Stress among employees in psychiatric nursing

Introduction: Evidence suggests that stressful situations are frequent in the field of psychiatry and that professionals working in this speciality are more prone to stress. Stressful situations may be compounded by ignoring the principles and strategies of therapeutic communication in all interactions with patients. The purpose of the research was to determine the presence of stress among the nursing team members. Methods: The research is based on a quantitative methodology; the data were collected using a semi-structured questionnaire. The sample consisted of 73 nurses working in a special social welfare institution (n = 37) and in a psychiatric hospital (n = 36). The survey was conducted in the first half of the year 2016. Descriptive statistics and chi-square test were used. Results: The list of stress factors most frequently reported by the participants include low pay (n = 40, 55 %), poor interpersonal relationships in the workplace (n = 23, 32 %), and the sense of insecurity due to unpredictable behaviour of patients (n = 32, 44 %). One fifth of the respondents are regularly subjected to patient physical violence and psychological abuse in the workplace (n = 14, 19 %) and a large majority (n = 53, 72.5 %) are frequently exposed to dangerous situations. The respondents are not fully aware of the crucial importance of therapeutic communication with the patients (n = 38, 52 %). Discussion and conclusion: It is impossible to completely avoid stressful situations in psychiatric settings. Psychiatric nurses should possess good communication skills and the ability to develop good interpersonal relationships.


Introduction
Previous studies have indicated a probable high prevalence of stress in nursing staff worldwide (Weinberg & Creed, 2000).The nursing employees spend a large portion of their lives in the workplace (Kramli, 2007).Responsibility, an essential component of professional nursing practice, and the heavy, responsible and demanding workload require that nurses develop the necessary characteristics, such as compassion, reliability, understanding, readiness to help other people, and tolerance (Thaler, 2007, p. 56).Nursing employees claim that they are burdened with expanding responsibility and that the team work is practically non-existent due to hierarchical relationship within nursing.For the majority of nurses exercising the profession has become just a job to earn one's living and a constant source of stress.In the field of psychiatric nursing, 70 % of employees have reported perpetual threats from patients, work overload, and physical fatigue (Čuk & Gnezda, 2007).
Stressful situations in mental health settings have become a norm in everyday work.Several nursing studies have confirmed that a constant stress is due to the demanding and responsible work and life of the employees (Weinberg & Creed, 2000;Peterka Novak, et al., 2010;Bregar, et al., 2011;Rössler, 2012;Berring, et al., 2016).The frequent stressful situations in psychiatric settings are mainly due to specific pathologies of patients.The involuntary admission to a psychiatric facility, the patients' violent behaviour and severe staff shortage in one shift may adversely affect employee work performance.Additional stress may be generated by insufficient use and knowledge regarding therapeutic communication.It is therefore of key importance that health workers are involved and engage in continuing professional education and training (Kržišnik & Čuk, 2010).
Health workers tend to ignore therapeutic communication in order to avoid work-related emotional stress.They therefore deny and avoid the patients' problems and limit their communication with the patients to the basic necessities.They adopt impersonal attitudes and maintain personal distance in order to protect themselves from emotional distress (Čuk & Gnezda, 2007).Due to the unique nature of the psychiatric profession, the employees may incur injuries or experience tension, insecurity, psychological pressure, stress and also the risk for burnout (Čuk & Gnezda, 2007;Kramli, 2007;Čuk, 2010;Lapanja, 2010).
Beyond the effects of the above stressors, the employees have to cope also with difficult interactions with other health professionals as part of multidisciplinary teams (Kindy, et al., 2005;Peterka Novak, et al., 2010;Bregar, et al., 2011;Rössler, 2012).Peterka Novak and colleagues (2010) conducted a research in six psychiatric facilities at a secondary and tertiary level of health care to determine the causes and incidence of stress and burnout.Consistent with the findings of other research studies, the present study indicates that the psychiatric staff have to endure also the harassment or emotional and psychological pressure by co-workers, employee grouping leading to strained interpersonal relationships within a healthcare and nursing team (inter-and intraprofessional conflicts), insincerity among employees, unsatisfied individuals, stressful meetings with superiors, and compromises in inter-professional cooperation in the pursuit of common goals.The psychiatric nurses also report poor work environment, not clearly defined responsibilities, great responsibility for patients, nonparticipation in organisation of work, poor prospects for career advancement, work shifts, and adverse and unpredictable situations (Čuk & Gnezda, 2007, p. 31), pace of work and intensity, high physical and psychological demands of workload, shortage of staff (Zeller, et al., 2009;Peterka Novak, et al., 2010;Bregar, et al., 2011;Ferri, et al., 2016;Lantta, et al., 2016).The list of stressors includes also long bedside visits, constant hurry, a large number of concurrent interventions and the triage during on-call time, acting against patients' will, non-voluntary admission, physical restraint of patients, involuntary treatment, incidents (e.g.suicide attempt), demolished biorhythm, etc. (Lapanja, 2010, pp. 50−51).
Typical of psychiatric settings, especially in clinical environment and social welfare institutions, is an increased risk of patient aggression, hetero-aggression and auto-destructiveness (Peterka Novak, et al., 2010;Bregar, et al., 2011).Zeller and colleagues (2009) argue that the major stress factors for employees are the challenges and burdens of patient aggressive behaviour, especially verbal threats and insults, and physical violence (e.g.kicks and bites).Other studies (Reininghaus, et al., 2007) confirmed that violence presents the primary work-related stress.Ferri and colleagues (2016) concluded that workplace violence against health professionals is a major global public health issue with an increasing incidence and that all health workers, especially nurses, are at risk of suffering aggressive assaults.It has also been established that organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout (Hamaideh, 2011).Burnout was first identified in nurses and other professional caregivers (Schmiedel, 2011) and it is also the main cause of changing the job.A great majority of psychiatric employees (90 %) define their job as stressful and burdensome, and feel to be at risk of job burnout (Čuk & Klemen, 2010).

