This article describes workplace stressors and coping strategies, compares and contrasts cross-cultural literature on nurses workplace stressors and coping strategies, and delineates a variety of stress management activities that could prove helpful for contending with stressors in the workplace. (Lambert and Lambert 2010, Nurses workplace stressors and coping strategies). In Baguio City, hospital nurses are not spared from the environmental culprit called stress.
They are too prone to this even a seated individual can easily observe, but stress as they say always come with the work, nurses chose to be of service to the sick, and sick people are in the verge of experiencing most of the stresses, sometimes the nurses who takes good care of them are the absorbers to some of these stresses. Possibly yet, stress is also present in the work place when nurses are overworked and unavoidably there are build up tension among themselves causing now a strained working relationship.
According to Betty Neuman, a nurse theorist she said that stressful environment causes the majority of illnesses and when it becomes severe and neglected it could lead to death. Stress has been categorized as an antecedent or stimulus, as a consequence or response, and as an interaction. It has been studied from many different frameworks (or perspectives? ). For example, Selye proposed a physiological assessment that supports considering the association between stress and illness.
Conversely, Lazarus advocated a psychological view in which stress is a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being. Nevertheless, stress has been regarded as an occupational hazard since the mid-1950. In fact, occupational stress has been cited as a significant health problem. Work stress in nursing was first assessed in 1960 when Menzies identified four sources of anxiety among nurses: patient care, decision making, taking responsibility, and change.
The nurses role has long been regarded as stress-filled based upon the physical labor, human suffering, work hours, staffing, and interpersonal relationships that are central to the work nurses do. Since the mid-1980s, however, nurses work stress may be escalating due to the increasing use of technology, continuing rises in health care costs, and turbulence within the work environment. (B. M. Jennings, 2010, Work Stress and Burnout among Nurses). The writers opinion with regards to the sudden rise and use of technology in the hospital, these are true and stressful especially among older nurses.
Some of them feel intimidated about it since they need to learn how to use computerized gadgets and equipments needed to fasten treatment. Some institutions require knowledge to advance technology in order to be hired, some they assume all nurses are computer literate, if they are not; this becomes a failure to their evaluation which later on could serve as basis for their termination a major impact to the life of a nurse. Workplace stress can be described as the physical and emotional outcomes that occur when there is disparity between the demands of the job and the amount of control the individual has in meeting those demands.
Anytime stress occurs, it is an indication that the demands placed upon the person have exceeded the persons personal resources, whether these resources are physical, emotional, economic, social, or spiritual. Thus, workplace stress occurs when the challenges and demands of work become excessive, the pressures of the workplace exceed the workers ability to handle them, and job satisfaction turns to frustration and exhaustion. (Lambert and Lambert, 2010). Nevertheless, work stress and burnout remain significant concerns in nursing, affecting both individuals and organizations.
For the individual nurse, regardless of whether stress is perceived positively or negatively, the neuroendocrine response yields physiologic reactions that may ultimately contribute to illness. In the health care organization, work stress may contribute to absenteeism and turnover, both of which detract from the quality of care. Hospitals in particular are facing a workforce crisis. The demand for acute care services is increasing concurrently with changing career expectations among potential health care workers and growing dissatisfaction among existing hospital staff.
By turning toxic work environments into healthy workplaces, researchers and nurse leaders believe that improvements can be realized in recruitment and retention of nurses, job satisfaction for all health care staff, and patient outcomes particularly those related patient safety (B. M. Jennings, Chapter26 Work Stress and Burnout among Nurses: Role of the Work Environment and Working Conditions). In one article entitled Job Stressors and Coping Mechanisms among Emergency Department Nurses in the Armed Force Hospitals in Taiwan it states that, nurses, as one of the professional service groups, tend to be exposed to extreme workloads.
Their works are generally characterized by having a high contagious potential, being labor-intensive, having an overwhelming job shifting, and experiencing malicious complaints from patients. Compare to other general and professional service jobs, nursing requires handling complicated and dynamic occurrences under strict time pressures. Studies have generally revealed that continuously excessive workloads tend to lower their job satisfaction and deteriorate in turnover intentions.
These contextual difficulties indeed continuously challenge a nurses temper and professional performance. This may be particularly true for nurses in the emergency departments of the AFH. (Wei-Wen Liu, Feng-Chuan Pan, Pei-Chi wen Sen-Ji Chen, Su-Hui-Lin, 2010). In another study entitled Effects of job rotation and role stress among nurses on job satisfaction and organizational commitment, they mentioned that Job rotation inspires nurses to achieve higher performance, allowing continuous growth at work, extended knowledge and skill, and increasing clinic patient care-taking quality.
