CHAPTER 1

INTRODUCTION

Background of the Study

Errors and discrepancies in radiology practice are uncomfortably

common, with an estimated day-to-day rate of 3–5% of studies reported, and

much higher rates reported in many targeted studies. Nonetheless, the

meaning of the term’s “error” and “discrepancy” and the relationship to

medical negligence are frequently misunderstood. This review outlines the

incidence of such events, the ways they can be categorized to aid

understanding, and potential contributing factors, both human- and system-

based. Possible strategies to minimize error are considered, along with the

means of dealing with perceived underperformance when it is identified. The

inevitability of imperfection is explained, while the importance of striving to

minimize such imperfection is emphasized. What’s needed is a pathway

through the demand that not only supports the radiologist but provides a

deeper and richer framework within which they can operate more effectively.

Ultimately, the human factor is critical in ensuring the diagnosis is made

correctly but the inordinate pressure on people has to be mitigated or

removed to ensure this diagnosis is accurate. (Brady A., 2016).

However, Medical errors, even those that are relatively minor, can have

serious consequences, such as misdiagnosis and longer and costlier hospital

stays. Reducing errors requires all members of the health care clinical and

administrative team to commit to the effort, and effective risk management

addresses system-wide causes of errors. Errors often result from poor

communication, inadequate training, chronic fatigue, and entrenched

workplace hierarchies. Error reduction strategies support high-quality patient

care, even in the most stressful and complex situations. ( Brusin,2014)

In Connection of this studies, the level of error in radiology has been

tabulated from articles on error and on "double reporting" or "double reading".

The level of error varies depending on the radiological investigation, but the

range is 2-20% for clinically significant or major error. The greatest reduction

in error rates will come from changes in systems.( P. Goddard, A. Leslie et al.

2001) .

A study conducted by (Ulster Med J. ,2012). conclude that all branches

of medicine, there is an inevitable element of patient exposure to problems

arising from human error, and this is increasingly the subject of bad publicity,

often skewed towards an assumption that perfection is achievable, and that

any error or discrepancy represents a wrong that must be punished 1.

Radiology involves decision-making under conditions of uncertainty 2, and

therefore cannot always produce infallible interpretations or reports. The

interpretation of a radiologic study is not a binary process; the “answer” is not

always normal or abnormal, cancer or not. The final report issued by a

radiologist is influenced by many variables, not least among them the

information available at the time of reporting. In some circumstances,

radiologists are asked specific questions (in requests for studies) which they

endeavor to answer; in many cases, no obvious specific question arises from

the provided clinical details (e.g., “chest pain”, “abdominal pain”), and the

reporting radiologist must strive to interpret what may be the concerns of the

referring doctor. (A friend of one of the authors, while a resident in a North

American radiology department, observed a staff radiologist dictate a chest x-

ray reporting stating “No evidence of leprosy”. When subsequently confronted

by an irate respiratory physician asking for an explanation of the seemingly

perverse report, he explained that he had no idea what the clinical concerns

were, as the clinical details section of the request form had been left blank).

Notwithstanding these complexities, the public frequently expects that a

medical investigation will produce “the correct answer”, all the time. This

unfortunate over-simplification of a multi-factorial process is often informed by

representations on TV dramas, media reports describing every discrepancy or

dispute over interpretation as a scandal, and the political imperative to divert

anger over perceived failings on to others, preferably easy targets, often

portrayed and perceived as privileged.

Meanwhile, there are so many misunderstanding in the literature on what

factors that can explain the influencing factors of errors and discrepancies in

radiology department relationship between personal factors and

environmental factors, Leadership related factors which is related to

excessive workload and staff shortage. Among the widely recognize

interacting variable is the as the cause of error and discrepancies in radiology

department. In addition to bias and personal factors, research has found that

around 60-80% of interpretive errors in radiology are caused by perceptual

errors. These errors influenced by attention and perception are complex to

identify and control. Human interpretation of anything is prone to this type of

diagnostic error and, as research has indicated, the layers of inattentional

blindness that influence error and decision making cannot be entirely

prevented. “Identifying contributing factors is one of the keys to developing

interventions that reduce or mitigate diagnostic errors.” – Fundamentals of

Diagnostic Error in Imagine, (Jason et al.,2018)

 The issues that influence diagnostic errors in radiology are not confined to

the practitioner alone. There are significant system errors that can further

impact on diagnosis and patient care as well. These system-related factors

can account for up to 65% of radiology errors types and include factors such

as teamwork, communication, technical failures, equipment failures,

processes, policies and procedures.

