A COMPARATIVE STUDY TO ASSESS THE LEVEL OF STRESS AND COPING

STRATEGIES ADOPTED BY STAFF NURSES IN PSYCHIATRIC HOSPITALS AND

GENERAL HOSPITALS IN SELECTED DISTRICTS OF MAHARASHTRA, WITH A VIEW TO

DEVELOP INFORMATIONAL BOOKLET.

INTRODUCTION

Nursing is an emotionally demanding and a highly stressful profession as nurses has to deal

with different people, in various situations and different times of the day. During their everyday work,

they have to cope with extremely emotionally charged and rapidly changing circumstances. An

occupational study was conducted on Sources of job stress and levels of job satisfaction of

occupational stress with 129 Victorian nurses. The information regarding job stress was obtained

through Gray-Toft and Anderson’s Nurses stress scale (NSS) and levels of job satisfaction by Nurses

Stress Index. Results showed that the nurses rated their workload as highly stressful in terms of both

frequency of its occurrence and its perceived effect upon themselves. The nurses reported higher

levels of stress associated with lower levels of job satisfaction.

In recent years there has been broad discussion on the nature of stressors experienced by

members of “high risk” occupations and professions, for instance nursing and emergency workers,

whose role is to support others through traumatic scenarios. Health care professionals, especially

emergency department staff, are at risk for experiencing critical incidents. Emergency Department

nurses are in a position that is expected to deal with additional stressors. These include unexpected

numbers of patients at any time, unexpected rapid changes in patient’s situations and response to

distressing or traumatic incidents such as sudden death, patient violence, inappropriate attendees and

physical or verbal abuse on a daily basis. Emergency nursing is a highly stressful profession. Nurses

need to adopt with or cope up with the situations faced by them in workplace. Various coping

strategies are needed to be adopted by the nurses in general as well as mental health settings.

NEED FOR STUDY:

The levels of stress are recognized problems in health care workers. Especially in the field of

nursing the stress has been identified in high range. It was found that job stress brought about

hazardous impacts not only on nurses’ health but also in their abilities to cope with job demands. By a

number of studies nursing has been identified as a stressful occupation. Stress has cost individuals in

terms of health, wellbeing, and job satisfaction, as well as for the organization in terms of

absenteeism and turnover, which in turn may impact the quality of patient care.

A worldwide shortage of nurses has been acknowledged by the Global Advisory Group of the

World Health Organization (WHO). As the worldwide nursing shortage increases, the aged

population becomes larger, there is an increase in the incidence of chronic illnesses and technology

continues to advance, nurses continually will be faced with numerous workplace stressors.

Occupational stress is the cause of approximately 40% of turnover and 50% of workplace absences.

The annual cost of occupational stress and its effects in the US is estimated to be over $60 billion

to employers and $250–300 billion to the economy.

In India, the studies related to stress and coping strategies adopted by staff nurses are very

less, thus the researchers felt the need to assess the stress and coping strategies adopted by the nurses

in psychiatric hospitals and general hospitals.

PROBLEM STATEMENT

A COMPARATIVE STUDY TO ASSESS THE LEVEL OF STRESS AND COPING

STRATEGIES ADOPTED BY STAFF NURSES IN PSYCHIATRIC HOSPITALS AND

GENERAL HOSPITALS IN SELECTED DISTRICTS OF MAHARASHTRA, WITH A VIEW TO

DEVELOP INFORMATIONAL BOOKLET.

OBJECTIVES:

1. To assess the levels of stress and coping strategies adopted by staff nurses in selected psychiatric

hospitals and general hospitals.

2. To compare the levels of stress and coping strategies adopted by staff nurses in selected psychiatric

hospitals and general hospitals.

3. To find out association between level of stress with selected demographic variables of both staff

nurses in selected psychiatric hospitals and general hospitals.

4. To find out association between coping strategies adopted by staff nurses with selected demographic

variables in both staff nurses in selected psychiatric hospitals and general hospitals.

HYPOTHESIS:

H1: There is significant association between levels of stress adopted by staff nurses in psychiatric

hospitals and general hospitals with selected demographic variables.

H2: There is significant association between the coping strategies of staff nurses in psychiatric

hospitals and general hospitals with selected demographic variables.

