AL Quads University

Graduate Studies

Relationship between occupational stress and

psychosomatic symptoms among oncology nurses
in west bank hospitals

Prepared by :HunaidaThabata
Supervision :Dr.SalamAlkatib
 List Of Contact
No Subject Page
1 Introduction
2 Problem Statement
3 Significant of study
4 Aim of the study
5 Objective of the study
6 Questions of the study
7 Definitions
8 Conceptual framework
9 Literature Review
A Search strategy
B Quality of research papers
9.1 Occupational stress and psychosomatic symptoms
in Arab countries
9.2 Occupational stress and psychosomatic symptoms
in other countries
10 Methodology
10.1 Study Deign
10.2 Setting Of The Study
10.3 Target Population
Inclusion Criteria , Exclusion Criteria
10.4 Sample and sampling technique :
10.5 Data Collection Procedure
10.6 Ethical Consideration
10.7 Data Analysis
10.8 Summary
11 Results
12 Discussion
13 Strengths
14 Limitation
15 Recommendations
16 References
17 Attachments

List of tables

???List of figures
????Abstract in Arabic and English

..…Acknowledgment etc

Chapter one

Introduction

1. Introduction:

Health care professionals in general are thought to have a high vulnerability to

burnout as a result of experiencing high levels of emotional strain, owing to stressful
working environments exacerbated by sick and dying patients to whom they provide
care (Maslach, 2003).As well as the physical danger of infectious disease and injury
(Spector, 1999).Nurses in particular however, have been found to experience higher
levels of burnout compared to other health care professionals, owing to the nature of
their work (Khamisa, 2013).

It has been suggested that nurses are at a high risk of occupational stress-related
problems due to the distinctiveness of stressors experienced (Lu &Shiau, 1997).
Stress in nursing is attributed largely to the physical labor, suffering and emotional
demands of patients and families, work hours, shift work, interpersonal relationships
(e.g., inter- and intra professional conflict), and other pressures that are central to the
work nurses do (Jennings, 2008).

There is substantial evidence that a high level of occupational stress in general,

and nursing stress in particular, is strongly associated with low levels of self-reported
health and well-being (Tyler, Caroll, & Cunningham, 1993).Alongand continued
exposure to stress results in physical symptoms such as easy fatigue, headaches and
high blood pressure. In addition, there are emotional symptoms related to depression,
frustration and mental dysfunction that lead to impaired performance and judgment, a
negative attitude towards work and indecisiveness (Arafa etal., 2003).

Also between 50% to 80% of the diseases experienced by employees at work are
stress-related; higher levels of job stress can lead to poor health outcomes and injury
(Edwards, 2003). Other studies have reported that work-related stress can increase
psychosomatic symptoms such as loss of appetite, stomach aches, sleep disturbances,
backaches, panic attacks, unpleasant feelings and depression (Mojoyinola, 2008).

 In general, work related stress is negatively related to psychological wellbeing and
poor health among nurses (Tucker et al., 2010). Specific stressors such as higher
physical and emotional demands (van Tooren, &de Jonge, 2008) as well as work
overload, role stress, hostility with physicians and patients are directly and indirectly
related to burnout and psychosomatic complaints (Jourdain, &Chenevert, 2010).And,
physical tiredness, working with demanding patients, losing a patient, lack of free
time and burnout were also found to be related (Bressi, 2008).

The incidence of psychosomatic disorders was increased in Indian hospital nurses

who reported higher self-reported stress scores; stomachache, back pain, and stiffness
of shoulders and neck were related to exposure to stressors at home and the workplace
(Kane, 2009).

Whereas numerous researches have extensively studied occupational stress among

nurses in different settings, several studies have investigated the possible
consequences on physical and mental health of nurses. But little has been written
about that in Palestine. Therefore this study will be conducted to examine the
relationship between occupational stress and psychosomatic symptoms among
oncology nurses in Palestine.

