Impact of Work Related Stress in Nurses

Impact of Work Related Stress in NursesWORK RELATED STRESS AMONG NURSES AND ITS EFFECTS ON QUALITY vexation DELIVERY IN TAMALE TEACHING HOSPITALBACKGROUNDStress is a concept describing the inter semblanceship betwixt a individual and the environment. It is the response by a person to latent hostilityors in the environment. Selyes popular Adaptation Theory (Selye, 1976) expound distort response as biophysiologic in nature. When the person is subjected to a separate outor, a characteristic syndrome of physical reactions entrust occur. The pains concept bed as well be seen as active in a holistic gain of the person. The accent response can be physical, psychological, turned on(p) or sacred in nature and is unremarkably a combination of these dimensions. Stress, similarly, can tog out from one or more dimensions and can be either berth(a) or orthogonal.Stress and the blackb solely outcomes of idiom constitute been recognized as financi totallyy costly to any wel lness c atomic number 18 organization. Negative outcomes of argumentation hear among binds include illness, decline in overall flavour of c ar, transmission line dissatis occurrenceion, absenteeism, and round turnover (Schwab, 1996). Job try out describes the song associated with the professional or fiddle environment. Tension is created when the contends of the logical argument or the argumentation environment make pass the capacity of the person to respond incumbranceively. Job var. varies with each reach environment.Job satisfaction has been shown to be closely affected by military control distort. In a metaanalysis of variables think to nurses job satisfaction, Blegen (1993) identified the variables of age, autonomy, commitment, communication with peers and supervisors, education, fairness, locus of control, professionalism, recognition, melody and geezerhood of experience. Blegens analysis found song and commitment to aro workout the strongest blood with job satisfaction. Irvine and Evans (1995) alike found a strong negative coefficient of correlation between idiom and job satisfaction although not as strong as that found by Blegen. Job satisfaction has overly been negatively linked to intention to leave and actual turnover (Hinshaw A twainod, 1983 Irvine Evans, 1995 expenditure Mueller, 1981). Although job satisfaction is a complex construct, the strong negative correlation to stress and demeanoral intent to leave employment warrants the guardianship of nurse administrators. Attention to job satisfiers may not be sufficient to scrub the job stress experienced by nurses thus introduceing to thoughts of divergence employment.Freudenberger coined the term burnout in 1974 to describe workers reactions to the chronic stress common in occupations involving numerous direct interactions with nation. Burnout is typically conceptualized as a syndrome characterized by emotional exhaustion, depersonalization, and sign ond pers onal accomplishment.PROBLEM STATEMENTNurses occupy a in particular interesting position in the provision of health c atomic number 18. Often they be the sole intermediary between the doctor and the long-suffering and in the present line of health re break upments. nurse requires a great deal of coaction with other clinical professionals with different cultures, social backgrounds, as well as the ability to take on various roles during a single workday. These exponent include participation in teams, attendance during rounds and meetings, field trips, palliative work, providing focus to patients and their families, and social services. These stressful situations obviously ca utilise problems for nurses in their chance(a) work.Job stress among healthc atomic number 18 staff is becoming a common occurrence in more or less public health services (Winstanley and Whittington, 2002303). In the steep implore for effectiveness and efficiency of public health service oral commun ication, nursing staff is put on a high responsibility to ensure the demand of public citizen is satisfied (Ritter et al., 1995164). Nursing focuses on activities that relate to diagnosis and interjection of clement responses to health and illness phenomena. However, inherent in this caring occupations ar numerous sources of built-in stress that compose occupational hazards for nurses (Huber, 1996560). There be many components to this experience of stress much(prenominal) as staff shortages, high level of responsibility, dealing with the death and the dying, dealing with patients relatives, lintel with the unpredictable, making comminuted judgment to the highest degree hindrances and treatment, and balancing between work and family commitments. These are forces that realistically generate stress among nurses (Gordon, 1999285 Aurelio, 19931-10). The issue of insufficient nursing staff and its do has scored many nurses experiencing job stress in carrying out their respon sibility and maintaining the standards of patient care in public health services (Mackay, 198960-61). Furthermore, staff shortages with increase workload raise concerns to the nurses ability to distribute and deliver adequate service to the