1 INTRODUCTION Todays age is called The Age of Anxiety and this century is called The Century of Stress.

Today vast majorities of people are in a state of Stress. Their fast-paced lifestyle demands that they are raring to go always and are always under pressure to perform. This pressure usually leads to Stress. Stress can be due to various reasons. And Stress in many cases causes Tension, Depression, Anxiety, etc. A lot of research has been conducted into stress over the last hundred years. Some theories about it are now settled and accepted; others are still being researched and debated. Hans Selye was one of the founding fathers of research on stress. He stated in 1956 that Stress is not necessarily something bad it all depends on how we take it. The stress of exhilarating, creative successful that of failure, humiliation or infection is detrimental. Since then, a great deal of further research has been conducted on the subject, and new ideas have come to light. Stress is now viewed as a "bad thing", with a range of harmful biochemical and long-term effects. These effects have rarely been observed in positive situations. Stress is that stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize. In short, it is what we feel when we think we have lost control over events. There are very many proven skills that we can use to manage stress. These help us to remain calm and effective in high-pressure situations, and help us avoid the problems of long term stress. Stress is something that occurs all the time and affects everyone one way or another at least some of the time. Stress can be a good thing. It can be a source of motivation to help get something done or help one to react quickly to a potentially dangerous situation. A lot of research has been conducted into stress over the last hundred years. Some of the theories behind it are now settled and accepted; others are still being researched and debated. During this time, there seems to have been something approaching open warfare between competing theories and definitions: Views have been passionately held and aggressively defended. Hans Selye was one of the founding fathers of stress research. His view in 1956 was that stress is not necessarily something bad it all depends on how you take it. The stress of exhilarating, creative successful work is beneficial, while that of failure, humiliation or infection is detrimental. Selye believed that the biochemical effects of stress would be experienced irrespective of whether the situation was positive or negative. Since then, a great deal of further research has been conducted, and ideas have moved on. Stress is now viewed as a "bad thing", with a range of harmful biochemical and long-term effects. These effects have rarely been observed in positive situations. 1

2 . The most commonly accepted definition of stress (mainly attributed to Richard S Lazarus) is that stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize. In short, it's what we feel when we think we've lost control of events. . In todays changing and competitive work environment, stress level is increasing both in the workers as well as the managers. As a result of this work stress, more and more managers are showing signs of chronic fatigue and burnout. Research has concluded that stressed out managers are not good for their companies or shareholders. In most cases, stress leads to reduced efficiency in even the best of individuals, which in turn leads to reduced productivity. Stress is a problem in almost all the countries of the world, irrespective of whether the economy is strong or weak. Therefore, it become very essential to include work stress as one of the chapters in studying human behaviour, because we must know what is actually stress, what are the causes of stress, what are its consequences and then, what should be done to reduce it. Considered from an individuals point of view, stress is our bodys physical, mental and chemical reactions to circumstances that frighten, confuse, endanger or irritate you. If controlled, stress is a friend that strengthens us for the next encounter. If handled poorly, it becomes an enemy which can cause diseases like high blood pressure, ulcer, asthma and overactive thyroid. As per the medical explanation of the term stress is the bodys general response to environmental situations. It can lead to : Physiological discomfort. Some kind of emotional unhappiness. Strained relationships with other people. And very simple words, stress refers to an individuals reaction to a disturbing factor in the environment. Stress is defined as an adaptive response to an external situation that results in physical, psychological and/or behavioral deviations, for organizational participants. Stress is a dynamic condition in which an individual is confronted with an opportunity, constraint or demand related to what he or she desires and for which the outcome is perceived to be both uncertain and important. According to Ivancevich and Matterson, Stress is the interaction of the individual with the environment. It is an adaptive response, mediated by individual differences and/or psychological process; that is a consequence of any external (environmental) action, situation or event, that places excessive psychological and/or physical demands upon a person According to Beehr and Newman, Job stress is a condition arising from the interaction of the people and their jobs, and characterized by changes within people that force them to deviate from their normal 2

3 functioning. Some important point relating to the nature of stress are : 1. Stress is a neutral word. It is not bad in and of itself. But when stress is created by undesirable outcomes, it becomes Distress. On the other hand, if it is created by desirable and successful effects it is called Eustress. Eustress is a healthy, positive and developmental stress response. It is primarily the Distress form of stress which requires examination and steps to cope with it; because distress is generally associated with heart disease, alcoholism, drug abuse, marital problems, absenteeism etc. 2. Stress is associated with Constraints and Demand. Constraints prevent an individual from doing what he or she desires. If a person wants to buy something, but he does not have the necessary cash, it is a constraint. Demands refer to the loss of something desired. If a person wants to go and watch a movie, but he is unable to do so because of pressing official work, it amounts to a demand. Both Constraints and Demands can lead to potential stress. 3. Two conditions are necessary for potential stress to become actual stress. There must be : uncertainty over the outcome, and Outcome must be important. . Stress is usually very high when there is uncertainty over the outcome and the outcome is very significant. Both these conditions are necessary. If there is no uncertainty but the outcome is significant, there will not be any stress. On the other hand, if there is uncertainty, but the outcome is not significant, there will again be no stress. 4. Stress is not simply anxiety. Stress may be accompanied by anxiety, but the two are not synonymous. Anxiety is psychological and emotional whereas stress operates in the physiological sphere also along with Psychological sphere. 5. Stress should also be differentiated from nervous tension. Nervous tension may be a result of stress. Stress is a subconscious action. Even unconscious people have exhibited stress, whereas nervous tension is a conscious action. People may bottle up their emotions and not reveal them through nervous tension. 6. The term burnout is also closely associated with stress. Some researchers contend that burnout is a type of stress, but others treat it differently. Burnout is closely associated with helping professions like nursing, education and social work, it is characterised by emotional exhaustion, depersonalisation and diminished personal accomplishments. Even though, technically, burnout is different from stress, these are generally used interchangeably. . Stress is highly individualistic in nature. Some people have high tolerance for stress and thrive well in face of several stressors in the environment. In fact, some individuals will not perform well unless they 3

4 experience a level of stress which activates and energises them to put forth their best efforts. On the other hand, some people have very low level of tolerance for stress and they become paralysed when they have to interface with routine everyday factors that appear undesirable to them. . For every individual, there is an optimum level of stress under which he or she will perform to full capacity. If the stress experienced is below this level, then the individual gets bored, the motivational level to work reaches a low point and apathy sets in. If one operates in very low stress environment and constantly experiences boredom, the person is likely to he psychologically or physically withdrawn from work. Psychological withdrawal will result in careless mistakes being frequently made, forgetfulness and absentmindedness. Physical withdrawal will manifest itself in increased rate of tardiness and absenteeism which will ultimately lead to turnover. . If, on the other hand, the stressors in an individuals environment are too many or too intense, there effects on performance will again be adverse. Errors will increase, bad decision will be made and the individual will experience insomnia, stomach problems and psychosomatic illnesses. Organizational performance and individual health are at their peak at optimum levels of experienced stress. It is explained with the help of the following figure:

STRESS LEVELS Reactions

LOW STRESS

OPTIMUM STRESS

HIGH STRESS Exhaustion

Boredom/Apathy

High Energy

Behaviours Low carelessness

motivation High

Motivation Anxiety Nervousness High Indecisivene ss Bad

Heightened perception Physical involvement

Psychological withdrawl

withdrawl Inactivity Performanc Low performance e 4 High performance

Judgement Poor performance

5 Health effects Dull health Good health Insomnia psychomatic illnesses

. Though, the optimum stress level may be different for different individuals, each individual can sense and determine how much stress is functional for him or her to operate in a productive manner. . Personality of a person is the most dominating factor which influences the way he or she responds to all events and situations. In personality, we include values, attitudes and behaviour patterns that make up the uniqueness of an individual and ultimately make him more or less vulnerable to stress. . The origin of much personal stress lies within our perception or our concept of self. Low self esteem can lead to a number of stress inducting problems, inability to adapt, willingness to place excessively high demands on ourself and lack of assertiveness. It can also lead to poor self expression, so that we harbour negative emotions such as anger, fear, aggression and anxiety rather than giving vent to them. . Those with high self esteem handle stress with ease since a high self concept and confidence in their abilities allows them to develop positive attitudes towards the management of stress and enables them to deal with stressful situation with calmness and clear thinking.

NEED FOR THE STUDY

As I am a student of management I need to do the project work and submit to the university under which I am doing my MBA. The purpose of study is to know the employee's opinions and their views about the STRESS MANAGEMENT in the organization. To know about the decisions regarding stress relief techniques that is being followed in the organization. To provide information to diagnose my topic. To provide feedback about the level of stress that the employees at CARE are facing due to excessive work load.

7 OBJECTIVES OF THE STUDY The main objectives of my project study are as follows: To study and recognize the overall impact of stress in modern life of the doctors and nurses at care hospitals. To identify the common stress indicators and stress related diseases. To review and analyze how stress leads to the poor job performance and relationship problems with the superiors. To study and monitor the employees own stress levels and to understand the body's bio-chemical reactions to the stressors. To analyze and study about the negative feelings of self worth and lowered tolerance for everyday problems. To identify appropriate stress management techniques, how to manage and control the stress effectively.

METHODOLOGY OF THE STUDY

Data-Collection is the term used to describe a process of preparing and collecting the business data for example as part of a process improvement or similar projects. Data-Collection usually takes place early as in the improvement project, and is often formalized through a data-collection plan, often contains the following activity:1. Pre-Collection activity= agree goals, target data, definitions, methods 2. Collection of Data Present findings- usually involve some form of sorting analysis and for presentation. Generally, there are two methods that are successfully used for data collection, which are discussed below:-

PRIMARY DATA:In primary data-collection, the data is generally collected by using methods such as interviews and through questionnaires. The, key point here is that the data collected is unique until it is published, no one else has access to it, and it is done to get the real scenario and to get the original data present in the organization. DATA COLLECTION TECHNIQUES:Questionnaire: - Questionnaire means which are used for collection of the data, but are difficult to design and often require many modifications before an acceptable questionnaire is produced. Interview: - This technique is primarily used to gain an understanding of the underlying reasons and motivations for peoples attitude, preferences or behaviors. The interview was done by asking questions and I encouraged the respondents to talk freely.
SAMPLING METHODOLOGY:

Sampling Technique: - Initially a rough-draft was prepared keeping in mind the objective of the research. A simple random sampling in order to know the accuracy of the questionnaire, and the final questionnaire was arrived only after certain important changes were done. 8

9 Sampling-Unit: - The respondents who were asked to fill the questionnaires are the sampling units. Sampling size =50.

SECONDARY DATA:
All, the methods of data collection can supply quantitative data (numbers, statistics and financial) or qualitative data (usually words or text). Secondary data is the data that has already been collected by someone else for a different purpose.

NEED OF USING THE SECONDARY DATA:

Are, as follows

1. Data is of use in the collection of the primary data. 2. This is of the cheapest and easiest means of access to information 3. Secondary data may actually provide enough information to resolve the problem 4. Secondary data can be a valuable source of new-ideas that can be explored later through primary research.

LIMITATIONS OF THE SECONDARY DATA:

1. May be out dated.

Are as follows

2. No control over the data collection. 3. May not be reported in the required form. 4. May not be very accurate. 5. Collected for some other purposes.

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LIMITATIONS OF THE STUDY

The project is a collection of study, observation, and practical experience during my project work done in CARE hospital, Visakhapatnam.

I tried to perform this project in the best possible manner. In spite of all my efforts in this regard due to the far stretching activities conducted at CARE hospital, my project lack in some of the following heads, where there is a chance of further elaborating study on the same subject.

1. Some information being very sensitive as far as organization is concerned is left untouched and not mentioned in any way.

2. Top-level strategic type of decisions and information too are not taken under study to avoid any favor to the business counter parts.

3. The data presented here is taken by prepared questionnaire, information and feedback received from the management.

4. No research has been conducted on this topic for the purpose of this project thus holds a complete field research and development.

5. Due to Time Constraints I was not able to touch all aspects of stress management.

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11 FRAME WORK OF THE STUDY The total study of my project work is mainly divided into five important chapters. First chapter mainly deals with the introduction part, need for the study and objectives of the study, methodology and its design and the major limitations has been discussed. The second chapter mainly lists out a brief description about the overall industry profile and the company profile of the CARE HOSPITALS, Visakhapatnam. The third chapter mainly deals with the theoretical frame work of my project study STRESS MANAGEMENT. The fourth chapter deals with the data analysis and interpretation results through tables, graphs and with a structured questionnaire. And , finally the fifth chapter gives an outline of summary , suggestions , findings and conclusion to my study on STRESS MANAGEMENT , i.e., done at CARE HOSPITALS, Visakhapatnam.

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INDUSTRY PROFILE
HEALTHCARE AND HOSPITAL INDUSTRY

Healthcare industry is a wide and intensive form of services which are related to well being of human beings. Health care is the social sector and it is provided at State level with the help of Central Government. Health care industry covers hospitals, health insurances, medical software, health equipments and pharmacy in it. Right from the time of Ramayana and Mahabharata, health care was there but with time, Health care sector has changed substantially. With improvement in Medical Science and technology it has gone through considerable change and improved a lot. The major inputs of health care industries are as listed below: Hospitals Medical insurance Medical software Health equipments Health care service is the combination of tangible and intangible aspect with the intangible aspect dominating the intangible aspect. In fact it can be said to be completely intangible, in that, the services (consultancy) offered by the doctor are completely intangible. The tangible things could include the bed, the dcor, etc. Efforts made by hospitals to tangibles the service offering would be discussed in details in the unique characteristics part of the report. Different types of health care services available in India Hospitals, Pathology Clinics, Blood Banks, Meditation Centre, Emergency services like Ambulances,

etc. Online Medical Services, Telemedicine Naturopathy Yoga Centre, Fitness Centre, Laughter Clubs Health Spas.

