RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

A STUDY TO ASSESS THE JOB RELATED STRESS AND ITS COPING PATTERN

AMONG STAFF NURSES WORKING IN CRITICAL CARE UNIT IN A SELECTED

HOSPITAL IN BANGALORE.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

SRI SHARADA COLLEGE OF NURSING,

UTTARAHALLI, BANGALORE -61.

Mr. GIRISHA H.B

PSYCHIATRIC NURSING

I YEAR M.SC NURSING

1

SRI SHARADA COLLEGE OF NURSING

BANGALORE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 NAME OF THE

CANDIDATE AND

ADDRESS

Mr. GIRISHA H B

1ST YEAR M.Sc. NURSING

SRI SHARADA COLLEGE OF NURSING

#42-45 UTTARAHALLI MAIN ROAD,

UTTARAHALLI.

BANGALORE-560061.

2 NAME OF THE

INSTITUTION

SRI SHARADA COLLEGE OF NURSING

#42-45 UTTARAHALLI MAIN ROAD,

UTTARAHALLI.

BANGALORE-560061.

3 COURSE OF THE STUDY

AND SUBJECT

M.Sc. NURSING 1 YEAR

PSYCHIATRIC NURSING

4 DATE OF ADMISSION TO

THE COURSE

04– 06 – 2012

5 TITLE OF TOPIC ”A STUDY TO ASSESS THE JOB RELATED STRESS

AND ITS COPING PATTERN AMONG STAFF

NURSES WORKING IN CRITICAL CARE UNIT IN A

SELECTED HOSPITAL IN BANGALORE.”

2

6. BRIEF RESUME OF THE INTENDED STUDY

INTRODUCTION

For us who nurse, our nursing is a thing which, unless we are making progress every

year, every month, every week, take my word for it, we are going back... Florence nightingale

According to the World Health Organization, the main determinants of health include the

social and economic environment, the physical environment and the person's individual

characteristics and behaviors. Generally the context in which an individual lives is of great

importance on his life quality and health status. The social and economic environment are key

factors in determining the health status of individuals given the fact that higher education levels

are linked with a higher standard of life as well as a higher income. Generally, people who finish

higher education are more likely to get a better job and therefore are less prone to stress by

comparing to individuals with low education levels. The example set by the family as well as the

relationship with friends and family can have a great impact on one's general health.

Nonetheless, genetics may play a role in the manner in which people cope with stress. In daily

life failure to which represents with many emotional reactions may be as anxiety, fear,

aggression or violence etc.1

Health research plays a major roll in advancing science, in providing solution for health

problems and can contribute to growth, development equity, global security and fight against

poverty. The massive imbalance in health research funding and output in terms of populations

addressed has been referred to as 10/90 gap. Mental and Neurological Disorders are responsible

3

for 13% of behavior related disorder for another third of the global burden of disease. Despite the

evidence, mental health is a more neglected area within public health

Anger is a normal human emotion that is crucial for individual growth and is a present in

all relationship. When handled appropriately and expressed assertively, anger is positive creative

force that leads to problem solving and productive change. When channeled inappropriately and

expressed as verbal aggression or physically aggression, anger is a destructive and potentially

life force. Physical aggression is also called assault or violent. It is important to note that most

violent individual is not psychiatrically ill. It is commonly associated with psychotic disorder,

such as delirium, drug intoxication or withdrawal, central nervous system disorder etc.4 Hence

aggression can be defined as verbal aggression which could be demanding or argumentative,

shouting, yelling or screaming, swearing or using abusive language, other things includes

generally in a bad mood irritable or quick to fly off handle critical, sarcastic or derogatory,

saying someone is incompetent impatience or anger if something does not suit him /her or for

that matter being angry with him/her are also included. 7

Workplace stress has long been recognized as a challenge for the nursing

profession .stress is perceived when environmental demands exceed the individual

resources .role –stress occurs through perceived mismatch between the expectations of the role

and the accomplishment. Lazarus considered stress as the transaction involving individual and

his or her environment.

4

There is growing body of research about stress in nursing in addition to some general

indications. For example, occupational mortality figures in early 1980s indicated that the suicide

rate for female nurses was significantly higher than national average. 3

5

6.2 NEED FOR THE STUDY:

Job life is one of the important parts of our daily lives which cause a great deal of stress.