client, which in turn create a stressful environment indoors nursing profession (Mackay,198960 Huber, 1996561).PURPOSE OF THE STUDYThe purpose of this think over is to determine the level of work related stress among nurses of tamale command infirmary, its make on their health and effects of the stress in their delivery of quality care to the patients.OBJECTIVES To determine the level of work related stress among nurses and its effect on quality care delivery in Tamale pedagogics Hospital. precise OBJECTIVESTo investigate the most prominent sources of job stress among nurses in Tamale Teaching hospitalTo investigate the most prominent effects of job stress among nurses in Tamale Teaching hospitalTo explore the most preferred header mecha nism to void job stress among nurses in Tamale Teaching hospitalRESEARCH QUESTIONSWhat are the most prominent sources of job stress among nurses in the hospitalWhat are the most prominent effects of job stress among nurses in the hospitalWhat is the most preferred coping mechanism to reduce job stress among nurses in hospitalSIGNIFICANCE OF THE STUDYThis seek is to identify the sources of job stress, effects of job stress on the nurse and coping mechanism adopted among nurses. It is hoped that the findings lead provide great fel paltry feeling of the major causes of job stress and its effects towards nurses in Tamale Teaching Hospital. The findings will also address few implication concerning the coping mechanism adopted by nurses in Tamale Teaching Hospital when dealing with job related stress.OPERATIONAL DEFINITION OF TERMSStress is a concept describing the inter blood between a person and the environment.Burnout is typically conceptualized as a syndrome characterized by emo tional exhaustion, depersonalization, and reduced personal accomplishment.LITERATURE REVIEWStress has been apply to describe the clays mobilization on dealing with a challenge or threat (Griffin, 1990). Drafke and Kossen, (2002) defined stress as the embodys non-specific response to any demand. Selye classify stress into two categories, each with two variations distress (harmful or disease-producing stress) and eustress (beneficial stress) (Drafke and Kossen, 2002). Selye introduced General Adaptation Syndrome (GAS) model in his study of stress, which consisted of 3 shows alarm, resistance and exhaustion. The tubercle between short and long term effects of stress on the body is brought out by this model (Marshall and Cooper, 1979). Besides the physiologicly orient approach to stress represented by the classic GAS model, attending is also being given to the psychological and the behavioral dimension of stress (Luthans, 1998). exclusively three dimensions are strategic to t he catch of job stress and coping mechanism in modern organizations. Stress is an unavoidable singularity of modern living. The impact of dynamic and un trustworthy environment characterized by restructuring, reengineering, layoff and furlough threatenes ones personal security of employment (Huber, 1996). Generally, stress is always thought of in negative terms. That is, stress is perceived as something bad, annoying, threatening and not valued (Mckenna, 1994). For example, words or phrases such as depression, feeling out of control, overworked, megrim or headache, time pressure, anxiety, cannot sleep, are commonly utilise to express what stress means to us personally (Sutherland and Cooper, 2000). Stress is one of those words that everybody knows the substance of but none can define it (Woodham, 1995). As a result, it is life-sustaining to give attention to what stress is not about in todays organization. As pointed out by Luthans (1998) three major misconceptions about str ess are as followsStress is not simply anxiety. Anxiety operates solely in the emotional and psychological sphere, whereas stress operates both and also in the physiological sphere. Thus, stress may be accompanied by anxiety, but the two should not be equated.Stress is not simply nervous tension. interchangeable anxiety, nervous tension may result from stress, but the two are not the same. Unconscious state have exhibited stress and some people may keep it bottle up and not reveal it done nervous tension.Stress is not necessarily something damaging, bad or to be avoided. Stress is inevitable. Stress is not damaging or bad and is something people should seek out rather than avoid. The key is how the person handles stress.A certain fare of stress is necessary to sustain life and moderate amounts resolve as stimuli to perform but overpowering stress can cause a person to respond in a mal accommodative physiological or psychological manner (Sullivan and Decker, 2001). From the o rganizations viewpoint, stress in the study usually is perceived as something undesirable and is a normal pressure most people experienced at work (Krumm, 2001). Stress is generally viewed in terms of the fit between peoples needs, abilities, and expectations with environmental demands, changes, and opportunities (Cummings and Worley, 1997).The General Adaptation Syndrome or GAS is an early model of stress which viewed stress response as a natural human adaptation to a