The problem Introduction:
‡ Nursing gained recognition in the 19th century with the activities of Florence Nightingale. Many nurses have specialties like psychiatry, critical care and other areas of specialization. Nurse-practitioners, clinical nurse specialists, nurse-anesthetists, and nurse-midwives undertake tasks traditionally performed by physicians. ‡ Among Asian countries, the Philippines has the highest quality of nursing education with over 190 educational institutions accredited by the Commission on Higher Education that offer nursing courses.

For the past many years, the Filipino nurses have become a much sought-after healthcare worker in Asia, the Middle East, Europe, North America and Africa establishing a popular figure in major hospitals, nursing homes, and other healthcare institutions in the United Kingdom, United States of America, Ireland, Kingdom of Saudi Arabia, united Arab Emirates, Kuwait, Singapore, Malaysia and others.

The decision to work abroad as a nurse requires intense consideration. While motivation is important, preparedness and determination are essential. In this complex and competitive world, a nurse·s performance is very much affected by stress. Research has shown that stress creates a variety of effects and consequences which can either increase or decrease one·s level of performance.

‡ This study holds to the assumption that for various reasons, stressors and coping mechanisms are very important determinants of work performance, moreover, the determinants of postreaction performances like personal attitudes and preferences that affect interpersonal relationship.

According to Hawley, 1992
Nursing profession has been increasingly characterized by occupational stress. It is a phenomenon where the individual is exposed to a range of external environmental demands which need his response.

The relevance of the study lies on the fact that its purpose is to bring together the implications of understanding stressors, how they affect the lives of Filipino nurses abroad and how they cope with them. Specifically, it aims to provide a basis for the development of a predeployment orientation program for nurses who are seeking employment abroad.

Statement of the Problem
This study aims to determine the stressors and coping mechanisms of nursing graduates of Sacred Heart College, Lucena City Batch 20052009 working Overseas. Specifically, it aims to answer the following sub-problems: 1. What is the profile of the respondents in terms of their 1.1. Age 1.2. Gender 1.3. Marital status 1.4. Area of Assignment 1.5. Country of Employment

2. What are the stressors experienced by the respondents classified as 2.1. Physical 2.2. Psychological 2.3. Professional 3. What are the effects of the stressors in the job performance as assessed by the Nurse- respondents?

4. Is there a significant difference in the stressors experienced by the respondents when they are grouped according to their demographic profile? 5. What are the coping mechanisms used by the respondents? 6. What is the implication of the study for the improvement of the performance of the nurses who are working overseas?

With the foregoing sub-problems, it is hypothesized in this study that:
There is no significant difference in the stressors experienced by the Filipino nurses working overseas when they are grouped according to:
‡ age ‡ gender ‡ marital status ‡ area of assignment ‡ country of employment

Conceptual Paradigm

‡ Evans (2001) and Cohen (1986)

‡ Anderson (1991) and Tyler and Cushway (1995) ‡ Shinn and colleagues (1984)

Conceptual Framework
The conceptual paradigm of this study is anchored on the belief that an effective and realistic pre-deployment orientation program that gives emphasis on stress management for nurses who will seek employment overseas is indispensable and helpful in addressing the stress and work adjustment problems to be able to achieve an efficient and quality work performance.

Significance of the Study
The study will have significant value to the following:
‡ Nursing Graduates ‡ Nursing Institutions ‡ Clinical Instructors and Hospital Administrators ‡ Nursing Organizations ‡ Concerned Government Agencies ‡ Future Researchers

Scope and Limitation of the Study
This study focuses on finding out the different stressors and coping mechanisms of nursing graduates of Sacred Heart College Batch 2005-09 working overseas.

Definitions of Terms:
The operational definitions of the following terms used in this research are provided in order to clarify each term. ‡ Burn-out. It is the exhaustion of one·s strength due to overwork. ‡ Coping Mechanism. It is a strategy which can be cognitive, emotional or behavioral used to manage and reduce stress and its effects. ‡ Distress. It is an intense, continuous and repeated stress. ‡ Eustress. It is a moderate level of stress.

‡ Job Performance. It refers to the quantity and quality of job rendered . ‡ Physical Stressors. Physical signs of stress which includes fatigue, changes in sleeping and eating, lack of energy, loss of interest in sex. ‡ Pre-deployment Orientation Program. It is a program that covers subjects which will benefit concerned agencies and the nurses who are going to work abroad. It includes training of registered nurses planning to work abroad tailored to meet their needs in preparation to their new challenges and responsibilities. ‡ Professional Stressor. It is the work related source of stress which includes loss of commitment, meaning and integrity. ‡ Psychological Stressor. It is the emotional and psychological source of stress which includes irritability, hypersensitivity, frustration, negative outlook and forgetting ‡ Stressor. It is the sources of stress which are classified as to Physical, Psychological and Professional Stressors. ‡ Workload. It is the amount of work apportioned to a person


