The causes of stress at work amongst social workers

Social workers work in an ever-changing social, political and cultural environment, they are exposed to contacts with persons of different social backgrounds, people experiencing behavioural and various social problems. In complicated, ever-continuing, multidimensional situations, there arises the risk of stress. In order to manage stress at work, it is important to identify the causes of stress. The objective of this study is to reveal the causes of stress experienced by social workers at work basing on the experience of social workers. Qualitative research type was chosen for the study. The method of a semi-structured interview with social workers, who work in different institutions providing social services, was used. The study revealed both external and internal causes posing stress to social workers at work. The external causes of stress are associated with working conditions, for example, the absence of stability and clarity at work. Social workers often remain alone to resolve problems; they can have a heavy workload. There is the lack of cooperation between institutions, such as the police and other institutions when they inform about the problematic behaviour of their client. Stress is caused by the absence of change and excessively high requirements for an employee. Social workers experience negative behaviour of service receivers, for example, threat of physical violence, psychological violence, and pressure from clients in order to receive something. Relationships with management can also cause stress. There is the lack of incentive, the lack of benevolence, an employee is noticed only when he needs “to be taught a lesson”; the conditions of employment are not satisfactory – an employee is offered only a fixed-term contract, low pay. The internal causes of stress are related to excessively high requirements for social workers, the pursuit of perfection when resolving the problems of service receivers, the fear of failure and an inflated sense of responsibility.


Introduction
The activity of a social worker is complicated and complex. According to International Federation of Social Workers [1], social work profession promotes social change and development, social cohesion, and the empowerment and liberation of people. Social work engages people and structures to address life challenges and enhance wellbeing. The Republic of Lithuania Law on Social Services defines [2] social work as a professional activity which empowers people, families, communities and society to resolve mutual relations and social problems by promoting social change, improving the quality of life and strengthening solidarity and social justice.
In the socio-cultural context of Lithuania, the complexity of the professional activity of a social worker is reflected by the complexity of client's problems, the multidimensionality of the empowerment process, the newness of the profession, its status in society, societal culture etc. [3]. In the majority of EU countries, as well as in Lithuania, social work falls under the category of a greater professional risk [4]. According to R.Lazutka et al. [4], occupational risk factors in social work are very diverse, as well as social work itself and environment, conditions and situations, under which a social worker performs their duties, are diverse. In the system of interconnection "employee -client -environment," tensions arise and conflict situations occur [5]. Social workers, communicating with clients in their environment and other institutions, experience emotional, physical and psychological overload. Pressure from the environment and internal discomfort, which they experience, causes stress and anxiety [6]. Such negative phenomena of social work as low prestige of the profession, undefined criteria for the evaluation of the results of their work, a large number of clients, continuous encounter with negative phenomena, overtime and low pay encourage higher turnover of personnel and have influence on the quality of client service [7]. The aforementioned phenomena also cause fatigue, the feelings of failure or the loss of motivation, which are symptoms of stress and burnout [8].
Stress is defined as a special relationship between a person and their environment, which is assessed by the person as burdensome or exceeding their existing resources and a threat to their well-being [9]. A. Schünemann [10] defines stress at work as an individual psychological, physiological or behavioural reaction to understanding that it is not always possible to perform job specifications correctly and that it can cause health problems, which may bring severe social consequences. In 2005, Ministry of Health of the Republic of Lithuania adopted "Methodological Guidelines for the Investigation of Psychosocial Factors of Occupational Risk" [11]. They define stress at work as a negative reaction of an employee to unfavourable psychosocial factors of working environment conditions, work requirements, work organisation, work content, relations between the members of staff and (or) relations with an employer. The majority of researchers underline that experienced stress and its impact on working persons is an emerging problem in the context of the quality of work life [12][13][14]. Over the past few decades, an increased level of the negative impact of stress on the quality of work life has been observed. Constantly experienced stress at work is linked to the increased morbidity, poor physical health, depression symptoms, psychosomatic disorders, a lower level of satisfaction at work, a more frequent change of a job and conflicts at work [15]. Not only does stress at work generate health problems amongst employees, but it also affects the efficiency of work, its results and incurs major expenses to an organisation. Stress becomes a major problem when there is a failure to react to stress signals over a prolonged period, in which case a crisis may arise [16].
