https://doi.org/10.33698/NRF0278-Deepika C Khakha, Merin Thomas, Anita, Bobby Seymlieh
Introduction: Global evidence shows that today’s work environment has adverse effects on the health of nursing personnel. Objective: To investigate the effect of 12-hour workshop on workplace stress and wellness among nursing ofcers at AIIMS, New Delhi. Methodology: A quasi experimental study was conducted on 28 nursing ofcers from AIIMS, New Delhi. Data was collected at Continuing Medical Education Technology Hall (CMET), AIIMS, New Delhi using standardized tools which includes Ardell Wellness Stress Test and Workplace stress survey. Pre-test and post-test was taken before start of the workshop and after the end of the workshops respectively. The duration of workshop was 12 hours. Descriptive statistics was used to compute the mean and standard deviation. Student’s t test was used to see the mean differences between the scores. Results: The baseline score of participants on Ardell wellness scale was 35.57 ± 16.4 which was found to be increased after the workshop to a score of 45.14 ± 11.39 and the difference was also found to be statistically signicant (p=0.001). The baseline score on Workplace stress was 47.07 ± 10.8, which decreased to a score of 41.96 ± 13.38, and the difference was also found to be statistically signicant (p=0.003). Conclusion: This study revealed that nursing personnel suffer from moderate levels of workplace stress, which can be easily improved if issues regarding their well-being are intervened appropriately. Since nursing constitutes the largest workforce in the healthcare sector, impaired health of nursing personnel might affect the quality of health care.
Keywords: Nursing Personnel; Wellness; Workshop; Workplace stress
Address for correspondence
Deepika. C. Khakha Lecturer, College of Nursing,
All India Institute of Medical Sciences, Ansari Nagar, New Delhi- 110 029, India.
INTRODUCTION:
“Nurses are the heart of healthcare. Nursing is not for everyone. It takes a very strong, intelligent and compassionate person to take on the ills of the world with passion and purpose and work to maintain the health and well-being of planet. No wonder we are exhausted at the end of the day!” Donna Wilk Cardillo Nurses’ quality of life directly and indirectly has an impact on the quality of care they provide. Therefore, it is essential to identify the key factors that has an inuence on nurses’ quality of life in the healthcare delivery system.1 Occupational stress among nurses is a common issue at workplace which can be caused by undesirable nursing environment which is faced by nurses on a routine basis.2 There are numerous factors that make workplace stressful for the nursing personnel , such as, facing death and grief, dealing with uncooperative patients and their relatives, taxing workload, shift duties, and conict among various health team members3. They are expected to perform the best quality care while they may not be provided with all the necessary equipment and resources.
Work stress among nursing personnel was rst assessed in 1960 when Menzies identied four sources of anxiety among them: decision making, change, taking responsibility, and patient care. Nurse’s role has been regarded as stress-lled based upon physical labor, human suffering, working hours, stafng, and interpersonal
Materials & methods
Pre-experimental research design was used. The study was conducted on 28 purposely selected nursing ofcers from AIIMS, New Delhi. Participants were invited from different departments of AIIMS, New Delhi to register for the workshop. Nursing ofcers who registered themselves for the workshop were included in the study. The participants who did not gave consent to participate and did not attend all sessions of the workshop were excluded from the study.
The workshop was conducted at CMET, AIIMS, New Delhi. The total duration of the workshop was 12 hours, conducted in two days. Expert speakers were invited to take the sessions. The topics included in the sessions were overview of mental health, relationships.4 However, since mid-1980s C h a n g i n g w o r l d o f w o r k p l a c e ,
Stress at workplace may lead to various p r o b l e m s s u c h a s d e c r e a s e d j o b satisfaction, compassion fatigue and burnout. Stress due to shift work, and long working hours in nursing profession may lead to various psychosomatic disorders such as stiffness in neck and shoulders, back pain, acidity, anger, and forgetfulness7. Occupational stress is also identied as a factor for increased turnover among the nursing personnel.8 In view of the above factors, this study attempted to assess the level of stress and wellness among nursing ofcers at AIIMS, New Delhi and the effect of interventions on stress and wellness scores.
