CHAPTER III

METHODOLOGY

3.1 PROBLEM:

“To identify the Emotional Intelligence, Stress, Coping Styles of

Nursing Staff in Corporate Hospitals”.

3.2 OBJECTIVES:

The objectives of the current study are:

1. To assess the Occupational stress of Nurses working in different

corporate hospitals.

2. To examine the relationship between Emotional Intelligence and

Stress.

3. To identify the efficiency of Coping Styles.

4. To study the effectiveness of intervention on Stress and Emotional

Intelligence in Nurses.

3.3 HYPOTHESIS:

1. Stress levels will be higher in Nursing Staff working in Intensive

Critical Wards as compared to the Cubical General Ward.

2. The Emotional Intelligence will be higher in Nurses working in Critical

Care as compared to other wards.

3. The higher the Emotional Intelligence the lower will be the Stress level.

4. Nurses with cognitive focused coping styles will have lower levels of

stress.

5. Nurses with cognitive focused coping styles will have higher level of

Emotional Intelligence.

6. Intervention will lower the stress level of nurses.

7. Intervention will increase the Emotional Intelligence in Nurses.

3.4 SUB-HYPOTHESIS:

a. The higher the experience of Nurses in working area the lower

will be the Stress than compared to those who are less

experienced.

b. Nurses with higher age will have high Stress as compared to

lower age.

c. Nurses with more number of work experiences have higher

Emotional Intelligence.

d. Nurses of General Nursing Midwife will have higher Emotional

Intelligence than ANMC / B.Sc.

e. Emotional Intelligence is lower in low age group Nurses.

f. Nurses working in intensive and critical area have higher

Emotional Intelligence.

g. Nurses with higher working experience will have good coping

styles.

h. Nurses with higher education will have higher Coping Styles

compared to those of other Nurses

i. Higher Coping Styles will be adopted by GNM Nurses than those

compared to ANM ONES.

j. Nurses of age 30 – 50 years have higher Coping Styles.

3.5 SAMPLE:

In this research, Working Nurses of Corporate Hospitals were

selected for the study. Target sample was 250 (Two hundred and Fifty)

working nurses in three different Corporate Hospitals were selected for the

present study. All the three hospitals are corporate hospitals with 150-350

bedded hospitals.

The various courses completed by Nurses are GNM, ANM,

B.Sc.(Nursing).

ANM – Auxiliary Nursing & Midwife course which is of 18 months

duration and those who have completed 10th Class are eligible

for this course.

GNM – General Nursing & Midwife course which is of 3 ½ Years

duration and those who have completed Intermediate are

eligible for this course.

B.Sc.(N) – Bachelor of Science (Nursing) is a 4 years degree course and

those who have completed Intermediate with Science group are

eligible for this course.

The academic qualifications of the nurses help us to understand the

maturity of the mind of nurses.

The working areas of nurses :

IP – In Patient Wards

OPD – Out Patient Ward

OT - Operation Theatre

CT - Cardiac Intensive

Post OT – Post Operated Patient Ward

INCU – Neuro Intensive Unit

LTC – Liver Transplant Unit

S.I.C. - Surgery Unit

General Ward – Two types - Male & Female Units

Cubical – Common Ward

Dialysis – Place of dialysis

Cath Lab – Unit related to Cardiac analysis

Casualty – Emergency Ward

Though male nursing staff are also working, but for the current study

data is collected from female nursing staff those who completed their

professional Diploma, Degree courses such as ANM, GNM and

B.Sc.(Nursing).

Table 3.5.1 gives the sample characteristics.

Table 3.5.1

Sample Characteristics (n=200)

Parameter Variable n Percentage

Experience

< 5 yr 115 57

5-10 Yrs 65 33

>11 Yrs 20 10

Hospitals working

Hospital-I 60 30

Hospital-II 60 30

Hospital-III 80 40

Educational

Qualifications

ANM 19 9

GNM 131 66

B.Sc.(Nursing) 50 25

Martial Status Married 74 37

Single 126 63

Age group

21-30 yrs 167 83

31-40 yrs 25 12

41-50 yrs 5 3

>50 yrs 3 2

Family Joint Family 64 32

Nuclear 136 68

Area of work

General Ward 55 28

Intensive Ward 59 29

Dialysis Ward 5 3

OPD(Out Patient) 27 13

Post Operative

Ward

14 7

Cathe lab 4 2

Emergency /

Casualty

14 7

Cubical Ward 22 11

Duties Shift 107 54

General 93 46

3.1 Diagram shows the various educational courses of Nurses

3.2 Diagram shows the various age groups of Nurses

9%

66%

25%

Educational Qualifications

ANM

GNM

B.Sc.(Nursing)

83%

12%

3% 2%

Age group

21-30 yrs

31-40 yrs

41-50 yrs

>50 yrs

3.3 Diagram shows the various work area of Nurses

Samples belonged to different age groups. Out of 200 samples, 167 are

aged between 21-30 yrs; 25 belonged to 31-40 yrs; 5 belonged to 41-50 yrs

and 3 are more than 50 yrs. Thus the distribution of sample across the age

group shows a concentration in the two middle age ranges.

