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Note: Tables and figures
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Introduction
Stress first coined in the 1930s, has in more recent
decades become a commonplace of popular parlance. Stress
could be defined simply as the rate of wear and tear on
the body systems caused by life 1. It occurs
when a person has difficulty dealing with life
situations, problems and goals 2. Stress has
physical, emotional, and cognitive effects. Although
everybody has the capacity to adapt to stress, not
everyone responds to similar stressors exactly the same
3.
Nursing
involves activities and interpersonal relationships that
are often stressful. Caring for clients who are
experiencing high levels of anxiety can be stress
provoking for nurses 4. Coping has been
viewed as a stabilizing factor that may assist
individuals in maintaining psychosocial adaptation
during stressful events. Thus, the actual reaction to an
environmental event may be as important as the event
itself 5. A stressor can be social,
physiological or environmental origin 6.
Coping
responses can be described as positive or negative and
as reactive (i.e. reacting to an individual's own
thoughts and feelings) or active (dealing with actual
stressful situations or events). Active or reactive
coping responses can be positive or negative, depending
on the situation and the content of the response 7.
There
are many ways to cope with stress. Research on stress
indicates that people tend to use a number of different
coping approaches rather than just one 8, 9.
Positive coping strategy is learned techniques used by
individuals to reduce tension, stress, and anxiety; for
example, deep breathing techniques, and relaxation
exercises 10. These strategies can result in
successful adaptation. They can be therapeutic and non
therapeutic. Therapeutic coping strategies usually help
the person to acquire insight, gain confidence to
confront reality, and develop emotional maturity 11.
The
coping process is an important aspect of the
person-environment interface. The kinds of coping
strategies used in a given situation are a function of
individual differences in personality or experience as
well as characteristics of the situation 12, 13.
Objective
We carried out this study to determine how and how much
nurses cope with the stressful events (apply positive
methods or negative responses) and to find out
relationships between job coping and health outcomes in
the nurses.
Material and method
A cross-sectional study included all nursing staff
working in two medical centers of Sanandaj city (Tohid
and Besat hospitals) of Kurdistan-Iran, carried out in
year of 2006. The participants represented all grades of
100 registered nursing staff. They were asked to respond
to 50 items questionnaires with Likert-scale responses
(i.e. "Never", "seldom", "Sometimes", "Often" and "Most
of the time"). Demographic variables including gender,
age, position, marriage and tenure state, shift and
place of work (environment) were included in the
analyses. The position variable contributed junior staff
(assistant nurses) and senior staff (clinical nurse,
nurse manager). The tenure state included Official
(permanent) and experimental (causal) employment. The
relationships between these variables and application of
coping methods were determined.
Coping
strategies were drawn from the Adolescent Coping
Orientation for Problem Experiences (A-COPE) developed
by Patterson & McCubbin in 1986.
Positive coping strategies were: listening to music,
shopping books or cassettes or tapes …, going to shop
with friends, watching films on TV or in cinema,
reading, writing, singing or composing, dozing, hiking,
sporting, tools or table arrangement at work, repairing
or reconstruction at home, participating in game groups
or going to conferences or concerts…, going to the
parks or nature or mountains, sitting lonely in a quiet
space, playing with animals, praying or meditation,
relaxation exercises, gardening or painting, taking
bath, talking with a friend or colleague about the
problems, visiting family members or friends, chess or
playing with computer games, getting busy with the home
or another one works.
Negative coping methods included: disputing, profanity
or insulting, shouting, self negative speeches,
overdrinking tea or coffee, overdrinking alcohol,
smoking, drug abuse, suicide thoughts, impatience, speed
driving, overeating or eating very small, isolation or
getting distance from others, looking forward to bad
ending, crying a lot, tossing objects, nail chewing. Two
items were allotted for other methods (both positive and
negative) might be used by participants.
We
marked never, seldom and sometimes, often and most of
the time as the following degrees: 0, 1 and 2.
We
considered achieved degrees of positive coping as weak,
moderate and good representing the degrees of 0-21,
22-33, 34-48, accordingly, and degrees of negative
coping as low, moderate and high symbolizing 0-18,
19-26 and 27-36, accordingly.
All
data were analyzed using SPSS for Windows, Version 18.
Pearson’s χ2 test and chi-square method were
used for categorical comparison. A p value < 0.05
considered as the level of significance.
Results
One-hundred nursing staff included in this study. They
were between 20 to 49 years old. Most of the subjects
were 30-39 years (60%). Demographic characteristics of
participants were explained in table 1.
Positive coping with stress in our nursing staff was
good (19%), moderate (51%) and weak (30%), as drawn in
figure 1.
Negative responses to stress were low (22%), medium
(29%) and high (49%), as displayed in figure 2.