Scholars have all proposed that job rotation may help employees to acquire multiple capabilities and expand vision, and that it can be an approach to reduce job burnout. But emotional pressure often occurs in the work environment where interpersonal interactions are highly involved. Especially, the nurses working at hospitals not only implement independent and professional nursing activities in accordance with doctors advice, but take responsibility for any immediate threat to patients lives as well. Thus, the importance of nurses is undeniable, and the influence of urses qualities and capabilities on medical care quality can never be ignored.
Therefore, the primary concern of the practical field of medical care is to exhaustively recognize how role stress among nurses could affect their job satisfaction and organizational commitment, and effectively utilize the job rotation system to enhance and develop nurses job satisfaction and organizational commitment, in order to promote competitive advantages (Wen-Hsien Ho, Ching S. Chang, Ying-Ling Shih and Rong-Da Liang, 2010, Effects of Job Rotation and role stress among nurses on job satisfaction and organizational Commitment).
It is the writers point of view that stressful lives among nurses are sometimes not all related to work, some nurses go to work stressed. This maybe due to presence of children, relationships or overworked at home so that when they report for work they are already exhausted and becomes exhausted all the more if there are many patients to attend to. These are also true most especially among women, since they do much of the work at home; attending to school activities of their children and attending to the needs of the whole family, physically, financially, and socially they become vulnerable to stress and illness.
Despite all the work stress that the nurses endure, there are also some ways that help nurses cope with stress. To keep them physically, emotionally, and mentally stable if not strong, they divert their attention to activities which they consider relaxing. Nurses learn techniques on how to control their temper when being stressed at work, for some they just endure tensions and exhaustion but once they reached home it is there that they find comfort and peace of mind, but to others, home sometimes adds to more stress, so they prefer staying out like malling.
In an article entitled Nurses Workplace stressors and coping strategies it describes strategies to help nurses cope; coping can be defined as the constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person. Coping activities may be problem-focused in that they are directed externally and involve attempts to manage or change the problem causing the stress.
On the other hand, coping activities may be emotion-focused in that they are internally directed and involve attempts to alleviate emotional distress. Examples of problem-focused coping includes problem-solving activities, recognizing ones role in solving a problem and confronting the situation by using some degree of risk-taking behavior; while emotion-focused coping includes wishful thinking, avoidance of confrontive behavior, and detachment or disengagement from the situation.
This study will use the Integrative Transactional Process Model by Beehr and Schuler to guide on the effects of stress among registered Nurses in the workplace. According to the Integrative Transactional Process Model by Beehr &schulers 1982, it corporate environmental stressors, perceptions, the stress response and stress outcomes, plus a host of moderator variables. The environmental stressors pertain to what the registered nurse encounters in his/her workplace perceived as stressful stimuli.
The coping mechanisms that registered nurses utilize in combating the effect of stress to her/himself pertains to the perceptions and the response of a registered nurse to stress. This method model is in accordance with Lazarus conceptualization of stress by focusing on the role of cognitive appraisal (individual perception) which also highlights the nature of the (mis) fit between the organism and the environmental demands. The discrepancy between, whether challenges or goals, and the way the person perceives his potential responses to his demands cognitive stress.
It is the persons own perception of the stressful event and the appraisal of ones ability to cope that stress. Time (duration of stress) is incorporated through the separation of the immediate perception of stress and longer term response segment of model. The name of the model implies that its relationship is reciprocal, happens across time and/or stressor and integrated diverse areas of theory. This had implied the importance of time in the stress process. That is why the years of service and the age of the registered nurse was taken as variables in the scope of the study.
Individual and contextual differences such as organizational changes, job qualities personal experiences, and individual needs/values are given central role in the models which are also considered strengths of this model. These qualities correlate to the variables specifically to the ward assignments of these registered nurses and their working relationship among nurse supervisors and other health personnel. Their everyday encounter in the workplace give them the opportunity to gain experience which maybe a nurturing or bad experience that may contribute to the stress of the registered nurse.