2. Problem statement :
Nursing is generally perceived as a demanding profession. It is both physically
and psychologically challenging(Aoki,Keiwkarnka&Chompikul ,2011).Over the past
several years, signs of occupational stress appear to be increasing among nurses. This
has been attributed to many factors including downsizing, restructuring, and merging
role boundaries and responsibilities (Cropanzano, Rupp, & Byrne, 2003).

High levels of work stress among nurses may result in increasing job-related
accidents, late arrivals and absence of work, and may thus result in decreased
productivity and responsibility( Lee, & Wang, 2002)and may affect the nurses’
professional efficiency, which might reduce the quality of patient care (Lindegård,
Larsman, Hadzibajramovic, &Ahlborg, 2014).

Several studies have reported an association between occupational stress on the

psychosomatic symptoms complaints. But little has been written about that in
Palestine. Therefore, this study aimed to examine the relationship between
occupational stress and psychosomatic symptoms among nurses in Palestine. And can
determine the problem of the study in the following question:

What are the relationship between occupational stress and psychosomatic symptoms
among oncology nurses in Palestine?

3. Significant of study :

High levels of perceived stressful working conditions have been found to have an
adverse effect on the physical and mental health of nurses (Mojoyinola, 2008). Stress
leads to psychosomatic disorders such as asthma, diabetes mellitus, back pain,
hypertension, anxiety, depression and arthritis (Madhura, Subramanya, &Balaram,
2014). Also many studies of stress in nurse in developed countries have shown
chronic stress as a major contributor to suicide or suicidal thoughts, smoking,
excessive coffee consumption, and alcohol intake( Feskanich et al, 2002).

Knowing workplace stressors in clinical areas among nurses help nurse managers and
health care administrators to adopt strategies that manage job stressors effectively in
work settings such as work scheduling, reduce workload, and improve work
environment. Efforts to alleviate stressful working conditions among nurses can lead
to increase quality of care delivery (Khamisa et al., 2013).

So psychosomatic symptoms in nurses needs to be researched further to help the

policy makers in choosing the effective way to control the sours of stress and reduce
the psychosomatic symptoms among oncology nurses, in order to improve the work-
life balance for oncology nurses in Palestine.

4. Aims of study:
This study is an investigation into psychosomatic symptoms among oncology
nurses in Palestine to determine the relationship between the psychosomatic
symptoms and occupational stress. Also to examine the impact of demographic
variables on psychosomatic symptoms and occupational stress. And the results can be
used as the basis for increasing awareness of these types of workplace stressors and
for improving nurses‟ health and well-being.

This study aims to find out the correlation between occupational stress and
psychosomatic symptoms among oncology nurses in Palestine.

5. Objectives of this study :

1. To assess level of occupational stress among oncology nurses in Palestine.

2. To assess the prevalence rate of psychosomatic symptoms among oncology
nurses in Palestine.
3. To determine relationship between level of occupational stress and
psychosomatic symptoms amongoncology nurses in Palestine.
4. To examine association between psychosomatic symptoms and selected
demographic variables (included gender, age, education, years of experience
and marital status).
5. To examine association between interpersonal source of stress and the
psychosomatic symptoms.
6. To examine association between social source of stress and psychosomatic
symptoms.
 6. Study questions :
And can determine the problem of the study in the following questions:

1. What is the level of stress among oncology nurses in Palestine?

2. What is the prevalence of psychosomaticsymptoms among oncology nurses in
Palestine?
3. Is there any relationship between level of occupational stress and psychosomatic
symptoms amongoncology nurses in Palestine?
4. Is there an association between psychosomatic symptoms and selected
demographic variables (included gender, age, education, years of experience and
marital status) amongoncology nurses?
5. Is there an association between interpersonal source of stress (include conflict ,
relationship with peers, emotions (to the death, dying)) and the psychosomatic
symptoms ?
6. Is there an association between social source of stress (include(Workload, type of
shift, shift long) and psychosomatic symptoms ?

