Stress Health And Leisure Satisfaction

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Stress, health and leisure satisfaction: the case of teachers

Janice T.S. Ho Nanyang Technological University, Singapore

Suggests that although stress research has burgeoned in recent years, little attention has been paid to the relationship between leisure satisfaction, work stress and psychological wellbeing. Presents data from secondary school teachers in a major UK city. A validated teacher stress measure comprising rolerelated, task-based, and environmental stress was used to tap the nature and prevalence of teacher stress. Results showed that overall teacher stress arose from five main areas: role-related issues (e.g. overload, conflict, ambiguity); general job satisfaction; life satisfaction; supervisory support; and student discipline problems. A positive association was found between the amount of work stress reported and poor psychological health as measured by the General Health Questionnaire (GHQ). While no strong relationship was found between leisure satisfaction and stress, overall leisure satisfaction was significantly correlated with life satisfaction. The findings provide evidence that relaxational leisure satisfaction could well be a moderator of occupational stress for some teachers.

International Journal of Educational Management 10/1 [1996] 41–48 © MCB University Press [ISSN 0951-354X]

Introduction Considerable research has been devoted to the study of potentially deleterious consequences of occupational stress on psychological wellbeing[1-5]. Studies of the teaching profession have indicated that teaching may be one of the most stressful of all occupations, following air traffic controllers and surgeons[6]. A recent nationwide investigation into stress among teachers in the UK found teachers to be reporting stress-related manifestations which were far higher than those the population norms and other comparable occupational groups[7]. Cox and Brockley’s[8] comparison of teachers with nonteachers found that 67 per cent of teachers reported that work was the main source of stress for them, as opposed to 35 per cent of the non-teachers. The study also indicated that 30 per cent of non-teachers claimed to have no stress while only 11 per cent of teachers made this claim. The extent of the problem of teacher stress is further emphasized by Hodges’[9] finding that the number of male teachers dying while approaching the end of a career in teaching had doubled in the previous ten years and the number qualifying for a breakdown pension had more than trebled. Kyriacou and Sutcliffe[10] in a study of 700 comprehensive school teachers in England found that 25 per cent of the sample recorded their job to be “very stressful” and “extremely stressful”. Spooner[11] found that 19 per cent of his sample of 294 teachers reported their work to cause “much stress” or to be “extremely stressful”. The implications of such studies throw concern on staff reactions to work pressure and the effects of stress on teachers’ health and wellbeing. Teachers have a wide range of meanings when they use the term stress and when they accept or deny the existence of stress in themselves or in their colleagues. Some teachers define stress as anxiety, fear, inability to cope, frustration and unhappiness[12], while others associate stress with personal weakness and professional incompetence[13]. Previous studies tended to emphasize the prevalence of stress in the teaching profession, but overlooked the relationship between teachers’ perceived stress and their general wellbeing.

Stress and leisure satisfaction Cox[14] described a “transactional model” of stress that illustrates the dynamic process by which people experience and respond to problems and difficulties. Stress is seen as an individual phenomenon, the result of a transaction between the person and his situation – thus emphasizing the active and adaptive nature of the process. The basis for the model is the relationship between four aspects of the individual and the environment (see Figure 1). The person is central to this model, and he/she is continually appraising the demands being made on him/her by the situation and his/her ability to meet those demands. Following from this transactional model of stress, the notion of leisure satisfaction as a possible moderator of stress can be explored as part of the “person” aspect of the model. Leisure satisfaction could be viewed as a personal resource or simply gratified needs of the individual, which would then play a part in the person’s appraisal of the situation, and the demands made on him/her. Previous research activities carried out under the notion of the “quality of working life” had virtually a single focus on work as the important point of intervention for improvement of an individual’s overall wellbeing[15,16]. Central to the quality of working life literature is the belief that improvements in a person’s work experiences will have a substantial impact on other aspects of his/her life[17]. However, attempts have also been made to redress the balance so that the non-work side of individuals’ lives is viewed as an important contributory factor to general wellbeing[18-20] Thus, leisure or, more specifically, one’s satisfaction with one’s leisure activities, could well be a potential moderator of work stress thus making it a viable coping strategy in stress reduction. Evidence suggests that the mental health of adults is dramatically influenced by the amount of satisfaction an individual receives from his/her leisure activities. Moreover, the findings from a number of studies suggest that satisfaction with leisure, rather than satisfaction derived from job, family, health, or financial resources, is the foremost determinant of mental wellbeing[21-24].