3.6 TOOLS USED:

Three instruments are used for the study viz.,

(i) Emotional Intelligence Scale (EIS) – by Anukool Hyde,

Sanjyot Pethe and Upinder Dhar

27%

29%

3%

14%

7%

2% 7%

11%

Area of work

General Ward

Intensive Ward

Dialysis Ward

OPD(Out Patient)

Post Operative Ward

Cathe lab

Emergency / Casualty

Cubical Ward

(ii) Occupational Stress Index Scale (OSIS) – by A.K.Srivastava and

A.P.Singh; and

(iii) Coping Strategies Scale (CSS) – by A.K.Srivastava.

Each of these instruments is described in detail in the following paragraphs.

(1) Emotional Intelligence Scale (E I S) :

This instrument is developed by Anukool Hyde, Sanjyot Pethe and

Upinder Dhar for suitable self-report measure for Indian milieu. The scale

purports to measure learned optimism of which the subject has some

awareness. It should not be used as a tool for individual diagnosis unless

supported by other evidences. Therefore, observation of other self-related

perceptions is also required. The scale contains 34 items (Appendix I),

measuring 10 different dimensions that are directly related to the concept of

Emotional intelligence of an individual. Each of these items were rated on a

five point scale varying from “Strongly Agree” to “Strongly Disagree” on the

degree of agreement with the statement. The subject’s emotional intelligence

is measured based on the responses of agreement with the statement. The

following table 3.5.1 gives five dimensions and the appropriate items under

each dimension.

Table No.3.6.1

Description of Emotional Intelligence Scale (EIS)

Sl.No. Factor Item Numbers

A Self-awareness 6,12,18,29

B Empathy 9,10,15,20,25

C Self-motivation 2,4,7,8,31,34

D Emotional Stability 14,19,26,28

E Managing Relations 1,5,11,17

F Integrity 16,27,32

G Self-Development 30,33

H Value Orientation 21,22

I Commitment 23,24

J Altruistic behaviour 3,13

(2) Occupational Stress Index Scale (OSIS) :

This instrument is developed by A.K.Srivastava & A.P.Singh. The

Occupational Stress Index Scale purports to measure the extent of stress that

employees perceive arising from various constituent and conditions of the job.

The scale contains 46 items (Appendix II), measuring 12 different dimensions

that are inherent in any occupation. Each of these items were rated on a five

point scale varying from “Strongly Disagree’ to ‘Strongly Agree’ on the

degree of agreement with the statement. The subject’s stress is measured

based on the responses of disagreement with the statement. Out of the 46

items, 18 are negative statements where the scores had to be reversed called

“false-keyed items’ (A.K.Srivatsava and A.P.Singh, 1984). The following

table 3.5.2 gives five dimensions and the appropriate items under each

dimension.

Table No.3.6.2

Description of Occupational Stress Index Scale (OSIS)

Sl.No. Dimensions of the Scale Item Numbers

1 Role Overload 1, 13, 25 36, 44, 46

2 Role Ambiguity 2, 14*, 26, 37

3 Role Conflict 3,15*, 27, 38, 45

4 Unreasonable group &

pol. pressures persons

4, 16, 28, 39

5 Under participation 6*, 18*, 30*, 40*

6 Powerlessness 7*, 19*, 31*

7 Poor peer relations

Intrinsic

8*, 20*, 32*, 41*

8 Impoverishment 9, 21*, 33*, 42

9 Low Status 10*, 22*,34

10 Strenuous working

conditions

12,24,35,43*

11 Un-profitability 11,23

(*) False-keyed items

(3) Coping Strategies Scale (C S S) :

This instrument is developed by A.K.Srivastava. The Coping Strategies

Scale purports to measure the extent of Coping Strategies that employees

perceive arising from various constituent and conditions of the job. The scale

contains 50 items (Appendix III), to be rated on five point scale, describing

values of coping behaviour underlying following five major categories of

Coping Strategies based on the combinations of ‘operation’ and ‘orientation’

of the coping behaviour :

1. ACTIVE / APPROCH COPING (Problem- Focused Coping)

a. Behavioural Approach Coping Strategies

b. Cognitive Approach Coping Strategies

c. Cognitive Behavioural Approach Coping Strategies

2. AVOIDANCE COPING (Emotion – Focused Coping)

a. Behavioural Avoidance Coping Strategies

b. Cognitive Avoidance Coping Strategies

Each of these items was rated on a five point scale varying from

“Never’ to ‘Almost Always’ on the degree of agreement with the statement.

