The effects of professional training on occupational stress and personal affect in rehabilitation practitioners.

An exploratory analysis was conducted to determine whether a professional training program for rehabilitation practitioners that focused on core skills and competencies, might have some beneficial effects on perceived levels of job related stress and tension, and feelings of positive and negative affect. Results of the analysis indicated that training participants showed significant improvements in perceptions of job stress, tension, and positive affect compared with a group of control respondents who did not take part in the training. There were no changes in negative affect. Problems and limitations of the study are addressed and the importance of further understanding of the complex dynamics of job stress in rehabilitation professionals is emphasized.

Introduction

The importance of education for rehabilitation professionals and the relationship between education and on the job performance, are issues that have concerned researchers for some time (e.g., Abrams & Tucker, 1989; Dunn, 1990; Stubbins, 1982; Syzmanski & Parker, 1989a, 1989b). The underlying assumption is that better educated rehabilitation practitioners will perform more effectively and generate better outcomes for the client. Despite this being an intuitively appealing notion, a number of authors have noted the considerable conceptual and methodological difficulties associated with investigating relationships between professional education and rehabilitation outcomes (e.g., Cook & Bolton, 1992; Dunn, 1990; Parker, 1990: Thomas, 1990).

Several recent studies employing sophisticated methodologies have shown a significant relationship between masters level education and case performance and client outcomes (e.g., Cook & Bolton, 1992; Syzmanski, 1991; Syzmanski & Danek, 1992). These studies have focused on client populations with severe disabilities and have used relatively narrow and circumscribed indices of performance (case closure rates, case service costs).

Less research has investigated performance from a psychological perspective. Although few would doubt the importance of objective criteria for assessing job performance, it seems reasonable to suggest that job performance might also be related to subjective evaluations of one's job. Feelings of job stress and tension are very real experiences that diminish the psychological quality of life (Campbell, 1980) and are likely to be related to job performance, at least indirectly (Wallis, 1987). Rehabilitation professionals are often called upon to function in an environment that may be under-resourced, frustrating, uncertain and stressful (Flett & Biggs, 1992; Flett, Biggs & Alpass, 1992; Flett, Biggs, & Alpass, in press). Parker (1990) suggested that rehabilitation professionals operate "....in a world of unremitting flux....persistent challenges in philosophical and ethical realms, and chaotic policy shifts....create a climate of frustrating uncertainty......they face decisions daily with outdated and conflicting information, and, too often, no information whatsoever."

Clearly, one might argue that job performance in such an unpredictable and rapidly changing environment might be undermined by feelings of job stress and tension and generally lowered levels of wellbeing. In this context, professional education and training may have an important empowering role by further developing and refining the skills, knowledge, and competencies necessary for effective functioning and thereby reducing feelings of job related stress and tension. Research evidence suggests that rehabilitation professionals perceive both further educational opportunities and ongoing networking with others in the same field, as potentially important strategies for reducing the stress of rehabilitation work (Flett & Biggs, 1992; Flett, Biggs, & Alpass, in press). Similarly, Cook (1990), in a survey of American Rehabilitation Counseling Association Members, noted that continuing education programs and opportunities for networking with other professionals were seen by members as important activities that the Association could work to improve.

Therefore, if it can be demonstrated empirically that education and training has a positive effect on feelings of job stress, job tension, and general levels of psychological wellbeing, then this would be an important first step in developing a more complete and multifaceted model of the relationship between education and job performance. The purpose of the research reported here was to probe the possible links between ongoing education of rehabilitation professionals, and specific psychological outcomes (i.e., job related stress, tension, and psychological wellbeing, i.e., frequency of positive and negative affect). The study is described as a "probe" in the sense that it utilizes a simple two-group design and thus provides only preliminary information on the relationships between ongoing education and psychological outcomes.

Method

The study was conducted at Massey University in Palmerston North, a university city in the North Island of New Zealand.