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13 The Hospital Industry Some Facts Indias healthcare industry is currently worth Rs 73,000crore which is roughly 4 percent of the GDP. The industry is expected to grow at the rate of 13 percent for the next six years which amounts to an addition of Rs 9,000cr each year. The national average of proportion of households in the middle and higher middle income group has increased from 14% in 1990 to 20 % in 1999. The population to bed ratio in India is 1 bed per 1000, in relation to the WHO norm of 1 bed per 300. In India, there exists space for 75000 to 100000 hospital beds. Private insurance will drive the healthcare revenues. Considering the rising middle and higher middle income group we get a conservative estimate of 200 million insurable lives Over the last five years, there has been an attitudinal change amongst a section of Indians who are spending more on healthcare. Corporate hospitals mushroomed in the late eighties. The boom remained short lived and out of the 22 listed hospitals scrips, most are being trading below par. An increasingly fragmented market, lack of statistics, capital intensive operations and a long gestation period are all wise reasons to shy away from investing in the healthcare industry. Government and trust hospitals dominate the scene. Many of the trust hospitals suffer from poor management. Good corporate hospitals are still too few to amount to a critical mass. Corporate hospitals failed a decade ago because they emerged in isolation and werent part of a larger phenomenon. However, now, there are the insurance companies, the hospital hardware and the software companies that have come together to create the boom. Factors Attracting Corporate In the Healthcare Sector (Recognition as an industry): In the mid 80s, the healthcare sector was recognized as an industry. Hence it became possible to get long term funding from the Financial Institutions. The government also reduced the import duty on medical equipments and technology, thus opening up the sector. Since the National Health Policy (the policys main objective was Health For All by the Year 2000) was approved in 1983, little has been done to update or amend the policy even as the country changes and the

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14 new health problems arise from ecological degradation. The focus has been on epidemiological profile of the medical care and not on comprehensive healthcare. Socio-Economic Changes: The rise of literacy rate, higher levels of income and increasing awareness through deep penetration of media channels, contributed to greater attention being paid to health. With the rise in the system of nuclear families, it became necessary for regular health check-ups and increase in health expenses for the bread-earner of the family. Brand Development: Many family run business houses have set-up charity hospitals. By lending their name to the hospital, they develop a good image in the markets which further improves the brand image of products from their other businesses. Extension To Related Business: Some pharmaceutical companies like Wockhardt and Max India, have ventured into this sector as it is a direct extension to their line of business. 7 Ps of marketing for hospitals: Product: The service product is an offering of commercial intent having features of both intangible and tangible, seeking to satisfy the new wants and demands of the consumer. Hospital industry is action oriented and there is a lot of interaction with the customers (patients). The service product of the hospitals normally have the following features: Quality Level: When we talk about marketing hospitals, it is natural that we are very particular our services in the right fashion. Supportive services play an important role in

about managing

improving the quality of medicare. These services which include laboratory, blood-banks, catering, radiology and laundry, in a true sense determine the quality of services made available by medical and Para-medical personnel. They get a strong base for treatment since the diagnostic aspect determines a direction. To get the best result from OT, it is natural that equipments are properly sterlised. In addition, the dresses and clothes are also required to be made bacteria free. The patients are required to wear disinfected linen which should be made available. The radiology department should have hi-tech facilities keeping in view the pressure of work. Of late, we find sophisticated equipments and unless hospitals make the same services available the same, the quality of services cannot be improved. Accessories: This is a very good way of segmenting customers. Many hospitals provide additional services such as catering, laundry, yoga sessions, cafeterias, etc. for the customers (patients)who are willing to pay extra. Hospitals have different wards - General and Special.

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15 Certain hospitals provide services for the family members of the patients (when they are not from the same city) accommodation and catering. Packaging: It is the bundling of many services into the core service. Eg: Apollo hospital offers a full health check-up to the patients. Similarly other hospitals also offer package deals for health check-ups. For example if a person has to undergo a bypass surgery, he can pay a lump sum amount during admission, say rupees 1 lakh for all procedures, tests, stay, etc, at once. Product line: hospitals through their services offer many choices to the patients and cover a wide range of customer needs. For example: Apollo hospital has dental department, cardiology department, etc. and within the dental department it has dental surgery, root canal, etc. Brand name: The hospitals, to differentiate themselves, and their services from others use a brand name. The intangibility factor of the service makes it all the more important for the hospitals to do so. Place: Under hospital marketing, distribution of Medicare services plays a crucial role. This focuses on the instrumentality of almost all who are found involved in making services available to the ultimate users. In case of hospitals the location of hospital plays a very important role. The kind of services a hospital is rendering is also very important for determining the location of the hospital. Eg. Tata memorial hospital specializes in cancer treatment and is located at a centre place unlike other normal hospitals, which you can find all over other places. It can be unambiguously accepted that the medical personnel need a fair blending of two important properties i.e. they should be professionally sound and should have in-depth knowledge at psychology. A particular doctor might be famous for his case handling records but he may not be made available for all the patients because of the place factor. Now in this case the service provided, that is the doctor may be a visiting doctor for different hospitals at different locations to beat the place factors. Unlike other service industries, under hospital marketing all efforts should be for making available to the society the best possible medical aid. In a country like India, which is geographically vast and where majority of the population lives in the rural areas, place factor for the hospitals play a very crucial role. A typical small village / town may be having

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16 small dispensaries but they will not have super speciality hospitals. For that they will have to be dependent on the hospitals in the urban areas. People

Under hospital marketing the marketing mix variable people includes all the different people involved in the service providing process (internal customers of the hospitals) which includes doctors, nurses, supporting staff etc. The earliest and the best way of having control on the quality of people will be by approving professionally sound doctors and other staff. Hospital is a place where small activity undertaken can be a matter of life and death, so the people factor is very important. One of the major classifications of hospitals is private and government. In the government hospital the people factor has to be specially taken care of. In Indian government hospitals except a few almost all the hospitals and their personnel hardly find the behavioural dimensions significant. It is against this background that even if the users get the quality medical aid they are found dissatisfied with the rough and indecent behaviour of the doctors. Under hospital marketing a right person for the right job has to be appointed and they should be adaptable and possess versatility. The patients in the hospitals are already suffering from trauma, which has to be understood by the doctors and other staff. The people of the hospital should be constantly motivated to give the best of their effort. Process

Process generally forms the different tasks that are performed by the hospital. The process factor is mainly dependent on the size of the hospital and kind of service it is offering. A typical process involved in a medium sized hospital can be as follows. Apart from this flow there are other allied activities like record keeping administration at services etc which fall under the process factor. These stages do not exist separately but are interlinked. The most important elements are lines of communication within the setup. The experience of the patient depends on the final interplay of all these factors.

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17 Physical evidence

It does play an important role in health care services, as the core benefit a customer seeks is proper diagnosis and cure of the problem. For a local small time dispensary or hospital physical evidence may not be of much help. In recent days some major super speciality hospitals are using physical evidence for distinguishing itself as something unique. Physical evidence can be in the form of smart buildings, logos, mascots etc. a smart building infrastructure indicates that the hospital can take care of all the needs of the patient. Promotion: both after taking into consideration the

Hospitals for promotion use either advertisement or PR or target customers, media type, budget and the sales promotion.

Since a few years the prime times in T.V. are reserved for advertising social issues like family planning, use of different types of contraceptives, care for the girl child and so on. These commercials use the common man approach for reference group appeal. In case of health care products and services use for common man appeal is widely prevalent. The use of celebrities is not as effective as that of a common man. An ordinary person thinks that if it works well for people like him, it will also work equally well for him. The identification with the common man is easy and quick. 17

18 Opportunities: With global revenues of approximately US$ 2.8 trillion, the healthcare industry is the worlds largest industry and India is emerging as a major player in this industry, because of its high population. As per the Insurance Regulatory and Development Authority (IRDA), the Indian healthcare industry has the potential to show the same exponential growth that the software and pharmaceutical industries have shown in the past decade. Further, as per the IRDA, only 10 percent of the market potential has been tapped till date and market studies indicate a 35 percent growth in thecomingyears.

A big opportunity for the industry emerges from the privatization of the insurance segment, which would extrapolate into a new delivery system in India. There is a vast insurable population in India, given that only 2 million people i.e. 0.2 percent of the total population are covered under Mediclaim. According to a recent study, there are 315 million potentially insurable lives in the country. A World Health Organization report states that India needs to add 80,000 hospital beds each year to meet the demand of its population. The huge shortage of beds outlines a major opportunity for the industry. The healthcare industry is a fast growing industry and coupled with strength of Indian innovative and scientific manpower and also low costs, it is slowly achieving key industry status in India. The Future Healthcare industry is booming all over the world. In the US it is already the largest service sector. And world-wide it is slated to be a $4 trillion market by 2005. A World Bank Report in November 1999 points at the emergence of large-scale, investor-owned hospitals in the country as a "dramatic" development. The Corporate hospitals will play a positive role in the healthcare sector by taking the load off government hospitals, whose performance hasnt been upto the mark. The Healthcare Industry is on the threshold of a major Growth Spiral which shall assimilate all new technologies to provide cost effective Healthcare. It shall not only employ the largest chunk of all available capital but shall also employ a large proportion of the skilled work force. The Healthcare Industry is poised to become the biggest Employer in all Countries. It shall also be the biggest consumer of all new technologies. Specifically, in the next decade, it is anticipate that the Healthcare Industry shall grow at an accelerated pace and will achieve a Growth Rate of 8 - 10 % per annum in India and a Growth Rate of 4 - 8 % per annum in most of the Countries of third World. As a result, most of the Countries in the world (Other than USA) shall add more Hospital Beds. 18

19 This accelerated growth will require a large body of skilled Healthcare Providers. As a result, the Medical Education Sector, including Medical and all Para-medical staff, shall also witness a faster growth. It is anticipated that the numbers of skilled Healthcare Providers shall double in next decade. The addition of Hospital Beds shall catalyze a Growth in Hospital Equipment Industry. It shall also fuel the growth of Pharmaceutical Industry. It shall specifically affect the Medical and Surgical Supply Segment and there too, the Prosthetic Devices Segment shall witness a very rapid growth. In the next decade, the Earth's Population shall reach a peak number. This, coupled with availability of better Healthcare shall lead to a higher Expectancy of Life at Birth. The average age of Earth's Population shall increase. This will require a far superior understanding of Multiple Organ Syndromes and there treatments. There shall be a shift in focus of providing Healthcare. The Hospitals shall tend to be the providers of Acute & Intensive Healthcare; while new cost effective modalities shall provide intermediate care or nursing only care. These new modalities shall not follow the rigid standards as set for Hospitals & shall employ a smaller number of trained medical manpower. These modalities shall augment the Home Care, as is available in the Joint Family Environment to more than half the population of world today. This will necessitate a greater interaction between the Healthcare Provider, the Medical Charge and the other segments of Healthcare Industry. This growth of Healthcare Industry shall be supported by Political Will and Social Understanding at all levels of any Society. It must, therefore, meet the new challenges, by providing cost effective Healthcare in a manner that improves the Quality of Humane Life. Some Suggestions for improving the position of the hospitals The general perception that large hospitals, with high bed-occupancy rate, are profitable, is misleading. Global experience shows that hospital with more than 250 beds dont do well. Many Indian hospitals are following the US healthcare industry, by decreasing the average length of stay of patients and increasing patient turnover. US research shows that 80% of the revenues form a patient comes in the first 72 hours post- admission. Hospitals generate a lot of revenues from General Inspection, because the patient turnover is very high. A large percent of revenues come from specialized services like operations and surgeries. It is because of these reasons that many corporate are planning for small 100 beds specialized hospitals, which caters to specific diseases like cardiac, cosmetic surgery, neurology etc. Research shows that there exist a lot 19

20 of space for super-specialized hospitals with 100-150 beds, which generate revenues equivalent to large 500 bed general hospital. Typically large hospitals with approximately 500 bed capacity takes about 910 years to break even whereas super-specialty hospitals with about 100 beds take about 6-7 years to break even. Therefore, going in for super-speciality hospitals seems to be a more viable option today. Hospitals could also generate revenues from medicines if they are supplying them in-house. Some hospitals make it mandatory for the patients to buy medicines from the hospitals chemist shop. A margin of 15-20 % can be charged for such medicinal supplies. Though many hospitals run by Trusts do not earn this way, but new entrants or corporate for whom private healthcare sector is a direct extension of their line of business (e.g. Pharmacy companies), can generate good returns from medicine supply. Health Plan packages can be provided by hospitals to family and corporate. For example Family Health Plan Services (FHP), a subsidiary of Apollo Hospitals does health management of employees of its clients. With a wide net work of Hospitals and Healthcare providers countrywide, and a tie -up with General Insurance Corporation of India, FHP offers a range of services to employees and dependants, such as Preventive Healthcare, Corporate Counseling, welfare Programs, Claims Administration, Patient-care Coordination and so on. So FHP's healthcare packages, optimize the benefits while keeping the cost under control. Apart from preventive healthcare, stress management programs could be provided. For example Effective Stress Management Programme offered by Wockhardt Hospital. This Programme provides a medical perspective of stress and is conducted by a medical professional. The Programme includes a series of one-to-one sessions, with a clinical Psychologist highlighting the factors responsible for inducing stress, and the methodologies, which can be adopted to cope with this phenomenon practically. Hospitals can become integrated healthcare systems i.e. when medicines, food services, laundry and linen etc will become "purchased" services. These third-party operations will increase the profit margins. Mergers could be used for synergy of skills - i.e. to help the merged organizations benefit from one another's individual strengths by applying them across the board. It also helps them to make joint investments in branding or information technology and also to react effectively to the changed market forces. 20

21 Alternatively hospitals can go in for Group Purchases, as in USA. The buying power of large GPOs in USA like Premier, VHA / UHC and AmeriNet gives them the clout to exert price pressure on suppliers, particularly for products in lower demand. And as GPOs have consolidated, manufacturers have offered bigger discounts to hang on to their contracts. So there exists a lot of supply management opportunity, which will affect spending productivity.