ASSUMPTION

There may be significant difference between the levels of stress and coping strategies adopted

by staff nurses in a selected psychiatric hospitals and general hospitals at selected districts of

Maharashtra.

METHODOLOGY:

1. Research Approach: Quantitative research approach was considered appropriate research

approach for the present study.

2. Research Design:, The comparative research design selected for the present study.

3. Variables under study:

Research Variables

The research variables in this study were levels of stress and coping strategies adopted by staff

nurses.

Demographic Variable The demographic variables in this study were age, gender, years of experience, marital status,

professional qualification, working area in psychiatric hospital, working area in general hospital, no.

of children, type of family.

4. Population:

The population selected for the study was staff nurses those who were working in Psychiatric

hospitals and general hospitals at selected district of Maharashtra.

5. Sample size:

The sample size selected for the study was 50 staff nurses of psychiatric hospitals and 50 staff

nurses of general hospitals in selected districts of Maharashtra.

6. Sampling Technique:

Convenient sampling technique was been used for the present study.

7. Inclusion and exclusion criteria:

Inclusion Criteria:

The staff nurses of government hospitals in both psychiatric and general settings who are available

during the data collection.

The staff nurses of government hospitals in both psychiatric and general settings who are willing to

cooperate during the data collection.

Exclusion Criteria:

ANM staff nurses of government hospitals in both psychiatric and general setting. The staff nurses of government hospitals in both psychiatric and general settings who are not

available during the data collection.8. Method of Data Collection:

The data here was collected by using modified structured nurses stress assessment scale and modified structured coping mechanism scale.

9. Description of the Tool:Description of the tools- It is divided into 3 sections.SECTION I: Socio demographic data. (Total 09 items)

SECTION II: Modified structured nurses stress assessment scale. This part of tool consists of items related to assessment of stress level of staff nurses. It consists of 20 items. Scoring for the items was done as “Never” is “0”, “Sometimes” is “1”, “Always” is “2”. The score was evaluated asScore < 10: No stressScore 11-20: Mild stress Score 21-30: Moderate stress Score 31-40: Severe stress

SECTION III: Modified structured coping mechanism scale. This part of tool consists of items related to assessment of ways of coping adopted by staff nurses. It consists of 20 items. Scoring for the items was done as “Mostly” is “4”, “Rarely” is “3”, “Sometimes” is “2”, “Never” is “1”. The score was evaluated as,Score 60-80: Superior adopted coping strategy.Score 40-59: Above average adopted coping strategy. Score 20-39: Average adopted coping strategy.Score 0-19: Below average adopted coping Strategy.

PLAN FOR DATA ANALYSIS

The data obtained was analyzed using both descriptive and inferential statistics based on

objectives and research question of the study under the following headings.

Descriptive statistics:

To describe the distribution of demographic variables by using frequency and percentage.

To determine the stress and coping strategies among staff nurses in both clinical settings by using

mean, median, standard deviation.

Inferential statistics:

The significance of difference between the occupational stress and coping strategies among staff

nurses in both clinical settings by using t-test.

To find out the association between demographic variables with the stress and coping strategies

among staff nurses in both settings by using Chi square test.

ETHICAL CONSIDERATIONS:

The topic of the study was approved by the institutional ethical committee. The permission for

conducting the study was obtained from the administrative department of selected hospitals. The

nature of the study, aims and objectives were explained to the subjects after assuring that their

information would be kept confidential and used for research purpose only.

RESULTS:

The findings of the study were organized as follows:

Age wise distribution among staff nurses in psychiatric hospitals and general hospitals.

Age of the participants.

Psychiatric Hospital StaffNurses

General Hospital StaffNurses

Frequency Percent Frequency Percent21-30 10 20.0 14 28.031-40 15 30.0 15 30.041-50 14 28.0 14 28.051-60 11 22.0 7 14.0Total 50 100.0 50 100.0

Table reveals age group wise distribution of staff nurses to study the stress and coping strategies.While discussed about nurses among psychiatric hospitals out of 50(100%) staff nurses

maximum 15(30%) were in age group of 31-40 years, 14(28%) were in age group of 41-50 years, 11(22%) were in age group of 51-60 years and 10(20%) were in age group of 21-30 years. On the other hand about staff nurses among general hospitals out of 50(100%) staff nurses maximum 15(30%) were in age group of 31-40 years, 14(28%) were in age group of 41-50 years, 14(28%) were in age group of 21-30 years and 7(14%) were in age group of 51-60 year.

