RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1.Name of the candidate MS. P. NALINI JULIET THANGAM 2. Name of the institution Diana College of nursing No. 68, Chokkanahalli, Jakkur Post, Bangalore-64 3.Course of study and subject Masters of science in Nursing Psychiatric Nursing 4.Date of admission to course 10-06-2009 A STUDY TO ASSESS THE LEVEL OF
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA
SYNOPSIS
FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.Name of the candidateMS. P. NALINI JULIET THANGAM
2. Name of the institution
Diana College of nursing
No. 68, Chokkanahalli, Jakkur
Post, Bangalore-64
3.Course of study and subject Masters of science in Nursing
Psychiatric Nursing
4.Date of admission to course 10-06-2009
5.Title of the topic
A STUDY TO ASSESS THE LEVEL OF
STRESS AND COPING STRATEGIES AMONG
NURSES WORKING IN CASUALTY UNITS
OF SELECTED HOSPITALS, BANGALORE
WITH A VIEW TO PROVIDE AN
INFORMATION BOOKLET.
6. Brief resume of the intended work
INTRODUCTION:
Stress, a buzzword of the 90s, is an everyday fact of life. At one point or the other
everybody suffers from stress. Relationship demands, physical as well as mental
health problems, pressure at workplaces, traffic snarls, meeting deadlines, growing-
up tensions-all of these conditions and situations are valid causes of stress. In fact, a
certain amount of stress is necessary for survival. Stress refers to a broad group of
experiences in which external or internal demands, or both, tax or exceeds a person’s
resources or coping capabilities. The source of stress, external or internal, is called a
stressor.1
Stress is the emotional and physical strain caused as a result of our response to what
happens around us. Stress can affect anyone-kids, teenagers, adults and the elderly. It
is an inborn instinct which helps the person to deal with everyday difficulties. But, if
it goes on for too long, it can harm the physical as well as psychological health,
making it difficult to handle day-to-day living.2
Stress or stressors undergoes many changes in our body. Our nervous system and
certain hormones get activated. These hormones quicken our heart rate, breathing,
metabolism and blood pressure. Our body begins to sweat as a preventive measure to
keep its temperature cool. These responses by the body to counter a stressful
situation, helps to handle the event effectively and perform well even under pressure.
However after tackling the stressful event, the body returns to normal. This natural
ability of the body to deal with stress is called as stress response. Any event where
the body fails to respond in this manner can cause stress.2
Stress is important for nurses for it influences nurses working performance or their
problem solving ability and their ability to supply their self-care needs. In the meta-
analyses study in which investigated factors affecting work satisfaction of nurses, it
was pointed out that job satisfaction could not be explained by a single factor; instead
it was related to various factors. A study showed that stress and organizational
devotion are emphasized as being the most important variables affecting job
satisfaction. Heavy workload, unsupportive work environment, and stress are the
most common reasons of work dissatisfaction and resigning from work among
nurses. 3
Nurse’s occupational stress appears to vary according to individual and job
characteristics, and work-family conflict. Common occupational stressors among
nurses are workload, role ambiguity, interpersonal relationships, and death and dying
concerns. Emotional distress, burnout and psychological morbidity could also result
from occupational stress. Nurses’ common coping mechanisms include problem
solving, social support and avoidance. Perceived control appears to be an important
mediator of occupational stress. Coping and job satisfaction appear to be reciprocally
related. Shift work is highly prevalent among nurses and a significant source of
stress. 4
Nurse’s high job stress is well documented. In particular, the job stress of nurses
working in acute and specialized care units has been widely studied. Heavy work
load, poor staffing, dealing with death and dying, inter-staff conflict, strain of shift
work, careers and lack of resources and organizational support have been identified
as the major source of job stress5
Emergency services are the need of any hospital and are very vital and integral unit
of the modern hospital. The atmosphere of the unit is highly demanding and
emotionally charged. The attending nurses are working under pressure to attend each
and every patient to the level of satisfaction for the patient and their family members.
This service is provided non-stop, round the clock, and throughout the year and the
rule of thumb in emergency is the preparedness for 'flexible workload'. A thriving
well-resourced, forward looking and innovative emergency department is key to the
success of the hospital.6
"Medical emergency is defined as a situation when the patient requires urgent and
high quality medical care to prevent loss of life and limb and initiate action for the
restoration of normal healthy life." Emergency services, which can be provided by
any hospital depends upon the number of beds, and the policy of the hospital. In
general in our country smaller hospitals run accident and emergency services called
'Casualty' during the non outpatient department (OPD) hours and share facility with
the OPD. Out of all aspects of medical care, emergency is the most crucial and vital,
as the patient and attendants perceive it as an emergency, which called for urgent
action. Therefore, not only it's the life of patients is at stake but also the image and
reputation of the hospital and the health care providers. From the point of
administration, it is one of the most stressful, and sensitive areas, which can trigger
off serious chain reactions hampering the functioning of the hospital.7
The casualty nurses do not have the luxury of a leisurely assessment; every second
counts. Most emergency situation includes elements of danger and confusion, thus
the physical and emotional stress factors may be extreme. Casualty is the stressful
period for the nurses. The factors which might alter the harmony of the systems are
classified as factors related to knowledge, environment and emergency care in the
casualty. If these stimuli are perceived as positive stressors it leads to early treatment
process, whereas if the nurses perceives them as negative stressors then it leads to
delayed care.8
Stressors are of two types namely positive and negative stressors. Negative stressors
are uncontrollable and lead to maladaptive behavior. Positive stressors are
controllable and lead to growth. Some of the hospital areas such as recovery room,
emergency room and intensive care unit are prone to be emotionally affected by
many events and produce stress to the nurses.9
Coping is a cognitive and behavioral effort to manage specific external and/or
internal demands that are appraised as taxing or exceeding the resources of the
persons. Coping is the means by which we think, feel, and act to advance our cause.
