http://doi.org/10.33698/NRF0017 -R S Mehta, R N Chaudhary
Abstract: It is a hospital based descriptive exploratory study, carried out on 81 nurses working iii critical care areas of the B.P. Koirala Institute of Health Sciences, Nepal to find out the job related stress factors among them. Total 57 subjects were selected purposively. Structured questionnaire was used to collect the data. Ma0jority of the subjects reported that shortage of nursing staff (57.7%), too high workload (59.6%), lack of recognition of ones effort (29.8%), aggressive relatives (31.9%), demanding patients (12.6%), poor promotion opportunity (48.9%), lack of support from supervisors (25.5%), poor evaluation system (44.7%), poor nursing administration (40.4%) and low pay scale (31.9%) were the main factors of stress among the nurses working in BPKIHS, Nepal.
Key Words: Nurses, stress, critical care, job
Correspondence at:
Mr. Ram Sharan Mehta,
Assistant Professor,
Medical-Surgical Nursing Dept. College of Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Nepal
Introduction
On the threshold of a new century, nurses are well positioned to influence the divers trends impacting on health care and nursing. The changing demographics influenced by an aging population, a shift to diseases patterns and advances in medical and information technology, challenges nurses to keep up with changing health care demands through life long learning with foresight, regular environmental scanning and sound health policies. The major trends can be monitored and their impact can be analyzed to help guide future planning and action. In U.K. total of 342 nurses committed suicide in the six years i.e. 1992 to 1998, a rate of 11 per 100,000, Stress and depression are like a virus: you catch it at work and take it In this complex world vast majority of people are in state of stress. It is inevitable. Stress has always been around in one from another. We all are individual creature with unique requirements. Stresses are unique as well. It is impossible to avoid stress, stressors will be always being there because we live in an imperfect and unpredictable world.
Stress is a part of our life. Stress can also create positive and negative influence in our daily lives. As a positive influence stress is a motivating force towards progress and it can create new awareness and exciting new perspective. As a negative influence it creates feeling of distress, rejection, depression, which leads to variety of physical and psychological problems. Many types of disease (psychosomatic illnesses) have been linked with stress including high blood pressure, heart attack, heart disease, peptic ulcer, headache, pain in the neck, asthma, cancer, depression etc.
People might get sick sometime in their life. Each patient has right to receive best nursing care while he/ she is in the hospital. Nursing care is directly provided by nurses in hospital. Competent nursing care makes treatment more economics, promotes morale at work, shortens the duration of hospitalization and increase the confidence of the patient in the nursing care as they receive.
Stress occurs when there are demands on the person which tax or exceed his adaptive resources. Eustress causes increased mental activity, pleasure and euphoria, which can be constructive. On the other hand distress can cause reduced attention, forgetting, poor work performance, all of which can be potentially dangerous for critical care unit nurses.
Objective
The main objective of this study is to find out the job-related stress factors among the nurses working in critical care areas at BPKIHS.
Materials and methods
It was hospital based descriptive exploratory study conducted at BP Koirala Institute of Health Sciences (BPKIHS). It is one of the pioneers Health Sciences teaching institute in eastern region of Nepal. It was established in 1993. Over the years it has been grown in every sphere and render the hospital services in various specialties, such as medical, surgical, orthopedics, Eye, ENT, Dialysis, maternity, pediatrics, psychiatric besides a number of super specialty (ICU, CCU, NICU, PICU, MICU and Dialysis) services. At present the bed strength of hospital is around 700 and about 400 nurses working in this institution. The data was gathered from critical care units comprised 10 bedded ICU, 4 bedded CCU, 30 bedded emergency, 13 bedded NICU/ Nursery, 6 bedded PICU/MICU. Out of total 81 staff nurses in this area, total 57staff nurses are selected purposively as a study subjects.
After explaining the purpose of the study, verbal consent was obtained from each subject. Subjects were assured about the confidentiality of the information given by them. A structured questionnaire was given to each study subject separately and asked them to return it on completion to investigators. The collected data was analyzed using the software program of Excel and SPSS- 4.
Results
Study results shows that total 57 staff nurses were participated in the study. Majority of subjects i.e. 37 (64.91%) were less than 25 years of age, who had participated in the study. Only 05 (08.77%) study subjects were older than 30 years of age (Table- 1).
Table 1: Age wise distribution of study subjects
N=57
| Age in years n(%) | |
| < 25 | 37 (64.91) |
| 26-30 | 15 (26.31) |
| >30 | 05 (08.77) |
Table- 2 depicts that maximum number of subjects i.e. 20 (35%) were from emergency and rest 16 (26.0%), 08 (14.0%), 08 (14.0%), 06 (10.5 To) were from Intensive Care Unit, NICU / Nursery. PICU / MICU, Cardiac Care Unite respectively. Number of subjects ranged from 06 to 20 from every Critical Care Unit / ward. Staff nurses from Cardiac Care Unit, 1\11CU / Nursery and PICU / MICU are proportionally lesser in number as study subjects.