Due to the competitive nature of the job environment most of the people in the world are

spending their time for job related work purpose resulting ignore the stressor those one

influencing their work and life. Usually people are more worry about their outcome of work that

can even affect the and relatives)

The working environment of intensive care unit nurse is constant source of stress

researches have described CCU as stressful environment because of the complex nature of

patient’s health problems requiring an intensive use of very sophisticated technology.2

Nurses not only have to cope with sophisticated technology but also regularly face ethical

dilemmas concerning issues of patient care management .the changes in health care delivery has

also created new nursing roles and responsibilities and has also contributed to source of stress.

Stress occurs when nurses try to manage patients nursing care within the scope of nursing

stress also occurs when there is a constant desire to achieve only the best Studies have also

shown that high level of stress can affect the competence and job performance of nurse. Nurses

working in environments where verbal and physical aggression is prevalent are more likely to

experience the effects of stress.4

Nurses as one of the professional service of tend to be exposed to extreme workloads.

Their works are generally characterized by having a high contagious potential, being labor-

intensive, having an overwhelming. Job shifting and experiencing malicious complicated and 6

dynamic occurrences under strict time pressures. Studies have generally revealed that

continuously excessive working loads tend to lower their job satisfaction and deteriorate in

turnover intentions.

Previous research has also indicated that the source among CCU nurses is more

organization in nature .organizational stressors could be physical, psychological and social in

nature. Nurses working in environments where verbal and physical aggression is prevalent are

more likely to experience the effects of stress. The other determinants causing the stress in CCU

nurse could be due to increased job demand, nursing shortages, overload of work, and lack of

support from colleagues a lot of paperwork and high expectations from the superior. 5

7

6.2 REVIEW OF LITERATURE

A study was conducted on working in ICU different hospitals in Palma demallorca

descriptive and factors analysis about causal and emotional factors to work stress in ICU nursing

staff. The importance of accurate measurements. Such emotional are divided into seven factors

which explain 65.31% of the variance and define states of personal satisfaction,

depersonalization, and anxiety low self esteem. The results corroborates previous research

findings on work stress provide a simplified tool for assessing this and show the need to quantify

the degree of such manifestations in the assessments.12

A study was conducted on workplace stressors coping, demographic and job satisfaction

in Chinese intensive care nurses in department of nursing in tongji medical school, huazhong

university of science and technology wuhan, china. It remains unclear is the findings of the

research conducted in western culture countries are applicable to Chinese nurses .the study

design used administered four self report questionnaires. The results suggested that the almost

frequently cites workplace stressor was workload, while the most commonly used coping

strategy was planning. Two hundred and twelve significant positives and negative correlations

were found among the various workplace stressors, coping strategies, demographic

characteristics and the different factors comprising job satisfaction.13

A study was conducted on job stress and the coping of ICU nurses in college of

nursing, pusan national university, busan koren. The data was accumulated from 206 ICU nurses

services at least more than one year in 500 order hospitals during the period of three months. The

averages job stress was 2.96% -95 points, which was 2.55-23points, for the prevention of job 8

stress, every effort is required to analysis the causes of stress caused by job circumstances and to

pose an appropriates solution. Mean which, job stress, needs to be controlled using, a solution for

the central problem, and search for social support.14

A study was to identify and analyses professional stressors, evaluate the level of

stress in nurses in intensive care units and assess the correlation between the perception of stress

and psychological and somatic symptoms or disease shown by nurses. The research, design as a

cross sectional study, was carried out in the intensive care units in health centers, in Serbia. The

sample population encompassed 1000 nurses; expanded nursing stress scale was used as the

research instrument. In view of permanent, escalation of professional stressors, creating a

supporting working environment is essential for positive health outcomes, prevention of job

related diseases and better protection of already ill nurses.15

A study was conducted on registered nurses stress in intensive care units in

Australia perspective this is describe a study of stressors and coping mechanisms in different

grades of registered nurses in intensive care unit. The research demonstrated that significant

correlation existed between relating what and when to report clinical patient changes and relating

theory to practices. The findings conforms that environmental stressors are the major stressors in