stressor (to change or leave the stressors) in the individuals physical or psychological environment (Champoux, 2003). Selye describe the process of GAS into three stages (Cooper and Marshall, 1978)Alarm reaction in which an initial shock phase of lowered resistance is followed by countershock during which the individuals defense mechanisms become active.Resistance the stage of maximum adaptation and hopefully successful give up to equilibrium for the individual. If, however, the stressor continues or defense does not work, the individual will terminate on toCollapse or Exhaustion when adaptive mechanisms collapse.Fully infrastanding stress and its many effects must involve great attention to the three related stages (Selye, 1956). Arousal rises quickly to high levels and many physiological changes that prepare our bodies for strenuous activity (either flight or fight) to take place. The body prepares to fight or adjust to the stressor by increasing respiration, heart rate, vigour tension and blood sugar. The initial reaction is soon replaced by the min stage known as resistance. At this point, if a stressor is too acute the individual may feel restless to carry off with it. However, after a short block of alarm the individual will gather all strength and start resisting the negative effects of the stressor. The body tries to return to a normal state by adapting to the stressor. If stress persists, the bodys resources may become scummy and the final stage known as exhaustion occurs. During the exhaustion stage the body begins to wear down from exposure to the stressor. At this point, the ability to cope decreases sharply and severe biological damage may result if stress persists. If a person experiences the stressor long enough and does not effectively wield the source of stress then stress-related illnesses can appear. The damaging effects of stress occur in this stage for both the individual and organization (Baron and Greenberg, 1990 Champoux, 2003 Payne and Walker, 1996 Greenberg, 2002 Griffin, 1990). patch stress is reflected by the sum of the nonspecific changes which occur in the body at any one time the GAS encompasses all nonspecific changes as they develop through with(predicate)out time during continued exposure to a stressor (Selye, 1956). The GAS is a useful model for explaining physiological processes which may lead to stress-related illness (Payne and Walker, 1996). The GAS theory says (Selye, 1956 Rice, 2000 Lyon, 2000).All life events cause some stress.Stress is not bad per se, but excessive or inessential stress should be avoided whenever possible.The stressor is the stimulus eliciting a need for adaptation stress is the response.The nonspecific aspects of the bodys reaction to an agent may not be as obvious as the specific effects. Sometimes, only disease or disfunction will make an individual realize that he or she is under stress.Stress should be monitored.Removal of the stressor eliminates stress.Stress is a natural and essential part of living and growing (Burns, 1992). Moderate levels of stress and stimulation such as challenging but achievable goals can energize and move employees. The middle area of the graph shows the stress levels that result in the great performance. When a level of arousal exceeds our ability to meet the demand placed upon us we will experience feelings of burnout, exhaustion and ultimately will invalidate employees performance (Wright and Noe, 1996). Extremely high and extremely low level of stress tends to have negative effects on performance.A certain amount of stress among employees is generally considered to be advantageous for the organization because it tends to increase work performance. However, when an employee experiences too much or too little stress, it is generally inexpedient for the organization because it tends to decrease work performance (Certo, 2000).In conclusion, stress is an environmental action that places special physical and/or psychological demands that produce an adaptive response that is influenced by individual differences (Kreitner and Kinicki, 2004).SOURCES OF STRESSA variety of studies have shown that quantitative work overloads are potent sources of stress in the employment in which individuals are asked to do more work than they can bang in a specific period of time (Cassar and Tattersall, 1998 Mullins, 1999 Fox et al., 1993 Ganster and Murphy, 2000). some other major source of job stress is associated with a persons role a t work (Marshall and Cooper, 1979). Role ambiguity refers to an employee who is uncertain about how to perform on the job, what is expected in the job and unclear relationship between job performance and expected consequences (Rue and Byars, 1997). Role battle arises from inconsistent expectations of the organization or from job-related expectations conflicting with a persons other roles (Wright amd Noe, 1996). Cooke and Rousseau (1984), in their study on air mile teachers to investigate the effects of family roles and work-role expectations on strain. Role theory predicts that multiple roles can lead to stressors (work overload and inter-role conflict) and, in turn, to symptoms of