Stress risk in a professional activity has attracted considerable attention of scientists in Lithuania. I. Dirgėlienė [3] argues that, in Lithuanian socio-cultural situation, the first mention was made on the stress incurred by law enforcement officials, the causes of their stress, consequences and exit strategies are presented as well. Scientific studies appear, which also analyse the contexts of other human assistance professions, in particular, in the area of medicine, in terms of stress risk [17][18][19][20]. However, the risk of stress during the process of social work is a less studied area. Stress incurred by social workers is most often analysed in the context of a supervision perspective [4,6,21,22].
Scientists argue that, in order to overcome stress at work successfully, it is important identify the causes of stress. Kuodytė et al. [23] recommend starting of managing of stress at work from the identification of the conditions, which cause stress to employees. T. Trufanova [24] also notes that it is necessary first to clarify factors that fuel stress at work, the causes of stressful tension. R. Lazutka et al. [4] observes that, when assessing the causes of stress in working environment, it is important to take into consideration the opinion of employeeswhat causes of stress they encounter at work.

Int. Conf. SOCIETY. HEALTH. WELFARE. 2018
It should be pointed out that there is a lack of studies analysing the stress experiences of social workers at work. The problem under examination is defined by the key question: what reasons cause stress to social workers at work. The objective of the study is to reveal the causes of stress incurred by social workers at work basing on the experience of social workers.

Research methodology
Qualitative research type was chosen for the study. The method is a semi-structured interview with social workers who work in different institutions providing social services. Problematic issue of the study is what reasons cause stress to social workers at work. The obtained data were analysed using the content analysis method. The qualitative content analysis was performed regarding the following sequence [25]: repeated reading of the content of transcript interview texts, distinction of meaning elements in the text analysed, the grouping of the distinguished meaning elements into sub-categories and categories, the integration of the categories/sub-categories into the context of the phenomenon analysed and the description of their analysis.
Criteria-based sample was used in the study. The informants were chosen according to three criteria: 1) educational background -social workers have a degree in higher education; 2) the experience in social work -social workers have been working in the area of social services for over three years; 3) diversity -social workers work in different institutions providing social services.
The study was conducted in the January-February of 2020 in one Lithuanian district. The study involved 7social workers (all females). The study was based on the theoretical principle of saturation: when a researcher finds out that, in the last text of an interview, there is no new information compared with the content of the texts of previous interviews the process of an interview is stopped [26].
We obtained the permission of the heads of social services institutions to conduct the research in their institutions. Personal permission of the informants to take part in the research was sought. The researchers obliged themselves to the research participants not to divulge the information related to the organisation and the informant. The principles of anonymity, volunteerism and benevolence were followed. The social workers were acquainted with the goal of the research, the interview questions, and the importance of substantiated reflection on their experience.

Analysis of research results
The study sought to identify what reasons cause stress to social workers at work. After the analysis of the study data, 5 categories were distinguished, as well as 17 subcategories complementing them, which show external and internal causes having impact on stress at work ( Table 1).
The study established that stress at work amongst social workers is caused by external causes arising in the working environment surrounding social workers. These are causes connected with working conditions, the relations of employees with their management, service receivers and the conditions of employment. B. Pajarskienė and R. Jankauskas [27] revealed similar tendencies, they pointed out that work content, working conditions, employment relationships and mismanagement can cause stress at work.