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22 ABOUT THE COMPANY

CARDIAC ADVANCE RESEARCH AND EDUCATION Care foundation is a registered nonprofit society with the mandate of making quality health affordable and accessible to all through appropriate use of technology .The foundation has been established by a group of medical scientists and technologies with the stated mission of making advanced comprehensive health affordable and accessible to all. The foundation is a non- profit organization and is registered as a society under Andhra Pradesh Society Act 1365 Falsie. The patron of the foundation is renowned cardiologist padmashri Dr B.SomaRaju and the chairman of the foundation is prof.P.krishnam Raju. The foundation implements its mission of making advanced technology based affordable and accessible to common man under a three dimensional program. a. Conducting research & imparting specialized education, b. Developing cost effective medical products, and c. Providing health to people from the economically weaker sections of the society and those living in rural areas. In 1997, when Dr.B.Soma Raju and Dr.D.Prasada Rao led a team of medical professionals to set up the first Hospital, it signaled the dawn of a new era in medical. At the heart of this movement was a burning desire to practice medicine with compassion, concern and, with a single minded objective the recovery of the patient. Today, with Multi-Specialty Hospital across the state, and a reputation for humanization and selfless service of the highest order, Hospital enjoys an unbelievable amount of goodwill. A million smiles will bear testimony to that. The organization was incorporated with the main objective of running all kinds of hospitals, dispensaries ,nursing homes, clinical laboratories carrying out medical research, education and train medical students ,nursing professionals, hospital administrator, grant diplomas or recognitions as the company may deem fit and to render professional consultancy and advice to any individual firm, 22

23 company,Govt etc in the fields of research and development relating to medical, pharmaceutical andchemical industries. MISSION: At CARE, our mission is more than just a statement; its the cornerstone of all our efforts: The mission is more than just a statement; its the cornerstone of all efforts. And, of course a constant reminder of their movements founding values. To provide quality medical at an affordable price, delivered with compassion, concern and, through team spirit, training and technology. To develop a comprehensive health delivery model that suits their population. To develop centers of excellence in various medical specialties. To evolve a holistic approach to health by incorporating the best from various forms of medicine.

VISION:

To evolve as a unique university-based health-centre where the quest for new knowledge would continuously yield more effective and more compassionate for all. To nurture a new generation of professionals of long life commitment, dedication, knowledge, skills, wisdom and values. To strive for public trust and maintain medicines humane and noble place amongst professions. To be globally competitive in health and related businesses integrating local culture and ethos. To promote development of indigenous products and systems, adapting appropriate technologies generating clinical skills and removing barriers before patients accessing it through institutional partnership. 23

24 OBJECTIVES:

To bring down the cost without compromising on quality. To indigenize all the costly disposables in the next 10 years.

POLICIES: Sensitivity to pain and suffering shall be accorded highest priority to every employee. Same treatment for same illness, irrespective of ability to pay. Tests will be done only when medically necessary Selection of all employees shall be on the basis of merit. Compulsory continuous medical education to lab health personnel. All departments shall be run by full time consultants. Round the clock availability of cardiologists, C.T. Surgeons neurologists, anesthetists, labs and technicians MILESTONES: Hospital, The Heart Institute established at Hyderabad-200 beds July 1997. 50 bed cardiac centre established in Secunderabad June 1998. 100 bed Heart Institute set up in Visakhapatnam -April 1999. Foundation got defense technology spin-off award from Prime Minister-August 1999. The Institute of Neuro-Sciences set up in Hyderabad-October 2000. The Institute of Medical Sciences with Multi-specialty services with 350 beds at Banjara Hills(Hyderabad)-October 2000. Padmashri awarded to Dr.B.Soma Raju and DR.D.Prasada Rao, the founders of -January 2001. Bharat Ratna, Dr.APJ Abdul Kalam, inducted onto the board May 2001. Indias first V-SAT based publicprivate Telemedicine system launched by chief minister of APOctober 2001. 24

25 Established `a Community Model Hospital at Amalapuram-Jan 2002. Established a Primary Health Model Hospital at Lakhavaram-March 2002. Established a 50 bedded Hospital at Vijayawada-Dec 2003.

Values & principles:

The corner stone of values practiced at CARE stem from our ideology of to put patients interests first. The ideology dictates every aspect of the clinical governance, patient care and the work culture. The great heights we have achieved in delivering medical care with exceptional quality have been a result of these values-based health services. PRACTICE: Practice medicine as an integrated team of compassionate physicians, scientists and allied health professionals. EDUCATION: Service through efficient training and education of physicians, nurses and allied health professionals. RESEARCH: Conduct basic as well as advanced clinical research to improve patient care and quality in every service we undertake to offer. MUTUAL RESPECT: Treat everyone with respect and dignity. COMMITMENT TO QUALITY: Continuously strive to improve all processes that support patient care, education and research. WORK ATMOSPHERE: Foster teamwork, personal responsibility, integrity, innovation, trust and communication. SOCIETAL COMMITMENT: Support society we live in by assisting patients with limited financial resources. FINANCES: Allocate resources within the context of system rather than its individual entities.

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26 ABOUT THE LOGO

Brand Identity and Name are largely dependent on the Logo. People identify an organization with its Logo. It is a Logo that states in part the organizations ethics and values. The following list explains the CARE Logo The bold rectangular surrounding the frame logo exemplifies the well defined framework within which CARE operates. Each stroke that makes the pedestal identifies the multi-disciplinary teams working at CARE. The Foundation under the field depicts a level field for all, and talks about CAREs transparent dealings. On top of the towering pedestal, the figure lending a helping hand signifies a professional standing on excellence, while a figure hes helping up represents a patient down with disease. The color purple represents nobility and spirituality. And hence, it brings about certain spiritual calmness to those who come in contact with it. ABOUT THE HOSPITAL Continuous guidance, warm care and emphasis on putting the patients interests above us have emerged as the hall marks of CARE group. CARE Visakhapatnam was established in tune with these hall marks of the CARE group. CARE Visakhapatnam, a part of the CARE group chain of super-specialty hospitals, has been in the forefront in delivering quality medicine since 1999. And since then, it has made a mark for itself as a premier Institute. Originally started out as an exclusive hospital for treatment of cardiac and cardio thoracic ailments, it has firmly rooted itself into the community and gradually, over the decade, emerged as a multi-disciplinary super-specialty hospital. This 150 bedded hospital is designed to render services in various specialties like Cardiology, Cardio Thoracic Surgery, Neurology, Neurosurgery, Nephrology (Dialysis), Critical Care,

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27 Gynecology, orthopedics, Urology, Oncology, ENT, General Surgery, Physiotherapy and all other specialties. With a surplus of experienced and highly qualified surgical staff and envious state-of-the-art technology, the hospital has set its eyes of achieving the common CARE goal i.e. achieving the highest patient satisfaction by providing high quality care at affordable cost. The CARE hospital at Visakhapatnam is headed by Dr. V. Krishna Murthy MD, Executive Director. WHO WE ARE

Practicing medicine as it should be practiced. CARE is one of the fastest growing hospital chains in India, engaged in providing primary as well as tertiary healthcare services. It is a hospital chains that is founded and managed by professionals with a mission and a passion for providing healthcare for the needy. At CARE, the growth has been phenomenal. From a 100-bed single specialty Heart Institute facility focusing on cardiac care in Nampally (Hyderabad), CARE has become a multi-specialty hospital chain comprising of 1400 beds across 12 hospitals.

CAREs reputation for its humanitarian and selfless service has ranked this esteemed institution as the fourth largest healthcare provider in India (CRIS-INFAC report, 2006). Our effort to provide quality health care with compassion has rewarded us with the honor of being the top healthcare provider in Andhra Pradesh. CARE has carved a niche for itself by garnering the best reputation amongst the local masses. Armed with the best of the facilities in areas of Education, Research, patient care and highly qualified professionals, CARE endeavors to match global benchmarks and conquer healthcare market in the second decade of its establishment.

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28 ORGANISATION STRUCTURE

PATIENT S Nurses

Paramedics and House keepers

Departmental Manager

Support Manager

Directors
In structure, we see patients, are at high priority, at quality the main criteria is putting the patient first above ones own interest. They are treated as Elite Group of the organization. The next preference is given to doctors and nurses they are the people who give emotional support and satisfaction to the patients. The more comfort they give the more satisfied is the patient, here the nurses play a very important and vital role, they look after every aspect of the patient starting with their food to their medicines, for this they have to be very patient, humble and pleasing. The next comes Paramedics and Housekeeping, the more cleanliness the more attractive the hospital, so the housekeeping people play a crucial role in attracting the people to opt the hospital. Pharmacist is the one who delivers the prescribed medicines given by the physician, the more pro active they are the more willingness to buy the medicines from within the premises. Next comes the Departmental manager, who looks after the departments, its functions and the procedures to be followed. He is the person who is responsible for all activities to be carried for attaining the objectives. 28

29 ORGANIZATIONAL HIERARCHY

CHAIRMAN

VICE CHAIRMAN

BOARD OF DIRECTORS

HOSPITAL ADMINISTRATOR

GENERAL MANAGER

DEPUTY GENERAL MANAGER

MANAGER

ASSISTANT MANAGER SUPERVISOR

REGULAR STAFF

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30 ORGANIZATION POLICIES EMPLOYEE BENEFIT: Provident Fund: All the employees will contribute 12% of their basic salary which is 60% of their Gross 25% H.R.A 15% conveyance. All the employees who are on the pay roll are eligible for this and trainees after completion of their training get the eligibility on regularization. From the employee contribution of P.F. 8.33% will go to the pension fund and remaining 3.67% will be added to P.F. EMPLOYEE WELFARE: All the members are covered under Medi claim policy for self and family members. Each member is covered for 50,000 insurance Insurance coverage will be done after 3 months of service.

SALARY/WAGES Attendance is taken from the swipe machine in time office and uploaded into the pay roll management system. Pay roll is managed in the pay roll package (jeeva) Monthly statement like loss of pay, canteen deduction, pharmacy allowance. Nursing allowance, New joining, Resignation, Monthly increments, Doctors, Night shifts, Managers etc., are prepared along with salaries. Salaries are deposited into savings bank account directly.

LEAVE MANAGEMENT: Being an essential service regular attendance for work is a vital factor in ensuring smooth and uninterrupted operation. These require that employee plan their leave in order to guide to staff on subject of leave. There are: Casual leave Sick Leave Earned Leave : : : 12 per year 12 per year (Who were not under ESI) 15 per year 30

31 Maternity Leave Compensatory off : : 90 days Day

Leave on loss of pay /special Leave TRANSFERS: All the employees are subjected to transfer as follows: 1 .Intra Dept 2. Inter Dept 3. Inter Hospital Permanent Probationer Temporary Trainee Internees Honorary Trainee Contract Labor

ADMINISTRATION In any Organization, HR Department plays a very important role. All the major activities will be dealt in HR Department such as preparation of full and final settlement, maintaining record of each employee of Organization, pay roll following up of appraisal of potential, rewarding the BEST ASSOCIATE AWARD from various Departments of Organization based on their performance, skills, qualities, responsibilities. WORKING HOURS AND CONDITIONS: There are shifts for the employees working in the Organization. For Administrative department the working hours are 9 AM to 6 PM.

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32 CARE TECHNOLOGY

Ever since its establishment, CARE has constantly proved its merit through evolving cost-effective medical products and procedures. The perfect amalgam of cutting edge-research, advanced technology combined with the experience and insight of the expertise, heralded a medical technology that saw many firsts in the Health care arena. Along with these path-breaking inventions that are the first of its kind, CARE has imported the highly efficient and the best-of-its-kind equipment and procedures to enable stateof-the-art treatment to its patients. These state-of-the-art technological equipments are the first of its kind and unique to CARE. It is these technically and medically advanced equipment and technology that makes CARE a step above other - a truly unique organization. CARE Hospitals is one of the finest multi-specialty hospitals across the world. CARE is, perhaps, one of the few medical institutions that not only provide quality medical healthcare at a reasonable price, but also develop a holistic approach to healthcare by incorporating the best from various forms of medicine. ACHIEVEMENTS:

300 children with congenital heart defect received surgical care at no cost to 800 children with congenital heart defect received surgical care with state minimum support.

the patient government

More than 350 free camps conducted across the state and outside the state 32

33 Provides low cost CT and Echo facilities at Mahboobnagar through telemedicine. Frequent Community Wellness Programs, 32 free camps conducted More than 300 hundred rural free health screening programs Nearly 50% of the patients availed general operations at subsidized cost

APPROACH The approach to the research is based on the results of the survey that finds the following: Disease and risk factor prevalence surveys and a quantitative and qualitative assessment of health services. Low cost, evidence-based health interventions to address priority issues

BENEFITS: The research has shown that Coding of causes of death has generated useful statistics reflecting the epidemiologic transitions occurring in India. Analysis suggested that communities were likely to benefit from a cardiovascular disease prevention program. An intervention using algorithms to identify and manage adults at high risk of cardiovascular disease, provide low-cost treatment and deliver individual patient education has been designed. DEPARTMENT WISE ORGANOGRAM AAROGYASRI COMMUNICATION

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34 BILLING BIO-MEDICAL

BUSINESS DEVELOPMENT

CARDIO THORACIC

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35 CATH LAB CRITICAL CARE

CSSD

DOCTORS

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36 DIETICS FOOD AND BEVERAGES

FRONT OFFICE

GAS PLANT

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37 FINANCE AND ACCOUNTS GASTROENTROLOGY

GENERAL OPERATION THEATRE

GENERAL STORES

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38 HOSPITAL INFORMATION DEPARTMENT HOSPITALITY SERVICES

HUMAN RESOURCES

INTERNAL MANAGEMENT AUDIT

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39 LABORATORY MAINTENANCE

MEDICAL RECORDS

NEPHROLOGY

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40 NEUROLOGY NON INVASIVE LAB

NURSING

OPERATION THEATRE

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41 PHARMACY PHYSICIAN ASSISTANT

PHYSIOTHERAPHY

PURCHASE

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42 QUALITY RADIOLOGY

SECRETARIAL SERVICES

TRANSPORT

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43 OVERALL ORGANIZATIONAL STRUCTURE OF CARE HOSPITAL

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44

STRESS MANAGEMENT
DEFINITION:
STRESS can be defined as a form of tension or strain in the body or the mind for which there is no release or outlet. When under stress, one is like a car in the neutral gear with the accelerator on, trying to exert initially, but unable to do so . Stress is also defined as mental, physical, emotional tension, strain or distress. Stress is a fact of life. However, too much stress can result in the breakdown of a persons physical, mental and emotional health. It has physical and emotional effects on us and can create positive or negative energy. But not all stress is bad. Stress can have positive effects too. In fact, stress is a very natural and important part of life. Human body is designed to react to two types of stress. Good stress helps keep us alert, motivates us to face challenges, and drives us to solve problems. These low levels of stress are manageable and can be thought of as necessary and normal stimulation. However, Distress, on the other hand, results when our bodies

overreact to events.

