The Effect Of Stress On Efficient Nursing Care Delivery

Project and Seminar Material for Nursing (Science)

Abstract

Work stress of nurses has been widely researched, for example in specific health care units — intensive care, specific conditions — cancer. Personal characteristics like emotional involvement and depersonalization of patients are also suggested as stressors for nurses. In Nigeria the Department of Health has made a number of changes since 2014. One of the changes involved the restructuring of the different departments to unify the fragmented health services.

No comparison study was found for professional and trainee nurses. The objectives of this study were to determine the influence of work related stress towards nursing care of patients amongst selected nurses. A cross-sectional survey design was used. A random sample of professional nurses (N = 980) and enrolled (N = 800) nurses were used. The NSI was developed as measuring instrument and administrated together with a biographical questionnaire. Descriptive statistics and inferential statistics were used to analyse the data.

Five internally consistent factors were extracted. The first factor was labelled Stress: Patient Care. It relates to stress because of the care nursing staff provide to patients. The second factor was labelled Stress: Job Demands, and refer to the demands associated with the work of the nurse. The third factor indicated a lack of support in the organization as well as from supervisors and colleagues, and was labelled Stress: Lack of Support. The fourth factor was labelled Stress: Staff Issues, because it included item loadings on things like shortage of staff, and fellow workers not doing their job. The fifth factor contains items concerning working hours, especially overtime, and was labelled Stress: Overtime.

The results indicated that a difference in stress levels exists between professional and trainee nurses. Professional nurses’ severity for the different stressors are higher on all five the extracted factors than those of the trainee nurses. The sources of work stress for professional and trainee nurses were almost the same. One source of stress for professional nurses that the trainee nurses did not experience is management of staff. Professional nurses (compared with trainee nurses) obtained practically significant higher scores on two stressors, namely stress because of making a mistake when treating a patient and stress because of disagreement with medical practitioners or colleagues concerning the treatment of a patient. Recommendations for future research were made.

Table of Content

Chapter One

Introduction

1.1 Background to the Study
1.2 Statement of Problem
1.3 Purpose of the Study
1.4 Objectives of the Study
1.6 Hypothesis
1.7 Significance of the Study
1.8 Definition of Terms
1.9 Study Limitation
1.10 Organization of the Study

Chapter Two

Literature Review

2.1 Conceptual Review
2.2 Theoretical Framework
2.4 Empirical Studies
2.5 Summary of Literature Review

Chapter Three

3.0 Methodology

3.1 Research Design
3.2 Research Setting
3.3 Target Population
3.4 Sampling
3.5 Sampling Technique
3.6 Instruments for Data Collection
3.7 Validity of Instrument
3.8 Reliability of Instrument
3.9 Method of Data Collection
3.10 Method of Data Analysis
3.11 Ethical Consideration

Chapter Four

Results and Discussion

4.1 Data Presentation
4.2 Demographics Characteristics of the Respondents
4.3 Hypotheses
4.2 Discussion

Chapter Five

Summary, Conclusion and Recommendation

5.1 Summary
5.2 Conclusion
5.3 Recommendations
REFERENCES
APPENDIX

Chapter One

Introduction

1.1 Background to the Study

Stress refers to physical or mental overexertion. It is a form of pressure or adverse influences and circumstances that disturbs the natural physiological balance of the body. Stress imposes unusual demands on an organism. Stress occurs when there are demands on the person which task or exceed the person‟s adjustive resources.
On the other hand, stressor constitutes of things that causes stress (i.e. factors that causes stress). Some conditions such as military combat, imprisonment, natural disasters (such as flood and fire, disabling injuries, incapacitating illness, terminal illness such as advanced cancer, or death of a loved one) are all regarded as universal stressors. Many environmental situations are not stressful for everyone and reactions to such stressors depend on the kind of person one is, for example, being evaluated in examinations. Generally, stimuli that cause stress are called stressor.

They include emotional crisis, physical trauma, infection, physical restraint, extremes of heat or cold, etc.
Stress management involves the skill of controlling, directing or planning stress. Stress management strategies scales up an individual‟s psychological response to stress which is referred to as „stress reaction‟. Stress reaction often involves or stimulates behavioral attempts to deal with the stressor or with stress itself. Information or knowledge about stress, adopting correct attitude towards it and possession of skills in stress management among undergraduates (of any university) is very important for healthy, happy life and produces conducive environment for scholarship.

There have been many studies [1-4], which reported strong relationship between stress and undergraduates academic performance. Some individuals are more sensitive to some stressors than others, so the person‟s characteristics and behavior patterns must be looked at to determine their vulnerability to stress.