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Janice T.S. Ho Stress, health and leisure satisfaction: the case of teachers International Journal of Educational Management 10/1 [1996] 41–48

Figure 1 The basic components of the transactional model of stress Environment

Person

External environmental supplies and support

Personal resources (capability)

Balance/ imbalance

were obtained from 86 respondents, a response rate of 42 per cent. Respondents are all full-time teachers, and did the sample not include non-teaching headteachers or deputies. Of the 86 usable cases, 59 per cent were male and 41 per cent female, most of whom were in the 31 to 40 age-group. Seventy-three per cent of the respondents were university graduates and on the average, had about 11 to 15 years’ teaching experience.

The instrument External environmental (job) demands and constraints

Internal needs and values

To include the concept of leisure satisfaction in this study of teacher stress is to examine the assumption that social and psychological activities during teachers’ leisure time, rest periods or school holidays play a significant role in alleviating the pressures of teaching life. The sparse research in this area seems to indicate that the social and psychological restorative functions of leisure have so far been largely overlooked. A search of the literature found only one study which directly examined the association between stress and leisure satisfaction. In that study, Cunningham[25] found a small association between leisure satisfaction and level of stress in the sample of professional persons providing therapeutic recreation for the disabled. It was observed that people having higher leisure satisfaction experience lower levels of stress. This article explores the experience of stress in teachers in a major UK city and its relation to the general health of the teachers. Also addressed is the role of biographical mediators and the notion that the non-work side of individuals’ lives is an important contributor to general wellbeing. Specifically, this study examines first the relationship between teachers’ perceived occupational stress and their general wellbeing, and second the association between leisure satisfaction and occupational stress, in order to determine whether leisure satisfaction (or which aspects of leisure satisfaction), could moderate the effect of work stress.

Methodology Sample Nine co-educational comprehensive secondary schools in a major UK city participated in the study. Usable questionnaires

[ 42 ]

The instrument comprised four sections. The first section is a measurement of leisure satisfaction, assessed by the leisure satisfaction scale (LSS)[26], sampling significant domains of leisure experiences. The 24-item version of the LSS was employed. This instrument consists of a five-point scale asking respondents to indicate the applicability of each statement to him/her from “almost never true for you” to “almost always true for you”, with a higher score indicating greater leisure satisfaction (e.g. “My leisure activities give me a sense of accomplishment”; “My leisure activities contribute to my emotional wellbeing”.) The component structure of the LSS has been empirically validated and reconfirmed using factor analysis. Beard and Ragheb[26] reported the internal consistency coefficient equalling 0.93, and the Cronbach Alpha, 0.92. The LSS has six subscales: 1 psychological: a sense of freedom, enjoyment, involvement and challenge; 2 educational: intellectual challenge and knowledge gains; 3 social: rewarding relationships with other people; 4 relaxation: relief from strain and stress; 5 physiological: fitness, health, weight control and wellbeing; and 6 aesthetic: response to pleasing design and beauty of environments. Section II consisted of the Goldberg’s[27] 30item General Health Questionnaire (GHQ), a well-validated global measure of psychological wellbeing, widely used to assess mental health status and mild psychiatric morbidity, which may be regarded as a useful measure of a major aspect of mental health. A high score in the GHQ indicates a corresponding probability of psychiatric illness. The third section consisted mostly of a teacher stress measure developed in the USA[28]. This instrument comprised 65 items which tapped 13 teacher stress variables. These 13 stress variables could be categorized into four headings: 1 role-related (e.g. role conflict, role ambiguity, non-participation);

Janice T.S. Ho Stress, health and leisure satisfaction: the case of teachers International Journal of Educational Management 10/1 [1996] 41–48

2 environmental (i.e. a global measure of stress in the school environment); 3 task-based (e.g. student discipline problems, paperwork); and 4 stress-related (i.e. management style, job and life satisfaction, social support). A six-point scale was employed ranging from “strong agreement” to “strong disagreement” with each statement. The last section of the instrument requested personal, biographical, professional, and general school information.

Procedure A total of 20 unsealed self-addressed envelopes containing the questionnaire and a self-explanatory covering letter were delivered to each randomly selected school. Teachers had the option of returning the questionnaire by mail or leaving it with the general office for collection within two weeks. All questionnaires were completed anonymously.