Aims and objectives
The aim of the study was to determine the occurrence rate and the extent of work-related stress among psychiatric nurses in a clinical setting and in a special social welfare institution.Accordingly, the following objectives were set: to identify the most common sources of work-− related stress among psychiatric nursing employees; to establish the consequences of work-related stress − on the private life of psychiatric nursing employees; to determine the incidence of adverse events and the − patient psychological and physical violent behaviour in psychiatric settings; and to assess the frequency of use of therapeutic − communication among psychiatric nurses.
The research questions addressed the following topics: Which events and situations are the biggest − determinants of stress and how work-related stress affects the private life of employees?How often are the nursing team members faced − with the patient physical and psychological violent behaviour and which are the forms of patient aggression directed toward nurses in a workplace or on duty?Accordingly, the following hypotheses were proposed: H1: The psychiatric nursing team members have not yet been on sick leave due to work overload.H2: The employees are satisfied with their work position and environment.H3: The employees regularly use therapeutic communication in their interaction with patients.

Methods
The study was based on a non-experimental quantitative descriptive research method.

Description of the research instrument
For the purposes of the present study a questionnaire was designed on the basis of relevant literature review (Peterka Novak, et al., 2010;Schmiedel, 2011;Lipovšek, 2012).It consisted of ten closedended, three semi-structured and four open-ended questions.The questions were classified into four thematic sections.The first section comprised standard sociodemographic data, such as gender, age, educational level and years of employment in a psychiatric setting.The second section consisted of statements related to stressogenic factors in the field of psychiatric care, where the respondents rated each item using the following criteria: 0 − strongly disagree, 1 − neutral/no opinion, 2 − strongly agree.The third section included questions regarding the perceived safety at work, the prevalence of violent events, the use of therapeutic communication, the frequency of patient physical and psychological violent acts, the employees' personal history of victimisation, their tolerance levels, the lack of confidence in their skills and expertise in performing nursing interventions.
The fourth section inquired into the impact of workrelated stress on private life of employees, using the same grading scale as in the third section.The reliability of the research instrument was tested with the Cronbach's alpha coefficient.It ranged from 0.70 to 0.90, which indicates a strong internal consistency (UC Regents, 2016).

