A COMPARATIVE STUDY TO ASSESS THE LEVEL OF STRESS

AMONG STAFF NURSES WORKING IN PSYCHIATRIC AND

MULTISPECIALITY HOSPITAL IN BANGALORE”.

M.Sc Nursing Dissertation Protocol submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

By

MS.JINCY .M.VARGHESE

M.Sc NURSING 1ST YEAR

2010-2012

Under the Guidance of

HOD, Department of Psychiatric Nursing

Nightingale College of Nursing

Guruvanna Devara Mutt

Near Binnyston garden

Bangalore –23.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,

KARNATAKA CURRICULAM DEVELOPMENT CELL

CONFORMATION FOR REGISTRATION OF SUBJECTS FORDISSERTATION

Registration number :

Name of the candidate : Ms.Jincy.M.Varghese

Address : Guruvanna Devara Mutt, Near Binnyston Garden, Magadi Road, Bangalore-23

.

Name of the institution : Nightingale College of Nursing

Course of study and subject : M.Sc Nursing in psychiatric nursing..

Date of admission to course : 20-05-2010

Title of the topic : A Comparative Study To Assess The Level Of Stress Among Staff Nurses Working In Psychiatric And Multispeciality Hospitals At Bangalore.

Brief resume of the intended work : Attached

Signature of the student :

Guide Name :Ms Archana R.

Remarks of the guide :

Signature of the guide :

Co-guide name :

Signature of co-guide :

HOD name :Mr MohanaKrishnan

Signature of HOD :

Principal Name : Mrs.Jayakadambari

Principal Mobile No : 09886367287

Principal E-mail ID : nightingale_principal@rediffmail.com

Remarks of the Principal :Principal signature :

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECT FORDISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS

MS. JINCY.M.VARGHESE,I YEAR M.Sc. NURSING, NIGHTINGALE COLLEGE OF NURSING,GURUVANNADEVARA,MUTT BINNYSTON GARDEN, MAGADI ROADBANGALORE-560023

2 NAME OF THE INSTITUTION

NIGHTINGALE COLLEGE OF NURSING, GURUVANNADEVARA,MUTT BINNYSTON GARDEN, MAGADI ROADBANGALORE-560023

3 COURSE OF STUDY AND

SUBJECT M.SC NURSING IN PSYCHIATRIC NURSING

4 DATE OF ADMISSION TO THE

COURSE 20-05-2010

5 TITLE OF THE TOPIC:

A COMPARATIVE STUDY TO ASSESS THE LEVEL

OF STRESS AMONG STAFF NURSES WORKING IN

PSYCHIATRIC AND MULTISPECIALITY HOSPITALS AT

BANGALORE

6.0 BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

“Give your stress wings and let it fly away”. 

~Terri Guillemets

Stress is a term in psychology and biology, first

coined in the biological context in the 1930s, which has in more recent decades become

commonly used in popular parlance. It refers to the consequence of the failure of an

organism – human or animal – to respond appropriately to emotional or physical threats,

whether actual or imagined.1.

Stress symptoms commonly include a state of

alarm and adrenaline production, short-term resistance as a coping mechanism, and

exhaustion, as well as irritability, muscular tension, inability to concentrate and a variety

of physiological reactions such as headache and elevated heart rate.

Chronic stress can significantly affect many of the body's

immune systems, as can an individual's perceptions of, and reactions to, stress. The term

psychoneuroimmunology is used to describe the interactions between the mental state,

nervous and immune systems, as well as research on the interconnections of these

systems. Immune system changes can create more vulnerability to infection, and have

been observed to increase the potential for an outbreak of psoriasis for people with that

skin disorder2.

Stress is a subjective phenomenon based on individual perceptions,

producing positive (eustress) and negative (distress) perspectives. The workplace for

nurses provides a multiplicity of sources of stress. There are differences in the

perceptions of nurses in different workplaces, and even between individuals in the same

workplace. Progression along the continuum from eustress to distress is subjective,

depending upon the relationship between an individual and their environment. Thus,

whilst there is recognition that workload, leadership style, professional relationships, and

emotional demands are the most frequently reported major factors that cause workplace

distress for staff nurses3.