Bar chart showing gender wise distribution among staff in psychiatric hospitals and general hospitals.

Graph reveals gender wise distribution of staff nurses to study the stress and coping strategies.

Psychiatric Hospital Nurses General Hospital Nurses

35 32(64%) 31(62%)

30

19(38%)20

18(36%)

15

10

Male Female

While discussed about nurses among psychiatric hospitals out of 50(100%) staff maximum 36(64%) were females and 18(36%) were males.On the other hand about staff nurses among general hospitals out of 50(100%) staff maximum 31(62%) were females and 19(38%) were males.

Marital status wise distribution among staff nurses in psychiatric hospitals and general hospitals.

Marital status of the participants.

Psychiatric HospitalNurses

General HospitalNurses

Frequency Percent Frequency PercentSingle 10 20.0 11 22.0Married 33 66.0 26 52.0Widow 8 16.0 13 26.0

Total 50 100.0 50 100.0The table reveals marital status wise distribution of staff nurses to study the stress and coping

strategies.While discussed about nurses among psychiatric hospitals out of 50(100%) staff maximum

33(66%) were married, 10(20%) were unmarried and 8(16%) were widow/separated. On the other hand about staff nurses among general hospitals out of 50(100%) staff maximum 26(32%) were married, 11(22%) were unmarried and 13(26%) were widow/separated.

Professional qualification wise distribution among staff nurses in psychiatric hospitals and general hospitals.

Graph reveals professional qualification wise distribution of staff nurses to study the stress

and coping strategies.

While discussed about nurses among psychiatric hospitals out of 50(100%) staff maximum 20(40%) completed B.Sc. Nursing, 20(40%) P.B.BSc. Nursing, 9(18%) completed GNM and 1(2%) completed MSc. Nsg. On the other hand about staff nurses among general hospitals out of 50(100%) staff maximum 17(34%) completed B.Sc Nursing, 15(30%) completed GNM, 12(24%) completed P.B.BSc. Nursing and 6(12%) completed MSc. Nsg.

Years of experience wise distribution among staff nurses in psychiatric hospitals and general hospitals

20(40%) 20(40%) Psychiatric Hospital Nurses20

18

16

14

12

10

8

6

17(34%) General Hospital Nurses

15(30%)

12(24%)

9(18%)

6(12%)

1(2%)

GNM B.SC Nursing P.B.B.sc Nursing M.SC Nursing

Table reveals years of

experience wise distribution of staff nurses to study the stress and coping strategies.

While discussed about nurses among psychiatric hospitals out of 50(100%) staff maximum 17(34%) had less than 1 year of experience, 16(32%) had 6-10 years of experience, 14(28%) had 1-5 years of experience and remaining 3(6%) had more than 10 years of experience. On the other hand about staff nurses among general hospitals out of 50(100%) staff maximum 16(32%) had 1-5 years of experience, 14(28%) had less than 1 year of experience, 12(24%) had 6-10 years of experience and remaining 8(16%) had more than 10 years of experience.

Pie chart showing working area wise distribution among staff nurses in general hospitals.

Graph reveals year of working area wise distribution of staff nurses to study the stress and coping strategies in psychiatric hospitals. It was revealed that among psychiatric hospitals out of 50(100%) staff nurses, 18(36%) staff were working in male ward, 15(30%) staff were working in casualty, 11(22%) staff were working in female ward, 6(12%) were working in other wards.

No of children wise distribution among staff nurses in psychiatric hospitals and general hospitals

General Hospital Nurses

Others 18%

Causality 20%

Female Ward 32%

Male ward 30%

Year of experience.Psychiatric Hospital Nurses General Hospital Nurses

Frequency Percent Frequency Percent< 1 year 17 34.0 14 28.0

1-5 years 14 28.0 16 32.0

6-10 years 16 32.0 12 24.0

Above 10 years. 3 6.0 8 16.0

Total 50 100.0 50 100.0

Table

reveals number of children wise distribution of staff nurses to study the stress and coping strategies.While discussed about nurses among psychiatric hospitals out of 50(100%) staff maximum

26(52%) staff had two children, 13(26%) staff had no children, 10(20%) staff had only one child and remaining 1(2%) staff had three and above child.On the other hand about staff nurses among general hospitals out of 50(100%) staff maximum 20(40%) staff had two children, 14(28%) staff had no children, 14(28%) staff had only one child and remaining 2(4%) staff had three and above child.