The study data demonstrate that stressors related to working conditions can cause stress amongst social workers. One of them is the absence of stability and clarity at work. The employees pointed out that setting out to visit their clients, they are not aware of what situation they would encounter and what problem they would have to resolve on that day. "You go to a man, and you don't know what kind of problem it will be, what you will need to do, how you will have to resolve the problem -that also causes tension." I-, "You experience stress when you go to a family, and you don't know what you will find there, when I, having arrived there, find drunk, inebriated parents" I-6. The informants also mentioned that, for example, while visiting a family, at the same time, they could be summoned to resolve another critical case. The informants pointed out that the source of stress to them is "that work instability, unforeseen tasks, because of that you are unable to plan your schedule, that absence of stability, uncertainty cause stress, because you can't plan your day." I-3. Such situations demonstrate that social workers find it difficult to plan their schedule in advance, because it changes, haste makes them perform their work superficially and disallows to acquire a full understanding of a client's problem. Similar tendencies were noticed by N. Dirgėlienė and N.P. Večkienė [21], who maintain that social work takes place under the conditions of a highly changing environment, the accountability of a social worker for the effectiveness of the intervention process causes tensions. Therefore, there is a need for social workers to adapt constantly to changing environment conditions. The study demonstrates that social workers encounter stressful situations when they are left alone to resolve problems, and they have nobody, who would be able to give them advice. "Another thing that causes stress is that I am alone. I find myself lacking a colleague with whom I would be able to confer when a problem arises, how to deal with it so that it would be in the right direction, that everything would be done correctly regarding that person, in Int. Conf. SOCIETY. HEALTH. WELFARE. 2018 order to provide appropriate help" I-1. When deciding on the provision of assistance to a client, social workers feel their overriding responsibility and are afraid to make unreasonable decisions. L. Gualthérie van Weezel et al. [28] finds that social workers regularly encounter problematic, uncertain and unpredictable situations. It is extremely important that they would not be left alone, but would feel support when performing their hard work. It should be highly appreciated that social workers do not turn their backs on problems, but look for solutions to many complicated situations.
The study revealed that social workers experience heavy workloads. Social workers, who work with families, pointed out that they have to work with 15 families simultaneously. The informants pointed out that when they used to have fewer families, which they had to visit (up to ten), they were able to devote more time for resolving family problems. Now, according to the informants, while being with one family you are thinking about assistance to another family. It demonstrates that social workers lack time to plan and prepare for work with a family. "Your visit to that family is so short. You're running from one to another, so maybe that pace is such complicated. While being with one family you are thinking about another family. If you receive a call that there is some critical situation, you leave everything behind and are already on your way to that family, where a crisis has emerged" I-3. According to "Case Management Procedure" [29], there are no more than 10 families assigned to one social worker, who works with families, the maximum number of families, with which a social worker works, is 15. This means that social workers work with the maximum number of families. However, the results of the study demonstrate that such workload is excessive and just because of that the quality of services could be jeopardised. The study conducted by R. Bubnys and D. Petrošiūtė [30] revealed similar tendencies, namely that the majority of social workers, in their activity, encounter a huge workload, busy work schedule, the abundance of tasks, whereas that impedes the performance of assigned tasks.
The analysis of the study data demonstrates that the cooperation between institutions is not sufficiently effective when assisting a client. When resolving clients' problems organisations work as if independently, but not in mutual partnership while coordinating actions together. The informants point out that they sense pressure from other institutions, and that cooperation is in no way pleasant and positive, the competition is stronger than the seeking to resolve the problems, which have arisen to their clients, in the most constructive way. The informants' statements illustrate it. "The requirements of other institutions, with which we have to collaborate, for example, while producing the client's documents or resolving some other problem...they sometimes are only sending you from one room to another, whereas nobody wants to help, such kind of cooperation is not really pleasant. I-1 "As I have already mentioned, the meetings are attended by both the school and a health institution, or a nongovernmental organisation, but still, on the whole, they all are looking at a social worker and asking: 'And where have you been, why haven't you noticed?'You feel as if you're pressurized" I-3; "Cooperation with other institutions causes stress, the competition is felt more than the seeking to resolve the problems, which have arisen to clients, in the most constructive manner" I-5. This demonstrates that there is a lack of goodwill on the part of organisations themselves in the process of collaboration. Organisations lay the blame on others, while avoiding the acceptance of responsibility, shrugging of their responsibility onto social workers working with their clients directly. It can be established that such situation complicates the work of social workers, forces a social worker to feel guilty. They need to prove their competences, to apologise for the performed work. L. Mažylis and D. Vazgelevičius have also noticed similar problems [31], and state that obstacles to cooperation still exist. There is no complete mutual understanding between institutions, no sufficient consolidation of forces to act for the benefit of society.