Subjects

The non-random sample for this study consisted of a total of 52 rehabilitation service providers drawn from a range of agencies and consisting of two groups.

The first group (hereafter referred to as the Training Group) consisted of 33 respondents. Approximately two-thirds of this group (N=21) were Field Officers employed by the New Zealand Multiple Sclerosis Society, an agency concerned with the provision of support services for people with multiple sclerosis. The Society, through its eighteen regional bodies, provides community support services nationally with the Field Officers providing the major role in service coordination for clients. The rest of the Training Group came from a number of different agencies (e.g., Accident Compensation and Rehabilitation Insurance

Corporation, Area Health Boards, Department of Social Welfare). The control group, which did not participate in the training course, consisted of 19 respondents recruited from a number of different agencies involved in rehabilitation (e.g., Area Health Boards, Royal New Zealand Foundation for the Blind, various education settings).

Dependent Measures

Occupational Stress Scale: This scale was adapted from the 12-item perceived occupational stress measure described by House, McMichael, Wells, Kaplan, and Kanderman (1979). Respondents were asked to indicate how often each of the 12 items bothered them at work, on a 5 step frequency scale ranging from 0 ("not at all") to 4 ("nearly all the time").

The reliability and validity of these job stress items are documented elsewhere (e.g., Flett & Biggs, 1992). For the purposes of the present study, a total stress score was calculated by summing across the 12 items (Cronbach's alpha = .78).

Job Tension Scale: This 8-item scale was recently reported in Dewe (1991). Respondents were asked to indicate, for each item, how often they felt that way, on a 5-step frequency scale ranging from 1 ("not at all") to 5 ("all the time"). Typical scale items include: "How often do you work under a great deal of tension?", "How often does the job make you fidgety or nervous?", "How often do problems associated with the job keep you awake at night?" A total tension score was calculated as a sum across the 8 items (Cronbach's alpha = .81).

Wellbeing Scale: The 10-item adjective short form of the Affectometer 2 (Kammann & Flett, 1983; Maxwell, Flett & Colhoun, 1989, 1990) was included as a measure of psychological wellbeing (defined as the frequency of experience of positive and negative affect). Reliability and validity data on this scale have been extensively documented elsewhere (e.g., Kammann & Flett, 1983). In the present study, reliabilities (Cronbach's alpha) for the positive affect and negative affect subscales were 0.69 and 0.77 respectively.

Other Measures

Demographic Information: This included age, sex, relationship status, length of time in current job, number of children, number of children at home, hours per week worked, current annual salary.

Procedure

Prior to the commencement of the training course the participants were invited to take part in a job survey. The Control Group was invited to participate in the survey via letter. Both groups were informed, via a written introduction, that the questionnaire dealt with "....how rehabilitation workers view themselves and their jobs. The survey considers such topics as job stress and tension as well as more general feelings of overall wellbeing".

Respondents were informed that (a) their responses would be anonymous and confidential, (b) they could skip or omit any of the questionnaire items, and (c) they could discontinue participation at any time. A procedure was also outlined to respondents whereby they could receive feedback concerning the results of the survey. The questionnaire took approximately 45 minutes to complete. The Training Course group returned the questionnaires to an anonymous posting box. The Control Group returned the questionnaires via mail in prepaid envelopes.

Descriptive data for Training and Control Groups

                                 Training (n=33)            Control (n=19)

Sex                          28 females     5 males     11 females     7 males

Age (years)                   M = 42.3     SD = 6.6      M = 39.1     SD =
10.1

Hours worked per week         M = 30.2     SD = 10.0     M = 40.0     SD = 9.5

Years as a rehabilitation     M = 3.19     SD = 2.8      M = 3.8      SD = 2.8
practitioner

Marital Status (Married)            29                          14

Table 1

The training course was delivered in a distance teaching mode. The course addressed several core skills required of the human service worker including skills in accessing community and specialized services, and communication facilitation skills. Course participants, in addition, were required to focus on applying such knowledge in a disability content area of choice. Although the course is now a standard academic offering, this course from which the study sample was drawn, was relatively intense with participants completing the equivalent academic content of a two-semester second year undergraduate work unit over essentially one summer semester. At the beginning of the semester a week long course was held in the Rehabilitation Studies Section of the Psychology Department at Massey University. At this time the initial data collection phase (for the Training Group) took place. The Control Group data were also collected at this time (via questionnaire mailout).