 Many of these factors are interlinked and have a knock-on effect with regards

to efficiency and accuracy of diagnosis, and the communication of that

diagnosis to the relevant treating practitioner. They also influence the human

factors outlined above. Poor internal process, policy and procedure can play a

significant role in practitioner mood, capability, and fatigue. The same can be

said for the environment within which they operate and the technology with

which they work. Poor lighting, levels of work, speed of reading times, length

of shifts – each of these factors directly affect how well any radiologist

operates. 

Within all this, it is critical to always consider the impact of fatigue on

practitioner and radiology mistakes. Medical practitioners are under constant

pressure to perform to levels of accuracy that are often not anticipated in

other roles. This pressure is not only driven by image backlog and system

delays, but by the fact that life can potentially hang on an incorrect diagnosis.

The above research pointed to several sub-categories that fall within the

fatigue arena: visual fatigue, decision fatigue and, of course, physical fatigue.
Each of these must be considered when assessing the common errors

radiologists make and mitigating them.

Therefore, my study will determines on how to identify and deal with

underperformance, discrepancy in Radiology Department and What factors

affect the discrepancy rate between Radiologic Technologist and

interpretation of Radiologist specifically in Region XII, it will seek answers to

the following factors. In this way, it can be used as basis by every radiological

department in managing and reducing errors and discrepancies in a certain

imaging procedure. which can improve radiologic technologist personal

development and could promote high quality care and services.

Statement of the Problem

This study aims to determine the moderating role of self-awareness on

the relationship between work stress and psychological well-being of

radiologic technologist. Specifically, this will seek answers to the following

questions:

1. What is the degree of work stress of radiologic technologist in terms of:

1.1 disagreement and indecision

1.2 pressure on the job

1.3 job description conflict

1.4 communications and comfort with supervisor

1.5 job related health concerns

1.6 work overload stress

1.7 boredom induced stress

 1.8 time pressure

1.9 job barrier stress?

2. What is the level radiologic technologist in terms of;

2.1 reflection

2.2 rumination?

3. What is the level of psychological well-being of radiologic technologist in

terms of:

3.1.autonomy

3.2 environmental mastery

3.3 purpose in life

3.4 personal growth

3.5 positive relations

3.6 self-acceptance?

3. Is there any significant relationship between

3.1 burnout and psychological well-being

3.2 self-awareness and psychological well-being?

5. Do burnout and self-awareness significantly influence the psychological

well-being of radiologic technologist?

REVIEW OF RELATED LITERATURE

This section presents the related literatures and studies, information,

ideas, and insights from different sources related to the subject of the study.

Work Stress
  Stress is the body's reaction to a change that requires a physical,

mental or emotional adjustment or response. It can come from any situation or

thought that makes you feel frustrated, angry, nervous, or anxious (Morrow

2011). Therefore, stress has a large impact on a person’s well-being.

Furthermore, stress occurs in a wide range of work circumstances but is often

made worse when employees feel they have little support from supervisors

and colleagues, as well as little control over work processes. There is often

confusion between pressure or challenge and stress and sometimes it is used

to excuse bad management practice (WHO, 2014).

When people feel stressed by something going on around them, their

bodies react by releasing chemicals into the blood and it give people more

energy and strength which can be a good thing if their stress is caused by

physical danger (Gould, 2007). At the same time, too much of it can cause

significant problems (Huang & Mujtaba, 2009). The most damaging types of

stress are extended, unexpected, and unmanageable stress and if one does

not take necessary action to manage these kind of stress then it can lead to

health problems (Romas & Sharma, 2007). Stress can significantly affect

physical health (Gould, 2007). The American Psychological Association (APA)

survey found three quarters of people have experienced physical symptoms

as a result to stress, such as headache, fatigue and an upset stomach in

combination with feelings of irritability, anger, nervousness, and lack of

motivation. Moreover, prolonged exposure to work stress may affect the

autonomic nervous system and neuriendocrine activity directly contributing to

the development of the metabolic syndrome (Malik, 2005).