Bar diagram showing family type wise distribution among staff nurses in psychiatric hospitals and general hospitals.

Graph reveals family type wise distribution of staff nurses to study the stress and coping strategies.

While discussed about nurses among psychiatric hospitals out of 50(100%) staff maximum 30(60%) staff had lived jointly, 14(28%) staff had lived as nuclear, and remaining 6(12%) staff lived as extended. On the other hand about staff nurses among general hospitals out of 50(100%) staff maximum 29(58%) staff had lived jointly, 14(28%) staff had lived as nuclear, and remaining 7(14%) staff lived as extended.

Assessment of stress count among psychiatric and general hospitals staff members.

30(60%) 29(58%)30

Psychiatric Hospital Nurses

General Hospital Nurses

25

14(28%) 14(28%)15

6(12%) 7(14%)

5

Joint Nuclear Extended

No. of children. Psychiatric Hospital Nurses General Hospital Nurses

Frequency Percent Frequency PercentNo child 13 26 14 28.0

One child 10 2014 28.0

Two children 26 5220 40.0

Three and above 1 22 4.0

Stress Level Psychiatric Hospital Nurses

General HospitalNurses

Score Category Frequency % Frequency %Score Below 10 No Stress 0 0 0 0

Score 11-20 Mild Stress 9 18 17 34Score 21-30

Moderate Stress36 72 31 62

Score 31-40ExtremeStress 5 10 2 4

Table reveals that level of stress count of staff nurses among psychiatric hospitals as well as general hospitals.

While discussed about nurses among psychiatric hospitals out of 50(100%) staff 36(72%) staff had moderate stress, 9(18%) had mild stress and remaining 5(10%) had extreme stress. On the other hand about staff nurses among general hospitals out of 50(100%) staff 31(62%) staff had moderate stress, 17(34%) had mild stress and remaining 2(4%) had extreme stress.

Association of stress count among psychiatric and general hospital staff nurses.

Stress Level

Psychiatric Hospital Nurses

General Hospital Nurses

Chi- square p-value

Mild Stress 9(18%) 17(34%)

4.12 0.13Moderate

Stress 36(72%) 31(62%)Extreme Stress 5(10%) 2(4%)

The association of stress count among psychiatric and general hospital staff nurses was not statistically significant with P>0.05 and chi-square was 4.12.

Comparison of mean and standard deviation stress score between psychiatric and general hospitals staff members.

Comparison of Stress ScorePsychiatric Hospital Nurses General Hospital Nurses

Mean 23.58 21.84Standard Deviation 4.8 3.9

Unpaired t-test 1.988p-value 0.0496*

*significant when p<0.05

The mean stress level score among psychiatric hospitals nurses were 23.58±4.8, whereas the mean stress level score among general hospital nurses were 21.84±3.9. After comparing stress score between psychiatric and general hospital by using unpaired t-test it was found statistically significant with p<0.05 and furthermore it was revealed by mean that the stress score of staff nurses among psychiatric hospitals was more as compared to general hospitals.

Table showing assessment of coping strategy count among psychiatric and general hospital staff members.

Score Coping Category PsychiatricHospital Nurses

General HospitalNurses

Frequency % Frequency %Score 1-19 Below average adopted

coping strategy 0 0 0 0

Score of 20-39 Average adoptedcoping strategy 16 32 26 52

Score of 40-59 Above averageadopted coping strategy 34 68 24 48

Score 60 -80Superior adoptedcoping strategy 0 0 0 0

Table reveals the assessment of coping strategy count among psychiatric and general hospital staff members

While discussed about nurses among psychiatric hospitals out of 50(100%) staff maximum 34(68%) staff had adopted above average coping strategy, 16(32%) staff had adopted average coping strategy. On the other hand about staff nurses among general hospitals out of 50(100%) staff maximum 26(52%) staff had adopted average coping strategy, 24(48%) staff had adopted above average coping strategy.