ICU and demonstrates that sound knowledge and assessment skills are important factors in

reducing perceived stress.16

A study was conducted on a comparative study on the effectives of

professionalization on German and America intensive care nurses in a German us American

comparative study of 13 ICU nurses each analyzes what effects a higher degree of

9

professionalism has on every day nursing practice. Using the data of structured interviews,

dimension of job perception and aspects of coping capability with stress in regard to patient care

and relation with physician of both nursing groups are compared. The results show that US

American nurses often refer to cognitive, aspects of being in control of a situation and emphasize

their professional part. 17

A study was conducted on reviewing nursing stress according to a proposed coping

adaption framework in seton Hall University, college of nursing, south orange, newjersey. Is

stress is a common problem for nurses, who in intensive care units, stress coping theory is useful

in analyzing ineffective coping and its outcome. This study show compares stress among nurses

in ICU to stress in non ICU nurses. Effects of stresses, such as nursing dissatisfaction and the

loss of nurses to the profession will discuss .Research and commentaries, regarding stress in ICU

nurses, non ICU nurses will be reviewed. Areas for future research will be presented.18

A study was conducted on ICU nurses coping measures response to work-load stressors.

Stress is an integral part of every workplace. The environment of an intensive care unit exposes

critical care nurses to nurses to a proportionately greater amount of work-related stress than most

occupations. Several components contributing to stress as well as coping measures are

discussed.19

A study was conducted on critical care nurses, ethical decision making and stress. In

school of nursing, university of Pittsburgh, Pennsylvania. USA .this cross-sectional study

examines the relationship between selected aspects of ethical decision-making stress and selected

characteristics, sixty one critical care nurses completed the nurses’ ethical decision making –ICU

10

questionnaires and the health professions stress inventory. Finding revealed that nurses who

selected the patient advocacy model had significantly higher nurses’ autonomy scores, that

perceived anxiety had a negative association with nurses’ autonomy, and that workplace

restrictions and stress were related.20

A study was designed to investigate the sources of job stress and the adopted coping

strategies of nurses who were working in an accident and emergency department in Shiraz

University Iran. In their descriptive survey university of medical science ninety emergency ward

nurses from there large teaching hospital. The date was collected through a self administration

questionnaire to identify the sours of job stress and nurse’s profile and Lazarus standard

questionnaires to determine the types of coping strategies. The result was a respondent was

women 86.7% between 23-50 years old with less than 5 year of experience.56.7%. The following

stressors were identified. Problem related to physical environment, workload dealing with

patients or their relatives and handling their anger, being exposed to health safety hazards lack of

support by nursing administrations, absence of the corresponding physician in the emergency

room and lack of equipment, generally was issued.21

11

STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE JOB RELATED STRESS AND ITS COPING PATTERN

AMONG STAFF NURSES, WORKING IN CRITICAL CARE UNIT IN A SELECTED

HOSPITAL IN BANGALORE.”

6.3 OBJECTIVES

6.3.1 To assess job related stress among staff nurses working in critical care unit.

6.3.2 To assess the coping pattern of staff nurses working in critical care unit.

6.3.3 To find correlation between jobs related stress and coping pattern among staff nurses.

6.3.4 To find association between jobs related stress and coping pattern with selected

demography variables

6.4 RESEARCH HYPOTHESIS

H1: There is a significant correlation between job related stress and coping pattern.

H2: There is a significant association between job related stress and level of coping.

6.5 VARIABLES:

Dependent Variable:

Job related stress and coping pattern among staff nurses working in critical care

unit.

12

6.6 OPERATIONAL DEFINITIONS

6.6.1 Assess: Assess refers to the verbal response to know the job related stress and coping

pattern

6.6.2 Critical care units: Critical care unit is a departmental unit that focuses on caring for

patients who have critical and life threatening conditions. In this study it refers to medical

intensive care units, surgical intensive care units.

6.6.3 Staff nurses: They are the registered nurses who provide care to patients with serious

conditions in intensive care environments.

6.6.4 Job Related Stress: It refers to an emotional and physical strain caused by a pressure due

to nature of job of nurse working in a critical care units coping pattern.

6.6.5 Coping Pattern: coping pattern refers to staff nurses’ pattern of coping response related to

job related to stress

6.7 ASSUMPTION

1. Staff Nurses working in critical care unit may have more job related stress.

6.7 DELIMITATION OF THE STUDY:

The study period is delimited to 4 weeks of duration.