Description of the research sample
The total of 140 questionnaires were administered to the nursing employees of one of the psychiatric hospitals (n = 70) and the nursing employees of a special social welfare institution (n = 70), both situated in the northeastern part of Slovenia.Just over half of the questionnaires (n = 73) were completed and returned (36 from the hospital and 37 from a social welfare institution).The majority of the respondents have completed secondary school education (n = 51, 70 %) and only four (5 %) study participants have university education.Most of the participants involved in the research were female (n = 59, 80.5 %).Nearly half of the respondents (n = 33, 45.5 %) constituted the age group from 30 to 40 years (n = 33, 45.5 %), and only one respondent (1.5 %) belonged to the group of less than 20 years of age.The majority of the respondents had up to 20 years of employment in the field of psychiatric care (n = 26, 35.5 %), and the smallest proportion of the cohort had up to 40 years of employment in this field (n = 8, 11 %).

Description of the research procedure and data analysis
An oral ethical approval was obtained from the relevant authorities in both institutions prior to commencing the study, collecting the data and recruiting the participants.The study was conducted in accordance with the principles of research ethics.The research was conducted from March to May, 2016, in collaboration with the heads of nursing teams of the participating departments.All the participants were informed with the aim of the study and the content of the questionnaire ahead of time.Participation was voluntary and the participants were assured of the confidentiality of their responses.The data collected were statistically analysed using Microsoft Word 2007, Microsoft Excel 2007 andSPSS version 20.0 (SPSS Inc., Chicago, IL, USA).The descriptive statistics was used to establish the differences between the variables.The chisquare test (χ 2 ) was employed to test the null hypotheses regarding the participants' sick-leave due to work overload, the workers' job satisfaction, and the use of therapeutic communication in their interaction with patients.

Results
The study aimed to explore the events and situations causing work-related stress.The list of stressors was limited to the following sources: easy fatigability, constant lack of time for meals, insincere relationship among co-workers, uneasiness in the presence of superiors, a fast-paced work environment, short terms to meet the goals, multiple duties in one work shift, unpredictable situations, three-shift work, not feeling comfortable in providing care for unpredictable psychiatric patients, lack of support and understanding by the superiors, insincere communication with other professionals, low pay, dishonesty among coworkers, patient aggressive behaviour and reactions, implementation of special preventive measures, and the feeling of being overburdened with duties in comparison to other employees.The percentages given in the result section represent the proportion of subjects who strongly agree with a given statement.
A significant difference was established between the employees from the two participating institutions regarding the sources of stress.A certain level of agreement was, however, established in both institutions regarding the low pay, which was reported by 15 (41 % ) respondents from a special social welfare institution and 25 (69 %) respondents from a psychiatric hospital.Another common stress factor identified was also dishonesty among co-workers, which was reported by 14 (38 %) respondents from a special social welfare institution and 22 (61 %) respondents from a psychiatric hospital.The multiplicity of safety concerns due to unpredictable behaviour of patients is the third most frequently reported stressful situation in a special social welfare institution (n = 15, 40.5 %), while the patient physical violence was the third stressor reported by the respondents from a psychiatric hospital (n = 17, 47 %).Nearly half of all the respondents (n = 34, 46.5 %) reported a history of physical and psychological violence several times per month.
In a special social welfare institution 30 % (n = 11) of employees encounter patient physical and psychological violence on a daily basis, 30 % (n = 11) several times per week, and 40 % (n = 14) several times per month.In a psychiatric hospital, on the other hand, 8 % (n = 3) of respondents encounter patient physical and psychological violence on a daily basis, 36 % (n = 13) several times per week and 53 % (n = 19) several times per month.One of the respondents (3 %) never experienced patient violence.
A good half of the respondents from a special social welfare institution (n = 23, 62 %) claim that their safety in the workplace was at risk, manifesting as residents' unpredictable physical assaults (n = 12), aggressive behaviour (n = 6), and verbal threats (n = 10).In a psychiatric hospital, on the other hand, 83 % (n = 30) of the respondents specified that their risks to safety were manifested as verbal aggression, such as threats, insults, profane language, and spitting (n = 16), physical aggression, such as punching, kicks and bites (n = 12), and the attempted physical assaults (n = 11).
The study addressed also the issue of patient safety and the implementation of preventive measures to enhance the safe psychiatric environment.Half of the respondents from the psychiatric hospital (n = 18, 50 %) believe that patient safety and the prevention of injuries from violent acts were well provided for, while the other half (n = 18, 50 %) claim the contrary.Nonetheless, 17 (47 %) respondents from a psychiatric hospital report frequent occurrence of violent acts.A large majority of respondents from a special social welfare institution (n = 30, 81 %) affirm that patient safety and the prevention of injuries from violent acts were secured, although 13 (35 %) respondents report frequent occurrence rate of violent acts.It is interesting to note the lack of a relation between the self-reported experience of assault and injury and the perception of physical threat.
The respondents were also questioned about their lack of confidence in their skills and expertise in performing nursing interventions.All of the respondents from the psychiatric hospital (n = 36, 100 %) maintain that they are never in doubt about their professional competence.In a special social welfare institution, the majority of the respondents are fully confident in their professional skills and expertise, 19 % (n = 7) occasionally doubt their ability to perform certain nursing interventions, and one respondent regularly experiences such doubts.
Several studies have stressed the impact of workrelated stress and the well-being of employees also outside work.In the current study, the respondents from a special social welfare institution often anticipate stressful situations already on their way to work (n = 11, 30 %), they frequently revolve around their work obligations even outside working hours (n = 10, 27 %), while the respondents from a psychiatric hospital opine that the annual leave is not long enough to repose and renew one's strength (n = 9, 25 %).The results of the remaining items are presented in Table 1.