Int. Conf. SOCIETY. HEALTH. WELFARE. 2018
The study data revealed that giving information to the police and other institutions on the problematic behaviour of a client causes stress amongst social workers. "Situations, when you have to inform your management regarding the punishment of a person, because he failed to comply with certain requirements, are unpleasant. They cause tension" I-4; "<...>that taking out children from families, my own hands shake, and my heart palpitates, and my blood pressure gets high. I feel pity for those little children, but this is my work, they need to be taken from that family, to unsafe environment, so I assume that I'm doing a good work. I feel somewhat better, but the situation is one of the most unpleasant, there is much stress" I-6. In such situations, employees experience huge shocks, which manifest through negative reactions of their organism: shaking hands, more rapid heart rate, higher blood pressure and the like. It should also be mentioned that, in such difficult situations, a social worker attempts to discern a positive side of intervention assistance, he is aware that, for example, by taking a child from the family, in which there is unsafe environment, he performs his work properly, although the work itself causes unpleasant feelings affecting the health of a social worker. In the opinion of G. Žibėnienė et al. [32], a positive attitude towards risky situations at work may function as a factor encouraging a social worker to act in non-traditional situations, having summoned his courage and creativity. It is also corroborated by the opinion of the informants, which was recorded in the study.
The results of the study demonstrate that stress amongst employees is caused by the absence of change in the lives of their clients, whereas the management demands changes as the proof of a positive work with their client. It seems that employees understand that some time is required for changes to occur. However, demands made by the management force them to raise requirements to their clients, to offer their services, which the latter refuse, pressingly. The following informants' statements are evidence for it. "In fact, they fail to fulfil those obligations, they don't attend trainings, there is no evidence of changes at home, in particular, problems related to alcohol are a hard nut to crack. So sometimes such hopelessness falls upon me, because you can't resolve, do instead of that man until it dawns on him <...>" I-3; "When your clients are non-motivated, unwilling to change anything in their lives. Because you can't take responsibility for your client, and you aren't able to affect his opinion, you won't reach the level of 98 per cent of satisfied clients, whereas that is demanded from you, and it isn't possible to somehow ensure the opinion of another man that he would assess our work positively <...>" I-7. V. Rimkus and B. Kreivinienė [33] maintain that one of the most important objectives of social work is to bring about changes. However, no change will be sustainable, if it is imposed under compulsion, without taking into consideration the situation, values and socio-cultural context of a person.
The study data revealed that the management raise excessively high requirements for their employees, encourage their employees insufficiently, assigns additional work, which is not provided to social workers in the staff regulations, do not take a close look at the employee's workload, their possibilities, and do not provide enough time to perform a task. Such demands become unbearable and cause stressful situations. Under such working conditions, employees do not feel satisfaction with their work, they start doubting their own competence, do not trust in their own strength, they feel as if "persecuted". This is attested in the statements of the informants: "they demand too much, persecute, don't encourage, but only require, their requirements are groundless. They don't clearly know our opportunities and abilities, impose additional tasks which are not provided in the staff regulations or contract, request the impossible" I-7; "how is it possible to resolve a client's problem very quickly when actually it is impossible to resolve that problem so quickly? It causes stress, consequently, you feel tension, pressure from colleagues, from administration while performing your work, because they also hope that the work will be completed soon, and there will be results, although really there will be no immediate results" I-1.

Int. Conf. SOCIETY. HEALTH. WELFARE. 2018
The study data demonstrate that often service receivers cause stress amongst social workers by their negative behaviour. Social workers encounter the threat of physical violence from service receivers. When visiting clients at their homes it is possible to experience aggression both from service receivers themselves and from people from their immediate environment. The informants provide examples to illustrate it. "When visiting condominiums, those corridors are dark, and you don't know what you can encounter not only from a family, but also from that living environment itself. Difficulties arise when clients happen to be drunk, I even had to call the police, so such events related to work cause a lot of stress" I-3. According to the informants, they have to interact with a client who are inebriated, aggressive or with mental disabilities. "I sometimes don't feel safe at work, especially when I am alone in our institution, once I had to communicate with such homeless person who was a bit aggressive, I really don't feel safe" I-5; "People arrive inebriated or with mental disabilities and not taking medications, various situations occur" I-1. Similar tendencies were revealed in the study conducted by R. Lazutka et al. [4], which shows that social workers are exposed to contacts with persons from different social backgrounds, people experiencing behavioural, various social problems and with mental disorders, therefore, they often encounter aggression, violence and other occupational risks in their professional activity.