7. MATERIAL AND METHODS OF STUDY:

13

7.1 Sources of Data Collection

Data will be collected from the staff nurses in selected Critical Care Units at selected hospital,

Bangalore.

7.2 METHOD OF COLLECTING DATA

Data collection is planned through the structure questionnaire on job related stress and coping

Pattern among Staff Nurses.

7.2.1 RESEARCH DESIGN

Descriptive, correlation research design is adapted to this study

7.2.2 RESEARCH APPROACH

Survey Approach is adapted to this study

7.2.3 RESEARCH SETTING

The study will be conducted in selected hospital at Bangalore

7.2.4 POPULATION:

Staff nurses those who are working in selected critical care units at Bangalore.

7.2.5 SAMPLE:

Staff nurses those who fulfilled the inclusion and exclusion criteria will formulate the

samples of this study.

14

7.2.6 SAMPLE SIZE:

Sample comprises to 60 staff nurses.

7.2.7 SAMPLING TECHNIQUE:

The non-probability convenient sampling technique will be used for the selection of

sample.

7.2.8 CRITERIA FOR SELECTION OF SAMPLES:

Inclusion criteria

1 This study will include staff nurses those who are willing to participate in this study.

2 This study will include staff nurses who are available during the time of study.

Exclusion criteria

The study will not include other than Nurses who are in critical Care Unit

7.2.9 TOOL FOR DATA COLLECTION

The data collection tool will consist 2 parts.

Part A – Demographic variables of staff nurses.

Part B – Structured questionnaire on job related stress and coping pattern.

7.2.10 PLANS FOR DATA ANALYSIS:

It includes descriptive and inferential statistics

15

Descriptive Statistics

Frequency and Percentage distribution of demographic variables of staff nurses.

Mean and Standard Deviation for level of Job related stress and Coping Pattern of staff

nurses in critical care unit in selected area Bangalore

Inferential Statistics

1. Paired test is planned to compare pre-test and post-test knowledge.

2. Karl Pearson correlation coefficient will be used to correlate of stress related

stress and coping pattern.

7.3 DESCRIPTION OF INTERVENTION:

Not applicable

7.4 ETHICAL CLEARANCE

7.4.1 Informed consent will be obtained from the chosen samples?

Yes.

7.4.2 Has Ethical clearance being obtained from the institution?

Yes

7.4.3 Has the consent taken from intensive care Units Nursing Directors/ Nursing

Superintendents?

16

Yes

ETHICAL COMMITTEE

TITLE OF THE TOPIC "A study to Assess the Job Related Stress and its

Coping Pattern Among Staff Nurses, Working in

Critical Care Unit in a Selected Hospital in

Bangalore."

NAME OF THE

CANDIDATE

Mr. Girisha H.B

COURSE AND THE

SUBJECT

1st Year Master Of Science In Psychiatric Nursing

NAME OF THE GUIDE Mrs. VENKATALAXSHMI., M.Sc. (N)

Head of the Department

Department of Psychiatric Nursing

Sri Sharada College of Nursing, Uttarahalli,

Bangalore.

ETHICAL COMMITTEE Approved

17

MEMBERS OF THE ETHICAL COMMITTEE:

1. Prof. Baskaran .J. M. Sc(N)

Principal& Head of the Department

Department of Medical Surgical Nursing

Sri Sharada College of Nursing, Bangalore – 61.

2. Mrs. K. Padmavathi M. Sc(N)

Vice Principal &Head of the Department

Department of Medical Surgical Nursing

Sri Sharada College of Nursing, Bangalore– 61.

3. Prof. Maeshwari Bai MSc (N)

Head of the Department

Department of Mental Health Nursing

Sri Sharada College of Nursing, Bangalore – 61.

4. Mrs. Venkatalakshmi M. Sc(N)

Asst. Professor

Department of Mental Health Nursing

Sri Sharada College of Nursing, Bangalore – 61.

5. Mr. Anil Kumar R.V. M. Sc(N)

Head of the Department

Department of Child Health Nursing

Sri Sharada College of Nursing, Bangalore – 61.

6. Dr. Ganga Boriah

Statistician

Department of community medicine

Kempe Gowda Institute of Medical Science, Bangalore.

7. Dr.K.C. Tharun M.S

Chairman, Vishwabharathi hospital Pvt Ltd,

Sri Sharada Nursing College, Bangalore-61.