Coping helps advance a sense of increased control over the situation and is
characterized by dynamics and changes that are a function of continuous appraisals
and reappraisals of the shifting person-environment relationship. Coping
effectiveness is dependent on the match between coping efforts and other variables in
the stress-coping process, including one’s values, beliefs, and commitments10
6.1. NEED FOR THE STUDY:
Nursing personnel work in a wide range of health services settings including
hospitals, nursing homes, and ambulatory and community-based environments. In
performing their duties, they encounter a remarkable range of work-related hazards.
Some evidence suggests that fatigue related overwork and staffing patterns, including
shift work, can contribute to injuries and stress among staff providing nursing
services. Factors such as the physical work environment, organizational and
institutional characteristics and policies, and personal work habits contribute to
exposure to the risk of injury and stress.11
In a study of intensive care unit nurses, the investigators concluded that individuals
high on state-anxiety were not only at risk for burnout, but also for making medical
errors. In another study, higher trait-anxiety predicted psychological distress. In
addition, relationships with other staff—coworkers, physicians, head nurses, other
departments—were also predictors of psychological distress.12
Verbal abuse from physicians was noted to be stressful for staff nurses. In a study of
260 RNs, conflict with physicians was found to be more psychologically damaging
than conflict within the nursing profession. However, a study exploring verbal abuse
among 213 nursing personnel (95 percent RNs) found the most frequent source of
abuse was other nurses (27 percent). Families were the second most frequent source
of abuse (25 percent), while physicians ranked third (22 percent).13
WHO predicts that by 2020, Mental illness like stress and depression will be the
second leading cause of disability worldwide, after heart disease. The incidence of
stress within European society is on the increase and accounts for over 50% of all
absence from work. An annual survey of integrated disability management
programmes, found that incidence of disability are increasingly related to slowly
developing work-induced stress.14
The Canadian Mental Health Association says that emotions disturbances and stress
accounts for 20-30% of all employees. About 20% increase in stress cases was
reported by employee assistance programmes according to the Managing Director of
the Canadian Institute of Stress. 15
It has also been found that different nurses experience job stress differently. Some
studies reported that senior registered nurses and charge nurses experienced a higher
degree of stress than other ranks of nurses. However, other studies found that stress
level was significantly higher in junior nurses than in the senior nurses. There are
also studies reporting that the longer nurses had worked in their units the more likely
they were to experience stress regardless of their seniority. 16
The stress-resistant nurses were also distinguished by a less frequent use of defensive
or avoidance coping in handling their emotional reactions to stress. They perceived
greater family support than did the distressed nurses. Implications of the findings and
limitation of the study were discussed. 17
Now a day’s stress has become more common to all the casualty nurses when they
are facing the emergency situation. The investigator identified nurses who work in a
hospital set up or community set up have lot of ‘work stress’ due to work load, shift
work, overtime etc. So, the investigator has planned to help the nursing staff by
undertaking this study to assess the stress level and coping strategies in groups of
nursing staffs working in the casualty and also provide an information booklet on
stress management.
6.2.Review of Literature
A literature review is a written summary of the state of existing knowledge on
research problem. The task of reviewing research literature involves the
identification, selection of critical analysis and written description of existing
information on a topic (Polit & Hungler, 2003).
The review of literature in this study is organized under the following headings:
1. Literature related to stress of nurses working in the casualty unit.
2. Literature related to coping strategies of nurses working in the casualty unit.
3. Literature related to relationship between stress and coping strategies of the nurses
working in the casualty unit.
1. Literature related to stress of nurse working in the casualty unit:
A descriptive approach was carried out among casualty nurses of a selected hospital to
assess the stress and coping among casualty nurses. A sample of 110 nurses was
chosen by using convenient sampling technique. Out of 110 nurses, 46 were having
high stress score and remaining 54 nurses were found having less stress scores. The
findings revealed that majority of nurses were having high stress scores and poor
coping level.18
A study was conducted to assess the perceived stress among nurses working in a
casualty. 60 samples were selected for the study by using the simple random
sampling. The data was collected by using stress scale. The study findings revealed
that stress levels are high among the nurses with the sources of feeling nervous,
irritating life hassles and inability to control the environmental problems.23
A study was conducted in Northern Ireland to explore the attitude of casualty nurses
in attempting suicide. The nurse’s age and length of experience in casualty were the
independent variables. A total of 142 nurses from 11 hospitals in Northern Ireland has
questionnaire circulated to them, with a 66.9% response rate. The results revealed that
older and the more experienced nurses seems to have more positive attitude than the
younger or the less experienced nurses.24
A descriptive study was conducted based on stress module. A simple random
sampling technique was used to select 31 subjects from the hospitals. Among 31