Results Prevalence and nature of teacher stress Overall, the teachers’ perception of work stress is prominent. The mean on the teacher stress measure (TSM) is 3.7, with a standard deviation of 0.66. The TSM validation group of teachers in the USA (N = 264) had a mean score of 2.7, and a standard deviation of 1.09.

Figure 2 Teacher occupational stress profile: a comparison between the UK and the USA Mean stress value 5

Key UK sample USA

4

Significant stressors Stepwise multiple regression was used to investigate the predictive relationships among the variable set and the overall TSM score. To isolate the occupational stressors that would yield the optimal prediction equation, the cut-off point for stepwise multiple regression was set at 0.05[29]. Table I highlights the ten best predictors of overall teacher stress. Job dissatisfaction alone predicts 61 per cent of the variance of the total teacher stress measure, with role overload and non-participation contributing another 16 per cent and 8 per cent respectively. The only task stress variable that reached significance level is that of disciplinary problems of the pupils. Teachers’ general satisfaction with their lives also contributed to the prediction of the experience of work stress, thus supporting the notion that non-work roles also play a part in work stress. School environmental stress is predicted by role conflict (37 per cent), pupil discipline problems (18 per cent) and job satisfaction (8 per cent) (see Table II).

The effect of teacher variables on stress Although the difference in the overall TSM score for male and female teachers did not reach significance level, this study, unlike other studies, found that male teachers in general had a slightly higher overall stress score than their female colleagues (males: means = 3.30, SD = 0.63; females: means = 3.19, SD = 0.49). Only two variables demonstrated significant differences between male and female teachers: male teachers were more stressed by role preparedness, indicating that

Table I Ten best predictors of overall teacher stress

3

2

le

am Ro big ui le ty ov Ro erlo No le c ad on npa fli rt ct ic i p Ro at le i pr ve e p Sc ho are d ol st re T as M ss an k st ag em res Jo s en b di ss t st yl at Li e fe is fa di ct ss Su io pe ati n sf rv a is c tio or y su n pp Pe or er Ill su t ne pp ss or sy t m pt om s

1

Ro

The profile of the stress variables for the UK and US groups is similar (see Figure 2), with the exception that the mean of the UK sample is considerably higher than that of the US group.

Stressors

Variable

Mult R Adj R2 R2 change P

Job dissatisfaction Role overload Non-participation Role ambiguity Illness symptoms Supervisory support Role conflict Life dissatisfaction Task stress – discipline problems Role preparedness

0.787 0.884 0.930 0.951 0.963 0.971 0.977 0.983

0.613 0.775 0.857 0.898 0.921 0.937 0.948 0.961

0.988 0.971 0.991 0.979

0.619 0.163 0.082 0.040 0.023 0.015 0.011 0.012

0.000 0.000 0.000 0.000 0.000 0.000 0.001 0.000

0.009 0.000 0.008 0.000 [ 43 ]

Janice T.S. Ho Stress, health and leisure satisfaction: the case of teachers

Table II Best predictors of school environmental stress Variable

Mult R Adj R2 R2 change p

International Journal of Educational Management 10/1 [1996] 41–48

Role conflict Task stress discipline problems Job satisfaction Task stress problems of teachers Task stress extra hours

0.619 0.373

0.38

0.000

0.752 0.550 0.800 0.621

0.18 0.08

0.000 0.001

0.816 0.643

0.03

0.040

0.834 0.669

0.03

0.023

Table IV Most frequently endorsed health items Percentage of respondents endorsed “more than usual”

GHQ item (abbreviated)

they felt that the training they had received was inadequate for them to perform their jobs effectively. Female teachers, however, reported a higher incidence of psychosomatic symptoms such as headaches, stomach upsets, and sleep difficulties (see Table III).