Follow-up data collection:

At the conclusion of the training course (after approximately 4 months) both groups of respondents were mailed a follow up TABULAR DATA OMITTED questionnaire. Of the total of 33 Training Group members, 31 returned the follow up questionnaire (a return rate of 94%). Eighteen of the 19 respondents in the Control Group returned the follow up questionnaire (95% return rate).

Data Analysis:

Difference scores were calculated for each of the dependent measures (job stress, job tension, positive affect, negative affect). These were calculated as: Score at Follow up - Initial Score. This means that a difference score of 0 would indicate no change between initial assessment and follow up. A negative difference score would indicate a reduced level of stress, tension, positive and negative affect at follow up while a positive difference score would indicate an increased level of stress, tension and positive and negative affect at follow up. The difference scores between the groups (Training/Control) were compared by means of independent groups t-tests.

Results

The background information is presented in Table 1 for the Training Group and the Control Group separately. There was a predominance of females in both groups. There were no significant differences in age between the 2 groups, [Mathematical Expression Omitted]. Most members of each group were either married or currently partnered. There were significant differences between the two groups in the number of hours worked per week, [Mathematical Expression Omitted], (Training Group M=30.2, SD=10.0, Control Group M=40.0, SD=9.2). There were no significant differences between groups in average length (in years) of work experience as a rehabilitation professional, [Mathematical Expression Omitted]. Approximately 50% of the training group had completed some form of tertiary study while 100% of the control group were concurrently involved in other university study (via distance teaching).

The job stress, job tension and psychological wellbeing (positive affect, negative affect) scores (means, SD's), at both protest and posttest are presented in Table 2. These means compare favorably with data on these measures reported elsewhere (e.g., Flett & Biggs, 1992; Flett, Biggs, & Alpass, in press), which suggests that the present sample was not reporting unusually high or low levels of stress, tension and wellbeing. There were no significant differences between the two groups, at protest, on any of the measures reported in Table 2. A difference score was calculated by subtracting the pretest score from the posttest score (e.g., difference = posttest-pretest). The difference scores of the Training Group and the Control Group were compared by means of independent groups t-tests.

The Training Group showed a significantly greater reduction in job tension, [Mathematical Expression Omitted], and job stress, [Mathematical Expression Omitted], than the Control Group of rehabilitation professionals who had not participated in the training course. Fifty percent of the Training Group showed an improvement in job tension (i.e., a negative difference score indicating a reduction in reported levels of job tension) at post test. This compared with 23% of the Control Group whose job tension score improved between the 2 measurement phases. Similarly, 62% of the Training Group showed an improvement in job stress scores (i.e., a negative difference score indicating reduced levels of reported job stress) at follow up (compared with 41% of the Control Group).

The training course participants also showed a significant increase in positive affect over time compared with the control group, [Mathematical Expression Omitted]. Fifty-two percent of the Training Group reported an increase in positive affect (a positive difference score) at follow up (compared with 18% of the Control Group). For the negative affect measure there were no differences between the two groups, [Mathematical Expression Omitted].

Discussion

The present study has a number of limitations. The small sample size raises issues of statistical power (e.g., Kraemer & Thiemann, 1987). The research participants were clearly not a random sample of rehabilitation professionals and thus the extent to which generalizations are possible is limited. The research design lacks the methodological sophistication that some authors argue is essential for addressing this type of research question (e.g. Parker, 1990; Thomas, 1990). However, as was noted at the outset, the present study was intended to provide preliminary information about the relationships between ongoing training and psychological outcomes.