Participants used several strategies in order to cope
with the stressful situations at work. Positive coping
for senior staff was: good 17(20.5%), moderate 41(49.4%)
and weak 25 (30.1%), and for junior staff was: 2(11.8%),
10(58.8%) and 5(29.4%), accordingly. There was not
significant relationship between position and positive
coping with stress (p=0.67).
Regarding gender; in females positive coping was: good
10(17.5%), moderate 31(54.4%) and weak 16(28.1%), and in
males: 9(20.9%), 20(46.5%) and 14(32.6%), accordingly.
There was no significant difference (p=0.74).
Table 2
shows the relationship between 3 age ranges and positive
coping (p=0.028), which was significant. Positive coping
was more in nurses of 30-39 years old.
In view
of marriage state, attempting positive coping in 50(%)
singles was: good 10(20%), moderate 24(48%) and weak
16(32%), in 40(%) married: 8(20%), 24(60%), 8(20%), and
10(10%) in divorced: 1(10%), 3(30%), 6(60%),
accordingly. No significant difference was between
marriage state and applying positive coping (p=0.167).
Tenure
status showed significant difference with positive
coping (P =0.006), as shown in table 3. Those officially
(permanent) employed more positively coped with stress.
The
relationship between job experience and positive coping
with stress was presented in table 4, which was
significant (p=0.026).
Experienced staff with job experience of 5-9 years
significantly more practiced positive methods of coping.
In view
of the shift working, nurses were working in: morning,
evening and night, and rotating shifts. Positive coping
in 35(%) participants of the morning shift was: good
9(25.7%), moderate 15(42.9%) and weak 11(31.4%), in
40(%) nurses in the evening and night shift: 7(17.5%),
21(52.5%) and 12(30%), and in 25(%) in rotating shift:
3(12%), 15(60%) and 7(28%), accordingly. There was no
significant difference between work shift and positive
coping (p=0.654).
Table 5
displays the relationship between workplace and positive
coping (p=0.001), which was significant. Nursing staff
in Tohid hospital, more applied positive methods of
coping than those in Besat hospital. They were dealing
with elective and more stable patients.
Negative coping with stress in senior nurses was: low
19(22.9%), medium 21(25.3%), and high 43(51.8%), and in
juniors was: 3(17.6%), 8(47.1%) and 6(35.3%),
accordingly. There was no significant difference
(p=0.195).
Table 6 shows the relationship between gender and
negative responses to stress (p=0.000), which was
significant.
Negative coping in 24(%) nurses aged 20-29 was: low
10(41.7%), medium 4(16.7%) and high 10(41.7%), in 60(%)
nurses aged 30-39: 9(15%), 21(35%) and 30(50%), and in
16(%) aged 40-49: 3(18.8%), 4(25%) and 9(56.3%),
accordingly. In this study there was no significant
difference between age and negative coping (p=0.085).
Singles
had negative coping; low 7(14%), medium 15(30%) and high
28(56%). Married nurses possessed negative responses as;
10(25%), 12(30%), and 18(45%), and divorced persons:
5(50%), medium 2(20%) and high 3(30%), accordingly.
There was no significant relationship between marriage
state and negative coping (p=0.144).
Negative coping in experimentally employed nurses was:
low 9(18.4%), medium 12(24.5%) and high 28(57.1%) and in
officially employed nurses: 13(25.5%), 17(33.3%) and
21(41.2%), accordingly. There was no significant
difference between tenure status and negative coping
with stress (p=0279).
Table 7
shows the relationship between job experience and
negative coping, which was significant (p=0.035).
There
was no significant difference between shift working and
negative coping in our study (p=0.156). Negative coping
in nurses was as the following; in the morning: low
5(14.3%), medium 10(28.6%) and high 20(57.1), in evening
and night: 11(27.5%), 8(20%) and 21(52.5%) and in
rotating shift: 6(24%), 11(44%) and 8(32%), accordingly.
Nurses
in Besat hospital possessed negative responses to stress
as: low 12(26.1%), medium 9(19.6%) and high 25(54.3%)
and in Tohid hospital did: 10(18.5%), 20(37%) and
24(44.4%), accordingly. There was no significance
(p=0.153).
Limitation of study
In this study the research community
was small. We did not assess all parts of work stressors
and causal attribution.
Discussion
Stress and crises are inevitable in
every one’s life 14. Human beings experience
stress early, even before they are born. A certain
amount of stress is normal and necessary for survival
15.
Feelings of stress in humans result from interactions
between persons and their environment that are perceived
as straining or exceeding their adaptive capacities and
threatening their well-being. The element of perception
indicates that human stress responses reflect
differences in personality as well as differences in
physical strength or health 16.