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SYMPTOMS OF STRESS:
Some of the things you're likely to notice when you're in a stressed state are: Disrupted sleep patterns (including more dreaming) Negative feelings of self-worth More intense emotional state, including tearfulness, anger, impatience Inability to concentrate Inability to make decisions Digestive problems Drinking more, smoking more, eating more/less

Some of the things you won't always notice, but which have been associated with long-term stress are: Thyroid/endocrine burnout Brain damage Obesity/diabetes Immune suppression Infertility Auto immune stress related diseases High blood pressure Heart disease, cardiac failure

TYPES OF STRESS:
There are five main types of stress that people experience. They are Eustress Distress Hyperstress Hypostress 45

46 Neustress

EUSTRESS:

Eustress is a kind of short-term stress that provides immediate strength. Eustress can be defined as a plea sant or curative stress. We can't always avoid stress. There are certain times when we do not want to avoid stress because controlled stress gives us that competitive edge in performance related activities like athletics, giving a speech, or acting, etc. Eustress arises at points of increased physical activity, enthusiasm, and creativity. Eustress is a positive stress that arises when motivation and inspiration are needed. A gymnast experiences eustress before a competition. The Stress Curve diagram illustrates the concept that, for any performance-related activity, there is an optimal amount of stress. If you are involved in an oral interview for a job, you will benefit from a certain amount of stress. It is stress that provides you with focus and gives you your "competitive edge" that will help you think quickly and clearly and express your thought in ways that will benefit your interview process. Examples of Eustress: Graduating from college, Getting married, Receiving a promotion , Changing jobs for better prospects , Winning competition , Buying a new home
DISTRESS:

Distress is a negative stress brought about by constant readjustments or alterations in a routine. Distress creates feelings of discomfort and unfamiliarity. There are two types of distress. Acute stress is an intense stress that arrives and disappears quickly. Chronic stress is a prolonged stress that exists for weeks, months, or even years. Someone who is constantly relocating or changing jobs may experience distress. Examples of distress: Chronic Pain, Anxiety, Depression, Cramming for exams, troubled relationships Basically, distress is your bodys way of responding to what it views as a tragic or upsetting event in your life. It can affect both your physical and your mental health, especially for chronic sufferers.
HYPERSTRESS:

Hyper stress is an excessive amount of stress. It occurs when an individual is pushed beyond what he or she can handle. Hyperstress results from being overloaded or overworked. When someone is hyperstressed, even little things can trigger a strong emotional response. A Wall Street trader is likely to experience hyperstress. 46

47 Mothers are often victims of hyperstress, as they may work and care for the home, husband, and children, or they may stay at home, plus juggle marriage and the demands of motherhood.

HYPOSTRESS:

Hypo stress is the opposite of hyperstress. Hypo stress occurs when an individual is bored or unchallenged. People who experience hypo stress are often restless and uninspired. A factory worker who performs repetitive tasks might experience hypostress. Hypostress happens when you suffer from extreme boredom, or when you have nothing in your life that stimulates you anymore. If you go to work everyday at the same time, same place, and perform the same repetitive work, then you are likely to suffer from hypostress.
NEUSTRESS:

Neustress is neutral stress, neither good nor bad. Neustress describes sensory stimuli that have no consequential effect, neither good nor bad.It is a kind of stress which has no significant consequence. Also, from the scientific point of view, it has no real meaning. STRESSORS: The issues or factors that create stress are called stressors. Stressors are the situations, circumstances and other stimuli that are perceived to be a threat. Stress is often associated with situations that you find difficult to handle. How you view things also affects your stress level. If you have very high expectations, chances are that you will experience more than your fair share of stress. This includes for instance Personality Stressors: Self-perception, Need for control, anxious reactivity, Time urgency 47

48 Psychosocial Stressors: Financial insecurity, Life changes, Technological advances, Overload Frustration, Deprivation, Trauma, loss External Stressors: Occupation, Noise, Nutrition, Drugs, Environment etc Stressors can also be classified as short-term (acute) or long-term (chronic). Acute Stress - Acute stress is the reaction to an immediate threat, more popularly known as the fight or flight response. Common acute stressors include: * Noise, Crowding, Isolation, Hunger, Danger, Infection * Imagining a threat or remembering a dangerous event Normally, once the acute threat has passed, the response system gets inactivated and the level of stress hormones returns to normal. This condition is known as the relaxation response. Chronic Stress Chronic stress is something which is not short lived. A person with chronic stress experiences it every day on an on-going basis. The stress gets aggravated when an individual tries to suppress it. Common chronic stressors include: Ongoing highly pressured work, Long-term relationship problems, Loneliness, Persistent financial worries.

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Stress Management: Keeping Stress under Control

At Time Management Solutions we have a 7-way approach to stress management. It consists of the following parts:

Personal productivity skills: When your productivity is on a level where you know that you perform efficiently at work, you will experience less stress. Physical activities and doing sports: Physical exercise releases built up tension. It also releases hormones that make you feel good. A fit body helps your mind to stay focused and it also can handle stress for longer physically. This gives your mind a possibility to relax. Journaling: It is an excellent way of learning to know you better. It can also work more acutely; if something is stuck on your mind a good exercise is to write it down and just to discuss the matter in your diary for 10-20 min. Meditation: Meditation calms down the whirlwind of thoughts in your head. The effect is immediate, and done regularly it will be even stronger. Regular meditation will result in a generally calmer you. But most of us never manage to do it regularly

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50 Leading a balanced life: You should not base your identity merely on your job, income, or family, because it is risky. Leading a balanced life also means that you dont have any harmful dependencies of alcohol, drugs or lets say food. Conflict resolutions skills: Many times stress and bad feelings are a result from social situations. In order to resolve difficult social situations you need to be able to face reality, the problem, and to lead difficult conversations. Your mindset should not be tuned for avoiding problems. To put it short, conflict resolution requires maturity. Mindfulness: However, present moment awareness also means that you dont live too much in the future. It is O.K. to have dreams about your future and to enter that dream every now and then. But it is not O.K. to live a deferred life, where you are holding back on things because one day when you will have the perfect moment you will finally do this and that. That one day will probably never come, so start doing things you want to now.

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STRESS RELIEF TECHNIQUES:

Relaxation is a skill. With frequent practice you will improve these skills to control your emotions and improve your physical well being. These techniques can be practiced either day or night to assist you to relax and feel in control. It is really important to practice regularly. Slow breathing technique: This is useful if you start to over breath and when you are feeling the first signs of anxiety or stress. You are required to do the following: STOP what you are doing and sit down. Hold your breath and count to 10. When you count to 10 breathe out and say the word relax to yourself in a calm soothing manner. Breathe in and out through your mouth, focus on your breathing. Breathe in for 3 seconds and out for 3 seconds. Repeat saying relax to yourself every time you breathe out. At the end of each minute hold your breath for 10 seconds and then continue the 6-second breathing cycle. Continue doing this breathing cycle until all of your symptoms of over breathing are gone and you feel relaxed and back in control.

WORK STRESS:
Work-related stress is the response people may have when presented with work demands and pressures that are not matched to their knowledge and abilities and which challenge their ability to cope. Pressure at the workplace is unavoidable due to the demands of the contemporary work environment. Pressure perceived as acceptable by an individual, may even keep workers alert, motivated, able to work. Workers who are stressed are also more likely to be unhealthy, poorly motivated, less productive and less safe at work.

Their organizations are less likely to be successful in a competitive market. Stress can be brought about by pressures at home and at work. Employers cannot usually protect workers from stress arising outside of work, but they can protect them from stress that arises through work. Stress results from a mismatch between the demands and pressures on the person, on the one hand, and their knowledge and abilities, on the other. It challenges their ability to cope with work. This includes not only situations where the pressures of work exceed the workers ability to cope but also where 51

52 the workers knowledge and abilities are not sufficiently utilized and that is a problem for them.

STRESS RELATED HAZARDS:

Job Content Monotonous, under-stimulating, meaningless tasks Lack of variety Unpleasant tasks Aversive tasks Workload and Work pace Having too much or too little to do Working under time pressures Working Hours Strict and inflexible working schedules Long and unsocial hours Unpredictable working hours Badly designed shift systems Participation and Control Lack of participation in decision making Lack of control (for example, over work methods, work pace, working hours and the work environment)

WORK CONTEXT:
Career Development, Status and Pay Job insecurity Lack of promotion prospects Under-promotion or over-promotion Work of low social value Piece rate payments schemes Unclear or unfair performance evaluation systems Being over-skilled or under-skilled for the job Role in the Organisation Unclear role 52

53 Conflicting roles within the same job Responsibility for people Continuously dealing with other people and their Problems Interpersonal Relationships Inadequate, inconsiderate or unsupportive supervision Poor relationships with co-workers Bullying, harassment and violence Isolated or solitary work No agreed procedures for dealing with problems or complaints Organizational Culture Poor communication Poor leadership Lack of clarity about organizational objectives and structure Home-Work Interface Conflicting demands of work and home Lack of support for domestic problems at work Lack of support for work problems at home

EFFECTS OF WORK STRESS ON INDIVIDUALS:

Stress affects different people in different ways. The experience of work stress can cause unusual and dysfunctional behavior at work and contribute to poor physical and mental health. In extreme cases, long-term stress or traumatic events at work may lead to psychological problems and be conductive to psychiatric disorders resulting in absence from work and preventing the worker from being able to work again. When affected by work stress people may: become increasingly distressed and irritable become unable to relax or concentrate have difficulty thinking logically and making decisions enjoy their work less and feel less committed to it feel tired, depressed and anxious have difficulty sleeping experience serious physical problems, such as: 53

54 - Heart disease, - Disorders of the digestive system, - Increases in blood pressure, headaches - Muscle-skeletal disorders

PREVENTION OF WORK STRESS:

There are a number of ways by which the risk of work stress can be reduced. They are primary prevention: * Ergonomics, * Work and environmental design, * Organizational and management development, secondary prevention: * Worker education and training, and tertiary prevention: * developing more sensitive and responsive management systems and enhanced occupational health provision.

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RISK MANAGEMENT CYCLE:

Basic steps: Think about the different work groups or work places that make up an organization. Evidence we have got ( ex: high absence rate, poor health records) Investigate the way in which the work of these groups or workplaces is designed and managed, and examine their working conditions. Identify, collect and discuss the evidence that is available to you. Work in a team with others who understand the work groups and work places. Identify the main problems and their effects. Discuss this information with the responsible managers and other relevant people, such as Occupational Health specialists, and with the trade unions. Develop an action plan that is appropriate, reasonable and practical. Discuss how this plan might be implemented and made to work. Inform the workers of the plan and how it will be implemented. Before its implementation, determine how this plan might best be evaluated. Implement and evaluate the action plan. Discuss the results of the evaluation. Revise action plan and implement a new one to target unaccounted risks. Assessment of Risk

Learning and further Action

Design action plan to reduce risk

Evaluation of Action Plan 55

Implementation of action plan

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SOLVING WORK STRESS PROBLEMS:

Work redesign: The best strategies for work redesign focus on demands, knowledge and abilities, support and control and include: Changing the demands of work Ensure that employees develop the appropriate knowledge and abilities to perform their jobs effectively. Improve employees control over the way they do their work. Increase the amount and quality of support they receive.

Stress management training: Ask employees to attend classes on relaxation, time management, assertiveness training or exercise. Ergonomics and environmental design: Improve equipment used at work and physical working conditions. 56

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Management development: Improve managers attitudes towards dealing with work stress, their knowledge and their skills to deal with the issue as effectively as possible. Organizational development: Implement better work systems and management systems. Develop a more friendly and supportive culture.

There are basically three ways by which employers can detect problems early and prevent them from becoming serious. These are presented below. Regularly monitoring staff satisfaction and health. Making sure staff knows whom to talk to about problems. Knowing where the employees should refer for professional help when they appear to be experiencing real difficulties.

RESOURCES FOR MANAGING WORK STRESS:

Internal resources may include occupational health services, human resource management (personnel), training departments or other individuals with responsibility for staff well-being and health.

Individual problems which are complex, difficult and not manageable internally are best dealt with by a counseling psychologist, clinical psychologist, counselor, or an occupational physician who may consult with a general practitioner or other specialist functions as deemed necessary.

Identification of any groups at risk within your organization is crucial and should accompany the examination of available organizational resources for managing work stress.

SIGNS AND SYMPTOMS OF STRESS:

It is important to learn how to recognize when your stress levels are out of control or having an adverse effect. The signs and symptoms of stress overload can be almost anything. Stress affects the mind, body, and behavior in many ways, and everyone experiences stress differently.

Three common ways that people respond when they are overwhelmed by stress are:

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58 1. An angry or agitated stress response. You may feel heated, keyed-up, overly emotional, and unable to sit still. 2. A withdrawn or depressed stress response. You shut down, space out, and show very little energy or emotion. 3. Both a tens and frozen stress response. You freeze under pressure and feel like you cant do anything. You look paralyzed, but under the surface you may feel extremely agitated.

The following lists some of the common warning signs and symptoms of stress. The more signs and symptoms you notice in yourself, the closer you might be to feeling stress overload.