 Health consequences are most serious when stress is managed

poorly. According to American Psychological Association, four in ten

Americans (43 percent) say they overeat or eat unhealthy foods to manage

stress, while one-third (36 percent) skipped a meal in the last month because

of stress. Those who drink (39 percent) or smoke cigarettes (19 percent) were

also more likely to engage in these unhealthy behaviors during periods of high

stress. Significant numbers of Americans report watching TV for more than

two hours a day (43 percent) and playing video games or surfing the Internet

(39 percent). Healthy behaviors used to manage stress included: listening to

music (54 percent); reading (52 percent); exercising or walking (50 percent);

spending time with family and friends (40 percent); and praying (34 percent)

(APA, 2007).

Stress has been associated with a variety of psychological conditions

including anxiety and depression, physical conditions including heart attack,

ulcers, and stroke. It is also considered to be a contributing factor to low back

pain and repetitive stress injuries (Clarkin et al, 2005) Moreover, prolonged

stress can raise the risk for developing chronic—and costly—diseases.

Among them: heart disease, diabetes and even some cancers, which can

collectively account for a vast amount of all healthcare costs. Diabetes alone

cost business $58 billion in 2007 in just indirect medical expenses such as 15

million work days lost to absenteeism and 120 million work days with reduced

productivity (ADA, 2008) Similarly, American Institute of Stress revealed that,

an estimated one million workers miss work each day because of stress,

costing companies an estimated $602 per employee per year. And

absenteeism is to blame for 26 percent of health-related lost productivity in

business.

Another is that the term used to describe the opposite of absenteeism;

“presenteeism” is the phenomenon of employees coming to work yet not

functioning up to their capabilities on the job. (APA, 2008) Presenteeism

manifests in many ways, including making mistakes, more time spent on

tasks, poor quality work, impaired social functioning, burnout, anger,

resentment, low morale and other detrimental factors. Overall, the price tag

related to presenteeism adds up to nearly $150 billion a year in lost

productivity, according to the international Foundation of employee Benefit

Plans. The cost may be even higher if the stress underlying presenteeism is

not addressed, as absenteeism, job resignations, chronic illness, and

disability may be the result.

The World Health Organization (2001) predicts that by 2020, mental

illness will be the second leading cause of disability worldwide, after heart

disease. The International Labour Organization ((ILO), 2000) says mental

illness affects more human lives and gives rise to a greater waste of human

resources than all other forms of disability. Mental disorders are one of the

three leading causes of disability. In the EU, for example, mental health

disorders are a major reason for granting disability pensions. Five of the 10

leading causes of disability worldwide are mental health problems – major

depression, schizophrenia, bipolar disorders, alcohol use and obsessive-

compulsive disorders – and account for 25-35% of all disability (Cameron,

2000). Employers are greatly affected by their employees’ mental health, and

employers affect – positively or negatively – their employees’ mental health.

 Moreover, the American Psychological association suggests a range of

ways that a company’s culture can be changed to help reduce stress such as,

ensure that workloads are in line with workers’ capabilities and resources,

design jobs to provide meaning, stimulation and opportunities for workers to

use their skills, clearly define workers’ roles and responsibilities, give workers

opportunities to participate in decisions and actions affecting their jobs,

improve communications to help reduce uncertainty about career

development and future employment prospects, and provide opportunities for

social interaction among workers. (APA, 2004)

Self-awareness

Self-awareness can be broadly defined as the extent to which people

are consciously aware of their internal states and their interactions or

relationships with others (Trapnell & Campbell, 1999; Trudeau & Reich,

1995). Viewed as an overarching theoretical construct, self-awareness is

operationalized in different ways depending on the focus of the research. A

distinction is often drawn, for example, between situational and dispositional

self-awareness (Brown & Ryan, 2003), reflecting the different approaches of

social psychologists and personality psychologists respectively.