The experience of stress in human beings is universal, but there are also marked individual differences in how stress is experienced. According to Altmaier [5], stress has been known “to be the fuel the body uses to meet the challenges of our fast-paced modern life, although for others, it is the aversive by- product of such a life.” Stress has been associated with major life events, daily life hassles, and changes in life. Stress is created by excessive environmental and internal demands that need constant effort and adjustment.

The transition of moving to university and leaving home can be an added stressor for an undergraduate nurse. There are many first-year nurses who deal with being home-sick, whether it is mild and self-limiting or profound, creating grief and anxiety. There is a loss of control for nurses who are attending school and have to adapt to a different climate, new language, behavior, and social customs. The changes and transition are stressful for nurses because of this new environment. Fisher [2], notes that undergraduate nurses who are passive and mildly depressed prior to leaving home have been found to be those most likely to show raised level of homesickness following the move to university.

Many people recognize that stress comes in the form of negative tension that is caused by someone or something. Those who recognize stress as negative tension fail to realize that stress can generate a positive reaction to a stimulus. The positive reaction of stress can drive individuals to achieve and to test their potential to its fullest. Stress can be a positive aspect of learning. According to Robert and White [6], if nurses experience stress as a challenge, they can exhibit an increased capacity to learn. Many experiences distress rather than challenges which can lead nurses to feel threatened and helpless.

Health work may reflect some of the high level of stress that undergraduate nurses have reported. For instance, most undergraduate nurses experience grade pressures that cause them to have problems with stress. Too much stress can interfere with a nurse‟s preparation, concentration and performance. Yet, positive stress can be helpful to nurses by motivating them out of weak performance.

Schafer [7] had observed that when individuals fall short of their own or others‟ expectations in schools, job, athletics or any other activity, one risks both external and internal costs, threat to academic or career prospects, disapproval, rejection, humiliation, guilt, and a low to the self-esteem. Thus, fear of failure can help motivate the nurses to prepare and perform well, yet, sometimes fear of failure can become extreme, which then creates unnecessary stress.

One of the main causes to academic stress is test anxiety. Most undergraduate nurses seem to emotionally vulnerable to examinations related stress. Increased anxiety from tests has a debilitating effect on their performance. When information generated by worrying about the test reduces the capacity available for performing the tasks, the result is that performance breaks down and the result becomes self-confirming

1.2 Statement of Problem

Some of the effects nurses have from the stressors can be characterized by a lack of overt skills in handling a stressful situation. This can be marked also by poor performance or avoidance because nurses lack the skill to deal with these stressors. Stress management techniques usually filter out some of the stress and equip individuals to cope with stress situations.

There are a variety of coping skills that can be used to help nurses with stress. One of the first ways to begin coping and managing stress is, knowing what ones physical and emotional limits are in order to eliminate negative stress that may occur in life. This is also applicable to nurses. He or she needs to identify the cause of the stress. As noted by Greenberg and Valetutti [4] a strong psychological adjustment on the part of an individual is known to effectively help offset the dysfunctional effects of stress. The coping skills selected by an individual or a nurse to stress situation need to be techniques that are available and ought to be among one of the best coping skills that meet such needs.

As applicable to other Hospitals, nurses of Lautech, Ogbomoso also encounter some level of stress as they attend to their daily schedules as nurses.. Against the above background, it is important to investigate the subject Influence of work related stress towards nursing care of patients amongst selected nurses at the Lautech teaching hospital, Ogbomoso.

1.3 Purpose of the Study

The main purpose of this study is to assess the effect of stress on efficient nursing care delivery

1.4 Objectives of the Study

To investigate the most common sources of stress among nurses
To determine the effects of stress on nurses
To identify the most preferred stress management practices to reduce stress among nurses

1.5 Research Questions

The following questions were formulated to guide the study based on the research objectives;

What are the most common sources of stress among nurses
What are the effects of stress on nurses?
What are the most preferred stress management practices to reduce stress among nurses?

1.6 Hypothesis

HO: There is no significant relationship between knowledge and practice of stress management among nurses
H1: There is significant relationship between knowledge and practice of stress management among nurses

1.7 Significance of the Study

This study will be of great significance to the schools, nurses and the health seactor. From the findings of this study, nurses would be provided adequate information to enable deal successfully with challenges of stress and burnout. It will also be relevant to the nurses by providing more insight that could influence the formulation and implementation of policies that will ensure maximum support for nurses in academic settings. Information from this study will fill the gap on the body of knowledge related to stress management, and also contribute to the existing knowledge on the concerned issues.