Cognitive Symptoms:
Memory problems Inability or difficulty concentrating Poor judgment Seeing only the negative Anxious, racing, or ruminating thoughts Constant worrying

Emotional Symptoms:
Moodiness Irritability or short-tempered Agitation, inability to relax Feeling overwhelmed Sense of loneliness or isolation Depression or general unhappiness

Physical Symptoms:
Aches and pains, muscle tension Diarrhea or constipation Nausea, dizziness, or butterflies in the stomach Chest pain or rapid heartbeat Loss of sex drive Frequent colds 58

59 Shallow breathing and sweating

Behavioral Symptoms:
Eating more or less Sleeping too much or too little Isolating yourself from others Procrastinating or neglecting responsibilities Using alcohol, cigarettes, or drugs to relax Nervous habits (nail biting, pacing)

50 Common Signs and Symptoms of Stress:

1. Frequent headaches, jaw clenching or pain 2. Gritting, grinding teeth 3. Stuttering or stammering 4. Tremors, trembling of lips, hands 5. Neck ache, back pain, muscle spasms 6. Light headedness, faintness, dizziness 7. Ringing in the ears 8. Frequent blushing, sweating 9. Dry mouth, problems swallowing 10. Cold or sweaty hands, feet 11. Frequent colds, infections 12. Rashes, itching, hives, goose bumps 13. Unexplained or frequent allergy attacks 14. Heartburn, stomach pain, nausea 15. Excess belching, flatulence 16. Constipation, diarrhea 17. Difficulty breathing, sighing 18. Sudden attacks of panic 19. Chest pain, palpitations 20. Frequent urination 21. Low sexual drive or performance 22. Excess anxiety, worry, guilt, nervousness 59

60 23. Increased anger, frustration, hostility 24. Depression, frequent or intense mood swings 25. Increased or decreased appetite 26. Insomnia, nightmares, disturbing dreams 27. Difficulty concentrating, racing thoughts 28. Trouble learning new information 29. Forgetfulness, disorganization, confusion 30. Difficulty in making decisions 31. Feeling overwhelmed
32. Frequent crying spells or suicidal thoughts

33. Feelings of loneliness or worthlessness 34. Little interest in appearance, punctuality 35. Nervous habits, feet tapping, fidgeting 36. Increased frustration, irritability 37. Overreaction to petty annoyances 38. Increased number of minor accidents 39. Obsessive/compulsive behaviors 40. Reduced work productivity 41. Lies or excuses covering up poor work 42. Rapid or mumbled speech 43. Excessive defensiveness or suspiciousness 44. Problems with communication 45. Social withdrawal or isolation 46. Constant tiredness, weakness, fatigue 47. Frequent use of over-the-counter drugs 48. Weight gain or loss without diet 49. Increased smoking, alcohol, or drug use 50. Excessive gambling or impulse buying

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STRESS RELIEVING TECHNIQUES:

Mindfulness:
Meditation that cultivates mindfulness can be particularly effective at reducing stress, anxiety, depression, and other negative emotions. Mindfulness is the quality of being fully engaged in the present moment, without over-thinking or analyzing the experience. Rather than worrying about the future or dwelling on the past, mindfulness meditation switches the focus on what is happening right now. Mindfulness meditation is not equal to zoning out. It takes effort to maintain your concentration and to bring it back to the present moment when your mind wanders or you start to drift off. But with regular practice, mindfulness strengthens the areas of the brain associated with joy and relaxation. Mindfulness provides a potentially powerful antidote to the common causes of daily stress such as time pressure, distraction, agitation, and interpersonal conflicts.

How to do a Mindfulness Exercise:

Find a comfortable place to sit. It can be on a chair or on the floor, but do not slump or slouch. Keep your posture straight but relaxed, making sure you are not rigid or stiff. Focus on your breathing. Concentrate your attention completely on your breathing. Become aware of the sensations inside your air passages as the air enters the nose. Just become aware of that feeling as your breath goes in and out. Do not attempt to influence or check your breathing; just let it happen naturally. Marvel at the quality and precision of internal sensations that are normally ignored. Wonder at how deeply you can sense the air inside you. Just allow yourself time to be aware of the air going in and out, nothing else. Keep your mind on your breathing; become your breathing. When thoughts come into your mind, thats o.k. Just examine the thoughts for what they are, as if they were some strange animal that wandered into your sight. When these thoughts come into your mind, allow them to wander off on their own and wish them well on their way. Do not get involved in the thought. Just notice that it is there and return your focus to your breathing. Treat each thought as a guest. When a thought or feeling arises, simply observe and acknowledge it. There is no need to interpret it or to use it. You might wonder where it came from, what caused it to surface now, what purpose it serves. Notice it like a precious jewel, turning it this way and that. If you feel yourself

61

62 drifting away on a thought then just return and refocus on your breathing. Use your breathing as the anchor for your mindfulness. Stay in the moment as long as you can. Continue to focus on your breathing. Aim to clear your mind completely for 5 minutes. With practice you will be able to extend the time to twenty minutes or more. Notice the repeating thoughts. As you progress you will come to recognize that the same thoughts are appearing, over and over, even in your calmest moments. Notice them and let them pass by, returning your attention to your breath. The following mindfulness meditation techniques can also be helpful for stress relief. Body Scan Body scanning promotes mindfulness by focusing your attention on various parts of your body. Like progressive muscle relaxation, you can start with your feet and work your way up. However, instead of tensing and relaxing your muscles, you simply focus on the way each part of your body feels, noticing any sensations without labeling then as good or bad. Walking Meditation You dont have to be seated or still to practice mindfulness. In walking meditation, mindfulness involves being focused on the physicality of each step; the sensation of your feet touching the ground; the rhythm of your breath while moving, and feeling the wind against your face. Mindful Eating If you reach for food when you feel stressed, or you gulp your meals down in a rush, try eating mindfully. Sit down at the table and focus your full attention on the meal. This means no T.V., reading the newspaper, or eating on the run. Eat slowly, taking time to concentrate on each bite, noticing the texture and taste of the food.

A Sample Meditation Exercise:

When you practice meditation at home, you will need to choose a quiet place where you will not be disturbed. If you wish you may sit cross-legged on a cushion on the floor, you may kneel, or sit in a chair with your back straight. You should feel comfortable, but not so comfortable that you fall asleep. While practicing mindfulness, it is important to stay alert. Remain seated in your chair. Sit with your back straight, feet flat on the floor, hands in your lap. Now close your eyes. Just breathe normally through your nose. As you continue breathing normally through your nose, begin to focus your attention on the sensations in and around your nostrils, and on your upper lip just below your nostrils, that are caused by the breath passing in and out. You might feel a slight tickle, or a feeling of warmth or coolness, or heaviness or lightness. Just keep your concentration fixed there. This area is your 62

63 anchor; the place you will always return to. Observe the changing sensations you experience in that area as the breath passes over your anchor. At the beginning of every breath, try noticing everything you can about the sensations caused by just that one breath. Do the same for the next breath, just one breath at a time. If thoughts arise, as they most certainly will, gently but firmly bring your awareness back to your anchor and remain focused on the in an out breath, one breath at a time. (Pause for a few seconds). Again, focus all of your attention on the changing sensations around your nose and upper lip that are caused by the breath as it goes in and out. Notice whether the breath is long or short. Does the air pass through one or both nostrils? Is the air cool or warm? If your mind wanders again, just note, Mind wandered away and immediately return it to your anchor. It is the minds nature to wander and your job to train it, so just keep bringing it back. Gently but firmly bring it back. If you are having difficulty bringing it back, you can try counting your breaths, just up to 10. Continue focusing on the in and out breaths for another four minutes. I will let you know when the time is up.

Exercises:
Feet and Legs:
With legs outstretched: Alternate curling and stretching the toes. Repeat three times and relax. Alternate flexing (bending) and extending (stretching) the whole foot at the ankle. Repeat three times. Rotate the ankles to the right as if drawing circles with your toes. Repeat three times. Rotate the ankles to the left. Repeat three times.

Arms and Hands:

With arms extended out in front of you: Move your hands up and down, bending from the wrist. Repeat three times. Alternate stretching your fingers, then making a fist. Repeat three times. Rotate your wrists three times, first to the right, then to the left. Relax. Repeat three times.

Shoulders:
Raise your right shoulder up toward your ear. On the exhale, release your shoulder down. Repeat three times. 63

64 Move your right shoulder forward. On the exhale, return it to the starting position. Repeat three times. Move your right shoulder back. On the exhale, return it to the starting position. Repeat three times. Repeat the sequence on the left side. Bring both shoulders up towards your ears, tense, and then drop your shoulders down as you exhale. Repeat three times.

Head and Neck:

Hold each of these positions, taking three easy breaths and relaxing tension with each exhalation, and then return your head to upright centre before doing the next movement. Drop your chin to your chest. Feel the weight of your head stretch out the back of your neck. Hold. Look as far as you can over your right shoulder. Hold. Look as far as you can over your left shoulder. Hold. Drop your right ear to your right shoulder. Hold. Drop your left ear to your left shoulder. Hold. Getting a massage provides deep relaxation, and as the muscles in your body relaxes, so do your overstressed mind. There are many simple self-massage techniques you can use to relax and release stress. SELF MASSAGE TECHNIQUES: Scalp Soother Place your thumbs behind your ears while spreading your fingers on top of your head. Move your scalp back and forth slightly by making circles with your fingertips for 15-20 seconds. Easy on the Eyes Close your eyes and place your ring fingers directly under your eyebrows, near the bridge of your nose. Slowly increase the pressure for 5-10 seconds, then gently release. Repeat 2-3 times. Sinus Pressure Relief Place your fingertips at the bridge of your nose. Slowly slide your fingers down your nose and across the top of your cheekbones to the outside of your eyes. Repeat 3-4 times. Shoulder Tension Relief Reach one arm across the front of your body to your opposite shoulder. Using a circular motion, press firmly on the muscle above your shoulder blade. Repeat on the other side. Foot Massage Sit in a chair or on the floor. Get comfortable. You may or may not want to use lotion or oil. If you are sitting up, rest one foot on the opposite leg. Put one hand on top of the foot and the other closer to your toes, then stroke smoothly from your toes to your ankles. Glide your hands to the sole of your foot and massage the underside of your foot. Support your foot with one hand and with the other make 64

65 a fist with a circular motion move along the sole of your foot. Support your foot with one hand and work on each toe individually. Squeeze and gently twist and stretch each toe. Stroke around the ankle with your fingertips, as you stroke up toward the leg and then glide back to your toes. Finish by stroking your entire foot again. Do the same for the other foot. Face Massage Begin by rubbing the palms of your hands together quickly. As you feel the heat build in your hands, stop rubbing your hands and place the now heated palms over your face. Feel the warmth, and the soothing sensation it immediately provides. Breathe deeply. Breathe in through the nose, filling your chest and stomach. Hold and slowly release through the mouth. You can have your eyes open or closed, whichever is more comfortable. Repeat the deep breathing several times until you begin to feel less stress. For relaxation, continue to breathe slowly and deeply throughout the entire self massage routine. Keep your head upright and centered. Use your thumbs for this exercise. Turn your hands outward, palms facing away from you. Place your thumbs at either side of the nose, beside the flares, where you feel a slight depression. Gently push in with your thumbs. Drag your thumbs across the sinuses, and maintain an even pressure throughout. Keep your thumbs on the face for the entire motion. Next, rest your thumbs on your neck or below the jaw. Take your four fingers, with your index finger at the top of the jaw and your baby finger lower along the jaw, and starting at the top of the jaw line massage along your jaw with tiny clockwise circular motions. As you do the circular motions, slowly move your fingers down along the course of your jaw until the fingers of both hands meet at the chin. Repeat at least 5 times.

38 STRESS BUSTERS:
1. Start off your day with breakfast. 2. Occasionally change your routine by meeting a friend or co-worker for breakfast. Allow time to relax and enjoy it. 3. Find some time during the day to meditate or listen to a relaxation CD. 4. Instead of drinking coffee all day, switch to fruit juice. 5. Organize your work - set priorities. 6. Don't try to be perfect. Don't feel like you must do everything. 7. Avoid trying to do two, three, or more things at a time. 8. Develop a support network. 9. If possible, reduce the noise level in your environment. 10. Always take a lunch break (preferably not at your desk). 65

66 11. Optimize your health with good nutrition, sleep and rest. 12. Get regular exercise. 13. Celebrate birthdays and other holidays. Turn more events into special occasions. 14. Look at unavoidable stress as an avenue before growth and change. 15. Avoid people who are "stress carriers." 16. Avoid people who are "negaholics." 17. Don't watch the 11 p.m. news. 18. Give yourself praise and positive strokes. 19. Develop a variety of resources for gratification in your life, whether it's family, friends, hobbies, interests, special weekends or vacations. 20. Treat yourself to "new and good things." 21. be assertive. Learn to express your needs and differences, to make requests, and to say "no" constructively. 22. Seek out the emotional resources available to you such as co-workers, partner, friends and family. 23. Don't be afraid to ask questions or to ask for help. 24. Allow extra time to get to appointments. 25. Take deep breaths when you feel stressed. 26. Try to find something funny in a difficult situation. 27. Take an occasional "mental health day." 28. Adopt a pet. 29. Take a mindful walk. 30. Understand that we do not all see or do things in the same way. 31. Practice mindfulness - learn to live in the moment. 32. Become a less aggressive driver. 33. Show kindness and consideration. Open a door for someone, pick up litter, etc. 34. When stressed, ask yourself "Is this really important?" and "Will this really matter a year from now?" 35. Resist the urge to judge or criticize. 36. Become a better listener. 37. be flexible with change - things don't always go as we planned. 38. If spiritual, pray; speak to God, a higher power, or your inner guide.

66

67

SECTION-B
1. Do you have enough time to perform your given (or) assigned work without any obstacles (or) disturbances?

TABULAR REPRESENTATION:
STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE ----25 3.75 DISAGREE 2.5 6.25

GRAPHICAL REPRESENTATION:
25

25 20 15
No of respondents

10 5 0 SA A

3.75 0
D
views of respondents

6.25 2.5
SD N

INFERENCE:
From the above table and chart it is very clearly that most of the respondents (25%) at CARE HOSPITAL have mostly agreed that they have minimum time to perform their assigned work without any disturbances and 3.75% disagree, 2.5% disagreed, 6.25% gave neutral opinions and none of the respondents has strongly agreed for the above statement. The main reason that most of the respondents have agreed is that most of them are working as nurses and in key areas. Their main duty is to safe guard the health of the patients and they have very less time as an interval. In hospitals like CARE more importance is given to the employees and as well as the patients. 3.75% of the respondents disagreed and 2.5% strongly disagreed because most of them often face certain obstacles during their works like attending emergency meetings, In/Out patient cases and other miscellaneous works apart from their assigned job. So, from above description it is clear that most of the respondents employed at CARE have completely agreed that their assigned job hasnt been affected by any disturbances. 67

68 2. Do you really have enough time to spend with your family members?