Testing of hypotheses
The first null hypothesis (H o ) 'The psychiatric nursing team members have not yet been on sick leave due to work overload.'was tested against the following statements: 'I take sick leave several times per month because of work overload.'and 'I take sick leave several times per year because of work overload.'According to the results, none of the participants (n = 73, 100 %) agrees with the first statement, while 72 respondents do not agree with the second statement, and one participant strongly agrees with the second statement.The chi-square test of independence revealed no statistically significant difference (χ 2 = 0.001, p = 0.987).Therefore the hypothesis was accepted and the following conclusion was drawn: the members of the psychiatric nursing team in the clinical setting and in a special social welfare institution did not take sick leave because of the work overload.
The second null hypothesis (H o ) 'The employees are satisfied with their work position and work environment.' was tested against the following two statements: 'I would like to change my work environment.' and 'I believe I deserve a better working environment.'The majority of the participants (n = 44, 60 %) do not agree with first statement, 24 (34 %) participants occasionally agree, and 5 (7 %) participants strongly agree with the first statement.A good half of the participants (n = 40, 55 %) do not agree with the second statement, 22 (30 %) participants occasionally agree, and 11 (15 %) participants strongly agree with the second statement.The results show a statistically significant difference for both statements (χ2 = 73.397,p < 0.001).The hypothesis that the employees are satisfied with their work position and environment is rejected.According to the results, the employees would like to change their work place and believe that they deserve a better work environment.
The third null hypothesis (H o ) 'The employees regularly use therapeutic communication in their interaction with patients.' was tested with the adverbs denoting frequency of occurrence.
Over half of the participants (n = 34, 53 %) always use therapeutic communication, 38 (46 %) use it frequently and one respondent (1.1 %) is not familiar with therapeutic communication.The results show a statistically significant difference (χ2 = 234.349,p < 0.001).The null hypothesis that the employees regularly use therapeutic communication in their interaction with patients is rejected.Instead, an alternative hypothesis that the employees do not always use therapeutic communication in their interaction with patients could be accepted.