1.8 Definition of Terms

Stress:

Is a feeling of emotional or physical tension, often resulting as a reaction to a challenge or demand, such as among nurses due to academic or anxiety related factors

Stress Management:

Refers to a wide spectrum of techniques and psychotherapies aimed at controlling a person’s level of stress, especially chronic stress, usually for the purpose of and for the motive of improving everyday functioning, in this case among the nurses.

Stress Management Practices:

These refers to the strategies that nurses in Lautech, Ogbomoso adopt to manage the stress associated.

1.9 Study Limitation

The study relied on respondents‟ subjective stress and was limited to participants who are aged 18 years and above.

The study findings were limited by the cross-section study design that did not allow examination of effects of stress over time.

Only those who were available for the study thus those who were not available were left out.

1.10 Organization of the Study

This study is divided into five chapters.

Chapter one is introduction which consists of the background to the study, statement of problem, research questions, research hypotheses, objectives of the study, the significance of the study, the scope and limitations of the study and finally the organization of the study.
Chapter two deals with the literature review which consists of the conceptual literature, theoretical literature, empirical literature, theoretical framework.
Chapter three gives the research methodology including research design, population of study, sample size, sampling technique, method of data collection, instrument of data analysis, method of data analysis, validity/reliability of instrument.
Chapter four is presentation and analysis of data, discussion of findings.
Chapter five gives the summary, conclusion

Chapter Five

Summary, Conclusion and Recommendation

5.1 Summary

The primary objective of the influence of work related stress towards nursing care of patients amongst selected nurses. A qualitative descriptive survey design and 120 nurses were used. A questionnaire was developed according to the objectives of the study to guide in the generation of information. Socio-demographic characteristics of the respondents and the research question were analyzed using simple frequency and percentage. Results revealed that the sources of stress among nurses were shown to include health work and activities (95.5%), role-based challenges and task execution (93.2%), changing nature of relationship with other people (79.5%), work calendar and tests (84.1%), and home and school interface (87.5%). From the findings, the effects of stress on nurses were shown to include headache (56.2%), anger (70.7%), tiredness (69.0%), low self-esteem (50.0%), being absent more than usual (75.9%), loss of concentration (84.5%), poor interpersonal relationship (73.9%), and eating disorder (62.5%). From the findings, the most preferred stress management practices were building group norms of cooperation not competition (94.8%), indulging in hobbies, leisure activities, recreation (93.1%), planning instead of responding to pressure (84.9%), build satisfactory relationship with lecturers (85.9%), and developing peer support (80.7%).

5.2 Conclusions

The following conclusions with regard to the specific objectives are made:

Stress and its effects on professional and trainee nurses. In the literature of stress concerning nurses, a large number of stressors received attention. The research concentrated on between one and three stressors at a time, and in a specific unit/ward, e.g. intensive care (Le Blanc, De Jonge, De Rijk & Schaufeli, 2011; Couden, 2012), psychiatric or mental wards (Erasmus; Poggenpoel, & Gmeiner, 1998; Humpel, & Caputi, 2011; Levert, Lucas, & Ortlepp, 2010), general nurses (Yip, 2011). A few comparison studies between different wards/units were found e.g. emergency department and general ward nurses (Yang, Koh, Lee, Chan, Dong, & Chia, 2011), general and mental nurses (Tummers, Janssen, Landeweerd, & Houkes, 2011), urban and rural nurses (Wilkens, & Beale, 2011). No comparisons for stressors were find for professional and enrolled nurse.
Different levels of stress for professional and trainee nurses. The research clearly indicates that a difference in stress levels exists between professional and trainee nurses. Professional nurses’ severity for the different stressors are higher on all five the extracted factors than those of the trainee nurses.
Different sources of work stress. The sources for work stress for professional and trainee nurses are almost the same. One source of stress for professional nurses that the trainee nurses did not experience, is management of staff.
Internal consistency and construct validity of the Nursing Stress Indicator. The alpha coefficients of the five extracted factors of the NSI are highly acceptable to the guideline of O,70 (Nunnaly & Bernstein, 2014). The values can be considered high and thus explain a large portion of the variance in the different scales (Clark & Watson, 2015). The mean inter-item correlation coefficients are in the recommended range (0, confirming the internal consistency of the factors of the NSI. This satisfactory internal consistency points to the utility of the instrument used in the research.

5.3 Recommendations

The following recommendations were made based on the findings of the study;

Nurses should be informed in advance of what difficulties they might face and encourage them to develop their own strategies to achieve personal goals during the influx of patients.
The hospital management should add stress management skills into the routine or through seminars and workshops or through interactive session between the nurse and the hospital authorities to enlighten and educate on stress management.
Improving hospital mental services and organizing peer counseling and self-help group can be of help in managing stress.
The hospital management should create a friendly management / nurses’ relationships