Job related stress

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  • 1. Job related stress among the nurses working in critical care areas at BPKIHS, Nepal R S Mehta, R N Chaudhary Abstract: It is a hospital based descriptive exploratory study, carried out on 81 nurses workingin 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 questionnairewas used to collect the data. Majority 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 evaluationsystem (44.7 %), poor nursing administration (40.4 %) and low pay scale (31.9 %) were the mainfactors of stress among the nurses working in BPKIHS, 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 toKey Words: diseases patterns and advances in medicalNurses, stress, and information technology, challenges nursescritical care, job 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 monitoredCorrespondence at : and their impact can be analyzed to help guideMr. Ram Sharan Mehta, future planning and action. In U.K. total of 342Assistant Professor, nurses committed suicide in the six years i.e.Medical-Surgical Nursing Dept. College of Nursing,B.P. Koirala Institute of Health Sciences, Dharan, 1992 to 1998, a rate of 11 per 100,000. StressSunsari, NepalNursing and Midwifery Research Journal, Vol-1, No. 2, April 2005 70
  • 2. and depression are like a virus: you catch it activity, pleasure and euphoria, which can beat work and take it constructive. On the other hand distress can In this complex world vast majority of cause reduced attention, forgetting, poor workpeople are in state of stress. It is inevitable. performance, all of which can be potentiallyStress has always been around in one from dangerous for critical care unit nurses.another. We all are individual creature with Objectiveunique requirements. Stresses are unique as The main objective of this study is towell. It is impossible to avoid stress, stressors find out the job-related stress factors amongwill be always being there because we live in the nurses working in critical care areas atan imperfect and unpredictable world. BPKIHS. Stress is a part of our life. Stress can Materials and methodsalso create positive and negative influence inour daily lives. As a positive influence stress It was hospital based descriptiveis a motivating force towards progress and it exploratory study conducted at BP Koiralacan create new awareness and exciting new Institute of Health Sciences (BPKIHS). It is oneperspective. As a negative influence it creates of the pioneers Health Sciences teachingfeeling of distress, rejection, depression, which institute in eastern region of Nepal. It wasleads to variety of physical and psychological established in 1993. Over the years it has beenproblems. Many types of disease grown in every sphere and render the hospital(psychosomatic illnesses) have been linked services in various specialties, such aswith stress including high blood pressure, medical, surgical, orthopedics, Eye, ENT,hear t attack, heart disease, peptic ulcer, Dialysis, maternity, pediatrics, psychiatricheadache, pain in the neck, asthma, cancer, besides a number of super specialty (ICU,depression etc. CCU, NICU, PICU, MICU and Dialysis) services. At present the bed strength of People might get sick sometime in their hospital is around 700 and about 400 nurseslife. Each patient has right to receive best working in this institution. The data wasnursing care while he/ she is in the hospital. gathered from critical care units comprised 10Nursing care is directly provided by nurses in bedded ICU, 4 bedded CCU, 30 beddedhospital. Competent nursing care makes emergency, 13 bedded NICU/ Nursery, 6treatment more economics, promotes morale bedded PICU/MICU. Out of total 81 staff nursesat work, shor tens the duration of in this area, total 57staff nurses are selectedhospitalization and increase the confidence of purposively as a study subjects.the patient in the nursing care as they receive. After explaining the purpose of the study, Stress occurs when there are demands verbal consent was obtained from eachon the person which tax or exceed his adaptive subject. Subjects were assured about theresources. Eustress causes increased mental confidentiality of the information given byNursing and Midwifery Research Journal, Vol-1, No. 2, April 2005 71