TABULAR REPRESENTATION:

STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE 1.25 23.75 18.75 DISAGREE 3.75 2.5

GRAPHICAL REPRESENTATION:

No of respondents

1.25

23.75 18.75

3.75

SA A D

2.50

views of respondents

SD N

INFERENCE:
From the above table and graph it is clear that majority of the respondents (23.75%) at CARE HOSPITAL have agreed that they have enough time to spend with their family members. 18.75% totally disagreed for the statement, 3.75% strongly disagreed, 2% gave neutral opinions and only 1% of the respondents has strongly agreed for the statement. The main reason that 18.75% of the respondents at CARE have disagreed is that they often find it difficult to have enough time to spend with their family members as they have to face the unexpected challenges and they have only one casual leave per month. 19% agreed because they might be in the other key areas like administration, HR departments etc have 8hours of work.

68

69 3. Do you often get angry when you are interrupted at work?

TABULAR REPRESENTATION:

STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE 7.5 1.25 28.75 DISAGREE 1.25 11.25

GRAPHICAL REPRESENTATION:

30 28.75 20 No of respondents 10 0 SA A D views of respondents SD N 7.5 1.25 1.25 11.25

INFERENCE:
From the above table and chart it is clear that majority of the respondents (28.75%) has totally disagreed that they dont get any anger when they are interrupted at work. 7.5% strongly agreed, 1% agreed and strongly disagreed and 11.25% gave neutral opinions for the statement. The main reason that 6% strongly agreed is that most of the respondents are from nursing department where they frequently get interrupted at work.

69

70 4. When your superior asks you to do something which is unplanned, do you respond angrily? TABULAR REPRESENTATION:

STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE DISAGREE

1.25

8.75

28.75

3.75

7.5

GRAPHICAL REPRESENTATION:
No of respondents

28.75 30 20 10 0 SA A D SD N
views of respondents

1.25

8.75

3.75

7.5

INFERENCE:
From the above table and graph it is clear that majority of the respondents (28.75%) has totally disagreed saying that they dont get any anger when their superior ask them to do something which is unplanned. 8.75% agreed for the statement, 3.75% strongly disagreed, 1.25% strongly agreed and 7.5% of them have given neutral opinions for the statement. The main reason that most of them disagreed is that no job is static in nature where the roles and responsibilities often change according to the situations and they need to be faced. 7.5% agreed that they get angry because they need to act immediately for the unplanned task and the chances of errors are high. 6% have given neutral opinions as they are ever-ready for the tasks. 1.25% has strongly agreed because they have given a clear answer that they are incapable of performing unplanned tasks. 70

71 5. Do you respond in a positive manner when asked to do something for which you have lack of training? TABULAR REPRESENTATION:

STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE DISAGREE

27.5

10

1.25

6.25

GRAPHICAL REPRESENTATION:

30 20 10 0

27.5 5
SA A

10
D

1.25
SD

6.25
N

INFERENCE: From the above table and chart it is very clear that majority of the respondents (27.5%) agreed

that they will respond in a positive manner when they are asked to do something for which they have lack of training. 10% disagreed, 6.25% gave neutral views, 5% strongly agreed and only a few portion 1.25% of the respondents strongly disagreed for the statement. The main reason that most of the respondents agreed is due to lack of proper training and experience. If they perform a task which is not familiar certain errors occur. 10% disagreed because at CARE the tasks to be performed will be very similar to the job assigned to them. 6.25% gave neutral views and 5% strongly agreed as they are totally incapable of performing new tasks without being trained.

71

72 6. Are you really happy with your pay package? TABULAR REPRESENTATION:

STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE DISAGREE

3.75

21.25

18.75

1.25

GRAPHICAL REPRESENTATION:

A, 21.25

D, 18.75

SA, 3.75

N, 5

SD, 1.25

INFERENCE:

From the above table and chart it is clear that majority of the respondents (21.25%) agreed that they are satisfied with their pay package. 18.75% disagreed, 3.75% strongly agreed, 1.25% strongly disagreed and 5% gave neutral views on the above statement. The main reason that majority of the respondents have agreed because their pay is fixed basing on the norms and geographical conditions in which they are residing. 18.75% disagreed because when compared to the other competitive hospitals their pays differ with huge margins. 4% gave neutral views as they dont want to share their views specifically. 3.75% strongly agreed due to the following reasons: * Their pay package is really interesting. * Some extra benefits other than salaries are being provided. * Salary negotiations are encouraged. 72

73 7. Do you lose temper while being stressed at your work? TABULAR REPRESENTATION:
STRONGLY STRONGLY AGREE AGREE DISAGREE DISAGREE NEUTRAL

3.75

17.5

2.5

2.5

23.75

GRAPHICAL REPRESENTATION:

SA A D SD N

INFERENCE: From the above table and chart it is clear that majority of the respondents (23.75%) gave

neutral views, 17.5% agreed, 3.75% strongly agreed, 2.5% disagreed and strongly disagreed for the above statement. The main reason that most of the respondents gave neutral views because they have their own reasons and they dont want to expose their inner feelings. 17.5% agreed because when they are stressed at work it stimulates irritation, anger and hence lose their temper. 2.5% disagreed and strongly disagreed because they may be capable of overcoming the work stress in the organization. 3.75% strongly agreed because they might not have the potential to overcome extensive work load. This might result in losing of temper and decline in the performance. 73

74 8. Do you plan your each day of your life and workout according to that plan?

TABULAR REPRESENTATION:

STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE DISAGREE

7.5

13.75

1.25

22.5

GRAPHICAL REPRESENTATION:

25 20 15 10 5 0 SA A D SD N
Views of respondents

13.75 7.5 1.25 5

22.5

SA A D SD N

INFERENCE: From the above table and chart it is very clear that majority of the respondents (18%) at

CARE gave neutral opinions that they carry out each day according to the scheduled plan. 13.75% agreed, 7.5% strongly agreed, 5% strongly disagreed, 1.25% disagreed for the above statement. The main reason that most of the respondents have given neutral views is that at CARE the each day work must be carried according to the schedule given by the top management, but not planned by them.

74

75 9. What strategies does the management really should adopt to relieve the employees from getting stressed? TABULAR REPRESENTATION:

HIGH

RECRUIT

TRAINING REDUCE WORK LOAD

SALARY SUPPORTING STAFF

25

10

GRAPHICAL REPRESENTATION:

6 10 9 25
HS RS

T
RS

HS

INFERENCE: From the above table and chart it is very clear that majority of the respondents (25%)

agreed that higher and better salary must be paid and 9% gave their opinion to recruit supporting staff. 10% said that sufficient training must be provided. 6% at CARE said to reduce work load. The main reason that most of them opined on higher salary is because it plays a major role for the employees satisfaction. If they are paid with more salaries they dont feel stressed as the motivating factor is the money but not the work. 9% opined that better supporting staff should be recruited for better relationships among the employees. 10% said that training must be provided and their skill levels should be updated frequently to cope up with the new challenges. 6% gave their opinion that work load should be reduced to an extent with employees capability kept in mind. 75

76 10. Do you agree that your peers are also stressed?

TABULAR REPRESENTATION:

STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE DISGAREE

3.75

17.5

2.5

2.5

23.75

GRAPHICAL REPRESENTATION:

25
20

23.75 17.5

15 10 5 0 SA A D SD N

3.75

2.5 2.5

views of respondents

SA
INFERENCE:

SD

From the above chart and table it is very clear that majority of the respondents (23.75%) employed at CARE gave neutral views that their peers are also stressed. 17.5% agreed, 3.75% strongly agreed, 2.5% disagreed and strongly disagreed for the above statement. The main reason that most of the respondents gave neutral opinions is they really dont have any clear picture about their coworkers job profile, roles and responsibilities.

76

77 11. Does your productivity decline when you work under stress?

TABULAR REPRESENTATION:

STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE DISGAREE

15

18.75

1.25

10

GRAPHICAL REPRESENTATION:

N 10%

SA 5%

SD 1.25%

A 15%

D 18.75%
INFERENCE: From the above table and chart it is very clear that majority of the respondents (18.75%) disagreed for the above statement, 15% agreed, 10% gave neutral views, 5% strongly agreed, 1.25% strongly disagreed for the statement. Majority of the respondents disagreed for the statement is because they might have the capability to overcome stress and they take care that it doesnt affect their performance. 15% agreed because they dont have the potential to cope up with the stress and decline in their performance. 10% gave neutral opinions on the statement because they cant be sure whether they decline in performance when working under stress. 5% strongly agreed as they gave their fair views, 1.25% strongly disagreed as they are confident on their performance. 77

78 12. Does your 24*7 working hours indirectly cause you the stress? TABULAR REPRESENTATION:

STRONGLY AGREE DISAGREE STRONGLY NEUTRAL AGREE DISGAREE

7.5

22.5

-----

15

GRAPHICAL REPRESENTATION: 25 20 15 10 5 0

INFERENCE: From the above table and graph it is clear that majority of the respondents (22.5%)

disagreed for the above statement, 15% gave neutral views, 7.5% agreed, 5% strongly agreed. The reason behind that majority of the respondents disagreed is because in CARE there are shifts named A, B, C and general shifts. They work in their respective shifts and hence dont feel stressed for 24*7 working hours. 15% gave neutral views on the statement above as they dont have a clear answer. 7.5% agreed, 5% strongly agreed because they might have been experiencing the night shifts too and being stressed.

78

79 13. Have you ever been treated for any of the following?

TABULAR REPRESENTATION: ANXIETY BIPOLAR DISORDER 30 20 0 ALCOHOL AND OTHER DRUGS 3.75

DEPRESSION

GRAPHICAL REPRESENTATION:

3.75%

DEPRESSION ANXIETY ALCOHOL AND OTHER DRUGS

20%
INFERENCE:

30%

From the above table and chart it is very clear that majority of the respondents (30%) agreed that depression is the main cause for their stress and often they are facing this situation which cannot be controlled. 20% opined that anxiety is the cause, 3% for alcohol and other drugs. Most of the respondents at CARE opined that they face extensive stress while they are undergoing different activities in their jobs. Most of the employees are facing high depression levels which in turn lead to ill-health, behavioral changes etc. 16% opined for anxiety where most of them overreact either positively or negatively. 3% agree that when they undergo extensive stress they are habituated to take alcohol and other drugs which relieve them from the stress for a certain point of time.

79

80 14. What is the main cause of stress for an individual human being? TABULAR REPRESENTATION: CONFLICTS LACK OF SOCIAL SUPPORT 21.25 5 17.5 6.25 ANY OTHER

LIFE CHANGES

GRAPHICAL REPRESENTATION:
LIFE CHANGES

25 20 15 10 5
ANY OTHER CONFLICTS

LACK OF SOCIAL SUPPORT

INFERENCE: From the above table and chart it is very clear that majority of the respondents (21.25%)

agreed that the main cause of stress for an individual is due to their frequent change in life style. 5% opined that conflicts are the main cause , 17.5% agreed for lack of social support and 6.25% gave their own reasons for the individual stress.

80

81 15. Do you find illness, exhaustion or confinement often result in low mood or depression?

TABULAR REPRESENTATION:

STRONGLY AGREE 3.75

AGREE

DISAGREE

STRONGLY DISAGREE

NEUTRAL

8.75

----

35

2.5

120

GRAPHICAL REPRESENTATION:

100
34.6 80 60 40 20 0 0 1 2 3 4 5 30.6 38.6 31.6

INFERENCE: From the above table and graph it is very clear that majority of the respondents (35%)

strongly disagreed that illness often results in low mood or depression. 8.75% agreed for the above statement. 3.75% strongly agreed, 2.5% gave neutral views on the statement. The main reason that majority of the respondents strongly disagreed because the two that are stated above play a limited role in stress levels but there are many unidentified factors which cause stress. 8.75% agreed as their work load cause illness. 3.75% strongly agreed as stress results in high depression due to various factors. 2.5% gave neutral views because they havent understood the above statement.

81

82 16. What are the negative consequences that arise out of the stress for both individuals and the organization as a whole?

TABULAR REPRESENTATION:

ANGER

HEART DISEASES

LACK OF SLEEP 47.5

DRUGS

31.25

1.25

1.25

DECLINE IN

INCREASE IN

COMPLAINING HAMPERING

PERFORMANCE ABSENTISM 21.25 27.5 6.25 5

GRAPHICAL REPRESENTATION:
ANGER LACK OF SLEEP HEART DISEASES DRUGS

82

83

INFERENCE: This question measures the consequences that aroused out of stress and the stress

consequences at CARE is categorized into 2 aspects. (a)For the individuals: From the above table and the chart it is very clear that the main consequences that aroused out of the stress where majority of the respondents opined that 31.25% makes them angry, 1.25% opined that stress leads them to cause heart diseases, 47.5% suffers from inadequate sleep and 1.25%opined that excessive stress may lead them to consume drugs like alcohol and usage of cigarettes etc. Majority of the respondents (47.5%) opined that excessive stress may cause lack of sleep due to unnecessary tensions. This may lead to various side effects like headache, lack of concentration; eye problems etc and 31.25% opined that showing frequent anger among their colleagues and on their family members due to excessive stress and the major consequences of stress is that they are unable to judge what is right and various circumstances of their given job and only a few portion 1.25% opined that stress leads to heart diseases and high usage of harmful drugs. (b)For the organization: From the above table majority of the respondents 27.5% opined that excessive stress may lead to high in the absenteeism and turnover of the employees and 21.25% opined that it leads to decline in the overall performance and 6.25% opined that they frequently complain about unimportant things agreed that it sports the human relations and communication between the employees. Majority of the respondents (27.5%)at ---is very high due to excessive stress the employees may fear to attend their given job regularly and to overcome their fear employees often absent themselves and the other major consequences caused due to the stress is high employee turnover rate, where most of the employees attempt to shift from the organization and 21.25% opined that the other major consequences of stress is showing poor performance due to the lack of concentration and other effects etc directly or indirectly on the employees given job.