Reasons for wanting to work abroad:
‡ the challenges of working and living in another country with a different culture ‡ by higher salaries ‡ a better standard of living ‡ by higher salaries and a better standard of living

Nurse·s responsibilities
‡ fulfilling certain aspects of the medical regimen delegated to them by physicians ‡ assessing and intervening within areas of expertise, such as with pain management and providing comfort, and teaching patients and their families ‡ liable for maintaining a safe and patient-centered care environment and routinely intervene when non-nursing support services are not available or are inadequate to maintain a clean environment ‡ ensure that patients receive adequate nourishment ‡ important functions associated with patient safety, quality of care, and patient outcomes is providing surveillance for early detection of adverse events, complications, and medical errors. Furthermore, nurses often have to deal with anxious families and sometimes with doctors who may not respect them. (Aiken et al., 2002).

‡ Demographic considerations in the labor force are particularly important especially in the light of the nursing shortage, both here and abroad ( Buchan 2002). ‡ The nursing staff ratio is known to be a factor in quality of care (Buerhaus et al., 2002; Steinbrook, 2002). ‡ There is concern about issues of staff quality in a marketplace where high demand has driven salaries up, schools of nursing being set up quickly to deal with the student waiting list here and abroad (Wickett and McCutcheon, 2002). ‡ Some note factors in the work environments (Needleman, 2004). These variables play potential roles as stressors in the patient care settings.

STRESS be described as a dynamic and can

reciprocal relationship between the person and the environment.

For over a decade, the nursing profession has been increasingly characterized by occupational stress, job turnover, and job dissatisfaction (Hawley, 1992) It is a fact that nurses employed in hospitals abroad are exposed to greatly different cultural backgrounds. Thus, a critical factor in stress levels is how a nurse values a particular stressor based on his/her cultural orientation

‡ ´Staff burnout is a critical problem for the human service professions: It is debilitating to workers, costly to agencies, and detrimental to clientsµ (Shinn, Rosario, Morch, & Chestnut, 1984). ‡ Nursing is one of the most stressful professions, with a great degree of job stress. It is a fact that nurses employed in hospitals abroad are exposed to greatly different cultural backgrounds. Thus, a critical factor in stress levels is how a nurse values a particular stressor based on his/her cultural orientation

Job stress
is a psychological syndrome in response to chronic exposure to emotional and interpersonal stressors on the job (Maslach, Schaufeli, & Leiter, 2001). ‡ Physical markers of stress, which can occur without coanscious awareness of environment demands (Cohen, Kessler & Gordon, 1995). ‡ Feelings of stress develop from various events, such as work overload, criticism, negligent coworkers, uncooperative patients, and lack of support from supervisors (Motowidlo, Manning, & Packard, 1986).

The national hospital average turnover rate

A moderate level of stress or "Eustress" is an important motivating factor and is considered normal and necessary. If stress is intense, continuous, and repeated, it becomes a negative phenomenon or "Distress," which can lead to physical illness and psychological disorders (Kane, 2009) Job stressors cause nurses to ´perform less effectively on tasks which call for tolerance for frustration, clerical accuracy, and the ability to avoid perceptual distractions«they also become less sensitive to othersµ with decreased altruistic tendencies (Cohen, 1980).

‡ All nurses have to do shift work or attend emergencies at night. The stress of shift work can also aggravate health conditions and lead to heart disease or digestive disorders (Pratibha, 2009) ‡ Fatigue can lead to error, injury, and carelessness. Long hours are a source of depression, low morale, and low motivation. ‡ Shift workers are on the job in the evening or on weekends and they sleep during the day. Hence, they often miss out on social or family activities. ‡ These stressors in the work environment can interfere with very complex cognitive tasks and are more likely to adversely affect performance if the stressors are prolonged or of high intensity (Cohen et al., 1986; Evans, 2001).


‡ Is mainly a state of mind, it causes many psychological problems. It is as detrimental to mental health as it is to physical health. ‡ After an extended period of time, stress can cause behavioral problems. ‡ Thus, they should be diagnosed carefully and addressed effectively as the other more visible effects.

RN workforce by 2020 (Buerhaus, Staiger, & Auerbach, 2000)

‡ The health care work environment as a source of overwork and stress has been implicated in the nursing shortage ( Institute of Medicine [IOM], 2003). Because stress-related illness contributes to rising health care costs and disability (Bruhn, Chesney, & Slacido, 1995) ‡ The reports from nurses in North America also indicate that the nurse manager position has been cut and that the chief nursing officer level of management has been eliminated in a number of hospitals. ‡ The added responsibility given to nurses might also be due to a low amount of nurses working in the hospitals. Aiken and associates (2002)

‡ Chronic stress decreases motivation. It can lead to increased absenteeism and increased turnover and attrition rates. Thus, it is mandatory for healthcare organizations to address this issue urgently. ‡ There is urgent need for proactive stress management, especially preventive strategies. There is need for coping techniques like team building, counseling, learning assertiveness, and communication skills, which should be taught to all nurses, even incorporated in their training curriculum (Pratibha, 2009)

Related Studies
E.M. Andal (2006). ´A Pilot Study Quantifying Filipino Nurses· Perception of Stressµ -Historically, many U.S. hospitals have recruited nurses from the Philippines to alleviate staffing shortages. - The study explored stress levels in Filipino registered nurses. - The result of the study indicates that inadequate experience, lack of support, unpredictable staffing and scheduling and unreasonable demands from doctors and patients are occasionally or frequently stressful.