Discussion
Nursing has long been recognised as one of the most stressful professions due to the pressures that are central to the nurses' work.These responsibilities and the excessive workload may translate into significant stress levels among nurses, especially in psychiatric facilities.The patients with mental health conditions may need institutional short or long-term care in special social welfare institutions or psychiatric units.Caregivers provide the necessary mental health assistance to acute and chronic psychiatric patients who are admitted and treated on their own accord or on an involuntary basis.The current study into problematic work environments was focused on the stress levels experienced by the nursing employees.This study produced results which corroborate the findings of a great deal of previous research which indicate that psychiatric nurses are more prone to experience workrelated stress than are those in other occupations.Prior studies have provided evidence that a strong relationship exists between the incidence of stress and workplace experiences in psychiatric nursing.The work-related stress my affect the employees' quality of work and their everyday life (Reininghaus, et al., 2007;Dickinson & Wright, 2008;Weinberg & Creed, 2000;Čuk, 2010;Čuk & Klemen, 2010;Hanrahan, et al., 2010;Peterka Novak, et al., 2010;Hamaideh, 2011;Lombardo & Eyre, 2011;Rössler, 2012;Berring, et al., 2016;Ferri, et al., 2016;Lantta, et al., 2016).As pressure in the workplace is unavoidable due to the demands of the contemporary work environment, the employees have to develop and use healthy coping strategies to manage stress, and meet as well as enjoy professional challenges.It should be reminded that not everyone responds to stressful events in the same way and that all coping responses have limitations.
On the question of safety, the study results reveal different views among the respondents from the participating institutions.The majority of study participants from the special social welfare institution claim that measures to optimize patient safety and to minimize the effects of violence on staff are being implemented.Some of the respondents, however, report frequent violent incidents in the workplace.The respondents from the psychiatric hospital, on the other hand, do not all agree that safety in the workplace is ensured.As regards the prevalence of violent incidents, there was more agreement among these respondents than in the sample from the special social welfare institution.It can be concluded that the general safety in the unit decreases the number of incidents perpetrated by patients.Čuk and Gnezda (2007) further report that poor working conditions can be a major source of stress.Hanrahan and colleagues (2010) highlighted that the safety of employees depends on general quality of work and efficient leadership.The inpatient mental health facilities and social welfare institutions should impose adequate measures to reduce the potential for violence and the risks to safety of patients and staff.Working with mentally disturbed or behaviourally compromised patients requires adequate staffing coverage, especially nurses, the ongoing safety assessment in the psychiatric milieu and the training for the management of patient aggression.Prior studies (Černoga, 2013) have provided evidence that permanent staff education and training plays a crucial role in ensuring and maintaining a safe environment.Bregar (2012) reported that there are critical shortages of highly qualified nurses (80 %) to perform advanced nursing tasks.Such a shortage may have a significant negative impact on the quality of work and safety of patients.Recent estimates suggest that the number of nurses should be increased by 20 % to meet the current health needs of the population.Kindy and colleagues (2005) investigated the impact of severe nursing shortages and confirmed that serious workrelated hazards exist in psychiatric facilities and they also provided insight into possible remedies.
According to the study results, the respondents do not utilise therapeutic communication in their daily contacts with patients or residents, which was contrary to our expectations.Therapeutic communication skills are essential to today's nurse, especially in contacts with mentally ill and behaviourally compromised patients (Gorše Muhič, 2000).Therapeutic communication facilitates the development of therapeutic (help and/ or care) relationship, which is a key ingredient and the cornerstone of mental health nursing, The quality of the relationship or the therapeutic alliance is one of the common factors for predicting the success or failure of therapy (Lambrette, 2015).In their work with patients, the psychiatric nurses often apply the theory/model of interpersonal relations developed by Hildegard E. Peplau (1991).One of the major concepts of this theory is that nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal.Another conceptual model commonly used in psychiatric nursing is the one developed by Virginia Henderson (1998), which categorises nursing activities into 14 components based on human needs.One of these components refers to the patients' needs to communicate with others and express their emotions, needs, fears, or opinions.This psychological component of nursing is fundamental in psychiatric inpatient facilities.Permanent education and training is therefore necessary to avoid automated care in mental health nursing.The staff should acquire and apply therapeutic communication strategies based on theories and research evidence to reduce their emotional distress and foster behavioural change of patients.A great majority of the respondents are fully confident in their ability to competently perform nursing tasks and interventions.Any doubt in one's professional competence may be a major source of daily stress in psychiatric nursing.
The work in psychiatric nursing may entail various negative effects on the private life of nurses (Kindy, et al., 2005;Augusto Landa, et al., 2008;Berring, et al., 2008;Bregar, et al., 2011;Lipovšek, 2012;Ferri, et al., 2016).The study therefore aimed to determine the extent to which the respondents' professional responsibilities interfere with their family life.Nearly one third of respondents from the special social welfare institution report the experience of anticipatory stress and anxiety on their way to work, and feel the weight of their job responsibilities outside work.The study conducted by Kržišnik and Čuk (2010) presents valuable insights into the work-family balance and how the effects of fatigue and stress experienced at work can affect family life at home.One fourth of the respondents from a psychiatric hospital claim that their annual leave is not sufficient to recover from stressful work conditions and recuperate their strength even though their annual leave is longer than that of other nursing employees.
The perceived stress and coping responses for stress depend on individual personal characteristics.The respondents from both samples agree that the major sources of stress are low pay and dysfunctional, nonsupportive relationships among co-workers.Similar findings were reported by Longo (2007), Dickinson and Wright (2008), Čuk and Klemen (2010), Bregar and colleagues (2011) and Rössler (2012).The study conducted by Lipovšek (2012) indicates that more than half of the study participants are not satisfied with their pay in psychiatric nursing, and that the main reason why they stay in a job under given conditions is financial security.Physical and psychological violence in mental health settings and in social welfare institutions cannot be avoided.All the respondents from the special social welfare institution have been subjected to patient violent acts during their career, either on a daily basis or several times per week or month.Similar results were established for the respondents from a psychiatric hospital.Lantta and colleagues (2016) concluded that patient violence against health care personnel at work is a widespread global concern, particularly in the fields of mental health care and, more specifically, psychiatric nursing.In the USA, for instance, about 40 % of all nurses have been exposed to physical violence and 70 % to violence of a non-physical type.Černoga (2013) reported that nearly all psychiatric employees experienced patient-onprofessional aggression involving direct verbal abuse, or they witnessed patient violent behaviours towards objects in their environment (e.g.throwing or breaking objects, causing mayhem).The same author also noted that the incidence of patient physical violence against psychiatric health care professionals was increasing.According to Perne (2005), psychiatric nurses working with behaviourally compromised patients report among the highest violent victimization rates among all types of healthcare providers.Patient aggressive and unpredicted behaviour is also one of the major sources of stress (Bregar, et al., 2011).Čuk and Gnezda (2007) reported that 70 % of nurses working in psychiatric settings feel threatened and that the critical issue of nurse safety has not been properly addressed.The current research yielded equal results (n = 53, 73 %,), which indicate that nurses are exposed to similar safety hazards in their work environment, and that caring for those who care still remains the main concern of psychiatric and welfare institutions.The findings of the present study also reveal a very high level of the respondents' tolerance towards psychiatric patients (n = 72, 98.5 %), although their frequent violent behaviour adds to the work-related stress.The members of the psychiatric nursing teams in both participating institutions do not need to take sick leave because of stress and work overload.A small percent of the surveyed employees (n = 5, 7 %) would like to leave their current job and believe that they deserve a better working environment (n = 11, 15 %).
The results of the study provide an overview of some aspects of work environment in two different psychiatric settings.Limitations of the study included a small sample size (n = 73) and a relatively poor response rate.For this reason, these findings cannot be generalized to the larger population of psychiatric settings where nurses provide care to patients with mental conditions and developmental issues.Further comprehensive research with larger population is required to determine the extent to which our findings can be generalized.