83

84 17. From the below tick any word that describes how you have been really feeling or acting when you are facing extensive stress.

TABULAR REPRESENTATION: OVER/UNDER ANXIOUS ISOLATED NOONE UNDERST ANDS YOU FEELING ACHES/ RACIN PAINS G THOUG HTS PESSIMISTIC

CONCENTRATION EATING

46.25

31.25

8.75

15

35

13.75

8.75

GRAPHICAL REPRESENTATION:

46.25
50 40 30 20 10 0
CONCENTRATION ANXIOUS NOONE UNDERSTANDS YOU FEELING RACING THOUGHTS

31.25 15 5 8.75

35 13.75 8.75

INFERENCE: This question measures and describes how the employees really feel or act when they are

facing extensive stress situation at CARE. From the above chart and the table majority of the respondents 46.25% + 31.25%opined that when they face extensive stress it leads to lack of concentration and being more anxious and 35% suffers from physical aches, 15% feel loneliness, 8.75% agrees that they wanted to be in isolated state and pessimistic thinking and 5% suffers from over eating 84

85 or not eating at all, 1.25% think of ending their lives and 13.75% agreed that they get racing thoughts for the above statement asked. Majority 46.25% + 31.25% is very high because concentration difficulty is a low ability to focus thoughts on something and these difficulties are related to impulsiveness, over activity or due to psychological problems etc. and 25% agreed that they will become more anxious or more angry for unnecessary events which sometimes also contributes to injuries. 35% feels that they undergo physical aches when they are facing excessive stress situation and which leads to excessive stress where the body and mind is not able to adopt an over load of stress and tensions and 13.75% opined that they frequently get racing thoughts where it refers to rapid thought patterns that often occur when the person is in manic, hypo manic situations which really cause a lot of disorders and only a fewer portion (1.25%) will think of committing suicide or getting thoughts of death, when they are really facing extensive stress.

85

86 18. What are the strategies that should be adopted to reduce the individual stress?

TABULAR REPRESENTATION:

OPTIMISM

SELF AWARENESS

TIME

PROFESSIONAL

MANAGEMENT ADVICES AND ACTIVITIES

13.75

23.75

11.25

18.75

GRAPHICAL REPRESENTATION:

30 20 10 0
OPTIMISM SELF AWARENESS TIME MANAGEMENT PROFESSIONAL ADVICES AND ACTIVITIES

23.75 13.75

11.25

18.75

INFERENCE: From the above chart and the table majority of the respondents 23.75% said that developing

self awareness should be adopted to low the stress, 18.75% opined for the professional advices and leisure time activities, 13.75% opted for optimistic learning, 11.25% have opted for the time management skills to be improved. Majority have opined for self awareness because about every field in the world awareness need to be created. All the knowledge, pros and cons of the respective jobs should be provided to the concerned employees. As a result their skills increase which in turn raise the productivity. 18.75% asked for the professional advices which would help them to work accordingly under proper guidance apart from continuous work load.13.75% opted for positive thinking for the better results. 9% opted for time management skills because time plays a major role in any organization, to maintain its standards, roles, responsibilities. 86

87 19. From this question tick the apt option, TABULAR REPRESENTATION:

Managing emotions & integrity

Role models Honest Speak about colleagues behind their backs Act calm in personal situations Doesnt pass stress to the team

SA

D 8.75 ----7.5

SD 1.25 -------1.25

NEUTRAL 1.25 1.25 -----

36.25 2.5 40 8.75

28.75 12.5

37.5

10

1.25 -----------

--------------

----5 --------

28.75 11.25 35 13.75

Welcomes suggestions
40 35 30 25 20 15 10 5 0 0 2 4 6

GRAPHICAL REPRESENTATION:
Honest

Role models

40 30 20 10 0 agree neutral

Speak about colleagues behind their backs

Act calm in personal situations

30 25 20 15 10 5 0 agree disagree

40 30 20 10 0 agree strongly agree disagree

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agree strongly agree neutral agree strongly agree

neutral strongly agree agree 0% 20% 40% 60% 80% 100%

35 30 25 20 15 10 5 0 agree strongly agree

Managing & communicating existing future work

Develop action plans Prioritize future work loads Deal rationally with the problems Decisive under decision making Act as a member of my team Provides regular help
Develop action plans

SA

SD

NEUTRAL

38.75 1.25 43.75 3.75 40 35 30 10 6.25 18.75

5 1.25 ----5 -----------

1.25 ----------2.5 1.25 ------

1.25 1.25 ----1.25 ------------

28.75 21.25

Prioritize future work loads

neutral st.disagree disgaree st.agree agree 0

1.25

neutral
1.25

1.25 1.25 3.75 43.75 20 30 40 50

disagree
5 1.25 38.75

strongly agree agree 0

10 20 30 40 50

10

Deal rationally with the problems

Decisive under decision making

40 40 20 0 agree strongly agree 10

40 30 20 10 0

35

6.25

2.5

1.25

agree

disagree

neutral

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Act as a member of my team

Provides regular help 30 28.75 21.25

30 30 25 20 15 10 5 0 agree st.disagree 1.25 18.75

25 20 15 10 5 0 agree

st.agree

INFERENCE: The above question is divided into 3 important areas. Managing emotions and integrity Managing and communicating existing future work Managing different situations Each and every area is again sub divided into integrity, managing emotions, proactive work environment, managing conflicts and use of the organizational resources.

* In managing emotions and integrity agreed that they act as good role models.2.5% strongly agreed, 8.75% disagreed, 1.25% strongly disagreed and 1.25% gave neutral opinions that they are good role models. 40% of the respondents agreed that they are honest.8.75% strongly agreed, 1.25% gave neutral opinions that they are honest. 28.75% agreed that, 12.5% strongly agreed, 7.5% disagreed, 1.25% strongly disagreed that they never speak about their colleagues behind their backs. 37.5% agreed, 10% strongly agreed, 1.25% disagreed that they act calm in personal situations. 28.75% of the respondents agreed, 11.25% strongly agreed and 5% gave neutral opinions that they dont pass their stress to their team members. 35% agreed, 13.75% strongly agreed that they welcome any suggestions which improve the performance of their team. * In managing and communicating existing future work category 38.75% agreed, 1.25% strongly agreed, 5% disagreed, 1.25% strongly disagreed and 1.25% gave neutral opinions that they develop their action plans on their own.

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90 43.75% of the respondents agreed, 3.75% strongly agreed, 1.25% disagreed and 1.25% gave neutral views that they prioritize future workloads. 40% of the respondents agreed, 10% strongly agreed saying that they deal rationally with their problems. 35% of the employees agreed, 6.25% strongly agreed, 5% disagreed, 2.5% strongly disagreed, 1.25% gave neutral views that they are decisive under decision making. 30% of the respondents agreed, 18.75% strongly agreed, 1.25% strongly disagreed saying that they act as a member to their team. 28.75% of the respondents agreed, 21.25% strongly agreed that they provide regular help to their team members.

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91 20. Are there any other comments you would like to make about the stress management arrangements, which are not covered in the questions that are mentioned above?

Ans: Most of the employees at CARE hospital suggested that it would be helpful to overcome stress at work place if the organization provides certain training and some quick breaks in between work hours in order to get relieved from extensive stress.

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SUMMARY
A study on stress management and its overall impact on the organization is done to the sample size of 50 respondents, the data is mainly divided into 2 types. They are primary data and secondary data. Primary data is collected through questionnaire and personal interviews. Secondary data is collected from journals, magazines and websites. To ascertain stress management in the CARE hospital a detailed study on stress, various methods used to overcome stress and how it effects the overall performance of the individual and the organization. Apart from the above complaints and suggestions are also welcomed. The present study has been undertaken with an intention of analyzing and interpreting of stress and its impact on both employees and the organization. Primarily the study is based mainly on the data that is collected with a structured questionnaire i.e., designed for a particular purpose. Basing on the results at CARE hospital a detailed study has been conducted by observing the various factors that cause stress among the employees. In 1997, when Dr.B.Soma Raju and Dr.D.Prasada Rao led a team of medical professionals to set up the first Hospital, it signaled the dawn of a new era in medical. Care foundation is a registered non profit society with the mandate of making quality health affordable and accessible to all through appropriate use of technology .The foundation has been established by a group of medical scientists and technologies with the stated mission of making advanced comprehensive health affordable and accessible to all. to that.The organization was incorporated with the main objective of running all kinds of hospitals, dispensaries ,nursing homes, clinical laboratories carrying out medical research, education and train medical students ,nursing professionals, hospital administrator, grant diplomas or recognitions as the company may deem fit and to render professional consultancy and advice to any individual firm, company,Govt etc in the fields of research and development relating to medical, pharmaceutical andchemical industries. STRESS can be defined as a form of tension or strain in the body or the mind for which there is no release or outlet. When under stress, one is like a car in the neutral gear with the accelerator on, trying to exert initially, but unable to do so . Stress is also defined as mental, physical, emotional tension, strain or distress. Stress is a fact of life. However, too much stress can result in the breakdown of a persons physical, mental and emotional health. It has physical and emotional effects on us and can create positive or negative energy. Stress affects different people in different ways. The experience of work stress can 92

93 cause unusual and dysfunctional behavior at work and contribute to poor physical and mental health. In extreme cases, long-term stress or traumatic events at work may lead to psychological problems and be conductive to psychiatric disorders resulting in absence from work and preventing the worker from being able to work again. When affected by work stress people may: become increasingly distressed and irritable become unable to relax or concentrate have difficulty thinking logically and making decisions enjoy their work less and feel less committed to it feel tired, depressed and anxious have difficulty sleeping experience serious physical problems

At CARE hospital the main aim of HR department is to identify all the sress related factors that effect the entire organization and also suggests with suitable measures how to overcome the stress. To address the above, a detailed study was conducted in CARE. To study the entire stress related management and the methods that are adopted to overcome the stress and also identify the human potential of its employees by conducting various stress related programs.

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FINDINGS

More than 25% of the employees at CARE, Visakhapatnam felt that they have enough time to perform their given work without any obstacles. At CARE more than 25% of the employees had enough time to spend with their family. More than 30% of the employees disagreed that they get angry when they are interrupted at work. Over 35% of the employees do not respond angrily when their superior ask them to do something. Majority of the employees i.e., more than 32% agreed that they respond positively when they are asked to do a task for which they lack in training. Most of the employees agreed that they are really happy with their pay packages. Majority of the employees of over 23% were not even sure whether they lose temper due to stress at work so gave neutral views. More than 22% were neutral that they plan their each day and workout according to that plan. Majority of about 25% suggested the management to adopt a strategy to increase salaries of the employees to relieve them from getting stressed. The employees about 23% were neutral that their peers are also stressed. About 20% of the employees disagreed that their productivity decline when worked under stress. Majority i.e., over 22% dont get stressed due to 24*7 working hours in the organization. Over 30% of the employees have been under depression due to stress. The changing life is the main cause for stress of an individual according to the employees at CARE. More than 35% of the employees strongly disagreed that they dont find illness, exhaustion due to depression. For the individuals over 31% of the employees at CARE stated that anger would be the negative consequence that is resulted out of stress.

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95 Majority of over 46% of the employees at CARE stated that they lack in concentration when they face stress extensively. The employees want the organization to adopt self awareness strategy to reduce the stress.

In managing emotions and integrity: Over 36% treat themselves as role models, over 40% state that they are

honest enough, more than 28% agreed that they dont speak about their colleagues behind their backs, 37% of the employees act calm in personal situations, over 28% of the employees doesnt pass their stress to the team and employees of about 35% welcome different suggestions from all the concerned team members. In managing and communicating existing future work: Over 38% of the employees develop action plans, majority i.e., 43% of the employees at CARE prioritize future work loads, more than 40% deal their problems rationally, the employees of about 35% are decisive under decision making, majority of the employees of over 30% act as a team member to their tea, and provides regular help to them.

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SUGGESTIONS
I would suggest the organization to adopt some of the below techniques to overcome their work stress.

RELAXATION RESPONSE:
The relaxation response is a physical state of deep rest that changes the physical and emotional responses to stress. When eliciting the relaxation response: * Your metabolism decreases. * Your heart beats slower and your muscles relax. * Your breathing becomes slower. * Your blood pressure decreases. * You return to a calmer state of being. Elicitation of the relaxation response is actually quite easy. There are two essential steps: * Repetition of a word, sound, phrase, prayer, or muscular activity. * Passive disregard of everyday thoughts that inevitably come to mind and the return to your repetition.

MINDFULNESS:
Meditation that cultivates mindfulness can be particularly effective at reducing stress, anxiety, depression, and other negative emotions. Mindfulness is the quality of being fully engaged in the present moment, without over-thinking or analyzing the experience. Rather than worrying about the future or dwelling on the past, mindfulness meditation switches the focus on what is happening right now. It takes effort to maintain your concentration and to bring it back to the present moment when your mind wanders. But with regular practice, mindfulness strengthens the areas of the brain associated with joy and relaxation. Mindfulness provides a potentially powerful remedy to the common causes of daily stress such as time pressure, distraction, agitation, and interpersonal conflicts. How to do a Mindfulness Exercise:

* Find a comfortable place to sit. It can be on a chair or on the floor, but do not slump or slouch. Keep your posture straight but relaxed, making sure you are not rigid or stiff. * Focus on your breathing. * Concentrate your attention completely on your breathing. Become aware of the sensations inside your air passages as the air enters the nose. Just become aware of that feeling as your breath goes in and out.