The concept of stress in the workplace is of great importance in

health care and especially nurse are generally considered a high risk group regarding

work stress and burnout. This syndrome has been a major concern in the field of

occupational health and healthcare worker, particularly those caring for patients suffering

from serious illness Stress affecting nurses across the globe has been convincingly

documented in the literature for more than 40 years. Nurses. environment include an

enclosed atmosphere, time pressures, excessive noise or undue quiet, no second chance,

unpleasant sights and sounds, and long standing hours4.

Nurses are trained to deal with these factors but chronic

stress takes a toll when there are additional stress factors like home stress, conflict at

work, inadequate staffing, poor teamwork, inadequate training, and poor supervision.

Stress is known to cause emotional exhaustion in nurses and lead to negative feelings

toward those in their care5.

In the absence of doctors, nurses are on the front line and

have to face verbal abuse from patients and relatives for issues that may not be directly

connected to their work. Physical violence and aggressiveness is also on the rise in

patients and their relations. Demanding patients and their relatives can cause conflict and

lead to more stress. Patient’s expectations from nurses are sometimes unreasonable and

they tend to be aggressive. No training is given to them to deal with confrontation6.

It is important to identify the extent and sources of stress

in a healthcare organization to find stress management strategies to help the individual

and the environment. Stress in nurses affects their health and increases absenteeism,

attrition rate, injury claims, infection rates, and errors in treating patients. Unless the

healthcare setups acknowledge the problem and taken preemptive steps to tackle the

growing menace of chronic stress, personnel costs will keep rising and add to the already

soaring costs of care. Nurses’ absenteeism, turnover, and sickness significantly increase

the cost of employment in healthcare units7.

6.1NEED FOR STUDY

Stress and burnout are concepts that have sustained the interest

of nurses and researchers for several decades. These concepts are highly relevant to the

workforce in general and nursing in particular. Many studies of stress in nurse in

developed countries have shown chronic stress as a major contributor to suicide or

suicidal thoughts, smoking, excessive coffee consumption, and alcohol intake.5

A moderate level of stress or Eustress is an important

motivating factor and is considered normal and necessary. If stress is intense,

continuous, and repeated, it becomes a negative phenomenon or Distress which can lead

to physical illness and psychological disorders. Nurses are the backbone of any

healthcare unit. The pressures of overtime and long working hours create a work

personal life imbalance, which begins to affect the health of the employees.7

Lack of professional respect and recognition by authorities and

doctors is the major cause of stress among nurses in India. Poor relationship with

physicians was related to stress, which is seen as the most important reason for nurses

leaving hospitals. Lack of autonomy, poor participation in patient care due to lack of

sufficient knowledge and empowerment deprives them from job satisfaction. Nurses in

India are mainly from the lower economic strata and have low educational qualifications.

Their main motivators are salary and benefits to support their home and maintain a

decent standard of living. Shortage of staff makes them easily succumb to increasing

their pay package by doing excessive hours of overtime at the expense of their health.

They have limited access to claims and compensation for occupational hazards.7

Changes in health care systems, including the international

shortage of nursing staff, have implications on role stress felt by nurses, especially by

nursing managers. In a review of 68 articles on nurses' role stress, the most frequently

identified stressors were workload, role conflict, ambiguity, and lack of support (Chang,

Hancock, Johnson, Daly, & Jackson, 2005). Stress leads to job dissatisfaction, burnout,

and absenteeism; also, negatively impacts patients (Aiken et al., 2001; Lee & Henderson,

1996).8

Vicarious trauma and burnout are serious manifestations of workplace

stress. Both can have substantial consequences for health care professionals, health

services, and consumers. a study examining the prevalence, distribution, correlates, and

predictors of vicarious trauma and burnout among Registered Psychiatric Nurses (RPNs).

A survey was distributed to all practicing RPNs in Manitoba, Canada (N = 1,015). The

survey contained the Maslach Burnout Inventory, the Traumatic Stress Institute Belief

Scale The RPNs were found to be experiencing high levels of emotional. Stress

experienced by RPNs, as well as strengths on which to build, clearly are evident in the

study results. Strategies for reduction in workplace stress may benefit psychiatric nurses,

clients, and health services9.

Nurses are responsible for creating the environment in which

nursing is practiced and patient care is given, it is important to explore interventions that

will reduce the stress and burnout experienced by nurses. By reducing the stressful nature

of the nurses’ work, nurse could be more satisfied in their positions. This role

satisfaction, in turn, could lead to improve the work environment for staff nurses.10

From the above reviews and investigators experience during

working in hospital investigator felt the need to assess and compare the level of stress

among nurses working in psychiatric and multi specialty hospitals for establishing the

existence and extent of work stress in nurses in a hospital setting, identifying the major

sources of stress, and finding the incidence of illness related to stress.