Table 2: Unit/ward wise distribution of study subjects
| Unit/Wards | n (%) |
| Intensive Care Unit | 15 (26.0) |
| Cardiac Care Unit | 06 (10.5) |
| Emergency | 20 (35.0) |
| NICU*/Nursery | 08 (14.0) |
| PICU*/MICU* | 08 (14.0) |
NICU*- Neonatal ICU, PICU*- Pulmonary ICU. MICU”- Medical ICU
Table- 3 depicts that the majority of the subjects (81.1%) had greater stress because of the shortage of staff followed by too high workload (80.9 %) and responsibility in patient care (55.3%). Total 40.4 C; subjects experienced moderate stress in relation of trying to achieve minimum standard of care but very much stress is experienced by only very few (14.9%) subjects for this phenomenon. It highlights that lack of manpower causes high workload, which ultimately leads to stress among staffs working in critical care areas.
Table 3: Factors of stress related to workload
N=57
| Responses ( % ) | ||||
| Stress factors | Not at all
(<25%) |
Slightly
(25-50%) |
Moderately
(50-80%) |
Very much
(> 80%) |
| Responsibility on patient care | 29.8 | 14.9 | 14.9 | 40.4 |
| Shortage of staff | 4.2 | 14.9 | 23.4 | 57.7 |
| Lack of time to spend with patients | 34.0 | 36.2 | 25.5 | 04.3 |
| Inadequate time to complete task | 23.3 | 34.0 | 29.8 | 12.8 |
| Workload too high | 6.3 | 12.8 | 21.3 | 59.6 |
| Trying to achieve minimum standard | 21.3 | 23.4 | 40.4 | 14.9 |
Table-4 depicts that the lack of recognition for ones effort (53.1%) was the major factors to produce stress followed by high sickness among staff (46.8%), lack of friendly working condition (38.3%), poorly motivated staff (31.9%). Whereas very less number of (08.5%) staff nurses has greater stress because of the lack of support from colleagues.
Table 4: Factors of stress related to lack of support and involvement
N=57
| Responses ( % ) | ||||
| Stress factors | Not at all
(<25%) |
Slightly
(25-50%) |
Moderately
(50-80%) |
Very much
(> 80%) |
| Lack of friendly working condition | 25.5 | 36.1 | 21.3 | 17.0 |
| Lack of support from colleagues | 51.1 | 27.6 | 12.8 | 8.5 |
| Poorly motivated staff | 42.6 | 25.5 | 10.6 | 21.3 |
| Lack of recognition for ones effort | 21.2 | 25.5 | 23.3 | 29.8 |
| High sickness among staff | 19.2 | 34.0 | 27.7 | 19.1 |
Table-5 depicts that the aggressive relatives (59.5%) were the major factors to produce stress, followed by demanding patients (36.1%). Impolite behavior of patients caused the moderately stress among 29.8% staff nurses but this factor has caused very high stress in only very few subjects (06.4%). Pressure from other staff has been lower in cards to cause very much stress among the critical care nurses.
Table 5: Factors of stress related to patients/relatives
| Responses ( % ) | ||||
| Stress factors | Not at all
(<25%) |
Slightly
(25-50%) |
Moderately
(50-80%) |
Very much
(> 80%) |
| Demanding patients | 36.1 | 27.7 | 23.5 | 1.6 |
| Aggressive relatives | 08.5 | 31.9 | 27.6 | 31.9 |
| Impolite behavior of patient | 42.6 | 21.3 | 29.8 | 06.4 |
| Pressure from other staff | 36.2 | 31.9 | 21.1 | 10.8 |
| High sickness among staff | 19.2 | 34.0 | 27.7 | 19.1 |
Table- 6 depicts that the poor promotion opportunity (74.4%) was the major factors to produce moderately to very much stress to the staffs nurses followed by organizational and management problems (53.2%), limited annual leave (51.0%) and poor organizational structure (46.8%). Whereas only 25.5% staff nurses experienced very much stress because the lack of support from supervisor but majority (34.0%) subject has not experienced any degree of stress because of this factor.
Table 6: Factors of stress related to administrative problems
| Responses ( % ) | ||||
| Stress factors | Not at all
(<25%) |
Slightly
(25-50%) |
Moderately
(50-80%) |
Very much
(> 80%) |
| Lack of support from supervisor | 34.0 | 21.3 | 19.1 | 25.5 |
| Poor promotion opportunity | 10.6 | 14.9 | 25.5 | 48.9 |
| Poor organizational structure | 19.1 | 34.0 | 23.4 | 23.4 |
| Limited annual leave | 19.1 | 27.7 | 31.9 | 19.1 |
| Organisational and management problems | 21.2 | 25.5 | 27.7 | 25.5 |
Table-7 depicts that majority of (68.1%) these critical care nurses are slightly to moderately overall satisfied with nursing career. But very less number of (21.2%) these nurses are very much satisfied with nursing career. Most of the respondents (48.2%) are very much satisfied with nursing care provided to the patient followed by physical facilities available in the unit (29.8%, guidance/supervision from seniors (19.5 %), job security (19.1%), and Security service (17.0%).