A
person’s adaptation to stress – whether positive or
negative – is influenced by a number of personal
factors. The total person is involved in responding and
adapting to stress. The stress is even greater for two
groups of nurses: new graduates, who must adjust to an
environment different from what they experienced as
students, and the nurses who work in settings such as
intensive care and emergency care 17.
This
study showed significant relationship between age,
workplace, job experience and tenure status with
positive coping.
Goldenberg and Waddlle concluded that age of the
respondent, number of years of full-time teaching and
tenure status were most often significant factors (<
0.05) relating to the level of stress Implications. One
critical factor is the repertoire of coping skills the
person already possesses and can use to adapt to the
crisis 18. The ability to adapt is decreased
in the very young, the very old, and those with altered
physical or mental health; who do not have the necessary
physiologic reserve to cope with physical changes
19.
In this
study, nursing staff of 30 to 39 years old more coped
with stress than the younger or older ages, as did the
nurses with 5-9 years experience of working than those
with less job experience. In this study, type of
employment (permanent or causal) was seen to have
significant association with proper coping as officially
employed nurses more applied positive methods than the
experimentally ones, because of the job security they
felt as Goldenberg reported 18. Nurses worry
not only about the further of their positions but also
about the safety of their patients 20.
The
healthcare work environment as a source of overwork and
stress has been implicated in today's nursing shortage
21. In this study significant difference was
between those working in a hospital with the other one,
as those working in Besat hospital less coped with
stress regarding they were dealing more with the
patients in intensive and emergent stage, as caring
trauma patients.
The
history of coping strategies studies is presented in
contemporary social-cultural background which
distinctive feature is high dynamism of social processes
22.
In our
study, 70% of nursing staff coped with stress well and
moderately. Unfortunately, 49% of the nursing staff in
our study had negative responses to stress.
Shift
working, particularly night shifts, traditionally
attracts pay enhancements but can have a significant
effect on personal and social life. Prolonged shift
work, especially night shift work, also has a health
risk as it produces symptoms that correspond closely to
those of mild or moderate distress 23.
However, neither positive nor negative coping, showed
significant difference to work shift, in our study.
Taylor
et al write that stress creates emotional distress often
with outward symptoms. One person may have tension
headache, another becomes irritable and another clenches
his or her fists. Many people consume legal or illegal
drugs, drink or smoke to excess, or eat compulsively.
These behaviors can be modified and adaptive mechanisms
strengthened through specific techniques aimed at
managing stress 24.There was significant
association between gender and job experience with the
negative responses to stress. In our study, males and
nursing staff with less than 5 years experience appeared
to more apply negative coping.
A
combination of problem – focused coping with the more
positive emotion- focused dimensions ought to be most
effective. The demand for organizational support and
personal training in stress management is clear 25;
in a survey 53% of nurses with significant signs of poor
psychological health were receiving counseling or other
supportive help 26. In view of the importance
of personal factors in influencing the perception of
stress, it is important to consider just how individual
nurses might be supported.
The way
we respond to stress depends on our basic personality
styles and our own unique defensive style. In order to
identify how personal circumstances exacerbate workplace
stress and how they may be used to reduce stress, it is
essential that personal/workplace interactions be
researched. Individuals must be supported better, but
this is hindered by lack of understanding of how sources
of stress vary between different practice areas, lack of
predictive power of assessment tools, and a lack of
understanding of how personal and workplace factors
interact 25.
Support
services should be preventative, so that health problems
for nurses can be averted. This requires more research
into identifying the most effective may of detecting
when individuals are experiencing early difficulties ,
and of improving their stress management techniques so
as to prevent the transition to severe distress . Until
the prediction of distress becomes possible,
organizational initiatives to meet the needs of the
majority remain the best starting point, but should not
be expected to provide the answer for all nurses.
Conclusion
Proper application of coping methods
in our study population was: good (19%), moderate (51%)
and weak (30%). Nursing staff possessed high level of
negative responses to stress (49%).
This
study showed significant associations between either
some personality styles and work environment and ability
to cope with stress. Age of respondent, work place, job
experience and tenure status had significant relation to
stress coping. The way of response to stress depends
not only on the personality and one`s defensive styles
but also on the workplace. It is preposterous to suppose
any individual separately from the workplace, and more
research is needed to identify how personal
circumstances exacerbate workplace stress, and how they
may possibly be used to reduce stress. There is a
necessity to teach proper methods of coping with stress
to the nursing community as well as the necessity for
supportive services. In the process of seeking health
and coping, the specification of appropriate strategies
ought to be developed and enhanced.
References
1)
Stranks J W.,
Stress at work: management and prevention.
Butterworth-Heinemann Press. 2005: P. 7.
2)
Videbeck S L.,
Psychiatric mental health nursing. USA, Philadelphia,
Lippincott Williams & Wilkins press. 2007; Chap. 13: P.