Understanding mental health problems, Work life balance, Development of policies for prevention and management of stress at workplace, Building resilience, Role of complementary therapy in managing mental health problems; Deep breathing and yoga session, Importance of mental health at workplace, Substance use and abuse at workplace, Mental health p r o m o t i o n s t r a t e g i e s , M a n a g i n g compassion, fatigue and burnout, Counselling skills, Conict resolution. There were also two demonstration sessions of Jackson Progressive Muscle Relaxation (JPMR), Laughter therapy and one session of group work on what employees can do to promote mental health and decrease stress.
Data was collected using questionnaires. Well-being of the participants was assessed using Ardell Wellness Stress Test while stress was assessed using Workplace Stress Survey. Ardell Wellness Stress Test incorporates physical, mental, emotional, spiritual, and social aspects of health and is a standardized questionnaire consisting of 25 items. Each item is rated on a scale of -3 to +3 with a maximum score of +75 while a minimum score of -75. Workplace Stress Survey is also a standardized questionnaire consisting of 10 items related to workplace stress. Each items were rated on a score of 1 to 10. Maximum attainable score was 100 while minimum was 10. Pre-test was taken before the start of the workshop and Post- test at the end of workshop. Descriptive statistics was used to compute mean score and standard deviation while Students t test was used to compare the mean difference between the scores.
Results: Total 28 participants were enrolled for workshop. Table 1 depicts s o c i o d e m o g r a p h i c v a r i a b l e s o f participants. The participants were in the age range of 25 to 59 years with mean age of 35.64 ± 9.51 years. The years of education of participants ranged from 15-19 years with mean number of years of education were 15.86 ± 1.07 years. The working experience of the participants was in range of 1.5 to 35 years with mean of 12.45 ± 9.41 years. Most of participants (82.14%) were females and 17.85% were male.
Table 1: Demographic variables of the participants N=28
| Variables | Mean ± SD | Range |
| Age ( years ) | 35.64 ± 9.51 | 25-59 |
| Education ( years ) | 15.86 ± 1.07 | 15-19 |
| Experience ( years ) | 12.45 ± 9.41 | 1.5-35 |
Tab 2 shows that the baseline Ardell wellness scale scores of the group was 35.57 ± 16.4 which increased to 45.14 ± 11.39 after the workshop and the difference was found to be statistically signicant (p=0.001). The baseline workplace stress score of the group was 47.07 ± 10.81, which was in the moderate stress category, decreased to 41.96 ± 13.38 moderate stress category after the workshop which was found to be statistically signicant (p=0.003).
Table 2: Comparison between pre-test and post-test scores
n=28
| Pre-test scores | Post-test scores | p value# | |
| Ardell wellness scale | 35.57 ± 16.4 | 45.14 ± 11.39 | 0.001* |
| Workplace stress scale | 47.07 ± 10.81 | 41.96 ± 13.38 | 0.003* |
#Student’s t test, *p<0.05
According to Wellness stress survey 24(85.7%) participants were found to have moderate level of stress before the intervention. After the intervention 5 (17.9%) participants showed signicant decrease in the levels of stress thereby falling into the category of mild stress. (table-3). At the end of workshop 67.8% participants had moderate stress and 32.1% had mild stress. The nurses were found to have higher levels of stress because of always being supervised under seniors and carrying out the instructions given by the doctors and thereby getting very less
Table 3: Workplace Stress as per Wellness stress survey
| Workplace Stress as per Wellness stress survey | Pre test | Post test |
| f (%) | f (%) | |
| Mild | 4 (14.2) | 9 (32.1) |
| Moderate | 24 (85.7) | 19 (67.8) |
| Severe | – | – |
Table 4: Wellness status of participants before and after intervention as per Ardell Wellness Scale
| Ardell Wellness Scale | Pre test | Post test |
| f (%) | f (%) | |
| Self actualized | 4 (14.3) | 7 (25.0) |
| Well mastered | 18 (64.3) | 19 (67.8) |
| Well oriented | 5 (17.9) | 2 (7.2) |
| Candidate for training | 1 (3.5) | – |
| Candidate for counselling | – | – |
| Candidate for major psychological treatment | – | – |
frequent chances of using decision making skills even if they are capable of it.