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97 * When thoughts come into your mind, thats o.k. Just examine the thoughts for what they are, as if they were some strange animal that wandered into your sight. When these thoughts come into your mind, allow them to wander off on their own and wish them well on their way. Do not get involved in the thought. Just notice that it is there and return your focus to your breathing. * Treat each thought as a guest. When a thought or feeling arises, simply observe and acknowledge it. There is no need to interpret it or to use it. Use your breathing as the anchor for your mindfulness. * Stay in the moment as long as you can. Continue to focus on your breathing. Aim to clear your mind completely for 5 minutes. With practice you will be able to extend the time to twenty minutes or more. The different mindfulness techniques are: 1. Body Scan Body scanning promotes mindfulness by focusing your attention on various parts of your body. Like progressive muscle relaxation, you can start with your feet and work your way up. 2. Walking Meditation You dont have to be seated or still to practice mindfulness. In walking meditation, mindfulness involves being focused on the physicality of each step; the sensation of your feet touching the ground; the rhythm of your breath while moving, and feeling the wind against your face. 3. Mindful Eating If you reach for food when you feel stressed, or you gulp your meals down in a rush, try eating mindfully. Sit down at the table and focus your full attention on the meal. Eat slowly, taking time to concentrate on each bite, noticing the texture and taste of the food.

RELAX IN A HURRY:
Mini-relaxation exercises help reduce anxiety and tension immediately. You can do them with your eyes open or closed. You can do them anywhere, any time, and no one will know that you are doing them. Here are some variations: Mini Version 1: Count very slowly to yourself from 10 down to zero, one number for each breath. With the first diaphragmatic breath, you say 10 to yourself, the next breath; you say nine, etc. If you start feeling light-headed or dizzy, slow down the counting. When you get to zero, see how you are feeling. If you are feeling better, great! If not, try doing it again. Mini Version 2: As you inhale, count very slowly up to four. As you exhale, count slowly back down to one. Thus, as you inhale, you say to yourself, one, two, three, and four. As you exhale, you say to yourself, four, three, two, and one. Do this several times. 97

98 Mini Version 3: After each inhalation, pause for a few seconds. After you exhale, pause again for a few seconds. Do this for several breaths.

RELAX YOUR BODY AT WORK:

Feet and Legs: With legs outstretched: Alternate curling and stretching the toes. Repeat three times and relax. Alternate flexing (bending) and extending (stretching) the whole foot at the ankle. Repeat three times. Rotate the ankles to the right as if drawing circles with your toes. Repeat three times. Rotate the ankles to the left. Repeat three times. Arms and Hands With arms extended out in front of you: Move your hands up and down, bending from the wrist. Repeat three times. Alternate stretching your fingers, then making a fist. Repeat three times. Rotate your wrists three times, first to the right, then to the left. Relax. Repeat three times. Shoulders: Raise your right shoulder up toward your ear. On the exhale, release your shoulder down. Repeat three times. Move your right shoulder forward. On the exhale, return it to the starting position. Repeat three times. Move your right shoulder back. On the exhale, return it to the starting position. Repeat three times. Repeat the sequence on the left side. Bring both shoulders up towards your ears, tense, and then drop your shoulders down as you exhale. Repeat three times. Head and Neck: Hold each of these positions, taking three easy breaths and relaxing tension with each exhalation, and then return your head to upright centre before doing the next movement. Drop your chin to your chest. Feel the weight of your head stretch out the back of your neck. Hold. Look as far as you can over your right shoulder. Hold. Look as far as you can over your left shoulder. Hold. Drop your right ear to your right shoulder. Hold. 98

99 Drop your left ear to your left shoulder. Hold.

PROGRESSIVE MUSCLE RELAXATION:

Progressive muscle relaxation is another effective and widely used strategy for stress relief. It is a great technique for reducing overall body tension. It involves a two-step process in which you tense and relax different muscles in the body. Find a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable. Loosen your clothing, take off your shoes and get comfortable. Take a few minutes to relax, breathing in and out in slow, deep breaths. Begin by tensing all of the muscles in your face. Make a tight expression, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for a count of eight as you inhale. Now exhale as you relax completely. Let your face go completely careless as though you were sleeping. Feel the tension ooze from your facial muscles and enjoy the feeling. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax. Continue down your body, repeating the procedure with the following muscle groups: chest, abdomen, entire right arm, right forearm and hand (making a fist), entire left arm, left forearm and hand (again making a fist), entire right leg, lower right leg, right foot, entire left leg, lower left leg, and left foot.

DEEP BREATHING:
Deep breathing is a relaxation technique that can be self-taught. Deep breathing releases tension from the body and clears the mind, improving both physical and mental wellness. We tend to breathe shallowly or even hold our breath when we are feeling anxious. Sometimes we are not even aware of it. Shallow breathing limits your oxygen intake and adds further stress to your body. Breathing exercises can help to reduce this stress. The key to deep breathing is to breathe deeply from the abdomen, getting as much air as possible into your lungs. When you take deep breaths from the abdomen, rather than shallow breaths from your upper chest, you inhale more oxygen. The more oxygen you get, the less tense, short of breath, and anxious you feel. This kind of breathing is called diaphragmatic breathing. It means to breathe from the depths of your belly, rather than from your chest and nose.

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GUIDED IMAGERY:
Guided imagery is a convenient and simple relaxation technique that can help you quickly and easily manage stress and reduce tension in your body. It is virtually as easy as indulging in a vivid daydream and, with practice; this technique can help you to ease the tension and stress that you feel. When used as a relaxation technique, guided imagery involves imagining a scene in which you feel at peace, free to let go of all tension and anxiety. Heres how to get started with guided imagery: Get into a comfortable position. If lying down will likely put you to sleep, trying sitting cross-legged. Close your eyes and breathe deeply, focusing on breathing in feelings of peace, and breathing out feelings of stress. Once you get to a relaxed state, begin to envision yourself in the midst of the most relaxing environment you can imagine. As you imagine your scene, try to involve all of your senses. Stay here for as long as you like. Enjoy your surroundings and let yourself be far from what stresses you. When youre ready to come back to reality, count back from ten or twenty youll feel more calm and refreshed.

SELF MASSAGE:
Getting a massage provides deep relaxation, and as the muscles in your body relaxes, so do your overstressed mind. There are many simple self-massage techniques you can use to relax and release stress. Self-Massage techniques: a) Scalp Soother Place your thumbs behind your ears while spreading your fingers on top of your head. Move your scalp back and forth slightly by making circles with your fingertips for 15-20 seconds. b) Easy on the Eyes Close your eyes and place your ring fingers directly under your eyebrows, near the bridge of your nose. Slowly increase the pressure for 5-10 seconds, then gently release. Repeat 2-3 times. c) Sinus Pressure Relief Place your fingertips at the bridge of your nose. Slowly slide your fingers down your nose and across the top of your cheekbones to the outside of your eyes. Repeat 3-4 times.

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101 d) Shoulder Tension Relief Reach one arm across the front of your body to your opposite shoulder. Using a circular motion, press firmly on the muscle above your shoulder blade. Repeat on the other side. e) Foot Massage Sit in a chair or on the floor. You may or may not want to use lotion or oil. If you are sitting up, rest one foot on the opposite leg. Put one hand on top of the foot and the other closer to your toes, then stroke smoothly from your toes to your ankles. Glide your hands to the sole of your foot and massage the underside of your foot. Support your foot with one hand and with the other make a fist. Squeeze and gently twist and stretch each toe. Stroke around the ankle with your fingertips. Finish by stroking your entire foot again. Do the same for the other foot. f) Face Massage Begin by rubbing the palms of your hands together quickly. As you feel the heat build in your hands, place the now heated palms over your face. Feel the warmth, and the soothing sensation it immediately provides. Breathe in through the nose, filling your chest and stomach. Hold and slowly release through the mouth. Repeat the deep breathing several times until you begin to feel less stress. Use your thumbs for this exercise. Turn your hands outward, palms facing away from you. Place your thumbs at either side of the nose, beside the flares, where you feel a slight depression. Gently push in with your thumbs. Drag your thumbs across the sinuses, and maintain an even pressure throughout. Keep your thumbs on the face for the entire motion. Next, rest your thumbs on your neck or below the jaw. Take your four fingers, with your index finger at the top of the jaw and your baby finger lower along the jaw, and starting at the top of the jaw line massage along your jaw with tiny clockwise circular motions. As you do the circular motions, slowly move your fingers down along the course of your jaw until the fingers of both hands meet at the chin. Repeat at least 5 times.

THOUGHT STOPPING TECHNIQUES:

Thought stopping involves concentrating on the unwanted thoughts and, after a short time, suddenly stopping and emptying the mind. The command Stop or a loud noise is generally used to interrupt the unpleasant thoughts. Explore and List Your Stressful Thoughts Create a list of stressful thoughts to help you assess which recurrent thoughts are the most painful and disturbing. Thought stopping requires consistent motivation. Imagine that Thought Close your eyes and bring into imagination a situation in which the stressful thought is likely to occur. Try to include normal as well as stressful thinking. In this way, you can interrupt the stressful thoughts while allowing a continuing flow of healthy thinking. 101

102 Thought Interruption Thought interruption can be accomplished initially by using one of two startler techniques: Set an alarm clock for 3 minutes. Look away, close your eyes, and meditate on your stressful thought as described above in Step 2. When you hear the ring, shout Stop! You may also want to raise your hand, snap your fingers or stand up. Set a goal of about 30 seconds after the stop, during which your mind remains blank. If the upsetting thought returns during that time, shout, Stop! again. Tape record yourself loudly exclaiming, Stop at irregular intervals. You may find it useful to repeat the taped stop messages several times at five-second intervals. Precede the same way as with alarm clock. Unaided Thought Interruption Now take control of the thought stopping cue, without the timer or tape recorder. Success at this stage means that you can stop thoughts alone or in public, without making a sound or calling attention to yourself. Thought Substitution The last of thought stopping involves thought substitution. In place of the stressful thought, make up some positive, assertive statements that are appropriate in the target situation.

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CONCLUSION

The company CARE hospital is appreciable in the context as it takes care of its employees in an effective way to make them overcome their stress. It is better for the organization to follow more alternatives to cope up from the stress levels and as a result it improves the overall performance of their workforce. The organization controls all the departments within and motivates their employees for their effective outputs. The CARE hospital takes care of many activities like recruitment, payroll, leave management, ERP, grievance handling, stress management and many more in order to make the employees work efficiently and thus as a result its overall organization performance is enhanced. The workforce in the organization is very friendly to communicate and the HR department which I dealt mostly is very supportive and gave everyone a scope to learn. This finally led to the enhancement of the entire productivity of CARE hospital, Visakhapatnam.

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BIBLOGRAPHY

NAME OF THE BOOK

STRESS AND STRESS MANAGEMENT STRESS MANAGEMENT FOR NURSES

AUTHORS
Klinic Community Health Centre

Brunero, CNC, Liaison Mental Health Nursing, Prince of Wales Hospital, Sydney; Darrin Cowan, CNC Liaison Mental Health Nursing, Greater Southern Area Health Service; Alan Grochulski, CNC, Mental Health Northern Sydney and Central Coast Health Service; and Angela Garvey, Professional Officer, NSW Nurses Association.
Stavroula leka, professor Amanda griffiths, professor Tom Cox.

WORK ORGANIZATION AND STRESS

WEBSITES REFERRED:

http://www.mindtools.com/pages/main/newMN_TCS.htm www.mindtools.com/stress/RelaxationTechniques/IntroPage.htm wellnessproposals.com/.../stress-management/stress-management-... www.carehospitals.com

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QUESTIONNAIRE ON STRESS MANAGEMENT:

Dear sir/madam, I k.sarika a student of 3rd semester MBA (specialization in HRM) studying in M.V.G.R college of engineering, JNTU (Kakinada) university. As a part of my academic curriculum Im carrying out a project-work in 'CARE HOSPITAL' on the topic "STRESS MANAGEMENT." In this regard a questionnaire has been prepared to collect all the necessary relevant information related to my project work and is being provided to you. Please express your fair views for the questions that are asked in the questionnaire. I therefore invite your fair opinions on the below mentioned questions. The outcome of the project work that was conducted by me will serve as mere academic interest only and not for any other purpose. Thanking you, K.SARIKA.

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SECTION-A PERSONAL DETAILS: NAME (In full block letters) AGE GENDER DESIGNATION DEPARTMENT : _______ : _____________ : _______________________________

: _______________________________ : _______________________________

SECTION-B 1. Do you have enough time to perform your given (or) assigned work without any obstacles (or) disturbances? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

2. Do you really have enough time to spend with your family members? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

3. Do you often get angry when you get interrupted at work? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

4. When your superior is asked to do something which is unplanned,do you respond angrily? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

5. Do you respond in a positive manner when asked to do something for which you have lack of training? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

6. Are you really happy with your pay package? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

7. Do you lose temper while being stressed at your work? . Strongly agree . Agree . Strongly disagree . Disagree 106 . Neutral

107 8. Do you plan your life each day and workout according to that plan? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

9. What strategies does the management really should adopt to relieve the employees from getting stressed? . High salary . Recruiting supporting staff . Training . Reduce work load 10. Do you agree that your peers are also stressed? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

11. Does your productivity decline when you work under stress? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

12. Does your 24*7 working hours indirectly cause you the stress? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

13. Have you ever been treated for any of the following? . Depession . Anxiety . Bi polar disorder . Alcohol and other drugs

14. What is the main cause of stress for an individual human being? . Life changes . Conflicts . Lack of social support . Any other please specify_________

15. Do you find that illness, exhaustion or confinement often results in the low mood or depression? . Strongly agree . Agree . Strongly disagree . Disagree . Neutral

16. What are the negative consequences that arise out of the stress for both individuals and the organization as a whole?

17. From the below tick any words or phrases that describe how you have been really feeling or acting 107

108 when you are facing extensive stress.

18. What are the strategies that should be adopted to reduce the individual stress? . Learned optimism . Developing self awareness . Time management

. Professional advices and leisure time activities 19. From, this question (Tick the appropriate option) AREA-1: RESPECTFUL AND RESPONSIBLE: - Managing emotions and having integrity

AREA-2: MANAGING AND COMMUNICATING EXISTING AND FUTURE WORK

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AREA-3: MAGING DIFFERENT SITUATIONS

20. Are there any other comments you would like to make about the STRESS MANAGEMENT" arrangements, which are not covered in the questions that are mentioned above? ______________________________________________________________________________________ ______________________________________________________________________________________ ________________________________________________________________. (THANKING YOU FOR YOUR KIND AND DEARER CO-OPERATION) (K.SARIKA)

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