Sutton (2016) of Europe's Journal of Psychology Dispositional (2016)

define self-awareness a primary means of alleviating psychological distress

and the path of self-development for psychologically healthy individuals. It is

conceptualized in several different ways, including insight, reflection,

rumination and mindfulness

Sutton added that self-awareness as a conscious awareness of one’s

internal states and interactions with others. A significant volume of research

has elucidated the relationship of various conceptualizations of self-

awareness with health-related variables (Ghasemipour, Robinson, &

Ghorbani, 2013) and different psychological variables, particularly well-being

(Brown et al., 2007). However, research on the more behavioral outcomes of

increased self-awareness tends to be fragmented and focus on one or two

outcomes at a time. If self-awareness is to be promoted as of direct value to

individuals, organizations and society, it is important to assess the full range

of potential outcomes. A comprehensive measure of the outcomes and effects

of self-awareness would not only give researchers a concise way of

evaluating the wide impact of self-awareness interventions but would also

help to elaborate the nature of the relationships between different

conceptualizations of self-awareness Sutton (2016).

Self-awareness was used as a component that reflects the importance

of recognizing one’s own feelings and how they affect one’s performance. It is

an ability to recognize own emotions, and the effects. Being guided of the

feelings by the personal values. It is like being aware of own emotions, and

how it affect in the behavior, is crucial to effective interaction with others. But it

can also be crucial to a personal health and well-being (Mowery, 2013).

On the other hand, Riedi (2014) defines self-awareness as the ability to

recognize and understand one’s own emotions. People with this competence

are able to identify subtle differences in their emotions and know how their

emotions affect their behavior, decisions, and performance. Moreover,

someone should be able to have their own radar by identifying, recognizing

and understanding every circumstance that will happen and make the right

responses.
 Reflection. The self-reflection is a measure of private self-

consciousness which would assess internal state awareness (insight)

separately from self-reflection. Self-reflection is defined as the extent to which

an individual pays attention to and evaluates his/her internal states and

behaviors, while insight is the clarity of understanding of these states and

behaviors that the individual has (Grant, Franklin, & Langford, 2002).

Furthermore, Grant et al. (2002) note that these abilities to monitor and

evaluate are essential components of self-regulation and goal-directed

behavior. While self-reflection and insight are related to well-being, it is not a

straightforward relationship. Insight is related to increased psychological well-

being and cognitive flexibility, while self-reflection is associated with higher

anxiety but lower depression. A so-called ‘self-absorption paradox’ seems to

exist: higher self-attentiveness is associated with both better self-knowledge

and increased psychological distress (Sutton, 2016).

Rumination. Rumination to neuroticism, reflects a tendency to focus

on negative self-perceptions and emotions. Reflection, on the other hand, is

related to the openness to experience trait and represents a tendency to

reflect objectively. The differential impact of these two forms of self-

attentiveness has been demonstrated in many areas, including the

interpersonal arena: rumination is associated with impaired interpersonal skills

and increased negative affect while reflection is associated with improved

interpersonal skills (Takano, Sakamoto, & Tanno, 2011).

Goleman (1998) has argued that self-awareness serves as an inner

barometer, gauging whether what we are doing (or about to do) is indeed,

worthwhile. Feelings give the essential reading. If there is a discrepancy

between action and value, the result will be uneasiness in the form of quilt or

shame; deep doubts or nagging second thoughts, queasiness or remorse,

and the like, such uneasiness acts as an emotional drag, stirring feelings that

can hinder or sabotage our effort. Indeed, Yeung (2009) has argued that if

emotional intelligence were a journey, then self-awareness would be the skill

of map reading. It tells you where you are at the moment, the current mood or

emotion you may be experiencing. And it shows you where you want to get to

a goal, or perhaps an emotion or mood that may help you to achieve your

goal.