  • 3. them. A structured questionnaire was given Table-2 : Unit / ward wise distribution ofto each study subject separately and asked study subjectsthem to return it on completion toinvestigators. The collected data was analyzed N= 57using the software program of Excel andSPSS- 4. Units / Wards n(%)Results Intensive Care Unit 15 ( 26.0 ) Study results shows that total 57 staffnurses were participated in the study. Majority Cardiac Care Unit 06 ( 10.5of subjects i.e. 37 ( 64.91 % ) were less than25 years of age, who had participated in the Emergency 20 ( 35.0 )study. Only 05 ( 08.77 %) study subjects wereolder than 30 years of age (Table- 1). NICU* / Nursery 08 ( 14.0 )Table-1 : Age wise distribution of studysubjects PICU* / MICU* 08 ( 14.0 ) N= 57 NICU*- Neonatal ICU, PICU*- Pulmonary ICU, MICU*- Medical ICU Age in years n(%) Table- 3 depicts that the majority of the < 25 37 ( 64.91 ) subjects (81.1 %) had greater stress because 26—30 15 ( 26.31 ) of the shortage of staff followed by too high > 30 05 ( 08.77 ) workload (80.9 %) and responsibility in patient Table- 2 depicts that maximum number care (55.3 %). Total 40.4 % subjectsof subjects i.e. 20 (35 %) were from experienced moderate stress in relation ofemergency and rest 16 (26.0 %), 08 (14.0 trying to achieve minimum standard of care%), 08 (14.0 %), 06 (10.5 %) were from but very much stress is experienced by onlyIntensive Care Unit, NICU / Nursery, PICU / very few (14.9 %) subjects for thisMICU, Cardiac Care Unite respectively. Number phenomenon. It highlights that lack ofof subjects ranged from 06 to 20 from everyCritical Care Unit / ward. Staff nurses from manpower causes high workload, whichCardiac Care Unit, NICU / Nursery and PICU / ultimately leads to stress among staffs workingMICU are proportionally lesser in number as in critical care areas.study subjects.Nursing and Midwifery Research Journal, Vol-1, No. 2, April 2005 72
  • 4. Table- 3 Factors of stress related to workload N= 57 Responses ( % )Stress factors Not at all Slightly Moderately Very much (< 25%) (25-50%) (50- 80%) ( > 80%)Responsibility on patient care 29.8 14.9 14.9 40.4Shortage of staff 4.2 14.9 23.4 57.7Lack of time to spend with patients 34.0 36.2 25.5 04.3Inadequate time to complete task 23.3 34.0 29.8 12.8Workload too high 6.3 12.8 21.3 59.6Trying to achieve minimum standard 21.3 23.4 40.4 14.9 Table- 4 depicts that the lack of motivated staff (31.9 %). Where as very lessrecognition for ones effort (53.1 %) was the number of (08.5 %) staff nurses has greatermajor factors to produce stress followed by stress because of the lack of support fromhigh sickness among staff (46.8%), lack of colleagues.friendly working condition (38.3 %), poorlyTable- 4 Factors of stress related to lack of support and involvement N= 57 Responses ( % )Stress factors Not at all Slightly Moderately Very much (< 25%) (25-50%) (50- 80%) ( > 80%)Lack of friendly working condition 25.5 36.1 21.3 17.0Lack of support from colleagues 51.1 27.6 12.8 8.5Poorly motivated staff 42.6 25.5 10.6 21.3Lack of recognition for ones effort 21.2 25.5 23.3 29.8High sickness among staff 19.2 34.0 27.7 19.1 Table- 5 depicts that the aggressive staff nurses but this factor has caused veryrelatives (59.5 %) were the major factors to high stress in only very few subjects (06.4produce stress, followed by demanding %). Pressure from other staff has been lowerpatients (36.1 %). Impolite behavior of patients in cards to cause very much stress amongcaused the moderately stress among 29.8 % the critical care nurses.Nursing and Midwifery Research Journal, Vol-1, No. 2, April 2005 73
  • 5. Table- 5 Factors of stress related to patients/relatives N= 57 Responses ( % )Stress factors Not at all Slightly Moderately Very much (< 25%) (25-50%) (50- 80%) ( > 80%)Demanding patients 36.1 27.7 23.5 12.6Aggressive relatives 08.5 31.9 27.6 31.9Impolite behavior of patient 42.6 21.3 29.8 06.4Pressure from other staff 36.2 31.9 21.1 10.8 Table- 6 depicts that the poor promotion structure (46.8 %). Where as only 25.5 %opportunity (74.4 %) was the major factors staff nurses experienced very much stressto produce moderately to very much stress to because the lack of support from supervisorthe staffs nurses followed by organizational but majority (34.0 %) subject has notand management problems (53.2 %), limited experienced any degree of stress because ofannual leave (51.0 %) and poor organizational this factor.Table- 6 Factors of stress related to administrative problems N= 57 Responses ( % )Stress factors Not at all Slightly Moderately Very much (< 25%) (25-50%) (50- 80%) ( > 80%)Lack of support from supervisor 34.0 21.3 19.1 25.5Poor promotion opportunity 10.6 14.9 25.5 48.9Poor organizational structure 19.1 34.0 23.4 23.4Limited annual leave 19.1 27.7 31.9 19.1Organizational and management 21.2 25.5 27.7 25.5problems Table- 7 depicts that majority of (68.1 career. Most of the respondents (48.2 %) are%) these critical care nurses are slightly to very much satisfied with nursing care providedmoderately overall satisfied with nursing to the patient followed by physical facilitiescareer. But very less number of (21.2 %) these available in the unit (29.8 %), guidance/nurses are very much satisfied with nursing supervision from seniors (19.5 %), job securitNursing and Midwifery Research Journal, Vol-1, No. 2, April 2005 74