It should be pointed out that social workers have to experience psychological violence. The study data revealed that social workers encounter insults and threats from their clients: "< . . . when you go to a family, if a teenager is in a bad mood on that day, you can experience a real stress. Well, I had a situation when I was called every name under the sun. I went to the police. All were only shrugging their shoulders. They said, "His home, his territory...>" I-6; "When it comes to psychological safety, problems may arise, you have to listen to threats, dissatisfaction. Those threats are most often that they will report on me to the management, if I don't do what they want" I-7. Labour Code of the Republic of Lithuania [34] regulates that the employer has a duty to protect honour and dignity of his employees and has to create such working environment in which an employee or a group of them would not encounter hostile, unethical, humiliating, aggressive, insulting and offensive actions. The code [34] specifies that the employer shall take all necessary steps to ensure the prevention of psychological violence in working environment and assist to persons, who have experienced psychological violence in working environment.
The study also revealed another external stressor -pressure experienced from their clients, in order to obtain something. "They have learned somewhere that it is possible to get something, they pressurize psychologically that you must buy something, must give something. They hope to improve their well-being without assuming their own responsibility" I-2; "Due to the fact that we work with a risk group, stress may be expected every day, because the risk group is such that they are unpredictable beforehand, different things can occur starting with some unexpected requests, demands of theirs and the like." I-4. When working with people at social risk, social workers encounter various pressures and requests. In such situations, it is hard for a social worker not to succumb to the influence and pressure of their clients. On the one hand, a social worker wants to maintain a good relationship with their clients, but on the other hand, they have to assist in resolving problems arising to their clients and to achieve objectives set out by their organisation.
One more external stressor, found out during the study, is relations with the management of an institution, which manifest by inappropriate behaviour at the management level. The study demonstrates that social workers do not receive any praise or incentives from their employer,an employee is noticed when they need "to be taught a lesson". The lack of support from the managerial level inhibits the motivation of employees to work. An employee begins to doubt their abilities and feels underestimated. It is demonstrated in the statements of the Int. Conf. SOCIETY. HEALTH. WELFARE. 2018 informants. "T he fact is that the administration has assumed an attitude that they rarely invite you to tell that you perform everything very well. Most often they invite you to express some problems, to tell you what you haven't done or have done, but they don't like it" I-1; "The management more often notices shortcomings than properly carried out tasks, there is the lack of that appreciation and support. You notice that you have a boss, when something bad happens, then he remembers you and explains how everything should be" I-5. According to J. Kasiulis et al. [35], when an employee is uncertain regarding what is expected from them, the problem of uncertainty and impreciseness of their role arises and a stressful situation occurs. B. Pajarskienė and R. Jankausko [27] maintain that one of the factors causing stress at work is authoritarian leadership. The answers presented by the informants also confirm it, which corroborate that their leadership only gives directions, however, exhibits no support whatsoever for their employees and most often notices only the shortcomings of their work.
The study also revealed the lack of benevolence on the part of leadership. It has to be assumed that such situations make social workers distrust their leadership. "The boss wasn't disposed amicably towards me, maybe he didn't like me, I don't know" I-6; "She is a careerist, if she needs, she will inform on anybody to her higher authority, she'll tell her boss, well, such a fox, in your presence she's good, sweet, but behind your back she'll talk differently. She's not really so good" I-5.
Another external stressor, which causes tension at work, relates to the conditions of employment, especially when a fixed-term contract is signed with a social worker, for example, for temporary work in a project. Such cases are frequent in nongovernmental organisations. It does not ensure long-term job prospects for an employee and causes the feeling of insecurity: "Maybe it is mostly uncertainty, ignorance about what will be later, if you're working in a project, then, that project lasts for a limited time, for example, 2 years, and after that, you have to look for a job again." I-5; "And when the project ends I don't know whether my contract will be extended, and it's only a year, and the project will end, and my job at the same time... because there is no certainty, that work with projects is a temporary job" I-7.