strain. The results of this study were generally consistent with the role theorys prediction for work-role expectations that were found to be related to work overload and inter-role conflict and these stressors were found to be related to strain. The finding also indicated that family roles found to be related to strain in three ways interaction with work-role expectation, those who are married, and those who have children (Cooke and Rousseau, 1984).In addition, there is a consistent relationship between the behavioral characteristics of different jobs and the levels of various stresses experienced by a group of employees. The findings indicated that five of the divisional job dimensions correlate with at least fractional of the 18 stress variables. Two studies, were conducted on occupational stress and its relation with antecedent variables and job performance among nurses in four hospitals. The finding of the low gear study indicated that work overload, uncooperative patients, criticism, negligent co-workers, lack of support from supervisors, and difficulties with mendelevium ca utilize stress to hospital nurses. As a result, nurses performed their jobs less effectively. The finding of the here and now study indicated that there was no significant relationship in years of n ursing experience, age, tenure in their nursing unit, tenure in their hospital, or whether they worked full time or part time with job-related stress and job performance among nurses (Motowidlo, 1986).The lack of supportive relationship or poor relationship with peers, colleagues and the superiors are also potential sources of stress, leading to low trust and low interest in problem solving (Khan and Byosiere, 1995 Baron and Greenberg, 1990 Schultz and Schultz, 1994). Relationship at workplace can be classified into relationship with superiors, colleagues, subordinates, those who use your goods/services, those who interpret you with goods/services and those whose decisions affect your status and resources (Ward, 1987).It is not possible to obtain a complete stress profile by looking only at sources of stress in the workplace. Thus, it is critical to consider the interfaces that exist between work, home and social life of an individual that contribute to stress. These include marri age, pregnancy, illness, divorce (Baron and Greenberg, 1990), hassles of daily life-household hassles, time pressure hassles, inner concern hassles, environmental hassles, financial responsibilities (Baron and Greenberg, 1990), worries about children, health, misplacing things, worry about crime and rising prices (Schultz and Schultz, 1994).EFFECTS OF STRESSIt is vital to know the effects of job stress on physical health, psychological and behavioral on an individual after understanding the nature of stress and major sources of job stress. There is overwhelming evidence to indicate that consecutive exposure to stressful situations, or an accumulation of stressors over a period of time, is directly associated with the onset of illness, emotional stress and engaging negative activities (Burns, 1992 Jones, 1988). The fact that stress can make people ill and is implicated in the incidence and development of coronary heart disease, mental illness, certain types of cancer, smoking, diet etic problems, excessive alcohol consumption and substance abuse, life dissatisfaction, accident and dangerous behavior at work, migraine, stomach ulcers, hay fever, asthma and skin rashes, matrimonial and family problems (Dalton, 1998 Cooke and Rousseau, 1983). Moreover, it was identified that an individual who has poor problem-solving and coping skills, softness to understand and cope with own emotions, and lack of social and self- assertion skills is more vulnerable to stress and subsequent alcohol and medicine misuse (Vetter, 1981).Generally, the effects of work stress occur in three major areas. The effects of stress on physiological include increased of blood pressure, increased of heart rate, sweating, virulent and cold spells, breathing difficulty, muscular tension and increased of gastrointestinal disorders. effects of stress on psychological consist of anger, anxiety, depression, lowered self-esteem, poorer intellectual functioning, inability to concentrate and make decisions, nervousness, irritability, resentment of supervision and job dissatisfaction (Chen and Spector, 1991). Decreased performance, absenteeism, high accident rates, higher turnover rates, higher alcohol and other drug abuse, impulsive behavior and difficulties in communication are few effects of stress on behavioral (Hellrigel, 1986 Bhagat, 1985).COPING MECHANISMSBased on the higher up reviews, job stress can be a detrimental to the health and well-being of an individual. Therefore it is important to discuss effectively ways of responding to stress on the individual level. Generally, coping has been focused on internal and external resources for coping with stress which deal with work and general life stresses (Cartwright and Cooper, 1996). make do can be defined as constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person (Lazarus and Folkman, 1984). Coping is also viewed as a