Pratibha 2009. ´Stress Causing Psychosomatic Illness among Nursesµ -This study have shown chronic stress as a major contributor to suicide or suicidal thoughts, smoking, excessive coffee consumption, and alcohol intake. -Resurfacing of repetitive problems and feeling of the work never getting done added to stress in this study. Turnover for skilled nurses is instigated by internal, on the job factors, which cause dissatisfaction and stress and a desire to leave -Poor nutrition leading to anemia contributes to the poor health of the nurses in this study. Meals are usually not taken in time. Missing breaks to finish work also increased stress.

Moira Attree in her research study entitled ´ A Critical Analysis of the Evidence-Base to Nurse Staffing Policies in Five European Countriesµ -The paper will contribute to the development of evidence-based policy and practice by stimulating critical awareness and debate about the current evidence-base to nursing workforce healthcare policies. -The review aimed to identify the extent to which current evidence about nurse staffing is implemented in national healthcare policies.

Shinn and colleagues (1984) investigated the effects of coping on psychological strain and "burnout" produced by job stress in human service workers -The researchers found that these stressors predicted job dissatisfaction, behavioral consequences as job performance and turnover in studies of human service workers, psychological symptoms and somatic symptoms.

‡ Callaghan (2001) in his study entitled ´Factors Related to Stress and Coping Mechanisms Among Chinese Nursesµ investigated factors related to stress and coping mechanisms among Chinese nurses in Hong Kong ‡ The results revealed that nurses reported lower stress levels than other workers. ‡ The respondents' major sources of stress were related to nursing issues like too much work, interpersonal relationships, and dealing with hospital administration. ‡ There was a statistically significant link between the respondents' stress and sickness levels.

Deanna Stewart. The study entitled ´ Job Stress, and Health in Nurses: the Mediating Role of Experienceµ examined whether or not the relationship between nurses· job experience and health is mediated by job stress. -The results indicate that nurses who have been working in a hospital setting longer experience less job stress than nurses who have been working for less years. -Therefore, job stress also appears to mediate the relationship between work experience and better health among nurses


Research Design
Non-experimental research design, specifically descriptive-correlation approach will be utilized in conducting the study.

Research Locale
This study will be conducted involving Sacred Heart College nursing graduates working as nurses in the United States, Canada, Saudi Arabia, Dubai, London, Australia, Japan and other places all over the world.

Population and Sample
To date, an estimated number of one hundred nurses who are alumni of Sacred Heart College, Nursing Department are working in the different parts of the world. Of this number, the researcher is aiming for a sample of at least fifty respondents for her research. The number is more than the minimum required number of samples for a valid representation of the population under study. The respondents of the research are Filipino nurses who are graduates of Sacred Heart College , school years 2005 to 2009. Although they are deployed in different parts of the globe, internet on-line system will be utilized by the researcher to reach the prospective respondents for their responses.

Research Instrumentation
The study will use on-line questionnaire and/or on-line interview method in obtaining the necessary data and information to answer the research problem. This will be done in order to facilitate easy collection of data, thus minimizing time and effort involved. The researcher will formulate guide questions based on related literature and studies as well as additional readings for the respondents to answer.

Statistical Treatment
To answer sub-problems no. 1 and no. 2 , simple count and percentage equivalents will be done using the formula: Percentage (%) = n / N x 100 Where: n = number of entries per group N = total number of entries

Sub-problems no. 3 and no. 5 which deal with the effects of stressors on job performance and the coping mechanisms respectively will be answered and computed using the weighted mean. Weighted Arithmetic Mean (WAM) will be computed using the formula: WM = (fw) n Where: WM = is the value of the scale or the weighted mean (fw)= is the sum of the products of frequency and weight n = is the total number of respondents Weighted means will be interpreted using the following continuum: 3.10-4.00 2.10-3.00 1.10-2.00 0.00-1.00 =ALWAYS = OFTEN = SELDOM = NEVER

Sub-problem no. 4 which tests if there is significant difference in the stressors experienced by the Filipino nurses working overseas when they are grouped according to categories identified in sub-problem no. 1 will be answered using the Chi-Square Test (X ). Computations will be done using the formula:

Where: O = observed frequency E = expected frequency X2 = chi-square

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