Yeung (2009) has further argued that successful people are usually no

cleverer than we are. What they are better at is self-motivation when they feel

despondent. They feel worried and afraid but decide to do it anyway. When

they lack confidence, they find ways to summon up courage, they get

embarrassed and angry too, but they hide it and get on with the task at hand.

The awareness of how our emotions affect what we are doing is the

fundamental emotional competence. Emotional awareness starts with the

realization of our feelings which is present in all of us and with recognition of

how these emotions shape what we see think, and do, and how the

awareness will affect those we are dealing with.

In a comparison of executives who derailed and those who did well,

finding suggests that both groups had weaknesses; the critical difference was

that those who did not succeed failed to learn from their mistakes and

shortcomings. The unsuccessful executives were far less open to

acknowledge their own faults, often rebuffing people who tried to point them

out. This resistance meant they could do nothing to change them. In another
study of hundreds of managers, from twelve different organizations, accuracy,

in self-assessment was a hallmark of superior performance, something poorer

performers lacked. It’s not that star performers have no limits on their abilities,

but that they are aware of their limits, and so they know where they need to

improve or they know how to work with someone else who has strength they

lack (Goleman 1998).

Goleman (1998) further describes those who lack accurate self-

awareness as being blind. Whenever somebody consistently mishandles a

given situation that is a sure sign of a blind spot. In a lower reaches of an

organization, such problem can easily be dismissed as “quarks”. But at higher

levels these problems are magnified in consequence and visibility, the

adverse effects matter not just to the person who has them, but to the group

as a whole.

Psychological Well Being

Generally, well-being has been characterized from two perspectives.

The clinical perspective specifies well-being as the lack of negative states and

the psychological perspective defines well-being as the figure of positive

attributes. Positive psychological definitions of wellbeing in general include

some of six generic characteristics. The six characteristics of well-being most

prevalent in definitions of well-being are the active pursuit of well-being, a

balance of attributes, positive affect or life satisfaction, pro-social behavior,

multiple dimensions, and personal optimization (Barwais 2011).

Psychological well-being refers to positive mental health (Edwards,

2005). Research has shown that psychological well-being is a diverse

multidimensional concept (MacLeod & Moore, 2000; Ryff, 1989; Wissing &

Van Eeden, 2002), which develops through a combination of emotional

regulation, personality characteristics; identity and life experience (Helson &

Srivastava, 2001). Psychological well-being can increase with age, education,

extraversion and consciousness and decreases with neuroticism (Keyes et

al., 2002). Moreover, Diener and Schwarz (1999) stated that the psychological

well-being is equal to the good life or satisfaction with life in a hedonic sense.

The concept of well-being finds its origin primarily in the hedonistic concept,

by which well-being is operationally defined by a high level of positive effects,

a low level of negative effects and high degree of life satisfaction.

Psychological well-being has undergone extensive empirical review

and theoretical evaluation (Wissing & Van Eeden, 1998). Bradburn’s (1969)

initial understanding of psychological well-being provided a depiction of the

difference between positive and negative affect. Preliminary research was

mainly concerned with the experiences of positive and negative affect,

subjective well-being and life satisfaction that were formed around the Greek

word ‘eudemonia’, which was translated as ‘happiness’ (Ryff, 1989).

Despite extensive evaluation and assessments, experts have indicated

that psychological well-being is a diverse multidimensional concept, with exact

components still unknown (MacLeod & Moore, 2000; Ryff, 1989b; Wissing &

Van Eeden, 2002). Ryff has extensively researched the objective

understanding of psychological well-being.

Ryff’s components of objective psychological well-being are outlined

separately below for explanation and clarification purposes. When unpacked

there appears to be a relationship between Ryff’s psychological well-being

components and the psychological skill components previously outlined, with

psychological well-being components seemingly inter-related with various

psychological skills components. A further association is that a variety of

techniques including breathing and self-talk are used to improve both

psychological skills and psychological well-being (Berger, 2001; Stelter, 1998,

2000, 2001; Wann & Church, 1998; Weinberg & Gould, 2007).