  • 6. (19.1 %), and Security service (17.0 %). very much satisfied with pay scale (06.4 %),Where as very less number of staff nurses are 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 Slightly Moderately Very much (< 25%) (25-50%) (50- 80%) ( > 80%)Job security 25.5 21.3 34.0 19.1Pay scale 31.9 29.8 31.9 6.4Nursing administration 40.4 25.5 27.7 6.4Evaluation system 44.7 23.4 21.3 10.6Nursing care provided to the Patient 6.4 6.4 38.3 48.9Security service/visitor control provision 27.6 21.3 34.0 17.0Cooperation from helpers/health aids 12.8 40.4 31.9 14.9Guidance/supervision service 12.8 42.6 25.1 19.5Availability of supplies 10.6 38.3 38.3 12.7Physical facilities available in theunit i.e. light toilet, furniture, etc. 6.4 27.7 36.2 29.8Overall satisfaction with nursing career. 10.7 31.9 36.2 21.2Discussion Majority of the subjects (81.1 %) had The present study was undertaken to greater stress because of the shortage of staffevaluate job related stress factors among the followed by too high workload (80.9 %) andnurses working in critical care areas at responsibility in patient care (55.3 %). AboutBPKIHS, Nepal. Role conflict and workload forty percent subjects experienced moderatewere linked to poor motivation and stress in relation of trying to achieve minimumperformance and more absenteeism among standard of care but very much stress isnurses. Job dissatisfaction resulting from lack experienced by only very few (14.9 %)of independence and decision making power subjects for this phenomenon. Similar findingshas been associated with poor provision of were reported by Hall 3, Shaver 4, Makhija 2,care and breakdown communication between and Bhattacharya1.patient and staff.Nursing and Midwifery Research Journal, Vol-1, No. 2, April 2005 75
  • 7. Lack of recognition for ones effor t (06.4 %) and evaluation system (10.6 %) of(53.1% ) was the major factors to produce the organization. Similar findings werestress, rest high sickness among staff reported by Hall 3 and Shaver 4(46.8%), lack of friendly working condition Keeping in mind these factors, required(38.3 %), poorly motivated staff (31.9 %) nurses patient ratio, conducive workingfactors has well contributed to stress among environment, recognition to good work,nurses providing critical care. In other hand effective motivation, better promotionalvery less number of critical care providing opportunity, attractive pay scale, enoughnurses (08.5 %) had greater stress because annual leaves, well managed nursingof the lack of support from colleagues. As per administration and evaluation system ispatient / relative and administrative problems recommended in an organization to havein critical care area are concerned, poor eustressed and well motivated nurses towardpromotion oppor tunity (74.4 %), the quality of nursing care which ultimatelyorganizational and management problems directs one towards excellent personal and(53.2 %), limited annual leave (51.0 %) and professional development.poor organizational structure (46.8 %),aggressive relatives (59.5 %), and demanding Referencespatients (36.1 %) are main factors to cause 1. Bhattacharya A. Stress among cardiacthe greater degree of stress among nurses nurses related to patient’s satisfaction duringproviding critical. The results of the study are hospitalization. Asian Journal Of Cardiovascular Nursing 1998;6 (1): 101- 106.comparable to other studies where similar 2. Makhija N, Gupta R. Personalityfactors are identified.1 development and stress reduction in nursing Very less number of (21.2 %) these personnel. NJI 2000; 89 (12): 275-276.critical care providers are satisfied with nursing 3. Hall DS. Work related stress of registeredcareer. But about half of them are satisfied with nurses in a hospital setting. Journal of Nurses Staff Development 2004;20(1): 6-14.nursing care provided to the patient. Other 4. Shaner KH, Lacey LM. Job and careerfactors like physical facilities available in the satisfaction among staff nurses: Effect of jobunit (29.8 %), guidance/supervision from setting and environment. Journal of Nursingseniors (19.5 %), job security (19.1 % ), and Administration 2003, 33(3):166-172.Security service (17.0 %) has contributory 5. Sura O. Strategies for stress. Nursingrespectively in satisfaction of the nurses Times 1989 Sept; 49 ( 7 ):13-19.providing critical. In other hand less number 6. Riding R. Occupational stress andof subjects were very much satisfied with pay cognitive style in nurses. BJN 1992; 4 (2): 49-scale (06.4 %), nursing administration 53. 7. Julia C . Opting out of burn out. Nursing Times 1991 May; 17 ( 2 ): 15-21.Nursing and Midwifery Research Journal, Vol-1, No. 2, April 2005 76