Association of coping count among psychiatric and general hospital staff nurses.

Score Coping Category Psychiatric Hospital Nurses

General Hospital Nurses

Chi-square p-value

Score of 20-39 average adoptedcoping strategy 16 26

3.385 0.068Score of 40-59

above average adoptedcoping strategy 34 24

The association of coping count among psychiatric and general hospitals staff nurses was not statistically significant with P>0.05 and chi-square was 3.385.

Comparison of coping score between psychiatric and general hospital staff members.

Comparison of Coping Score Psychiatric Hospital

NursesGeneral

Hospital Nurses

40.76 38.14Mean 8.3 7.9

Standard Deviation 1.467Unpaired t-test 1.606

p-value 0.1115

The mean coping score among psychiatric hospital nurses were 40.76±8.3, whereas the mean coping score among general hospital nurses were 38.14±7.9. After comparing coping strategies score between psychiatric and general hospitals by using unpaired t-test it was not found statistically significant with p>0.05 and furthermore it was revealed by mean that the coping score of staff nurses among psychiatric hospitals was quite less as compared to general hospitals.

Association between the levels of stress and socio-demographic parameters among psychiatric hospitals

Demographical Variables N

Psychiatric Hospital Df

Chi- sqaure p-

value

<Median N=20

≥ Median N=30

Age (in years)21-30 10 5 5 3

9.936 0.01931-40 15 3 1241-50 14 3 1151-60 11 8 3

Gender of the participant.Male 18 8 10 1

0.496 0.481Female 32 11 21

Marital status of the participant.

single10 2 8

2

4.733 0.094Married 33 12 21

Widow 8 5 2Professional qualification of the participant.

GNM 9 2 7 3

2.813 0.413B.SC Nursing 20 7 13

P.B.B.sc Nursing 20 10 11MSC NSG 1 0 1

Year of experience.< 1 yrs 17 6 11 3

0.336 0.9531-10 yrs 14 5 911- 20yrs 16 7 921- 30 yrs 3 1 2

Working area of general hospital.Causality 10 4 6 3

Male ward 15 3 12

4.425 0.219Female Ward 16

9 7Others 9 3 6

Table revealed that the association between the levels of stress and socio- demographic parameters among psychiatric hospital. Age was significantly associated with stress level among the staff nurses of psychiatric hospital. No other demographic variables were significantly associated with stress.

Association between the levels of coping and socio-demographic parameters among psychiatric hospital

Demographical Variables

N Psychiatric Hospital df Chi- square

p-valueAbove

average adopted coping strategy N=34

average adopted coping strategy N=16

Age (in years)21-30 10 7 3

3 2.515 0.569

31-40 15 12 341-50 14 9 551-60 11 6 5

Gender of the participant.Male 18 14 4

1 1.236 0.266Female 32 20 12

Marital status of the participant.single 10 10 0

2 5.914 0.052Married 33 20 13

Widow 8 4 3

Professional qualification of the participant.

GNM9 5 4

3 1.433 0.698

B.SCNursing 20 9 11P.B.B.scNursing 20 9 11M.SC

Nursing 1 1 0Year of experience.

< 1 year17 12 5

3 2.555 0.4651-5 years

14 10 46-10 years

16 9 7

Above 10 years. 3 3 0

Working area of general hospital.

Casualty10 7 3

3 0.648 0.885

Male ward15 10 5

Female Ward16 10 6

Others9 7 2

Number of child

No child. 13 8 5

310.655 0.0137

One child. 10 3 7

Two children. 26 22 4

Three and above. 1 1 0

Type of Family

Joint 30 22 8

2 1.155 0.5612Nuclear 14 8 6

Extended 6 4 2

Table revealed that the association between the levels of coping and socio- demographic parameters among psychiatric hospital. No demographic variables were statistically significant with p>0.05. Except the association between child numbers and coping strategy adoption was significantly associated where p<0.05.