Write a summary at the end of the chapter

7. Definitions :

- Psychosomatic symptoms: (operational definition)

The psychosomatic symptom scale include the following self-reported symptoms:

lower-back pain, tension headache, sleeping problems, chronic fatigue, stomach
paresis, tension ,diarrhea, and heart palpitation. This measure will use in order to
obtain information on the frequency of these symptoms during the last 12 months
.from data collection date.(Brassai, Piko, & Steger, 2011)

.Registered nurse: it includes the staff nurses and the practical nurses

- Staff nurse :

A health care professional who has graduated from an accredit
nursing program and has been licensed by publicauthority topractice nursing; may hav
.e advanced skills acquired through clinical master's or doctoral programs

- Practical nurse :

A health care professional who has graduated from a school of practical nursing
whose qualifications have been examined by a state board of nursing and who has
been legally authorized to practice as a licensed practical or vocational nurse (L.P.N.
.or L.V.N.), under supervision of a physician or registered nurse

- Cancer :
A disease process whereby cell proliferate abnormally , ignoring singles in
environment surrounding the cell.

- Oncology:

The branch of medicine dealing with the physical, chemical, and biological

properties of tumors, including study of their development, diagnosis,
treatment, and prevention.

- Oncology nurse :

Is a professional registered nurse with oncology-specific clinical knowledge who

offers individualized assistance to patients, families, and caregivers to help overcome
healthcare system barriers. Using the nursing process, provides education and
resources to facilitate informed decision making and timely access to quality health
and psychosocial care throughout all phases of the cancer continuum.

:Contributing variables

- Occupational Stress:

Occupational stress refers to the physical and emotional outcomes that occur when
there is disparity between the demands of the job and the amount of control the
individual has in meeting those demands (Bamber, 2006)

- Stress :

Blaug et al (2007) concluded that stress is a personal experience caused by demands

on an individual, and affects the individual's ability to cope.Stress results from a
change in the environment that is perceived as a challenge, a threat, or a danger. The
major sources of stress in our society arise from interpersonal relationships and
performance demands rather than from actual physical threat (Pender, Murdaugh, &
Parsons, 2006). Not only is stress a part of everyday experience, but a person’s
responses to stress are also necessary to life. Stress affects the whole person in all the
human dimensions (physical, emotional, intellectual, social, spiritual), positively or
negatively.

- Nurse stress :

Defined as the emotional and physical reactions resulting from the interactions
between the nurse and her/his work environment where the demands of the job exceed
capabilities and resources. (Nedd, 2006)

- Individual stressors: such as age, gender and marital status.

- Interpersonal stressors :Social stressors is collectively represent all those
factors which can present in the society and have positive or negative impact
on stress levels (conflict, relationship with peers, emotions (to the death,
dying) education , experience)
 - Social stressors: Stressors that are found in the surroundings (Workload, type
of shift , shift long).

Key words:psychosomatic symptoms;oncology; cancer; nursing; oncology

nursing; hematology; shortage; staffing; work environment; stress; occupational
stress; back pain .

8. Conceptual framework:
From literatures review, this basic DAG (Directed Acyclic Graph ) define the
relationship between variables which included in my study :

Personal
variables

Occupational Psychosomatic
stress symptoms

Interpersonal Social
variables variables

Chapter Two
 Literature Review:

A. Search strategy:
Search strategies involved extensive searching of two electronic database: PubMed
and Google-escholar, PsycINFO (Psychological Information Database). The key terms
that used: psychosomatic symptoms; occupational stress; nursing;work environment;
stress.

Twenty studies were identified. These studies assessed factors related to

psychosomatic symptoms and occupational stress among nurses published between
2003 and 2018. The reviewed studies were heterogeneous in aspects of design, sample
size, methods, results and outcomes. The studies employed a variety of research
methods and participants.It also highlights the prevalence of stress and psychosomatic
symptoms in Arab countries (including Palestine) and other countries.