Stress is like an iceberg. We can see one-eighth of it above, but what about

what’s below?”

6.2

REVIEW OF LITERATURE

INTRODUCTION

Review of literature is a key step in the research process. The typical

purpose of analyzing a review of existing literature is to generate questions and to

identify what is known and what is unknown about the topic. The major goals of review

of literature are to develop a strong knowledge base to carry out research and non

research scholarly activity.

In this present study to have in-depth information in the selected

problem the researcher has reviewed 8 literatures ranging from 2000 to 2010 studies and

articles which are chosen from books, journal article and internet publication.

In this study, the review of literature is presented under the following headings:

Section –A: Studies related to stress among nurses working in psychiatric

hospital.

Section –B: Studies related to stress among nurses working in multispecialty

hospitals.

Section–C: Studies related to comparison between stress among nurses

working in psychiatric and multispeciality hospitals.

.

STUDIES RELATED TO STRESS AMONG NURSES WORKING IN

PSYCHIATRIC HOSPITAL.

A study was conducted by Bai JY and Suh MJ. In 1999 “to

measure the degree of work stress perceived by clinical nurses working in psychiatric

ward”. The survey method was used and the subjects of this study consisted of 135

psychiatric nurses from 7 university hospitals and 4 provincial general hospitals. The

results of study were summarized as follow. The degree of perceived stress among

psychiatric nurses was considerably high (4.32 out of 6.00). Among the stressors,

inadequate staffing (5.04), hospital administration problems (4.7) and the conflict of

nurse-patient relationship were identified as the stress factors with high rank of degree

of stress. The relationship between several stress factors and some of the demographic

and the job-related variables were significantly identified.11

A study was conducted by Sherring S and Knight D. in

2009 “to describe burnout among mental health nurses” the study involved a

questionnaire survey of all 475 mental health nurses working at a city NHS Trust. A

deeper understanding of burnout within the Trust was developed, with statistically

significant relationships showing that nurses experiencing burnout were more likely to

take sick leave and to be considering leaving their jobs or the NHS. Levels of burnout

experienced were significantly related to academic qualifications, the frequency and

adequacy of clinical supervision, feeling supported and valued at work and feeling

involved in decision making and changes. Nurses who have higher-level academic

qualifications and who feel supported and valued at work have lower levels of

burnout.12

A study was conducted by McLeod T. in 2007 to “examines the findings of

a research study on the levels and sources of stress among community psychiatric

nurses” CPNs working with the severely mentally ill reported higher caseloads, less

training, lack of respect and understanding of their role by others and the need for more

supervision and support. Forty per cent of CPNs were found to be stressed according to

the General Health Questionnaire (GHQ 28). While there is debate about where CPNs

should focus their interventions and which clients should be prioritized, it appears that

working with the severely mentally ill is less attractive and more stressful to CPNs.13

A study was conducted by Robinson JR, Clements K,

Land C. in 2003 “to assess workplace stress among psychiatric nurses”. A survey was

distributed to all practicing RPNs in Manitoba, Canada (N = 1,015). The survey

contained the Maslach Burnout Inventory, the Traumatic Stress Institute Belief Scale

The RPNs were found to be experiencing high levels of emotional exhaustion (i.e., high

burnout) and even higher levels of personal accomplishment (i.e., low burnout). Stress

experienced by RPNs, as well as strengths on which to build, clearly are evident in the

study results. Strategies for reduction in workplace stress may benefit psychiatric

nurses, clients, and health services. 14

A study was conducted by Richards DA, Bee P, Barkham

M, in 2006 “To review the prevalence of low staff morale, stress, burnout, job

satisfaction and psychological well-being amongst staff working in in-patient

psychiatric wards”. Systematic review. Of 34 mental health studies identified, 13 were

specific to acute in-patient settings, and 21 were specific to other non-specified ward-

based samples. Most studies did not find very high levels of staff burnout and poor

morale but were mostly small, of poor quality and provided incomplete or non-

standardised prevalence data. The prevalence of indicators of low morale on acute in-

patient mental health wards has been poorly researched and remains unclear. Multi-site,

prospective epidemiological studies using validated measures of stress together with

personal and organizational variables influencing staff stress in acute in-patient wards

are required. 15

A study was conducted by Nolan G, Ryan D. In 2008 “to

explore the experience of stress among psychiatric nursing students undertaking their