The subject’s Coping Strategies Scale is measured based on the scores of the

five coping strategies.

The following table 3.5.3 gives five dimensions and the appropriate

items under each dimension.

Table No.3.6.3 Dimensions of the Scale and Item Numbers of Coping

Strategies Scale (C S S)

Sl.No. Dimensions of the Scale Item Numbers

1 Behavioural - Approach 2,4,5,6,12,20,21,26,29,33,35,4

1,45,47,48

2 Cognitive - Approach 3,7,8,25,42,43

3 Cognitive – Behavioural

Approach

11,13,17,23,30,31,37,48

4 Behavioural - Avoidance 1,10,15,16,18,19,22,27,28,34,

36,39,44,50

5 Cognitive Avoidance 9,14,24,32,36,40,46

After the completion of the field investigation data are classified and

tabulated.

3.7 PROCEDURE:

For the present study the Researcher individually contacted nurses

during their working hours by prior appointment from the Nursing

Superintendent of concerned Hospital authorities. The objectives of the

study were clearly explained to the participants. After establishing

sufficient rapport with them, the tools for study were administered.

After making clear about the study they filled the bio-data sheet. The

nurses were requested to read the structured instructions carefully provided for

answering each scale before giving their response. They were assured that the

response would be kept confidential and used for study for Research purpose

only. They were given the Emotional Intelligence Scale and Occupational

Stress Index Scales first. On submission of these two, they were given the

Coping Strategies Scale questionnaire.

The researcher administrated the questionnaire to 250 nurses but among

250 some were incomplete while other lacked information on demographic

variables, hence they had to be discarded. Finally only 200 completed

questionnaires of nurses were available which has constituted the sample for

the present study. After obtaining the response of the subjects, scoring was

done accordingly to the guidelines specified in the test manuals.

3.8 INTERVENTION:

Intervention is a methodology in which the Nurses with stress are given

education and self management skills about the problem, counseled about

coping strategies. A person gradually learns to cope with difficult situations

on stimuli often through controlled exposure to them. The goal is to modify

and gain control over unwelcome fear, anxieties and behaviours. The study

introduces interventions which form the core of comprehensive care in the

field of nursing care.

After identifying the specific area to be focused for intervention, the

therapeutic progrommes are :

1. Counseling on psycho socio factors and other concerned stress

2. Relaxation Techniques - (Jackson) Progressive Muscle Relaxation

Technique to help Nurses develop more control over somatic symptoms

of anxiety - Brief relaxation technique like rapid relaxation (20-30

seconds)

Therapeutic progrommes are described in detail in the following

paragraphs.

Relaxation therapy:

Jacobson’s Technique - Progressive relaxation (15-20 mts) :

Relaxation Technique can help individual develop the ability not only

to manage the stresses that increase their anxiety, but also to control some of

the physical symptoms. This treatment includes breathing re-training and

exercises.

P Muscle R.Jacobson 1938, Wolpe 1958, 1969, 1973) developed by

American physician Edmund Jackson in the early 1920s PMR (PMR) is a

popular relaxation training technique for anxiety stress that works on several

basic principles. Anxiety is often associated by muscle tension so by reducing

muscle tension, anxiety reduces.

It involves that the relaxation training technique for stress requires sleep

concentration in a relaxed setting. Mentally focus on distinct muscles, muscle

groups or body parts and systematically attempt to relax each one by one. The

process is often called body scanning. Body scanning is a great way to relax

muscles prior to or after physically working out as well. Time commitment it

requires 15-20 minutes. It is alone once a day at first, than as required daily

verbal instructions can be taped to help you proceed. The first stage of

relaxation training involves the progressive relaxation technique in which the

body is divided up into a series of large muscle groups and each group is

tensed and then relaxed by attaining tension and relaxation are taught to

discriminate between these two states and to become more relaxed of the parts

of the body in which they are particularly tense. In order to facilitate tension

to natural situation, Nurses do not lie on a couch during Progressive

Relaxation Technique. Instead they are asked to sit in a comfortable chair.

First the therapist models how the different groups of muscles should be

tensed and relaxed. Later the Nurses does the various tension relax exercises

at the same time, with the therapist checking that these are done correctly.