According to Ardell wellness Scale, 4 (14.3%) participants were well actualized persons, 18 (64%) participants were well mastered to wellness approach to life and had the capacity to deal creatively and efciently with events and circumstances and 5 (17.9%) participants reported of being a wellness-oriented person, with an ability to prosper as a whole person. Only one (3.5%) participant was a candidate for training and no participant needed counseling as major psychological treatment. After the intervention 7 (25%) participants reported of being a self- actualized person, nearly immune from the ravages of stress and 19 ( 67 . 8 %) participants reported of being mastered to wellness approach. While at the end of intervention no participant needed training, counselling or needed major psychological treatment. (Table-4)
Discussion
Stress affects almost all of us and is very common in health sector. Nursing profession has been always considered as an occupation with high levels of stress. The mental and physical health of the nursing personnel should be at their optimum level so that they can provide best quality care to their patients.
Majority of participants in the study were females (82%) having mean age of 35.64 ± 9.51 years and work experience of 12.45 ± 9.41years. Nursing personnel suffered from moderate level of stress (47.07 ± 10.81). A study done by Najimi A et al9 in Iran (2012) revealed that majority of the participants were females (78%) and had average age of 28 years. Majority of male and female nurses that is 87.5% and 94.6% suffered from normal stress and 4.7% female nurses had medium stress while no male nursing personnel was found in the medium stress category. A study done by Valizadeh L, et al at Iran (2012) showed that nurses in NICUs (Neonatal Intensive Care Unit) suffered from stress in the moderate range.10
A study done by Davey A et al,3 in Uttar Pradesh, India (2014) revealed that 51% hospital nurses in the study reported moderate levels of stress while 3% reported severe levels of job-related stress. The m a j o r s t r e s s o r s i d e n t i e d w e r e occupational stressors that is poor doctor’s attitude, posting in busy departments (emergency/ICU), inadequate pay, too much work, time pressure, and tiring job with insufcient time for rest and meals. In a study conducted by Pratibha P Kane, 11 in Maharashtra, India (2009) it was found that majority (66%) of the nurses working in private hospital suffered from moderate stress, while 26% suffered from mild and 7% suffered from severe levels of stress. The major cause of stress was revealed to be not being able to nish work on time (78%), backache due to standing for too long ( 61 %), s t a f f shortage ( 58 %) and troublesome relatives (68%) and patients (57%). The present study, however, did not try to identify the cause of occupational stress among nursing personnel.
The present study conducted a two day (12 hours) interactive workshop as an intervention to reduce workplace stress and promote feelings of wellness among nursing personnel which was found to be successful in doing so. The level of stress decreased from 47.07 ± 10.81 to 41.96 ± 13.38 after the workshop and feelings of wellness increased from 35.57 ± 16.4 to 45.14 ± 11.39. Rebekah KH (2016), conducted a web-based BREATHE: Stress Management program for Nurses on 104 nurses working in 6 different hospitals in New York. Results showed signicant decrease in the stress levels of the participants in experimental group. Many other studies have conducted different interventions such as use of mindfulness t r a i n i n g 1 2 , c o g n i t i v e b e h a v i o r a l interventions 1 3 , web- based s t ress management program for nurses14 and even easily improved if intervention regarding their well-being are done at an appropriate time. If stress in the workplace continues unchecked, it may lead to burnout and compassion fatigue among the workforce which will in turn lead to incidences of mistakes and errors and lack of empathy for the patients. Regular workshops to improve mental health and help the nurses de-stress will be helpful in the long run.
Stress should not be viewed as a personal problem to be dealt with at an individual level but rather as an organizational hazard as it can lead to issues such as absenteeism, decreased motivation among workforce and increased turnover. Further studies, on a larger scale can be done to identify the exact cause of stress so that interventions can be taken specic to the identied tai-chi practice15 to combat the issue of occupational stress among nurses. Review of literature shows that nurses suffer from occupational stress and measures need to be taken to address these issues least it d e v e l o p s i n t o b u r n o u t a n d o t h e r complications.
Strengths and Limitation :The strength of t h e s t u d y w a s t h a t s t a n d a r d i z e d questionnaires were used for data collection while limitation was that the sample size was low and it was a single center study.
Conclusion & recommendation: Since nursing constitutes the largest workforce in the health care sector, impaired health of nursing staff might affect the quality of care provided by them. This study revealed that nursing personnel suffer from moderate levels of workplace stress, which can be problem areas. References
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