COMPARATIVE STUDY TO ASSES THE STRESS
AND COPING STRATEGIES OF NURSES WHO
ARE WORKING IN GENERAL WARDS
AND PSYCHIATRIC WARDS IN
SELECTED HOSPITALS,
TUMKUR.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
MR. JOMON K JOY
AKSHAYA COLLEGE OF NURSING
S I T MAIN ROAD
TUMKUR
572102
DECEMBER – 2008
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1. Name of the candidate : MR. JOMON K JOY
2. Address : M.Sc. NURSING 1st YEAR
AKSHAYA COLLEGE OF NURSING
S I T MAIN ROAD
TUMKUR 572102
3. Name of the institution : Akshaya College of Nursing
4. Course of the study : M.Sc. Nursing 1st year
5. Subject : Mental Health Nursing
6. Date of admission : 28/06/2008
7. Title of the topic : Comparative study to assess the stress and coping Strategies of nurses who are working in general wards and psychiatric wards in selected hospitals at Tumkur.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Mental health is as important as physical health, if the nurse is to meet her responsibilities. A nurse is exposed to a variety of stress in her day to day life, which imposes a demand upon her to activate mental apparatus before any other system is involved. It is usually observed that nursing professionals undergo tremendous stress. This is more common in staff nurses working in specialized areas 1
Many writers have suggested that nursing is an occupation which can consider highly stressful. Stress can and does arise from many sources. Because stress is an occupation concern for nurses and a managerial concern generally. The related literature is extensive. At the most fundamental level the sources of stress arise from either the individual worker or the work environment. The individual sources of stress can be either external or internal.
A useful distinction can be made between stress deriving from an individual’s personality or personal family situation and that arising from the work environment. For e.g.: An individual’s personality or personal characteristics may not “fit” in a given situation (external or situational origin). The individual may carry inter personal or family conflicts over in to the work environment (internal origin) the need to balance multiple life roles may create personal stress.4
Contrasted with the individual sources are the stresses derived from the work itself or the specific work environment. Scholars have long recognized the stress related to nursing work. Being at the bedside around the clock to assist patients through their experiences of illness and hospitalization. Multiple and often conflicting demands and the role of the nurse have been identified as sources of stress. Stress is seen as varying with other organizational variables such as job satisfaction5 turn over, productivity and group cohesion as well as with other structural, procedural and contextual factors. E.g.: might include administrative support of nurses and nursing, Quality of nursing leadership; inter professional battles, constantly changing technology, or organizational restructing5
The sources of stress include the physical and technical environment. The social medium or pattern of interpersonal relations and the focal person under consideration. The sources of stress as falling into two major categories: Role based situation and Task based situation9
From the review of literature, stress having the following categories of stressors: The physical work environment, professional – bureaucratic role conflict, role strain and tension from multiple expectations, management communication pattern, and leadership style of nursing administration, staffing and workload problems, negative patient outcome, communication with physician, lack of participation in policy and practice decision, inadequate knowledge and skills for role functions18
The study says that “within nursing research stress has been as stimulus, a response, or a transaction”. The consequences of very high job stress in nursing have been identified as burnout. A role stress is external to a role occupant and is a social structural condition in which obligation are vague, irritating, difficulty, conflicting or impossible to meet17
Stress is a response to a number of triggers. But it’s wrong to think of stress as always negative. The stress response has value if there is an emergency that means we need to run faster or jump higher11. Whenever the word stress is used it is always referred with a negative connotation. Viz., distress which causes problem. The stressful factors are a part of our lives. It is essential to develop adaptive response to stress thereby minimizing illness generating health. Studying stress, stressors and ways of coping with stress by nurses will enable to find out suitable ways to reduce stress in nurses14
Coping is a complex process, which most commonly is conceptualized as a response to a person. Environment relationship. Because different experience may elicit difference coping efforts, it is necessary to assess behavior as they occur in response to particular situations. Studies often are limited by their failure to identify the specific coping domain for which behaviors are reported. Subsequently coping is not analyzed as a stressor – specific response. Coping can occur in anticipation of a stressful event, during exposure and the aftermath; each phase has a different potentials.
Education about stress and its management is essential to help nurses to understand their own problems, vulnerabilities and resources of coping. The more nurses are aware of their own emotional reactions, the better they can protect themselves. These are stress management workbooks available with practical exercise and suggestions. The need for peer support at work, as a means of preventing and reducing stress, has been the researcher3
Nurses need to become more sensitive and aware of the needs of their colleagues. It must be made acceptable for individuals to express their feelings or seek help. There are certain stresses inherent in nursing work. But there are also many unnecessary sources of stress which can be prevented or changed. If the problem of stress in nursing is adorned in a co-coordinated way, the benefits to both nurses and patients are potentially great.19
The above said information’s make clear that a nurse’s life is full of stressful conditions and if she feels uncomfortable, she/he should try to alter her reaction or situation and develop a positive attitude to life by selecting stress reduction methods.