Whereas very less number of staff nurses are very much satisfied with pay scale (06.4%), nursing administration (06.4%) and evaluation system (10.6%) of the organization.
Table 7: Level of job satisfaction
N=57
| Responses ( % ) | ||||
| Stress factors | Not at all
(<25%) |
Slightly
(25-50%) |
Moderately
(50-80%) |
Very much
(> 80%) |
| Job security | 25.5 | 21.3 | 34.0 | 19.1 |
| Pay scale | 31.9 | 29.8 | 31.9 | 6.4 |
| Nursing administration | 40.4 | 25.5 | 27.7 | 6.4 |
| Evaluation system | 44.7 | 23.4 | 21.3 | 10.6 |
| Nursing care provided to the Patient | 6.4 | 6.4 | 38.3 | 48.9 |
| Security service/visitor control provision | 27.6 | 21.3 | 37.0 | 17.0 |
| Cooperation from helpers/health aids | 12.8 | 40.4 | 31.9 | 14.9 |
| Guidance/supervision service | 12.8 | 42.6 | 25.1 | 19.5 |
| Availability of supplies | 10.6 | 38.3 | 38.3 | 12.7 |
| Physical facilities available in the unit i.e. light toilet, furniture, etc. | 6.4 | 27.7 | 36.2 | 28.8 |
| Overall satisfaction with nursing career. | 10.7 | 31.9 | 36.2 | 21.2 |
Discussion
The present study was undertaken to evaluate job related stress factors among the nurses working in critical care areas at BPKIHS, Nepal. Role conflict and workload were linked to poor motivation and performance and more absenteeism among nurses. Job dissatisfaction resulting from lack of independence and decision making power has been associated with poor provision of care and breakdown communication between patient and staff.
Majority of the subjects (81.1%) had greater stress because of the shortage of staff followed by too high workload (80.9%) and responsibility in patient care (55.3%). About forty percent subjects experienced moderate stress in relation of trying to achieve minimum standard of care but very much stress is experienced by only very few (14.9%) subjects for this phenomenon. Similar findings were reported by Hall3, Shaver 4. Makhija2, and Bhattacharyal1.
Lack of recognition for ones effort(53.1% ) was the major factors to produce stress, rest high sickness among staff (46.8%), lack of friendly working condition (38.3 To), poorly motivated staff (31.9 To) factors has well contributed to stress among nurses providing critical care. In other hand very less number of critical care providing nurses (08.5%) had greater stress because of the lack of support from colleagues. As per patient/ relative and administrative problems in critical care area are concerned, poor promotion opportunity (74.4%),organizational and management problems(53.2 %), limited annual leave (51.0%) and poor organizational structure (46.8 %),aggressive relatives (59.5%), and demanding patients (36.1%) are main factors to cause the greater degree of stress among nurses providing critical. The results of the study are comparable to other studies where similar factors are identified.1
Very less number of (21.2%) these critical care providers are satisfied with nursing career. But about half of them are satisfied with nursing care provided to the patient. Other factors like physical facilities available in the unit (29.8%), guidance/supervision from seniors (19.5%), job security (19.1%), and Security service (17.0%) has contributory respectively in satisfaction of the nurses providing critical. In other hand less number of subjects were very much satisfied with pay scale (06.45) nursing administration (06.4 %) and evaluation system (10.6 %) of the organization. Similar findings were reported by Hall and Shaver.4
Keeping in mind these factors, required nurses patient ratio, conducive working environment, recognition to good work, effective motivation, better promotional opportunity, attractive pay scale, enough annual leaves, well managed nursing administration and evaluation system is recommended in an organization to have unstressed and well-motivated nurses toward the quality of nursing care which ultimately directs one towards excellent personal and professional development.
References
- Bhattacharya A. Stress among cardiac nurses related to patient’s satisfaction during hospitalization. Asian Journal Of Cardiovascular Nursing 1998;6 (1): 101- 106.
- Makhija N, Gupta R. Personality development and stress reduction in nursing personnel. NJI 2000; 89 (12): 275-276.
- Hall DS. Work rebated stress of registered nurses in a hospital setting. Journal of Nurses Staff Development 2004;20(1): 6-14.
- Shaner KH, Lacey LM. Job and career satisfaction among staff nurses: Effect of job setting and environment. Journal of Nursing Administration 2003, 33(3):166-172.
- Sura 0. Strategies for stress. Nursing Times 1989 Sept; 49 (7):13-19.
- Riding R. Occupational stress and cognitive style in nurses. BJN 1992; 4 (2): 4953.
- Julia C. Opting out of burn out. Nursing Times 1991 May; 17 (2): 15-21.