Autonomy. Autonomy is the regulation of one’s own behavior through

an internal locus of control (Ryff, 1989; Ryff & Keyes, 1995). A fully-

functioning person has a high level of internal evaluation, assessing the self

on personal standards and achievements while not relying on the standards of

others. A high level of autonomy suggests independence with a low level

suggesting concern over self-perception. Internal locus of control is an

important component of motivation (Weinberg & Gould, 2007) with athletes’

generally requiring autonomy, personal insight and objectivity in order to

sustain self-confidence and belief. Autonomy is also linked to self-determined

motivation in sport participation (Huang & Jeng, 2005).

Personal growth. Personal growth is the ability to develop and expand

the self, to become a fully functioning person, to self-actualize and accomplish

goals (Ryff, 1989; Ryff & Keyes, 1995). To achieve peak psychological

functioning one must continue to develop the self through growth in various

facets of life (Ryff, 1989). This requires one to continually evolve and solve

problems thereby expanding one’s talents and abilities. An elevated level of

personal growth is associated with continued development while a depleted

level is suggestive of a lack of growth. Sportspeople with a growth mindset

realize hard work yields results (Dweck, 2005). A growth mindset requires
openness to a variety of new and diverse experiences. Athletes, who are

humble but confident, are constantly striving for personal growth and holistic

development (Weinberg & Gould, 2007); they generally use positive and

negative performances, as well as goals achieved, to enhance personal

growth. Personal growth is potentially the psychological well-being dimension

that is closest to eudemonia (Ryff, 1989).

Environmental mastery. Environmental mastery refers to choosing

and controlling the surrounding and imagined environment through physical

and/or mental actions (Ryff, 1989b; Ryff & Keyes, 1995). While a high level of

environmental mastery reflects control over one’s context, a low level is

related to inability to successful control one’s environment (Ryff, 1989b). A

mature individual is generally able to interact and relate to a variety of people

in diverse situations and adapt to various contexts upon demand. Being in

control of physiological and cognitive arousal can improve an athlete’s control

and understanding of their surroundings, as well as their interactions with

others. Imagery results in improved self-awareness as well as enhanced

situational and environmental understanding (Potgieter, 1997; Weinberg &

Gould, 2007). Environmental mastery means being able to control complex

environmental and life situations (Ryff, 1989b) and to seize opportunities

which present themselves. It often requires the ability to step out of one’s

‘comfort zone’ when striving for optimal sporting performance.

Purpose in life. Purpose in life refers to the perceived significance of

one’s existence and involves the setting and reaching of goals, which

contribute to the appreciation of life (Ryff, 1989; Ryff & Keyes, 1995). Mental

health includes awareness that one has a greater goal and purpose in life
(Ryff, 1989). Purpose in life creates direction, thereby eradicating

despondency. Goals are an important part of striving for success (Miller,

1997). Maturity involves having a clear sense of intentionality (Ryff, 1989).

Positive relations with others. Having positive relations with others is

an essential component in the development of trusting and lasting

relationships as well as belonging to a network of communication and support

(Ryff, 1989; Ryff & Keyes, 1995). A calm and relaxed approach reflects

maturity, leads to improved interactions and better consideration of others.

While good relations result in an understanding of others, poor relations can

cause frustration (Ryff, 1989). The ability to have good human relations is one

key feature of mental health with pathology often characterized by impairment

in social functioning (American Psychiatric Association, 2000).

Communication is an important part of team interactions (Miller, 1997;

Potgieter, 1997).

Self-acceptance. Self-acceptance is the most recurring aspect of

psychological well-being. It is a fundamental feature of mental health and an

element of optimal functioning (Ryff, 1989b; Ryff & Keyes, 1995). Healthy

levels of self-acceptance create a positive attitude and improved satisfaction

with life (Ryff, 1989). Moderate levels of confidence lead to greater

achievement and acceptance (Wann & Church, 1998; Weinberg & Gould,

2007), with positive feedback from others important in the maintenance of

self-confidence and belief. Self-acceptance is a key component of self-

actualization, enhanced psychological functioning and development (Ryff,

1989). It entails accepting the past and present as well as maintaining

direction for the future.

