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 working
in 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.
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 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.
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
Key Words:
diseases patterns and advances in medical
Nurses, stress,
and information technology, challenges nurses
critical 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 monitored
Correspondence at :
and their impact can be analyzed to help guide
Mr. Ram Sharan Mehta, future planning and action. In U.K. total of 342
Assistant 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. Stress
Sunsari, Nepal
Nursing 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 be
at work and take it constructive. On the other hand distress can
In this complex world vast majority of cause reduced attention, forgetting, poor work
people are in state of stress. It is inevitable. performance, all of which can be potentially
Stress has always been around in one from dangerous for critical care unit nurses.
another. We all are individual creature with Objective
unique requirements. Stresses are unique as The main objective of this study is to
well. It is impossible to avoid stress, stressors find out the job-related stress factors among
will be always being there because we live in the nurses working in critical care areas at
an imperfect and unpredictable world. BPKIHS.
Stress is a part of our life. Stress can Materials and methods
also create positive and negative influence in
our daily lives. As a positive influence stress It was hospital based descriptive
is a motivating force towards progress and it exploratory study conducted at BP Koirala
can create new awareness and exciting new Institute of Health Sciences (BPKIHS). It is one
perspective. As a negative influence it creates of the pioneers Health Sciences teaching
feeling of distress, rejection, depression, which institute in eastern region of Nepal. It was
leads to variety of physical and psychological established in 1993. Over the years it has been
problems. Many types of disease grown in every sphere and render the hospital
(psychosomatic illnesses) have been linked services in various specialties, such as
with stress including high blood pressure, medical, surgical, orthopedics, Eye, ENT,
hear t attack, heart disease, peptic ulcer, Dialysis, maternity, pediatrics, psychiatric
headache, 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 nurses
life. Each patient has right to receive best working in this institution. The data was
nursing care while he/ she is in the hospital. gathered from critical care units comprised 10
Nursing care is directly provided by nurses in bedded ICU, 4 bedded CCU, 30 bedded
hospital. Competent nursing care makes emergency, 13 bedded NICU/ Nursery, 6
treatment more economics, promotes morale bedded PICU/MICU. Out of total 81 staff nurses
at work, shor tens the duration of in this area, total 57staff nurses are selected
hospitalization 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 each
on the person which tax or exceed his adaptive subject. Subjects were assured about the
resources. Eustress causes increased mental confidentiality of the information given by
Nursing and Midwifery Research Journal, Vol-1, No. 2, April 2005 71

3. them. A structured questionnaire was given Table-2 : Unit / ward wise distribution of
to each study subject separately and asked study subjects
them to return it on completion to
investigators. The collected data was analyzed N= 57
using the software program of Excel and
SPSS- 4. Units / Wards n(%)
Results
Intensive Care Unit 15 ( 26.0 )
Study results shows that total 57 staff
nurses were participated in the study. Majority
Cardiac Care Unit 06 ( 10.5
of subjects i.e. 37 ( 64.91 % ) were less than
25 years of age, who had participated in the
Emergency 20 ( 35.0 )
study. Only 05 ( 08.77 %) study subjects were
older than 30 years of age (Table- 1).
NICU* / Nursery 08 ( 14.0 )
Table-1 : Age wise distribution of study
subjects 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 % subjects
of subjects i.e. 20 (35 %) were from experienced moderate stress in relation of
emergency 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 only
Intensive Care Unit, NICU / Nursery, PICU / very few (14.9 %) subjects for this
MICU, Cardiac Care Unite respectively. Number
phenomenon. It highlights that lack of
of subjects ranged from 06 to 20 from every
Critical Care Unit / ward. Staff nurses from manpower causes high workload, which
Cardiac Care Unit, NICU / Nursery and PICU / ultimately leads to stress among staffs working
MICU are proportionally lesser in number as in critical care areas.
study subjects.
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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 40.4
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 motivated staff (31.9 %). Where as very less
recognition for ones effort (53.1 %) was the number of (08.5 %) staff nurses has greater
major factors to produce stress followed by stress because of the lack of support from
high sickness among staff (46.8%), lack of colleagues.
friendly working condition (38.3 %), poorly
Table- 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 17.0
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 staff nurses but this factor has caused very
relatives (59.5 %) were the major factors to high stress in only very few subjects (06.4
produce stress, followed by demanding %). Pressure from other staff has been lower
patients (36.1 %). Impolite behavior of patients in cards to cause very much stress among
caused the moderately stress among 29.8 % the critical care nurses.
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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 12.6
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
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 stress
to produce moderately to very much stress to because the lack of support from supervisor
the staffs nurses followed by organizational but majority (34.0 %) subject has not
and management problems (53.2 %), limited experienced any degree of stress because of
annual 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 25.5
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
Organizational and management 21.2 25.5 27.7 25.5
problems
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 provided
moderately overall satisfied with nursing to the patient followed by physical facilities
career. 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 securit
Nursing 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 19.1
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 34.0 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 29.8
Overall satisfaction with nursing career. 10.7 31.9 36.2 21.2
Discussion Majority of the subjects (81.1 %) had
The present study was undertaken to greater stress because of the shortage of staff
evaluate job related stress factors among the followed by too high workload (80.9 %) and
nurses working in critical care areas at responsibility in patient care (55.3 %). About
BPKIHS, Nepal. Role conflict and workload forty percent subjects experienced moderate
were linked to poor motivation and stress in relation of trying to achieve minimum
performance and more absenteeism among standard of care but very much stress is
nurses. Job dissatisfaction resulting from lack experienced by only very few (14.9 %)
of independence and decision making power subjects for this phenomenon. Similar findings
has 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 were
stress, 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 working
factors has well contributed to stress among environment, recognition to good work,
nurses providing critical care. In other hand effective motivation, better promotional
very less number of critical care providing opportunity, attractive pay scale, enough
nurses (08.5 %) had greater stress because annual leaves, well managed nursing
of the lack of support from colleagues. As per administration and evaluation system is
patient / relative and administrative problems recommended in an organization to have
in critical care area are concerned, poor eustressed and well motivated nurses toward
promotion oppor tunity (74.4 %), the quality of nursing care which ultimately
organizational 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 References
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