'internship' or final year”. A questionnaire was administered to all 28 students in the

intern year in conjunction with the 28-item version of the General Health

Questionnaire. Approximately 48% of respondents reported levels of stress above the

threshold score as described by Goldberg (1978), indicating levels of distress unlikely

to remit without intervention. Interview data suggested that the main sources of stress

during the intern year were associated with relationships in the clinical environment;

clinical workload; matching competence and responsibility; and simultaneous clinical

and academic demands. 16

STUDIES RELATED TO STRESS AMONG NURSES WORKING IN

MULTISPECIALTY HOSPITAL.

A study was conducted by DePew CL, Gordon M, Yoder

LH, Goodwin CW. In 1999The “to determine whether the personality trait of

hardiness is a predictor of burnout” Forty-nine registered nurses working in 7 special

care units completed the Tedium Burnout Scale, the Nursing Stress Scale, and the

Hardiness Test. Results indicate that burnout, stress, and hardiness had a significant

relationship (P < .001). Hierarchical multiple regression analysis indicated that

hardiness alone accounted for 35% of burnout variance (P < .05) and that the addition

of stress had no effect. However, in this study, nurses from the Burn Intensive Care

Unit had the highest burnout and stress scores and the lowest hardiness scores of nurses

from the 7 units. This study confirms findings by a previous study that hardiness is a

predictor of burnout but is not a buffer in the stress-burnout relationship. 17

A study was conducted by Watson P, Feld A. in 2006 to “Assess stress

and burnout among nurses in a multispecialty hospital”. High stress and staff turnover

in a multispecialty paediatric area. Fifty-four percent (n = 14) of the paediatric nurses

completed a questionnaire booklet that included demographic data, the Burnout

Inventory. Results indicated levels of burnout and distress comparable with larger

studies. Conflict with doctors was the major source of stress, followed by workload,

inadequate preparation in dealing with the emotional needs of patients and their

families and death and dying. Conflict with doctors has not previously been identified

as the major source of stress. However, workload and death and dying are commonly

identified as sources in the literature. Suggestions for further research and the low

response rate are discussed. 18

A study was conducted by Jaracz K, Górna K,

Konieczna J. in 2005 to “evaluate professional burnout among multispeciality hospital

nurses” A study sample consisted of 227 nurses from general medical, neurological and

psychiatric hospital wards. A set of 3 questionnaires was used, including Maslach

Burnout Inventory (MBI), Coping Inventory for Stressful Situations (CISS) and

Subjectively Perceived Stresss (SPS).Average and high level of burnout in the

emotional exhaustion (EE), depersonalisation (D) and personal accomplishment (PA)

was present at 71%, 39.8% and 77% of nurses respectively. A significantly higher level

of burnout was noted in the subgroup of general medical nurses. The level of stress

influences the professional burnout among nurses. There is a diversity in the level of

burnout depending on the specialization at work, which is not accompanied by a similar

diversity in the subjectively perceived stress. 19

A study was conducted by Adachi H, Inoue M, Inaba R,

Iwata H. in 1999 to assess “Mental health and stress coping among specialty hospital

nurses”. A self-administrated questionnaire including questions on nursing work, the

General Health Questionnaire (GHQ) as well as the Stress and Stress Coping

questionnaire (SSCQ) was used. The subjects of this study were 225 female nurses. The

results obtained were as follows, either of the following determinants was related to

negative mental health: experience of 1-2 years; working in the operating room or in-

patient department. 2) The subjects whose working experience was < 5 years or > or =

10 years had higher scores in the SSCQ. These findings suggest that because working

conditions have a negative influence on mental health, educational system for both

inexperienced and experienced nurses is needed to develop an effective stress-coping

style in medical institutions. 20

A study was conducted by Han K, Kim NS, Kim JH, Lee

KM. in 2004 to “identify the factors influencing Symptoms of Stress among hospital

staff nurses”. Data was collected by questionnaires from 249 hospital staff nurses in

three multi specialty Hospital. The score of the symptoms of stress showed a

significantly positive correlation with the score of work stress (r=.22, p=.00). The most

powerful predictor of symptoms of stress was social support and the variance explained

was 16%. A combination of social support, ways of coping, and work stress account for

32% of the variance in symptoms of stress among hospital staff nurses. This study

suggests that social support, ways of coping, self efficacy, hardiness, and work stress

are significantly influencing factors on symptoms of stress among hospital staff nurses. 21

STUDIES RELATED TO COMPARISON BETWEEN STRES AMONG

NURSES WORKING IN PSYCHIATRIC AND MULTISPECIALTY

HOSPITAL.