dynamic process and response to situation characterized by uncertainty and important consequences (Latack, 1986). Furthermore, coping is illustrated as a process oriented, non-automated adaptive behavior, effort, and managing life stressors (Backer et al., 2000).With these general definitions, coping can be best illustrated as managing taxing circumstances, expending efforts to solve lifes problems and seeking to master or reduce stress (Burke and Weir, 1980).From the literature, successful coping does not mean eliminating all stress. It is important to understand the nature of stress at workplace and its effect in front we can reduce or moderate stress. A healthy person will face stress confidently, deals with it and gets beyond it. It is important for an individual to develop coping mechanisms to reduce job stress and apply these coping mechanisms into use in his/her everyday life (Krohne, 1996). The involvement of workers or workers group of all phases is equ ally necessary to ensure successful implementation of stress intervention to combat job stress in the workplace (Murphy, 1995). A coping mechanism can be effective if resources are targeted to specific problems and aimed at the elimination of the sources of stress. The success to reduce job stress in the workplace embraces both individual coping mechanism and effective organizational intervention on stress management.METHODOLOGYThis chapter describes the study design, the study area, the study people and the sampling procedure as well as the recruitment of respondents and the selective information prayer procedure. The data entry and analysis is also outlined in this chapter.RESEARCH DESIGNThis study is a cross-sectional study mode designed to determine the level of work related stress among nurses of tamale teaching hospital, its effects on their health and effects of the stress in their delivery of quality care to the patients.RESEARCH SETTINGThe study will be conducted at the Tamale Teaching Hospital (TTH). It is a primary tertiary referral midsection providing patient care to residents of Tamale and neighbouring towns and cities. The hospital has about 30 wards from which the respondents would be solicited. locate POPULATIONThis study will target the registered nursing staff with at least three years experience at the Tamale Teaching Hospital. ideal, SAMPLE SIZE, AND SAMPLING TECHNIQUEThe sample coat is 240 respondents this was arrived at by the utilize Cochran formula.Sample Size = z2 * p(1-p) / e2 / 1 + z2 * p(1-p) / e2 * NN = population sizez = z-scoree = margin of errorp = standard of deviationN= 655Z= 1.96 (using 95% confidence interval)E=0.05P= 0.5Sample size = (1.96)2*0.5(1-0.5)/0.052 / 1 + 1.962*0.5(1-0.5)/0.052* 655Sample size = 384.16/1.6375Sample size= 235An extra 5 was added to make it 240 respondents.INCLUSION CRITERIARespondents must be registered nurses with at least 3 years working experience in the Tamale Teaching Hospital.EXCLUSION CRITERIANursing students and nurses who have not worked up to three years will be excluded from the study.DATA COLLECTION TOOLA well-structured questionnaire will be used to collect socio-demographic data, fellowship on work related stress from the respondents. mathematical operation FOR DATA COLLECTIONProbability sampling technique will be used. This will be done to give an equal opportunity to all the targeted population. The data collection will employ the use of structured questionnaire which respondents will checked and also gave short answers to some questions to solicit data from respondents. All the wards will be successfully visited on a daily prat to get eligible participants for the study.Purposive sampling will be used to select clinicians from the hospital who will be available during the data collection from Tamale Teaching Hospital.The study collected data on the socio-demographic characteristics of respondents, general knowledge about hand washing, assess the diffe rences across age groups, gender and their experiences regarding handwashing through the use of a structured questionnaire administered by the research assistants with minimal light from the research assistants. Primary data will be collected and used in the analysis.DATA ANALYSISThe data will be coded into surpass and then entered into SPSS V.16 for analysis. Responses were assigned codes in the form of numbers, which made it easy for keying in the responses into a computer format. Univariate analysis was done for socio-demographic characteristics of respondents and also for areas that require only descriptive statistics. Bivariate analysis will be performed to find associations or relationships between socio-demographic characteristics and level of knowledge, attitudes and practices of clinicians on handwashingETHICAL CONSIDERATIONSApproval will be obtained from the Ethics and Research Committee of the hospital. Formal consent will be obtained from the respondents prior to admin istration of questionnaire. Participants will be informed the study is stringently for academic purposes and names will not be needed and guarantee them of their privacy. 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