The Relationship Between Sense of Coherence (SOC) and Coping with Stress Among Emergency Room Physicians

Dedication

I dedicate this study to my family. To my loving Husband. I would like to thank you for your patience and belief in me during this journey despite the many days of uncertainty and doubt. All that I have accomplished is a direct result of your love and support. I also thank my mother for all the sacrifices you have made for me over the years to ensure I received the best education possible. Thank you for instilling in me self-resilience and discipline. Thank you for believing in me and supporting me throughout this long and difficult journey. Thank you for encouraging me to always shoot for the stars and be the very best version of me possible. Above all, thank you mummy for your unconditional love and prayers. To my Dad taught me that the sky was my limit and always encouraged me to achieve my academic endeavors and go as far as possible who instilled in me the values of finishing what I set out to do and most importantly doing it the right way; no matter how long it takes. To my Sweetest Sister, thank you for listening to me when I cried, for coming to me when I needed you, and for always answering my calls and last not least for being on text message all nigh to encourage me to stay strong and be up late that I can concentrate on my writing. Thank you again for your prayers, love, and encouragement. To my lovely brother for all his support and believing on me that I can go through this chapter of my life. I never forget whenever he reminds me that I am good role model for him to keep him encourage to go through his Law school since he is youngest child in our family. I am blessed, God give me such family to help me and support me. Also, special thank you to my cute puppy (my baby) also being next to me and take stress away from me.

Acknowledgements

This project would not have been possible without the invaluable support of many people. First, and foremost, I relied upon my faith and belief in God, who has made all of this possible. I want to thank my admirable chair, Dr. Sharma for providing scholarly, professional, and mentoring guidance throughout the doctoral process. He always made himself available to assist in achieving my academic goals. His expertise and guidance encouraged an exploration of new possibilities and inquiries. Also, I am extremely grateful for the continuous scholarly feedback and update me with new information. I would also like to thank my committee chair for her support and superb guidance, as well as the time and attention she devoted to my project. Also, I would like to thank my URR reviewer for all of their encouragement, dedication, and support throughout this process of achieving my goal. Thank you all for keeping me on task and encouraging me not to give up.

Also Thank you from all Hospitals to give me permission to collect my data and also Thank you from all ER physician in hospital to spend their valuable time to fill out my survey and send to me and help me to finish this project with good result that all ER Physician can get help on their stress to give better treatment care for patients in future.

Table of Contents

Abstract ii
Dedication iv
Acknowledgements v
Table of Contents vi
Table of Figures viii
List of Tables ix
Chapter 1: Introduction to the Study 1
Problem Statement 4
Purpose of the study 5
Research Hypothesis and Questions 6
Research Model Diagram 8
Measurement of Variables 8
Theoretical Framework 9
Nature of the Study 10
Operational Definitions 11
Assumptions 16
Limitations 17
Significance of the Study 17
Summary 18
Chapter 2: Literature Review 20
Introduction 20
Literature Search Strategy 21
Theoretical Perspective 21
Stress Prevalence in Emergency Room Physicians 26
Sense of Coherence Concept 28
Relationship between SOC and Physicians Coping with Stress 33
Improving Coping Abilities Using SOC 34
Summary 46
Chapter 3: Research Methodology 48
Introduction 48
Research Design and Rationale 48
Study Variables 51
Methodology 52
Population 52
Sample, sample size and Sampling Procedure 52
Procedure for Recruitment, Participation, and Data Collection 53
Ethical Considerations 53
Instrument and Operationalization of Constructs 54
Operationalization of Variables 55
Data Analyses Plan 56
Data Management 57
Research Questions and Hypotheses 5
Threats to Validity 59
Summary 60
References 60

Table of Figures

Figure 1: Independent and Dependent Variables 17
Figure 2: The Work-SOC Questionnaire 26
Figure 3: A SOC Nine-Item Scale: Manageability, Comprehensibility and Meaningfulness 64

List of Tables

Table 1: Dependent and Independent Variable 26
Table 2: The three styles of success in a medical career dimensions 46
Table 3: Comparison of characteristics between low and high Sense of Coherence (SOC) scale score groups 48
Table 4: Dependent and Independent Variable 63

Chapter 1: Introduction to the Study

Emergency room physicians have often been associated with high levels of stress due to the nature of their roles which involves providing urgent care and dealing with complex patient situations (Tartas et al., 2014). However, their ability to plan actions or respond to stressful situations often varies between them and is associated with self-regulation (Silver, 2013). Different researchers such as Silver (2013) and Kleiveland, Nating and Jepsen (2015) have explored the issue and presented their perceptions of stress in the emergency room (ER) environment which often influences the physicians response. Schooley, et al. (2016), also confirm that ER physicians experience multiple issues including emotional exhaustion and depersonalization that cause burnout resulting in a negative attitude towards their work. ER physicians have a high prevalence of stress influenced by workplace related issues such as increased workloads and high patient to low physician ratios. On the other hand, Sense of Coherence (SOC) is a concept that has been closely associated with coping with stress based on the assumption that it influences the individuals ability to cope with stressful situations (Sharma, Atri, & Branscum, 2011, p.80).

SOC is the method and measure of how people view life and how they apply their skills of maintaining equanimity and balance when faced with stressful situations (Silver, 2013). Different researchers who have explored the topic such as Kleiveland, Natvig & Jepsen (2015), found that personality and SOC play a significant role in predicting Norwegian nurse students performance and response when exposed to stress in the ER. High SOC among general physicians leads to improved quality of life and ability to cope with work stress while low SOC levels limit professional competence and the physicians ability to cope with stress (Saijo et al., 2013). However, sense of coherence and its influence on coping among emergency room physicians has not been studied.

This study will explore the relationship between SOC and ER physicians ability to cope with stress and is centered on the idea that high SOC levels enhance physicians ability to handle stress in the ER. The study will also evaluate the SOC concept and establish ways in which individual physicians SOC levels can be determined in order to predict his/her ability to cope with stress among other challenging situations in their workplace. Hence, this research is imperative because it has the ability to improve the ER physicians well-being while ensuring the ability to execute his professional role effectively through an improved ability to manage stress. Hence, it has the potential to create social change and overall improvement in physicians lives as well as their professional roles.

BACKGROUND

According to previous research, physicians continuous exposure to stressful situations in the ER may translate to negative outcomes; however, SOC is deemed as a critical aspect since it enhances their ability to cope and concentrate on their roles (Li et al., 2014). Different researchers have explored the topic such as Schooley, Hikmet, Tarcan and Yorgancioglu (2016), who argue that ER physicians are susceptible to multiple stressors, which affect their physical and emotional well-being primarily when they have low SOC ability. SOC introduces three key elements, which determine the individuals ability to cope with stress. The three key components are comprehensibility, manageability and meaningfulness and serve as the basis for predicting the physician's response as well as the relationship between SOC and coping with stress. In a research article,Li (2015) asserts that SOC is directly related with the ability of physicians to cope with stress. The findings in the study mentioned above also indicated that various SOC concepts such...