B. Quality of research papers:

The quality of research papers and ,hierarchy of evidence‟ used in stress among
nurses and psychosomatic symptoms were assessed by using Hawker‟s et al (2002)
tool (see attachment1 ). This tool can be used for qualitative and quantitative studies
which is useful in this study (Dixon-Woods & Fitzpatrick, 2001). Nine areas are rated
on a 4- point scale as follows: very poor=1, poor=2, fair=3, good=4. The areas
included abstract and title, introduction and aims, method and data, sampling, data
analysis, ethics and bias,findings/results,transferability, implications and usefulness.
The quality assessment was applied to all included studies. For each paper it was
possible to calculate a total score (9 very poor-36 good), which indicated its
methodological rigor (Hawker et al, 2002). There is no cut-off point in score that
distinguishes good quality from low quality articles; so, the higher the total score, the
better the quality

The literature will be reviewed in two areas: Arab countries (including Palestine); as
it's done in closer condition to my study, also similar in language, religion and culture,
location, economy and level of health, and other countries; which can provide some
useful comparisons.
 8.1. Occupational stress and psychosomatic symptoms in Arab
countries :

1. Jaradat, Y. et al , 2016 :Psychosomatic symptoms and stressful working

conditions among Palestinian nurses: a cross-sectional study:

A cross- sectional study was conducted by Jaradat (2016), aimed to examine the
associations between self-reported stressful working conditions and Psychosomatic
Symptoms (PSS) in Palestine, and to investigate possible gender differences among
Palestinian nurses. The participantsrepresented 430 nurses who were working at
hospitals and primary health care centers in Hebron . A questionnaire developed in
Hungary was used. The main findings of this study were that women reported more
PSS than men, that PSS were associated with perceived self-reported stressful
working conditions or work situations and that this association was stronger for men
than for women. But the study has some limitations, that all of the nurses in their
study were younger than 45 years which may had influenced their reporting of
psychological complaints. Also the questionnaire that used to assessing the stress
level among nurses was developed in Hungary which is different than fPalestine in
several ways.

2. Jaradat ,Y. et al, 2012 : The impact of shift work on mental health
measured by GHQ-30: a comparative study

Across-sectional study was conducted by Jaradat (2012), aimed to estimate

associations between mental health and demanding work schedules( rotating shift)
among nurses. Also to examine possible differences in the association between type
of shift and mental health status by gender.And to study whether the level of job
satisfaction could moderate the association between the type of work schedule and
mental health status. A 422 nurses who were working in a primary health care and
hospital in the Hebron district included in analysis. The General Health Questionnaire
30- items (GHQ-30) used to measure mental distress, Health Risk Behavior, and
Generic Job Satisfaction scale to measure level of job satisfaction. The main finding
of this study are: mental distress symptoms were significantly more prevalent among
rotating shift workers than fixed day-workers. Men reported less distress than women.
Effects on mental health from rotating shift were moderated by job satisfaction.
 3. SafaaAbdelazem Osman Ali, Asmaa Kamal Ahmed Eissa, 2018:
Relationship between burnout and psychosomatic symptoms among staff
nurses in intensive care units:

A cross-sectional analytic study design was conducted to assess the relation between
burnout and psychosomatic symptoms among staff nurses working in Intensive Care
Units (ICUs) in Fayoum .They represent 86 nurses who work in Intensive Care Units
(ICUs) at Fayoum University Hospital and FayoumGeneral Hospital. A self-
administered questionnaire including scales for assessment of burnout and
psychosomatic symptoms was used. The study documented a high prevalence of
psychosomatic symptoms among intensive care units (ICUS) nurses, along with high
levels of job burnout. Also it showed that a marital status was the only statistically
significant independent positive predictor of burnout score, whereas the positive
predictors of psychosomatic symptoms score were the burnout score and the total
experience years, while the practice of regular physical exercises was a negative
predictor. The study recommended improvements in the work environment, with
more support along with empowerment of staff nurses. Periodic screening of nurses
for psychosomatic symptoms is needed for early detection and management.But ,the
cross-sectional study design has certain limitations and weaknesses. Also sample size
and setting, that they included just 86 nurses from two hospitals.