Conclusion
The major cause of stress of the present day is the modern lifestyle, with sometimes overwhelming job and home demands and expectations.Experiencing high levels of stress may put one's health and the entire wellbeing at risk.The way people cope with stress depends on their stress recognition and coping strategies -how they take charge of their lifestyle, thoughts, emotions and challenges so that they do not compound the problems.They may avoid unnecessary stress, alter the situation, adapt to the stressors or accept the things they cannot change.The caregivers in psychiatric settings are especially at risk for stress due to their work conditions and the type of patients they care for.Stress in clinical settings and social welfare institutions may also be caused by the perceived or actual threat to safety and patient violence against healthcare workers.The anticipation and elimination of potential safety hazards should be considered, but work in these facilities is not always entirely safe and free of risk.The compromised behaviour and violent acts of patients directed towards the nursing staff cannot be avoided and the violence rates have not decreased.Several respondents of the present study experienced some kind of patient aggression on a daily basis or several times per week or month.To alleviate the overall stress, the employees should strive for better interpersonal relations within the team of co-workers.One skill of great importance to workplace violence prevention is the use of therapeutic communication in caregivers' contact with patients.It should become an integral part of psychiatric nursing, which residents and patients expect and need.
The current research was presented to the representatives of both participating institutions.It was generally agreed that the study findings may have important implications for the implementation of changes, employee work satisfaction and better quality of work performance.They are also aware that the specifics of psychiatric nursing require more collegial and supervisory support.They suggested that further research be conducted on the impact of the environmental and job-specific factors on the health and wellbeing of psychiatric nursing employees.

Table 1 :
Effects of work-related stress on the wellbeing of respondents outside their workTabela 1: Vpliv stresa na delovnem mestu na položaj oz.

Table 1 :
Effects of work-related stress on the wellbeing of respondents outside their work