Theoretical Framework

This study is anchored on the Wellness Theory of Anspaugh, Hamrick

and Rosato (2006), and Lazarus and Folkman (1984) theory on Transactional

Model of Stress. The wellness theory emphasizes that an individual

relationship to wellness and its component to health. In relation to the study

the variables that affect the individuals response to wellness are the

following : physical (the ability to carry out daily tasks, achieve fitness); social

(the ability to interact successfully with people and within the environment of

which person is a part) ; emotional (the ability to manage stress and to

express emotions appropriately); intellectual (the ability to learn and use

information effectively for personal, family and career development; spiritual

(the belief in some force that serves to unite human beings and provide

meaning and purpose to life); occupational (the ability to achieve a balance

between work and leisure time; and environmental (the ability to promote

health measures that improve the standard of living and quality of life in the

community).

Meanwhile, the Lazarus and Folkman (1984) theory on Transactional

Model of Stress states that stress can be thought of as resulting from an

“imbalance between demands and resources” and thus become stressed

when demands (pressure) exceeds our resources (the ability to cope and

mediate stress). However, this study discusses the correlation of work stress

and well-being of an individual, working performance and the profile of

respondents. On the other hand, stressors such as disagreement and

indecision, pressure on the job, communication and comfort with the

supervisor, job related health concerns, work overload stress, problems of job
security, time pressure and job barrier stress are being studied to find ways

how an individual manage the daily stressful events in life.

Conceptual Framework

Figure 1 shows the conceptual model showing the relationships of the

variables. The independent variable is the work stress which refers to the

response to interpersonal stressors on the job resulting to exhaustion (Gemlik,

2010). The dependent variable is the Psychological well-being. It refers to

positive mental states, such as happiness or satisfaction. Meanwhile, the

mediating variable is the self-awareness which represents a higher form of

consciousness which makes it possible for us humans to become the object

of our own attention and to acknowledge our own existence.

INDEPENDENT VARIABLE

BURNOUT

MODERATING VARIABLE

SELF-AWARENESS PSYCHOLOGICAL
WELL-BEING
INTERACTION
BURNOUT

SELF-AWARENESS

Figure 1. Conceptual Framework Showing the Relationships of the

Variables

Chapter 2

METHOD

This chapter presents the research design, research locale,

respondents, research instruments, data gathering procedure, and statistical

tools.

Research design

This study will utilize the descriptive-correlational research design.

Descriptive research design is used to obtain information concerning the

current status of the phenomena to describe (Shuttleworth, 2008). Moreover,

it is a fact finding study that allowed the researcher to examine characteristics,

behaviors, and experiences of study participants (Calmorin, 2007).

Furthermore, the correlational design is used to identify the strength and

nature of association between two or more variables (Creswell, 2003).

 In this the study, it will determine the levels of work stress,

psychological well-being, and self-awareness. Moreover, the moderating role

of self-awareness on the relationship between burnout and psychological well-

being will be also investigated.

Research Locale

The study will be conducted in Region XI, Mindanao particularly in

Davao

City, Davao del Sur, and Davao del Norte. Davao City is the largest city in the

island of Mindanao and serves as the regional center of Region XI. Davao del

Sur is a province located in Davao region which is bordered by Davao City to

the north, and Cotabato, Sultan Kudarat, South Cotabato, and Sarangani to

the west.

Lastly, Davao del Norte is another province located in the Davao Region

which borders the province of Agusan del Sur to the north, Bukidnon to the

west.

Research Respondents

The radiologic technologist in Region XI will be the respondents of this

study. The purposive sampling technique will be employed in selecting the

respondents. This technique is a form of non-probability sampling in which

decisions concerning the individuals to be included in the sample are taken by

the researcher, based upon a variety of criteria which may include specialist

knowledge of the research issue, or capacity and willingness to participate in

the research (Oliver, 2006). To attain homogeneity, only those radiologic

technologist having at least 1 year experience in the hospital and presently

working during the pandemic situation will be selected as respondents of this

study. Those who do not meet the length of service criteria will not be part of

this study.