Relationship between perceived stress and health The mean score obtained on the GHQ-30 was 6.41, with a standard deviation of 7.61. The median score was 3.00. The increase in the GHQ scores above a threshold of about 6 points is concomitant with a growing need for psychiatric treatment[27]. About 30 of the present sample (approximately 37 per cent) appear to be at risk. Table IV highlights the GHQ items which teachers endorsed as experiencing “more than usual”. There is a significant positive relationship between high scores on the teacher stress measures and poor psychological wellbeing as measured by the GHQ. The correlation between stress and health scores was 0.63 (p < 0.0001). The GHQ scores were divided into three categories: good health (GHQ score 0-5; n = 49, mean = 3.09, SD = 0.48); poor health (GHQ score 6-12; n = 15, mean = 3.34, SD = 0.47); and very poor health (GHQ score 13-30; n = 17, mean = 3.75, SD = 0.57). An analysis of variance (ANOVA) in the stress scores for three classes of GHQ scores showed highly significant differences between the three states of health (F = 8.45, df = 59, p < 0.001).

Felt constantly under strain Having restless, disturbed nights Been taking things hard Found everything getting on top of you Inability to concentrate

53.5 38.4 33.7 30.6 30.2

The strongest relationship between health and the stress variables was between health and life satisfaction (r = 0.62; p < 0.0001), followed by an expected negative relationship between health and illness symptoms (r = –0.58; p < 0.0001) and role ambiguity (r = –0.54; p < 0.0001). The impact of work stress on the general health of the teachers was further examined by a stepwise multiple regression carried out to identify the key explanatory variables relating to perceived stress and health. The stress variable, “illness symptoms” was excluded from this analysis so as to avoid the problem of multicollinearity. The results are presented in Table V. Teachers’ general satisfaction with their lives is a major predictor of their general health, accounting for 35 per cent of the total variance. The other significant predictors are role ambiguity (12 per cent), the task stress of adjusting to changing professional standards (6 per cent), and supervisory support (3 per cent). The total variance accounted for comes to 56 per cent, thus indicating that the teacher stress measures together contribute more than half of the variance of teachers’ general health and wellbeing.

Relationship between perceived stress and leisure satisfaction A t-test performed on the low-high leisure satisfaction groups in terms of the number of hours spent on school work outside school

Table III Gender differences in stress perception

Role preparedness Male Female Illness symptoms Male Female * p < 0.05 [ 44 ]

N

Mean

SD

SE

t-value

df

44 30

3.13 2.80

0.71 0.59

0.107 0.108

2.15

69.12

0.035*

47 33

2.60 3.14

1.19 1.14

0.173 0.199

2.05

70.74

0.044*

2-tail probability

Janice T.S. Ho Stress, health and leisure satisfaction: the case of teachers

Table V Predictors of health Variable

Mult R

Adj R2 R2 change p

International Journal of Educational Management 10/1 [1996] 41–48

Life satisfaction Role ambiguity Task stress-changing professional standards Supervisory support

0.594 0.690

0.342 0.458

0.35 0.12

0.000 0.001

0.734 0.756

0.514 0.542

0.06 0.03

0.007 0.040

hours showed a significant difference between the two groups. Teachers who expressed low leisure satisfaction spent more time working outside normal school hours than those who expressed higher leisure satisfaction, as measured by the LSS (t = 2.11, df = 81, p < 0.05). The overall mean leisure satisfaction score was 89.15 (n = 86, SD = 14.63), with actual scores ranging from 36 to 115. The group’s average score was higher than the normative data[26], indicating that overall leisure satisfaction for this sample of UK teachers is relatively high. Activities of the type offering relaxation from the stress and strain of teachers’ working life made a greater contribution to overall leisure satisfaction than did those activities offering psychological, educational, social, physiological or aesthetic benefits. The overall leisure satisfaction score correlated positively and significantly with life satisfaction (r = 0.25; p < 0.05) and negatively with “regular usage of prescribed drugs” (r = –0.23; p < 0.05). No significant association was found between particular biographical sub-groups and leisure satisfaction.

stress group (mean = 9.36, SD = 8.63) (t = 3.27, df = 53.18, p < 0.01). Teachers reporting higher levels of stress not only demonstrated poorer general health, they also indicated lower job and life satisfaction when compared with teachers in the low stress group (see Figure 3 and Table VI). Findings did not render support to the concept of leisure satisfaction as a moderator of stress and health. However, the leisure satisfaction sub-scale that approached the possibility of moderating the relationship between stress and health was relaxational leisure. The results indicate that teachers with high relaxational leisure satisfaction, in general, had better health (mean = 7.65, SD = 8.5) than those with low relaxational leisure satisfaction (mean = 13.3, SD = 8.3). Although the difference between the two groups did not reach statistical significance (t = 1.78; p = 0.084), the results could have practical implications in that, for some teachers, participation in relaxational leisure activities may well provide relief from stress