This model considers the individual and contextual differences among registered nurses which in the study pertaining to their age and gender. The aim of the study is to find out the following effects of stress among registered nurses in the workplace. It specifically aims to find answers to the questions: 1. ) what are the effects of stress among registered nurses in the workplace considering the following a. ) Physical health b. ) Emotional health c. ) Mental health 2. ) Is there a significant difference on the effects of stress among registered nurses considering the following a. Age b) Gender and c. )Years of service in the hospital, 3. ) Is there a significant difference on the effects of stress among registered nurses when assigned to a. ) Emergency ward b. ) Operating Room c. ) Surgical ward, and lastly, 4) What are the coping mechanisms utilized by registered nurses to overcome stress in the workplace? This study is for the nurses themselves, the outcome of this will serve as a guide for them to determine, where thus the highest stress related factor occur in the lives of hospital nurses particularly the female nurses.
It will be an eye opener for them in a way that they will know that simple interaction among other people could mean two different things; it can be negative or positive in effect that could cause stress. To the nursing profession especially in the field of research, this study would serve as a tool to use, as a source of information and guide not only among nurses but to other health practitioners as well, from this output, they can yield flyers or pamphlets entitled what causes stress in the workplace, which would contain vital informations about stress, its causes and effects to ourselves and to the people that surrounds us.
Lastly, to the Hospital administrators, this research would serve as a source of information, so that they will become aware, up to what extent does stress do among workers. This could also serve as basis in giving rest days among workers when needed. A well rested employee becomes a productive, efficient and successful employee.
The study will utilize a questionnaire in the form of a self-assessment checklist that was developed by the researchers based on review of literatures. The first part of the questionnaire is a letter to the respondents that informs them of the purpose of the study to give full disclosure of information. The second part includes the demographic data inclusive of name (which is optional) and workplace of the respondents, followed by the questionnaire proper. This will be answered by the respondents thru checking the correct rating in assessing the Effects of Stress among Registered Nurses in the Workplace.
The questionnaire will be subjected by a research expert, Ms. Geraldine D. Delson, M.A.N. She was chosen to validate the questionnaire for the reason that she is an instructor in the SLU- School of Nursing, major in Psychiatry and therefore she is well-knowledgeable on the topic. She will be asked to evaluate the relevance of the items in the questionnaire using a four-point scale, where a score of 1 is not relevant, 2 as somewhat relevant, 3 as quite relevant and 4 as very relevant. After rating, all the items with a score of 3 and 4 will be counted and divided by the total number of items in the questionnaire. Her comments and suggestions will be taken into consideration during the revision of the tool. Reliability of the questionnaire will be subjected to a preliminary item analysis. The questionnaire will be distributed to thirty (30) staff nurses having their duty at the operating room, emergency ward and medical-surgical ward of SLU-Hospital of the Sacred Heart.
After answering, the questionnaires will be collected and will be asked for their comments and feedbacks regarding the questionnaire. Answers in the tool will be checked by the researchers to check for presence of ambiguity. Their comments will be taken into consideration in the revision of the tool before finally floating it. In the data gathering procedure, initially, the researchers will be giving a letter to the Chief Administrator of the Hospital informing her about the purpose of the study and that their respective Institution is chosen to be the locale wherein a number of nurses having their duty there will be taken as the respondents. Also, the letter will ask for permission to float questionnaires to the chosen respondents. After granted the permission, data gathering follows.
During the data collection, the researchers will be given different hospital wards based from the selected special wards of SLU-Hospital of the Sacred Heart where they will collect data. In all the special wards chosen, the researchers will introduce themselves to the respondents and will establish rapport. The researchers will also inform the participants of the purpose and nature of the study before consent will be taken. In cases wherein the respondents decline to be part of the study, their decision will be respected.
For the respondents who will agree, the researchers will present the checklist and they will give instructions as to how they will answer it. After giving the necessary instructions and reminders, the respondents will be given enough time to answer the questionnaire. The researchers will maintain a distance of 1-2 meters from the respondents while the questionnaires are being answered. To ensure anonymity, names will not be required to be written. The researchers will emphasize that any unanswered item will make their whole answers invalid. To prevent such occurrence, the researchers will stay with the respondents and double check on the answers of the questionnaire once it is passed to the researcher.
After the respondents finish answering the checklist, the researchers will retrieve it and the researchers gratitude for participation will be expressed. The researchers will assure the respondents that they will be informed of the results of the study. After collecting the checklist, the researchers will check it for any unanswered item. All incompletely filled out questionnaire will be disregarded.
The data collected will be collated, tabulated, organized and analyzed. Descriptive statistics will be used to describe and summarize the data that will be gathered, making the data readily comprehensible. Through it, the researchers will be able to identify significant differences between the variables of the study. Frequency count and percentage (Sanchez, 1988) will be utilized to measure and compare data such as age, total number of male and female nurse respondents and years of service.