Research Instrument

Work Stress Scale. The inventory is adopted from Stanton (2001).

This is a Likert type tool that is consists of nine areas. In evaluating the

degree of work stress, the following measures will be used:

Mean Interval Descriptive Level Descriptive Interpretation

4.50-5.00 Very High Degree Work stress is always evident

3.50-4.49 High Degree Work stress is oftentimes

evident

2.50-3.49 Moderate Degree Work stress is sometimes

evident

1.50-2.49 Low Degree Work stress is seldom evident

1.00-1.49 Very Low Degree Work stress is not evident

Psychological Well-being Questionnaire. This tool is adopted from

Springer and Hauser (2003) which contains series of statements reflecting the

six areas of psychological well-being: autonomy, environmental mastery,

personal growth, positive relations with others, purpose in life, and self-

acceptance. Respondents rate statements on a scale of 1 to 5, with 1

indicating strong disagreement and 5 indicating strong agreement. For each

category, a high score indicates that the respondent has a mastery of that

area in his or her life. Conversely, a low score shows that the respondent

struggles to feel comfortable with that particular concept. The measures of

internal consistency are: self-acceptance (alpha=.93), positive relations with

others (alpha=.91), autonomy (alpha=.86), environmental mastery

(alpha=.90), purpose in life (alpha=.90), and personal growth (alpha=.87).

Mean Interval Descriptive Level Descriptive Interpretation

4.50-5.00 Very High The Radiologic staffs always

exhibit mastery on certain
area of his or her life

3.50-4.49 High The Radiologic staffs

oftentimes
exhibit mastery on certain
area of his or her life

2.50-3.49 Moderate The Radiologic staffs

sometimes
exhibit mastery on certain
area of his or her life

1.50-2.49 Low The Radiologic staffs seldom

exhibit mastery on certain
area of his or her life

1.00-1.49 Very Low The Radiologic staffs does not

exhibit mastery on certain
area of his or her life

Self-awareness questionnaire. This questionnaire is adopted from

Reflection Rumination Scale (Trapnell & Campbell, 1999) which measures the

extent to which a person tends to think about or reflect on self. The RRQ

consists of 24 items measured on a 5 point Likert scale.

Mean Interval Descriptive Level Descriptive Interpretation

4.50-5.00 Very High The Radiologic staffs always

manifest self-awareness

3.50-4.49 High The Radiologic staffs

oftentimes
manifest self-awareness

2.50-3.49 Moderate The Radiologic staffs

sometimes
manifest self-awareness
1.50-2.49 Low The Radiologic staffs seldom
manifest self-awareness

1.00-1.49 Very Low The Radiologic staffs does not

manifest self-awareness

Research Procedure

A letter requesting to conduct research study in hospitals will be sent to

the Head of organizations. After the approval, the researcher with the help of

the representatives will communicate with the Directors of Radiologic

departments to request for appropriate schedule of data gathering without

disrupting the work and also to give enough time to facilitate the giving of

instructions in answering the questionnaire.

At the day of data collection, the respondents will be requested to sign

for letter of consent which was specified in the instrument for their voluntary

participation of the study. Only those who signed the consent letter will be

considered as part of this study. Respondents will be assured that their

responses will be kept confidential and that their names will never appear in

any part of this study. Hence, the explanation about the study and instruction

for the tests will be incorporated in the questionnaires. After retrieving all the

questionnaires, a data screening will be performed to minimize the possible

outliers during the analysis. After which, encoding, tabulating, and analyzing

will be done.

Statistical Tools

The following statistical tools will be used in the study:

 Mean will be used to measure the levels of burnout, self-awareness,

and psychological well-being of Radiologic technologist.

Pearson Product Moment Correlation will be utilized to determine

the relationships of burnout, self-awareness, and psychological well-being of

Radiologic technologist.

Multiple Regression Analysis will be used to measure the influence

of burnout and self-awareness on psychological well-being of Radiologic

technologist.

Modgraph will be employed to determine the mediating effect of self-

awareness on the relationship between burnout and psychological well-being

of Radiologic technologist.

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