A study was conducted by Hughes H, Umeh K. in 2005 to

“assess stress differentials between psychiatric nurses (PNs) and general nurses” It was

expected that PNs would report different (higher) stress levels than GNs given PNs'

lower levels of social support. A questionnaire was completed and returned by 73

nurses at several public hospitals in England. Multivariate analysis of variance showed

that social support moderated stress differentials between PNs and GNs, albeit not as

anticipated; the latter group reported significantly higher and lower stress levels when

social support was low and high, respectively. This interaction was applicable to both

the quality and quantity of social support. Overall, the benefits of social support seemed

to accrue primarily to GNs. Implications of these findings for the developments of

stress-reduction interventions are considered.22

A study was conducted by Yada H, Abe H, Omori H, Ishida Y,

Katoh T. to 2009 to “identify stressors (causes of stress) for psychiatric department

nurses, and to compare the differing stress variables and levels of stress encountered in

the acute ward and the recuperation ward”. The study uses a brief work stress

questionnaire and then asks 24 questions relating to the particular stresses that nurses in

a psychiatric department may encounter and the length of time they are exposed to

them. Answers were obtained from 36 nurses and associate nurses in two psychiatric

departments. The results of this analysis show that the factor scores for recuperation

ward nurses were significantly higher than those for nurses from acute ward, and in all

factors in the subscale "Stressors among Nurses in Psychiatric Department", indicating

that nurses in recuperation ward had high levels of stress. 23

A study was conducted by Pryjmachuk S, Richards DA.

in 2007 to describe “Mental health nursing students differ from other nursing students”

A cross-sectional survey of all nursing students on the department's roll (n = 1362),

using a range of self-report measures bound together in a 'questionnaire pack', was

undertaken. The findings revealed that mental health nurses were notably different

from the other three branches in terms of the quantity and characteristics of the sources

of stress they faced, the levels of stress they experienced, and the ways in which they

coped. These differences were largely advantageous to the students' well-being and

speculations are made as to whether the concept of 'hardiness'- especially its focus on a

sense of being in control - plays a role in explaining the findings.24

6.3

A study was conducted by Snelgrove SR. in 1999 to

“Assess occupational stress and job satisfaction: a comparative study”. This study

examines self-reported stress and job satisfaction of health visitors (n = 68), district

nurses (n = 56) and community psychiatric nurses (n = 19) in one health authority in

the UK. The levels and sources of stress and satisfaction were examined in relation to

speciality. Stress levels were assessed using The General Health Questionnaire-12. The

results showed that levels of stress were a function of occupation with significant

variation between groups. Health visitors yielded the highest stress scores and lowest

job satisfaction scores. indications were that all three groups were dissatisfied with

supervisory relationships. Recommendations include more creative and supportive

supervisory relationships, such as clinical supervision. 25

A study was conducted by Lyons JS, Hammer JS,

Johnson N, Silberman M. in 2001 to “compare of levels of occupational stress across

multiple units of a multi specialty hospital”. Using a scale designed to measure a four-

component model of occupational stress in medical environments, the results indicated

that a significant amount of the variation in this measure was accounted for by the unit

on which the respondent worked. There were no significant differences across levels of

employment (e.g., house staff, nurse clinician, registered nurse, licensed practical

nurse, clerk). 2

STATEMENT OF PROBLEM:

“A COMPARATIVE STUDY TO ASSESS THE LEVEL

OF STRESS AMONG STAFF NURSES WORKING IN

PSYCHIATRIC AND MULTISPECIALITY HOSPITALS AT

BANGALORE ”

OBJECTIVES OF THE STUDY

1. To assess the level of stress among the nurses working in psychiatric hospital.

6.4

6.5

2. To assess the level of stress among nurses working in multispecialty hospital.

3. To compare the level of stress among nurses working in psychiatric and

multispecialty hospital.