Figure 3 Low-high stress groups: difference in job and life satisfaction Stress level (measure of dissatisfaction) 5 Job 4

Stress, health and leisure satisfaction To test the relationship between leisure satisfaction and its effect on occupational stress and health, the sample of teachers was divided into two sub-groups; a high and low stress group. Results reflect that teachers in the low stress group (mean = 3.46, SD = 5.09) indicated better health than those in the high

Life

3

2 Low stress

High stress

Group

Table VI Low-high stress groups: job and life dissatisfaction

N

Mean

SD

SE

Job satisfaction Low stress group 28 2.61 0.66 0.13 High stress group 33 4.37 0.92 0.16 Life satisfaction Low stress group 28 2.36 0.65 0.12 High stress group 33 2.96 1.10 0.19 Note: higher mean stress scores indicate lower job and life satisfaction * p < 0.05 ** p < 0.001

t-value

df

2-tail probability

8.47

59.00

0.000**

2.53

59.00

0.014*

[ 45 ]

Janice T.S. Ho Stress, health and leisure satisfaction: the case of teachers

and strain of work, thus resulting in better general health and wellbeing.

International Journal of Educational Management 10/1 [1996] 41–48

Discussion and practical implications Teacher stress High levels of work stress were reported by the UK sample, and this was common to all teachers irrespective of age and length of teaching experience. School environmental stress was endorsed most heavily as the major stressor for 83 per cent of the teachers, emphasizing the theoretical notions of work stress which strongly suggest that the global environment itself can be very stressful[30, 31]. For teachers, it is not simply the task at hand, or the role-related issues, that are stressful, but also the global environment such as colleagues being frustrated with their jobs or the feeling that the school is a “tightly wound spring ready to explode”. Role conflict is felt by half the respondents while role ambiguity is reported by only 12.5 per cent of the respondents. As role conflict involves the presence of two or more incompatible work demands, and role ambiguity is the absence of clear or adequate information about the role one must perform, the results indicate that teachers in general are aware of what is required of them in their jobs, but that this awareness may not be sufficient for them to perform their jobs effectively because of conflicting demands from other sources. Role conflict can be reduced by each teacher having a clear job description, developed jointly by the teacher him/herself and the headteacher, specific to the individual situation. Teachers need to be involved in developing realistic individual and organizational, short- and long-term goals, and to know to whom they are directly responsible. The messages coming from the headteacher, other teachers and parents must be compatible; thus, effective channels of communication are essential. Teachers in this study ranked task stress as the third most important stress variable, experienced by almost half the respondents. However, the only task stress variable that reached significance level is that of pupil disciplinary problems, indicating that teacher stress does not occur solely as a result of the tasks that teachers have to undertake, but also because of other factors such as availability of social support, involvement in decisionmaking and clarity of roles and responsibilities. One way of eliminating task-based stress is to increase teacher non-contact time. It is

[ 46 ]

crucial that head teachers and administrators recognize the importance of “free” periods for teachers during the school day. Although theoretically these are scheduled on the timetable, all too often they do not exist as they are often taken up to cover absent colleagues. Teachers are therefore deprived of the important functions of these non-contact periods, such as relaxing, socializing with their colleagues, or simply catching their breath! Importantly, this also implies that teachers miss out on a vital means of obtaining social support and building networks with fellow teachers which is vital for coping successfully with work stress.

Teacher variables Two main differences between the genders were found – role preparedness, which represents stress resulting from feeling a lack of competence or preparation to perform a given role, and illness symptoms, which are the reported presence of certain stressrelated psychosomatic symptoms in the individual teacher. An examination of the nature of role preparedness as perceived by male and female teachers found that male teachers tend to have more problems adapting to the changing pressures and situations at work than do female teachers. If both male and female teachers undergo similar types of teacher training, this discrepancy in role preparedness may not be due to training per se. It is possible, however, that male teachers tend to be “less flexible or adaptive” to changes than their female colleagues. Alternatively, the issue could be that of a lack of “perceived control” where male teachers may feel more stressed not because they are not able to adapt to the pressures and changes, but because they feel they lack control of the situation. Female teachers, on the other hand, may not view the importance of “control” in the same manner, and therefore adjust and adapt themselves more readily to changes in their working life. Alternatively, perhaps the present teacher training scheme is not as effective in preparing males for the teacher role as it is for females, thus leading to the different perceptions in role preparedness between male and female teachers. This has implications for persons involved with the initial teacher training and in-service courses. With regard to gender and illness symptoms, female teachers could be “resigned to their fate” and therefore accept the changes and pressures of work as they come along. However, female teachers tend to express this “stress” in terms of psychosomatic problems, which manifest themselves by way of stom-