Association between the levels of stress and socio-demographic parameters among general hospitals

Demographical Variables N

General Hospitaldf Chi-

sqaure p-value<

Median N=22

≥ Median N=28

Age (in years)

21-30 14 6 83 0.932 0.818

31-40 15 7 841-50 14 7 751-60 7 2 5

Gender of the participant.Male 19 9 10

1 0.141 0.707Female 31 13 18Marital status of the participant.

Single 11 6 5

2 1.469 0.48Married 26 12 14Widow 13 4 9

Professional qualification of the participant.GNM 15 3 12

3 6.917 0.075B.SC Nursing 17 11 6

P.B.B.sc Nursing 12 6 6MSC NSG 6 2 4

Year of experience.< 1 yrs 14 7 7

3 0.791 0.8521-10 yrs 16 6 1011- 20yrs 12 6 621- 30 yrs 8 3 5

Working area of general hospital.Casualty 15 9 6

3 4.89 0.18Male ward 18 9 9

Female Ward 11 3 8Others 6 1 5

Table revealed that the association between the levels of stress and socio-demographic parameters among general hospital. No demographic variables were significantly associated with stress.

Association between the levels of coping and socio-demographic parameters among General hospitals

Demographical Variables N

General Hospital

Chi- sqaure p-value

Above average adopted coping strategy N=24

Average adopted coping strategy N=26

Age (in years)21-30 14 8 6

3 3.85 0.27831-40 15 8 741-50 14 7 751-60 7 1 6

Gender of the participant.Male 19 6 13

1 3.311 0.69Female 31 18 13

Marital status of the participant.

single 11 4 72 0.816 0.665Married 26 13 13

Widow 13 7 6Professional qualification of the participant.

GNM 15 4 11

3 6.746 0.08

B.SCNursing 17 12 5

P.B.B.scNursing 12 6 6

M.SC Nursing 6 2 4Year of experience.

< 1 year 14 8 6

3 3.461 0.326

1-5 years 16 9 76-10 years 12 3 9

Above 10 years. 8 4 4Working area of general hospital.

Causality 15 7 8

3 5.48 0.14

Male ward 18 12 6Female Ward 11 4 7

Others 6 1 5Number of child

No child.13 8 5 3

2.170 0.5380

One child.10 4 6

Two children.26 12 14

Three and above. 1 0 1Type of Family

Joint 30 14 162 1.007 0.6043Nuclear 14 8 6

Extended 6 2 4Table No. 21 revealed that the association between the coping strategies and socio- demographic parameters among general hospitals. No demographic variables were significantly associated with stress.

CONCLUSION

It is clear from the results of this study that staff nurses are exposed to a variety of stressors from clinical perspectives. Effectively managing stress is a priority for staff nurses. Overall time management for the staff nurses will determine their ability to successfully negotiate their way through the remaining times of their job. Including holistic care studies for staff nurses have shown to result in the ability to study better, better sleeping habits and general health improvement. Requiring stress management within the nursing curriculum assists nurses with teaching coping techniques to clients and hospital visitors. An effective nursing program provides ongoing stress management workshops during the off working time. There are unique interpersonal and environmental stressors for staff nurses. Administrators can address these with an assigned counseling management that supports at-risk of staff nurses. They are essential for managing the workload of nurses but can also directly contribute to the care of their clients. Insufficient knowledge about stress coping techniques is the primary barrier to its implementation. Implementation of these coping techniques within staff nurses prepares nurses for a professional career. For staff nurses away from home, creating a support system may fall last in their list of priorities. Providing support within the hospital system may involve group and individual counseling as well as direct access to resources. Creating a support system with family and friends is a primary stress reduction technique because having the ability to enjoy time away from nursing and studies supports self-care. Nurses must prioritize their own care with the other care they are required to provide. A positive outcome of these study findings indicate that the coping strategies appeared to be more effective in reducing the level of stress for staff nurses.

RECOMMENDATIONS A study on effectiveness of specific coping strategy can be done. A comparative study to assess the effectiveness of coping strategies and any other stress

management like guided imagery on reduction of stress can be done to implement appropriate stress management techniques to reduce stress among staff nurses.

Replication of the study at different setting could be carried out with a larger sample size.i. It is also recommended to conduct further research studies to discover more effective strategies to

promote the general well-being of staff nurses.ii. In addition, longitudinal studies to study the patterns of coping behaviors among staff nurses at

different periods during their course time should be done.

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