6.1 NEED FOR STUDY
The researcher in the area of stress has identified the cause of stress and called them stressors. The same man coined the term distress to describe the effects of too much normal stress which results in psychological and physical disorders. Such a professional has low energy, low enthusiasm, high anxiety, irritability, and strained interpersonal relations. This affects work efficiency and patient care16
The study about stress was viewed from a socio psychological perspective and defined in terms of nurses perceptions of their interactions with their environment. There is an increasing level of burnout in the nursing profession, resulting in a high rate of staff turn over and poor job performance. “For the nurses, the stress process begins with potential stressors including intra personal, organizational/ environmental and job component stressors which all interact in a reciprocal manner.9
Researches introduced a fundamental change in how we define coping, and in how we should pursue coping research. He conceives coping behavior as a process that changes over the course of situation. Coping behavior is dependent on the meaning of the event. The context and goals of the person in the situation. Research conducted extensive reviews of nurses on stress and coping and reached the following conclusions; most research has been descriptive and co relational in design, research questions commonly lack specificity in relation to the stressful event; studies often do not make links between the coping behaviors examined and outcomes of those behaviors. The limited amount of researches she as been done, had tendered to focus upon nurses working in critical care dress such as ICU. There have been no studies to our knowledge attempting to find out where there stress may also be an experienced by nurses working in the more traditional nursing specialties such as medicine, surgery, obstetrics, pediatrics, psychiatry. Hereby workload can affect the equality care and this was in consistent respondents conceptions of this rare. For nurses, who saw themselves serving plains? This challenge to the caring elements of this work was a source of frustrations of stress. 20
The Limited amount of Researches which has been done, has tended to focus up on Nurses working in critical care dress such as I.C.U. There have been no studies to our knowledge attempting to find out where there stress may also be experienced by nurses working in the more traditional nursing specialties such as medicine, surgery, obstetrics, peditriatics, Psychology. The work load can affect the equality care and this was in consistent respondents conceptions of their role. For nurses, who saw themselves serving plains? This challenge to the caring elements of this work was a source of frustrations of stress.
Job – related stress as a valuable. They suggested that job stress was mediated by job satisfaction and they found that job stress had no direct effect on anticipated turn over but only influenced job satisfactions. The major source to which the nurses attributed their stress was work load. Used work loads were attributed to government health care policy. Changes in the health care sector suggested that nurses work loads have also been changing. The development of medical terminology has added new forms of worked to traditional responsibility.18
Psychology Nursing shall working with mentally ill Patients exhibit more of the consequences of job-relayed stress than do other professional groups such as social workers Psychologists and occupational therapists. This may lead to job dissatisfactions and low morale with increased staff conflict, absenteeism and high staff turnovers. The researches have begun to look at the available resources that can be employed to enhance nurses ability to deal with stress.
One such Resource is social support in the work place. It is necessary to identify stress and coping strategies of nurse working in bolt General wards and psychiatric wards, as this will enable us to find out suitable ways to reduce stress in nurses. The concept of stressful situations. Coping behaviors influencing factors. Coping outcomes the relationship among the nurses are complex. Hence the researches felt that there is a need to understand the level of stress of nurses and to compare with nurses working in psychiatric hospital to other places. This will enable administrators, co-workers. Patient’s family members to know and understand the nurses in a better fashionable way.
6.2 REVIEW OF LITERATURE
This chapter deals with the literature focused on the stress and coping strategies of nurses who are working in general ward and psychiatric wards. Generally the nurses casing for the patients in general ward come across stressful situations and they try to develop certain coping strategies against stress. But the level of stress and coping strategies of nurses taking care of psychiatric patients will be entirely different.
· Literature related to the Information’s and studies about stress.
The word stress covers from the Latin word “stringers” which Means to draw tight. Researcher used the word stress to refer to the general break down of the body in response to the word and power of modern life. In this book entitled “stress”, the suggested that there are environmental agents called stressors and that the response of internal conditions of the organism when faced with stressors are from outside. Stressors create stress. It has been recognized that stress is compare and imprecise concept with no universally accepted meaning among social and behavioral scientist 16
Stress has been defined as an activity or conditions that requires coping. Stress is “something that everybody experiences; but nobody can quite define. Stress was originally an engineering term referring to physical force those after structures. Medicine and other field by science have also begun using the term. But for most of us, the word has psychological meaning. Stressful events are not new. Conflicts & injuries have occurred since the beginning of history26
Stress as a relationship between an individual and his /her environment that is appraised by the person as taking or exceeding his or her resources, and endangering well-being. Stress is very common event that no one can escape. There is potential for stress in situation that make demands, which threaten to exceeds a persons capability of coping with them. In these situations the reward for meeting the demands are weighed to grated than the carts of not meeting the demands stress shows up as absenteeism, sicker, poor quality work maintenance of the “status” and poor human relations. If not adequately managed, the pressure of work can lead to pre mature burnout. Retirement and for some permanent or long-term sick leave 20
Research conducted one such study, but looked at nurses support needs from a static perspective. The stress-supports model on the other hand, emphasizes the specific and dynamic nature of support. The support needs of individual stall nurses are infact both unique and constantly changing as a result of existing intrapersonal, organizational or environmental, and job component stress. Needs must therefore be assessed on an ongoing basis. Little existing research has explained the nurse’s perception of their own support need. The study say’s that stress occurs when one is faced with events or encounters that they perceive as an endangerment to their physical or psychological well being. Additional stress levels will increases when controllability and predictability in a situation decrease. There is an inverse relationship between stress and job satisfaction as stress goes up, job satisfactions falls. As a result these stress could commonly result in set job satisfaction set quality of life.
The cause of stress for nurses has and found to be related to the nature of the profession. Included is there stresses are an intense work environment with extended work hours, weekends, night and holidays. Stress could be realized to variables of shift work, which is both physically and mentally taking. This study also found varying degrees of depression in nurses ranging from mild to severe. Finally the study revealed that nurses were different and disconnected to the job by feeling either satisfied or unsatisfied with the work. Factors of the intense emotions support that is needed for the Patient’s family is yet another burden of stress placed on nurse. In addition exposure to pain, suffering and traumatic life events that the nurse experience on a daily basis can contribute to stress. These concerns can lead to emotional exhaustion for nurses.