For the physical, emotional and mental health effects, as well as the effects on whether they are nurses assigned at the operating room, emergency department or the surgical department, frequency count, and the coping mechanisms utilized, weighted mean and ranking will be used. Weighted mean measures the average of the responses (f) in relation to the weight or the rating (r) allotted to the said response. To determine the significant difference on the respondents responses on the effects of stress among registered nurses in the workplace, nurses are grouped based on age and gender, the F-test or analysis of variance (ANOVA) test ( Tan, 1997) will be utilized. A statistical technique designed to whether the means of more than two quantitative populations are equal. The variances are used to test the quality of more than two populations.
The effects of stress among registered nurses are categorized according to physical health, mental health and emotional health. The study was conducted among registered nurses of SLU-Hospital of the Sacred Heart regardless of gender, and those who are twenty five years of age and above, assigned at the operating room, emergency and surgical ward. The nurse respondents are also categorized according to their number of years in service After the researchers collected, collated, tabulated and organized the data, results were analyzed. Descriptive statistics were used to describe and summarize the data that were gathered.
Through it, the researchers were able to identify the significant differences between variables of the study. In table one (1), weighted mean and ranking were used, weighted mean measures the average of the responses. Looking at the table, in category one (1) effects of stress among nurses in their physical health, question number one (1) increase in overall sickness absence has the highest mean score of 3.1, while question number three (3) I do not want to go to work early garnered the least mean score of 2.4, meaning most of the nurses assigned at the operating room, emergency ward and surgical ward when under physical stress opt to absent from work by filing a sick leave. And only few nurses do not want to report to work early when under stress.
Second category which is the effect of stress in the mental health of nurses, question number eight (8) conflicts arise with colleagues, garnered the highest mean score which is 2.8 while question number six (6) I have ethical problems with my job, garnered the lowest mean of 2.1, while questions 11, 13, 14,15,16,17 and 19 (please refer to table 3) are all ranked as second question with the highest mean score of 2.6 and 2.7 respectively.
The highest result means that nurses when under stress have this tendency to create tension at work and lots of misunderstandings happen between and among them, which sometimes become evident when they are doing their job then suddenly commit mistakes. Then it is good that the lowest mean score is number six, having ethical problems with job, meaning nurses despite stressors and other problems, they still respect each other and remain professional when dealing with it. The third and last category which is effect of stress to nurses in their emotional health, question number twenty five (25) I feel overloaded at work has the highest mean score which is 2.7, while question numbers twenty seven (27) my relationship with co-workers are poor and twenty eight (28) poor relationship with patients, are the two with the least mean score of 2.2 respectively.
The meaning of the highest result which is I feel overloaded at work goes to show that nurses becomes work engine at the hospital, this could be due to under staffing or un equal division of work load. While it is a good remark that number 27 and 28 garnered the lowest mean score, because poor relationship with co-workers as well as with patients does not bring out the best in a nurse and in nursing service. In an article entitled Nurses workplace stressors and coping strategies, it defined stress as the physical and emotional outcomes that occur when there is disparity between the demands of the job and the amount of control the individual has in meeting those demands.
Table two (2) is the coping mechanisms used by nurses when under stress in the workplace. Weighted mean and ranking are the statistical treatment used to determine the results. Coping mechanism number five (5) I say no to overtime if I do not feel happy to do it garnered the highest mean score of 3.4, while coping mechanisms numbers two (2) I exercise regularly and number thirteen (13) I allow myself to feel angry and express this in a safe way have the least mean score of 2.4, meaning nurses are but human beings, they feel and they learn to say no when it comes to overtime because of exhaustion.
They reach the point when they are totally burn-out. In an article entitled Stress Management, it says that these stressors can lead to the classic burn-out syndrome. Instead of persisting until this happens, nurses can learn more effective coping strategies, become self-aware, acknowledge their own limitations, and acquire emotion-fcused and problem-solving skills (Selye, 1956). While that is the highest result, we come to the lowest which are numbers two and thirteen.
Exercising regularly got a low mean score most probably because nurses when they get home from work they are already tired and there is no more time for them to do some exercising. While the latter expressing anger the safe way, it got also a low score most probably because it was not clear to the respondents what was meant by safe way to express anger. Safe way can be counting from one to one hundred, inhaling and exhaling until the body feels calm. Or maybe drinking or eating your favorite dish, food can become an outlet of anger; these are few ways of safe outlet for anger.