Janice T.S. Ho Stress, health and leisure satisfaction: the case of teachers International Journal of Educational Management 10/1 [1996] 41–48

ach upsets and headaches at work. This is not apparent for male teachers because of their tendency to cope with stress by diverting the causes to external factors (e.g. inadequate teacher training), as opposed to females’ tendency to “internalize” their experience of stress. More research into this area, however, is required for a clearer understanding of the issue.

Stress and health Significant and positive relationships between the teacher stress measures and the GHQ were found, indicating that teachers’ health may well be affected by the very nature of their profession. The normal way of analysing the GHQ is to present the percentage of cases at risk. In this study, some 37 per cent of respondents were found to be at risk, that is, describing symptoms consistent with mild psychiatric morbidity. This appears to be a very high percentage compared with two other teacher-stress studies which had also employed the GHQ as a measure of psychological wellbeing. Pratt[12] found about 20 per cent of his sample (N = 124) to be at risk, whilst McGrath et al.[32], in a study of 168 teachers in Northern Ireland, found 31 per cent of their respondents at risk. Teachers’ satisfaction with their lives in general (i.e. whether it is enjoyable, rewarding, hopeful, etc.), and a lack of role ambiguity were found to be the two major predictors of teacher health. The importance of having supportive supervisory personnel is again highlighted as strong social support and makes a positive difference to the general wellbeing of teachers. Allowing the teachers to play a part in decision making on issues that would directly affect their work is also important in enhancing teachers’ sense of wellbeing and health.

Stress and leisure satisfaction Leisure is said to play an important role in psychological wellbeing. Leisure satisfaction was thus hypothesized to moderate, or alleviate, the levels of experienced stress. Although no significant relationship was found between leisure satisfaction and stress, the relaxational category of the leisure satisfaction scale gives some support to the premiss that activities which provide relaxational benefits could help to relieve the stress and strain of working life. Leisure theorists, however, have not concurred on the types of activities that provide greater relaxational benefits. Some theorists express the view that in order to relieve the stress and strain of modern life, people must find active outlets in play, indicating that individuals scoring high on the relaxational sub-compo-

nent probably participate in “active” forms of recreation such as aerobic exercise, physical active sports, or dance.

Conclusion This study, and other studies, have shown the high levels of work stress experienced by teachers. The importance of leisure activities and leisure satisfaction in contributing towards one’s health and general wellbeing is also highlighted. However, because teachers are unable to complete both administrative and teaching functions during the school day, inevitably work has to be brought home. It is apparent that the extra hours that most teachers put in to their work affects their leisure time and thus, leisure satisfaction. The relaxational sub-component of leisure satisfaction would, for some, be a means of maintaining good psychological health and keeping work stress at bay. Implications of the study for individual teachers and the school management are summarized below: 1 For individual teachers: • Recognizes own stress. • Focus on the good things associated with teaching. • Ensure that there is participation and role clarification. • Build a strong network of social support. • Do not cope by just working harder and longer. • Make time for relaxational leisure activities. 2 For the school: • Develop a co-operative and supportive culture. • Encourage teacher-involvement in decision making. • Increase teacher non-contact time. Reduce after-hours work. • Improve communication within the school. • Seek to provide better support facilities for staff including leisure facilities. • Ensure that teacher training includes training in stress and time management, and in the management of disruptive pupils.

References 1 French, J.R.P., Caplan, R.D. and Van Harrison, R., The Mechanisms of Job Stress and Strain, John Wiley & Sons, New York, NY, 1982. 2 Hockey, R. (Ed.), Stress and Fatigue in Human Performance, John Wiley & Sons, New York, NY, 1983. 3 Ivancevich, J.M. and Ganster, D.C. (Eds), Job Stress: From Theory to Suggestion, Howarth Press, New York, NY, 1987.

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Janice T.S. Ho Stress, health and leisure satisfaction: the case of teachers International Journal of Educational Management 10/1 [1996] 41–48

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