242.
3)
Timby BKa,
Fundamental nursing skills and concepts. USA,
Philadelphia, Lippincott Williams & Wilkins press. 2008:
P. 941.
4)
White L.,
Foundations of Nursing: Caring for the Whole Person.
USA; Georgia, Cengage Learning Press. 2000; Chap. 16: P.
290.
5)
Robin Walton L., A
Comparison of Perceived Stress Levels and Coping Styles
of Junior and Senior Students in Nursing and Social Work
Programs. In Doctor of Education Dissertation. College
of Graduate Studies, Marshall University; 2002.
6)
Sadock, B J.,
Kaplan HI., Sadock V A., Kaplan & Sadock's synopsis of
psychiatry: behavioral sciences/clinical psychiatry.
USA, Philadelphia. Lippincott Williams & Wilkins Press.
2007; Chap. 28: P. 815.
7)
Shields N., Stress,
active coping, and academic performance among persisting
and nonpersisting students. J of Applied
Biobehavioral Research, 2001; 6(2):65-81.
8)
Lazarus R.S.,
Coping Theory and Research: Past, Present, and Future.
J of Psychosomatic Medicine, 1993; 55:234-247.
9)
Baum, A., Singer,
J. E., & Baum, C. S., Stress and the environment, J
of Social Issues. 1981; 37:4-35.
10)
Fortinash K.M. and
Holoday-Worret P.A., psychiatric mental health
nursing (3rd edition). St. Louis: Mosby
press. 2004: P.208.
11)
Timby BKb,
Fundamental nursing skills and concepts. USA,
Philadelphia, Lippincott Williams & Wilkins press. 2008:
P. 64.
12)
Heerwagen J.,
Diamond R.C., Adaptation and coping: Occupant response
to discomfort in energy efficient buildings.
Proceedings of ACEEE, Summer study on energy efficiency
in buildings, Berkeley, CA: ACEEE, 1992; 10: 83-90.
13)
Pearlin L.I. and
Schooler C.,The structure of coping. J of Health and
social behavior, 1978; 19:2-21.
14)
Cooper C., Taft L.,
Thelen M., Preparing for Practice: Students and APOS;
Reflections on their final clinical experience. J of
Professional Nursing, 2005; 21(5): 293-302.
15)
Middlebrooks J.S.,
Audage N.C., The Effects of Childhood Stress on
Health Across the Lifespan. U.S. Department of
Health and Human ServicesCenters for Disease Control and
Prevention, 2008; Retrieved January 2010, from:
www.cdc.gov/ncipc/pub-res/pdf/Childhood_Stress.pdf.
16)
Stress,
Definitions. Encyclopedia of Mental Disorders, 2007.
Retrieved January 2010, from:
www.minddisorders.com/Py-Z/Stress.html.
17)
Crisp J, Potter
P.A, Perry A.G, Taylor C., Potter and Perry's
fundamentals of nursing, Elsevier Australia, 2005; Chap.
30: 588-609.
18)
Goldenberg D. and
Waddell J.,
Occupational stress and coping strategies among female
baccalaureate nursing faculty. J of Advanced Nursing,
1990; 15(5): 531-543.
19)
Saufl NM.,
Preparing the older adult for surgery and anesthesia.
J of PeriAnesthesia Nursing, 2004; 19 (6): 372-8.
20)
Simoni P.S. and
Paterson J.J., Hardiness, coping and burnout in the
nursing workplace. J of professional nursing.
1997; 13(3): 178-185.
21)
Shirey MR., Stress
and Coping in Nurse Managers: Two Decades of
Research. J of Nurs Econ.
2006; 24(4):193-203, 211.
22)
Belinskaya Elena
P., Coping as social-cultural problem. J of
Psikhologicheskie issledovaniya [= Psychological
Studies]. 2009: N 1(3) eng.
23)
Efinger J., Nelson
L.C. & Starr J.M.W., Understanding circadian rhythms: a
holistic approach to nurse and shift work. J of
Holistic Nursing, 1995; 13: 306–322.
24)
Taylor C., Lillis,
C., LeMone, P., Lynn, P., Fundamentals of Nursing:
The Art and Science of Nursing. Lippincott, Williams
and Wilkins Press. USA; Philadelphia. 2008: P. 571.
25)
Mc Vicar A.,
Workplace stress in nursing: a literature review. J
of Advanced Nursing, 2003; 44(6): 633–642.
26)
Ball J., Pike G.,
Cuff C., Mellor-Clark J. and Connell J. RCN Working Well
Survey, 2002. Retrieved January 2010, from:
http://www.rcn.org.uk/publications/pdf/working_well_survey_inside1/pdf.
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