The study revealed that social workers are dissatisfied with small salaries. The employees maintained that their work is not appreciated, that when working they have to encounter various occupational risks therefore they feel underestimated while receiving low pay. "I am partially satisfied. My salary might be larger. I-1; "<...> I think that the salary for a job like this is too small" I-6; "Small salaries, although now they have given a salary supplement, but they are small anyway" I-4; "The work of a social worker with the risk group poses a threat to an employee, leads to their insecurity, and the salary isn't adequate" I-2. Similar tendencies were revealed by the study conducted by J.R. Šinkūnienė et al. [8], which showed that a qualified employee, who receives a small salary, which is inadequate as regards the requirements imposed on him, will feel a sense of grievance, due to which his work motivation will decrease, apathy or a desire to change his job may occur.
The data, collected during the study, reveal that internal stressors as well can cause stress amongst social workers. They can be excessively high requirements imposed on themselves, as well as the pursuit of perfection when resolving client problems. The absence of change makes them feel disappointed with their work, decreases their self-confidence, the fear of failure arises. The following statements of the informants illustrate it. "When you address the administration with questions, you are always stressed -how they are going to look at that. Perhaps they will think that you can't cope with your job, you're unable, maybe you're unfit, they would think that you're doing a bad job" I-1; "Different things happen in the team, sometimes you don't want to ask anybody, you don't want to show that you don't know, Int. Conf. SOCIETY. HEALTH. WELFARE. 2018 you're afraid of that competition, a lack of recognition. Well, sometimes different things come to mind." I-5 According to T. Misiukonis et al. [36], the fear of failure arises when we raise particularly high requirements for ourselves, when we are afraid to lose our status and image, which we have created therefore it is not a coincidence that the participants of the study also noted that the fear of failure caused stress to them. In the opinion of T. Misiukonis et al. [36], the more effort we invest into the creation our image visible to others, the greater fear of failure we experience. Employees are afraid of failure therefore they avoid complicated or risky situations. However, it restricts their opportunities to learn -they find it harder to get involved in new activities or to introduce innovations and the like.
The participants of the study pointed out that an inflated sense of responsibility causes tension and stress to them. An inflated sense of responsibility increases nervous tension, therefore, working capacity declines and health deteriorates. Social workers often feel anxiety, because they have many unfinished tasks. They constantly think about what they have to do, what should be done and what they could do. Even during their leisure time, they think about their work and are concerned about it. According to M.J. Papa, T.D. Daniels, B.K. Spiker [37], that is how unnecessary tension is created, because there is not sufficient time to do everything, and when they have no time they start doubting themselves, begin to lose their self-confidence, become disappointed with themselves and commence being outraged at others.

Conclusion
The study revealed the external causes of stress arising to social workers in their working environment, which relate with working conditions, relations of employees with their management, with service receivers and the conditions of employment.
The study identified various types of the causes of stress related to employment and working conditions. Employment under fixed-term contracts causes stress to employees, because they feel uncertain and insecure about their future. Stress amongst employees is caused by the absence of stability and clarity at work, the fact that they are left alone while resolving problems, excessive workload, excessively high requirements, which are imposed on employees, and low level of payment. Stress amongst social workers is also caused by the absence of change in the lives of their clients, whereas management demands changes from social workers as the proof of their positive work with their client. Social workers experience stress when they need to inform the police and other institutions about problematic behaviour of their client. Social workers experience stress when there is a lack of cooperation between institutions, when, in the inter-institutional cooperation, they can feel competition and lack of benevolence more than the seeking to resolve problems, which have arisen to their client, in the most constructive manner.
The study established that stress amongst social workers is caused by the negative behaviour of service receivers. At their work, social workers encounter the threat of physical and psychological violence. Social workers also experience stress when there are no constructive relations with their management, when managers use an authoritarian leadership style more than democratic one. Social workers miss encouragement, praise and benevolence on the part of their managers. More often an employee is noticed only, when they need "to be taught a lesson".
The study revealed the internal causes of stress related to excessively high requirements imposed on social workers, the pursuit of perfection when resolving the problems of service receivers, the fear of failure and an inflated sense of responsibility.