Then the Nurse closes his / her eyes and the therapist takes his / her through

tensing and releasing the different muscle groups in the right order and at the

right tempo. Tension is normally maintained for about 5 seconds with the

subsequent relaxation of a muscle group lasting 10 – 15 seconds. Normally

each muscle group is tensed and relaxed only once. Therapist should check

whether Nurses are experiencing any problems in relaxing particular muscle

groups and help to deal with them. For the purpose of Progressive Relaxation

the body is divided into two parts. In the first session, relaxation of the hands,

arm, face, neck and shoulders is practiced. In the second session, the rest of

the body is also included. The main muscle group involved in each session

and instructions for tensing them as follows:

Session 1 – Clinch the right first, feeling tension in the forearm clinch

the left first, feeling the tension in the fist and forearm bend the elbow of tense

the biceps, keeping the hands relaxed, straighten the arm and tense the biceps

leisure the lower tri cups leaving the lower arm supported by the chair with

the hands relaxed. Winkle the forehead by raising the eyebrow bring the

eyebrows close together (as in a frown) – screw up the muscles around the

eyes tense the jaw by biting the tech together. Press the tongue hard and fist

against the root of the mouth and lips closed, notice tension in the throat. Press

the lips tightly together, push the head back as far as it will go (against a

chair) press the chin down on to the chest – hunch the shoulders up towards

the ears bend the shoulders towards the ears and circle the shoulders.

Session – 2 : First go through the exercises learnt in session 1. This

should take about 10 minutes. After completing the last shoulder exercise, go

straight into the following set of exercises breath calmly and regularly with

the stomach take a deep breath, completely fitting the lungs, hold the breath

for a few seconds then positively exhale tense the stomach muscles pull in the

stomach and the lower back away from the chair. Tense the buttocks and hip

muscles by pressing the hands to the floor keeping the legs straight. Tense the

calves by pressing the feet and toes downward tense the shrine by binding the

feet and toe upwards – continue breathing calmly and regularly with the

stomach.

Following each session the home work assignment is to practice

progressive relaxation procedure of practice on every day basis. Nurses should

choose a place and time when they will be comfortable and unlikely to be

interpreted. They should also keep a record of the time taken to relax and the

amount of relaxation achieved during each practice.

Rapid Relaxation Technique : 20-30 seconds -- 15-20 times per day

Rapid relaxation is the next phase after teaching progressive muscle

relaxation technique in applied relaxation which has two purpose (1) teaching

nurses to relax in natural in stressful situations (2) further reduce the time and

time takes to get relaxed. The goal being 20 – 30 seconds. in order to active

these goals, the person should relax 10 – 20 times a day in natural situations.

In Rapid Relaxation Technique the aim is to further reduce the time it take to

relax and give persons extensive practice in relaxing in natural, non stressful

situation. Therapist and nurses identify a series of cues which can be used to

remind the person to relax in the natural environment.

Steps:

1. Take 2-3 deep breath, slowly exhaling after each breath

2. Think relax before each exhaling

3. Scan the body for tension, and try to relax as much as possible

in the situation

Counselling: (A psycho education programme for Nurses relating to

Occupational Stress, Coping Styles and Emotional Intelligence

in work place.)

This programme of counseling help nurses to have possible change in

their areas. It is done in specific area viz., initial phase, middle phase and

termination.

After the psychological assessment of Nurses related to high stress they

were given required therapy in duration of 2 – 3 weeks and after ten week of

intervention on psychological tests the Nurses were measured in the areas of

Emotional Intelligence, Stress and Coping Styles.

Intervention was given in duration of 2-3 weeks. A gap of 2 weeks was

given depending on the grade of stress in Nurses so that intervention helped

them to activate stress levels, gain more confidence and support on coping

factors.

The whole intervention took place in duration of one month and the

plan was to assess immediate effects of the interventions. Hence after the

intervention, Emotional Intelligence, Stress and Coping Styles were assessed

to understand the effect of intervention on these functions.

Inclusion criteria:

Only female nurses

Profession – Nursing completed

Age group between 18 – 55 years

Corporate Hospitals

Working in various wards such as critical to general wards.

3.9 DATA COLLECTION:

The raw scores are collected from the response sheets of nurses. The

scoring is done as directed in the manual. Three scores viz., coping strategies,

stress and emotional intelligence of each sample are obtained. The trait

coping strategies have been scored separately with all subsets. Occupational

stress factor is also scored separately with all sub areas.

3.10 DATA ANALYSIS:

The raw scores are converted into Statistical Analysis using the

following methods:

a) Measures of Central Tendency

b) Measures of Variability

c) ‘t’ ratio to find the difference among the Group

d) Multivariate Analysis to see the trends and factors relating to

Stress.

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