupational stress, while the other variables will be considered as predictors for the study.

B. THE SPSS OUTPUT : ATTACHED BELOW SHOULD BE USED BY THE WRITER TO COMPLETE THE FOLLOWING SECTION:

RESULT SECTION: …………………….. 800 WORDS
REPORT THE RESULT SECTION FOR THE STUDY USING THE ATTACHED SPSS OUTPUT
INSERT TABLES FOR VISUAL DESCRIPTION……….
FREQUENCY TABLE: Gender (Male and Female)
1. DESCRIPTIVE TABLE: Both dependent and independent Variables ( Mean and Standard deviation)
2. ANOVA TABLE
3. REGRESSION TABLE: Hierarchical (Model 1 and Model 2) and explain the variability of each variables.
4. CORRELATION TABLE: determine the following
 the relationship between all the variables (Independent and dependent)
 the association of each variables to each other
 whether independent variables subscales predicts the dependent variable

NOTE: BELOW ARE THE INDICATION FOR THE VARIABLES IN THE SPSS
INDEPENDENT VARIABLE INCLUDES:
1. COPING STYLES WITH SUBSCALE of
 Problem _focused coping,
 Emotional_ focused _coping
 Avoidance_ focused_coping
2. ATITUDE TO DEMENTIA WITH SUBSCALES INCLUDES
 TOTAL_DAS_comfort
 TOTAL_DAS_knowledge
DEPENDENT VARIABLES:
 TOTAL_Occuptional_stress_scale

C. DISCUSSION : ……………………….2100 WORDS ( USE INTEXT REFERENCE)
D. CONCLUSION: …………………….. 400 WORDS ( USE INTEXT REFRENCE)

The writer should USE THE SECOND CORRELATION WITH MEAN SCORE AND TOTAL MEAN SCORE OUTPUT FOR THE RESULT (DO IGNORE THE FIRST CORRELATION TABLE). Take note that the SPSS OUTPUT labelling for correlation table for the variables is as follows:
MEAN SCORE for all the variables
Meanscore_OSS: Occupational stress (dependent variable)
Meanscore_PRC: problem focused coping (independent variable)
Meanscore_EFC; Emotional focused coping (independent variable)
Meanscore_AFC: Avoidance focused coping (independent variable)
Meanscore_DAS: Atitude to dementia (independent variable)

TOTAL SCORE VARIABLES
TOTAL_Occupational-stress_scale
TOTAL_problem focused _coping
TOTAL_Emotional_focused _coping
TOTAL_Avoidance_focused _coping
DAS_TOTAL_COM_KNOW (comfort and knowledge)
TOTAL_DAS_Comfort
TOTAL_DAS_knowlegde

PLEASE WRITER SHOULD NOTE THAT THE THIRD SPSS OUTPUT MUST BE USED FOR THIS ORDER.

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