Syzmanski and Danek (1992) noted that in increasingly stringent economic times there is increasing taxpayer pressure on agencies involved in rehabilitation to demonstrate greater cost efficiency. Clearly agencies also have a moral and philosophical obligation to utilize available resources to maximum effectiveness in order to provide the best possible service to persons with disabilities. In this context a greater understanding of the professionals who provide the service and the issues of job stress and tension that concern them, can only enhance work performance and positively influence methods of selection and training and overall professional practice in rehabilitation.

With this view in mind and despite the limitations of this study, a number of tentative speculations may be offered. The findings suggest that there may be some relationship between ongoing training and positive affect and feelings of job-related stress and tension. One possible interpretation of this finding is that the effect worked through some non-specific process such as demand characteristics or a group support effect rather than the effects of training per se. For example, it could be that the bringing together of a group of rehabilitation professionals and the opportunities for interaction that allows will positively enhance levels of stress, tension, and wellbeing regardless of the actual content of the training program. Clearly participation in any type of training program is an interpersonal exercise as well as a learning exercise. However, the distance teaching delivery mode of the training course meant that students worked primarily on their own (apart from a week-long on-campus course at the beginning of the semester). Thus, it is our contention that interrelational variables are unlikely to have significantly influenced the findings.

A second possible interpretation is that the effect was a function of the differing levels of tertiary education in the two groups. Higher stress levels might be expected for individuals who do not feel adequately trained or prepared for their jobs. One might therefore expect the training course participants (who had lower levels of exposure to tertiary education than the control group) to report higher levels of stress and tension prior to commencement of the study. There were, however, no differences between the groups on any of these measures at pretest. The two groups also had similar levels of work experience as professionals in the field. Clearly it would have been methodologically more desirable to have matching educational profiles across the two groups. However, taken as a whole the data suggest that the two groups were comparable at pretest and it therefore seems unlikely that the findings of the present study can be explained as being simply a function of preexisting differences in educational profiles.

A third interpretation is that the effect was in fact a function of participation in the training course. The question arises as to how participation in the training course might exert such positive benefits on stress related perceptions. One possibility is that training course participation may have acted to increase practitioner skills and competencies and, as has been argued elsewhere (e.g., Landy, 1985; Roessler & Rubin, 1992), increases in skills and competencies are seen as a significant way of helping individuals deal with job related stress. Including the assessment of practitioner competencies (e.g., Wright, Leahy, & Shapson, 1987) in future research, may clarify this possibility.

Clearly, future research efforts will need to concentrate on isolating the critical factors that contribute to the effects of training and education on psychological outcomes. One must also acknowledge here that while the terms education and training are often used synonymously in the rehabilitation literature, some writers have pointed out that they are not synonymous (e.g., Leung, 1987) and may have different goals and therefore different outcomes (Thomas, 1990).

However, notwithstanding possible alternative interpretations of the findings reported in this study, we nevertheless consider the results as sufficiently encouraging to warrant more sophisticated multi-group research designs to determine the critical aspects of education and training that will permit rehabilitation professionals to deal more effectively with job related stress and tension.

If such effects of education and training can be replicated then this clearly has a range of important implications. If one defines performance as the ability to perform or work efficiently and effectively then it is clear that an important component of performance is the subjective feeling of stress and tension that one experiences. The process of attempting to perform under conditions of high stress and tension is likely to render the objective aspects of performance less effective. If education and training programmes can have an impact on perceived levels of stress and tension (as the present findings suggest they might) then it is likely that "objective" performance may be indirectly enhanced.

Author Notes

The authors gratefully acknowledge the assistance of the New Zealand Multiple Sclerosis Society who partially funded the study reported here. The authors also appreciate the constructive and helpful comments made on an earlier version of this manuscript by two anonymous reviewers. Correspondence to Ross Flett, Department of Psychology, Massey University, Palmerston North, New Zealand.

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