8 LISTS OF REFERENCES: 18

1. Raja Laxshmi RG Department of Nursing, Ministry of Health Prevalence of Stress

and Coping Mechanism among Staff Nurses in the intensive care unit. med and health

2007 (2) :

2. Journal of mental health and human behavior 2011.

3. Journal of advanced nursing 1997 (26) page 953-961

4. European journal of social science a study of job stress on job satisfaction among

university staff in Malaysia volume 8.

5. Dorothy James. Stress and management. [Online]. Available from: URL:

http://www.righthealth.com/topic/stress/Depression_And_Seniors/overview/

healthcomarticles#ixzz17n0Epu8p

6. Gail w. Stuart Michele, T laria. Principle and practice of psychiatric nursing. 7 th

edition. New Delhi: Harcourt India PVT ltd; 2001.

7. Kaplan and Sadock C, Benjamin.J. Comprehensive text book of psychiatric nursing.

8th edition. 2005.

8. Louise rebrace shives, AnnLsaacs.Basic concepts of psychiatric mental health

nursing. 5th edition 2002.

9. www.wikiped.com.in

10. Chen G , Shen H, Chen G. Post traumatic stress disorder. Can J Psychiatry. 2012 Sep;

57(9):547-53.

19

11. Denise Polit, Cherry Tanto Beck. Nursing Research. Review of Literature. New

Delhi; Wplters Kluwer. 2008

12. Fornes vives J, gallego caminer O.G, Barcelo Oliver M, crespi capon, Gutierrez

Casado A edition intensive crib care nurse 1994, 3rd, 10th volume page No. 41-50.

13. Lij, Lambert V. A workplace stressors, coping demographics and job satisfaction in

Chinese intensive care nurses. Edition nurse crit care 2008 June –Feb. 13th volume

(IISu) page No .12-24.

14. Park H.S, Gang E.H a study on job stress and the coping ICU Nurses. Edition Tachan

Kanho Halkhoe chi 2007- Aug., 37th volume (1), Page No. 810-21.

15. Milutinovic D, Golubovic B, Brakic N, Prokes B professional stress and health

among critical care nurses in Serbia, edition Arh Hig rada Joksikol 2012 June .1, 63rd

volume (2), Page No. 171-180.

16. White D, Tonkin J registered nurse stress in intensive care units an Australian

perspective edition intensive care nurses. 1991 march 7th volume (1), Page No. 45-52.

17. Laubach W, brosig CE, a comparative study on the effects of professionalization on

German and American intensive care nurses. Edition pflege 1998 Feb., 11 th Volume

(1), Page No.21-26.

18. Harris RB, Reviewing nursing stress awarding to proposed coping – adaptation frame

work. Edition ANS Adv. nurse science. 1989 January 11th Volume (2), Page No. 12-

28.

19. Lewis DJ, Robinson JA. ICU Nurses coping measures; response of work – related

stressors. Edition critical care nurses 1992 February 12th edition (2), Page No. 18/23.

20

20. Eirlen J.A, Serika SM. critical care nurses. Ethical decision – making and stress.

Edtion J. Adv Nurse. 1997 November 26th Volume (5), Page No. 953-961.

21. Gholamzadchs, sharif F, Rad F.D, Sources of occupational stress and coping

strategies among nurses who work in admission and emergency Department of

hospital related to Shiraz university of Medical Sciences. Edition Iran J. Nurses –

Midwifery Res-2011, 16th Volume (1) Page No.41-46.

9 SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11.1 NAME AND DESIGNATION OF GUIDE Mrs. Venkatalakshmi. MSc. Nursing

of Psychiatric Nursing

Sri Sharada Nursing College.

Uttarahalli. Bangalore

11.2 SIGNATURE OF THE GUIDE

11.3 NAME OF THE CO-GUIDE(IF ANY)

11.4 SIGNATURE OF THE CO GUIDE

21

11.5 HEAD OF THE DEPARTARTMENT Mrs. Venkatalakshmi MSc. Nursing

of Psychiatric Nursing

Sri Sharada Nursing College.

Uttarahalli. Bangalore

11.6 SIGNATURE OF THE HOD

12.1 REMARKS OF THE PRINCIPAL Research Topic is relevant to profession and enhance the nursing problems

12.2 SIGNATURE OF THE PRINCIPAL

22