4. To associate the level of stress among nurses working in psychiatric and

multispecialty hospital with their selected demographic variables (sex, age.

qualification,working area,working hours)

HYPOTHESIS

1. H1: There will be a significant difference in level of stress between the nurses

working in psychiatric and multispeciality hospitals

2. H2- There will be a significant association between the level of stress of study

subjects with their selected demographic variables (sex,

age.qualification,working area,working hours)

OPERATIONAL DEFINITIONS:

ASSESS In present study word Assess refers to Measure the level stress among nurses

6.6

working in psychiatric and multispecialty hospital by using rating scale.

STRESS:

In present study word Stress refers to an emotional disturbance experience by the

nurses working in psychiatric and multispecialty hospital. It can be categorized into

three.

o Mild Stress : score on rating scale less than 50 %

o Moderate Stress: score on rating scale less than 50-75 %

o Severe Stress: score on rating scale more than 75 %

NURSES:

In present study word nurse refers to a qualified nurse having certification of state

nursing council completed a minimum of Diploma certificate that are eligible to impart

care to clients either in hospitals or community

MULTISPECIALTY HOSPITAL

In present study word Multispecialty hospital refers to an institution that provides

medical, surgical, psychiatric and all other specialty care and treatment for the sick or

the injured.

PSYCHIATRIC HOSPITAL:

In present study word psychiatric hospital refers to an institution that provides

psychiatric care and treatment for the mentally disabled patient.

6.7 ASSUMPTIONS

There will be increased level of stress among nurses working in

psychiatric and multispecialty hospital.

DELIMITATIONS:

6.8

6.9

7.0

7.2

Study is limited to 60 samples.

The study is limited only to assess the level of stress.

PROJECTED OUTCOME

The present study will help the staff nurses to gain an awareness regarding

their level of stress and there by necessitates research regarding the reduction of

stress level among staff nurses in future.

MATERIALS AND METHODS

7.1 SOURCE OF DATA

Nurses working in psychiatric and multispecialty hospitals in selected Hospital

at Bangalore.

7.1.1 RESEARCH DESIGN

The research design adopted for this study is pre-experimental design.

RESEARCH APPROACH

The research approach is descriptive.

7.1.2 SETTING:.

The study will be conducted in selected psychiatric and multispecialty hospitals at

Bangalore

7.1.3 POPULATION

The population selected are staff nurses.

METHOD OF DATA COLLECTION

7.2.1 SAMPLING PROCEDURE

The Sampling Technique adopted for this study is Non Probability –

convenient sampling technique

7.3

7.4

.7.2.2 SAMPLE SIZE

The sample size is 60.

7.2.3 INCLUSION CRITERIA

1. All age groups of nurses working in psychiatric and multispecialty hospital.

2 Nurses who can able understand and read either Kannada or English

7.2.4 EXCLUSION CRITERIA:

1. Nurses who are not willing to participate in study.

2. Nurses who are not present at the time of study.

7.2.5 INSTRUMENT INTENDED TO BE USED

SELECTION OF TOOL

This consist of two parts :

PART 1 :consist of demographic variables such as sex,education age,religion, area of

working.

PART 2: Rating scale will be used to assess the level of stress.

SCORING PROCEDURE

SCORING INTERPRETATION:

Level of knowledge Range

Mild Stress : score on rating scale less than 50 %

Moderate Stress: score on rating scale less than 50-75%

Severe Stress: score on rating scale more than 75 %

DATA COLLECTION METHOD

Prior permission will be obtained from the Nursing

7.5

7.6

7.7

Superintendent and Ward In- charge before conducting the study.Consent will be

taken from the staff nurses . Data will be collected within 4 weeks.

PILOT STUDY

6 samples will be selected and study will be conducted to find out the feasibility.

DATA ANALYSIS PLAN

The data obtained will be analyzed in view of the objectives of the

study using descriptive and inferential statistics.

The plan for data analysis is as follows: -

Frequencies and percentage of distribution will be used to

analyze the demographic data.

Mean, Median and Mode, Standard deviation is used for

assessing the stress scores.

Chi-square test to find out the association between the level of

stress with selected demographic variables. The significant

findings will be experienced in tables, figures and graph.

DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR

OTHER HUMANS OR ANIMALS?

- No-

HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION?

YES, Ethical clearance will be been obtained from the research

committee of Nightingale college of nursing.

Consent will be taken from the hospital and permission will be taken

from the study subjects before the collection of data.

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9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

11.3CO-GUIDE

11.4SIGNATURE

11.5 HEAD OF DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKSOF THE PRINCIPAL

12.2 SIGNATURE