4. Abdo, El-Sallamy, El-Sherbiny&Kabbash, 2015:Burnout among

physicians and nursing staff working in the emergency hospital of Tanta
University, Egypt :

A cross-sectional study was conducted over the period 1 November 2012 to 30 April
2013 and carried out on all physicians (n = 266) and a systematic random sample of
nurses (n = 284) in the emergency hospital of University of Tanta. To reveal the
prevalence of burnout among physicians and nursing staff working in the emergency
hospital of Tanta University and to identify some of the determinants of burnout. A
pre-designed self-administered questionnaire was use in collect data. Most of the
participants (66.0%) had a moderate level of burnout and 24.9% of them had high
burnout. Multivariate analysis of variables affecting burnout showed that age, sex,
frequency of exposure to work-related violence, years of experience, work burden,
supervision and work activities were significant predictors of burnout among the
respondents. One of the limitations of the study was that a cross-sectional study was
not considered the ideal tool to study the causes of burnout syndrome.
 5. Maryam, 2008: Sources of stress among female nurses (field study in the
hospitals of the Ministry of higher education in the province of Damascus.

The researcher used the descriptive database field (field survey), among 204 nurses
working in five hospitals of the Ministry of higher education in Damascus
governorate of 1952 nurse,to assess the source of occupational stress among female
nurses in thehospitals , in relation to factors of age, mitral status , years of works and
unit of work , also it aimed to determine the source of that stressors and the
differences between them. The result showed that therewas a very high percentage of
nurses experiencing the pressures of professional stress. 78.9 percent of the sample.
And nurses who had less experience years and the younger nurses were in risk to
suffer from stress than other female nurses.The weaknesses of this research was
limited to a sample of female nurses in the hospitals of the Ministry of higher
education, and not studied male nurses or nurses in general hospitals.

6. Umro, 2013 : Stress and Coping Mechanism among Nurses in Palestinian

Hospitals . (Pilot study ):

A cross-sectional descriptive analytical survey was carried out among 200 nurses
working in the different nursing units from 5 hospitals in Nablus district, to identify
the possible causes and frequency of stress experienced by Palestinian nurses working
in governmental and non-governmental hospitals, and to assess the most common
ways of coping mechanisms. Nursing Stress Scale (NSS) and three subscales of Ways
of Coping Checklist(WCC) were used in this study .result showed that nurses were
stressed. According to NSS, the greatest perceived sources of stress appeared to be
“workload” , followed by “conflict with other nurses” , and “emotional issues related
to death and dying” . Nurses in non- governmental hospitals have significantly higher
“conflict with other nurses” stress than those in governmental hospitals. According to
the ways of coping mechanism, nurses seemed to be resorting more to “confronting
coping” while “escape avoidance” was the least coping strategy employed. But the
study has some limitation, that the response rate is low ,some variables were not
included in the coping questionnaire. Such as praying, acceptance, sharing hobbies
with others, and schedule physical activities. Also the association of stress with other
demographic variables like marital status and income and education were not studied.

7. Elqerenawi , Abdel Aziz Thabet&Vostanis, 2017: Job Stressors, Coping

and Resilience among Nurses in Gaza Strip :

This study built on existing evidence by considering exposure to work-related

stressors, as well as on factors associated with later coping and resilience.to find type
of work stressors, used coping strategies, and resilience factors and relationship
between stressors and coping strategies as mediating factors and resilience as outcome
among Palestinian nurses working in Gaza Strip. So 275 randomly selected nurses
from representative health services in Gaza, who completed the Nurse Stress Scale,
The Connor-Davidson resilience scale, and Brief-COPE. Main result was that most
commonly reported job stressors were attending death of a patient, physician not
being present when a patient dies, criticism by a supervisor, and fear of making a
mistake while treating their patients. The mean score of nurses work stressors was
88.7. Nurses commonly used religious coping such as feeling comfort in religious
beliefs, thinking what next steps they have to take, having strategy about what to do
about situation what to do, and learn to live with situation as coping strategies with
stress. While, use drugs to feel better and to get through was the least commonly used
coping strategies. As recommendation of this study More research on how to improve
coping and resilience in nurses is needed.

8. YahiaJodah, 2003 : Job Stress Sources Among Palestinian Nurses

Working in Northern West Bank District Hospitals :

Descriptive study conducted among 276 nurses who working in Northern West
Bank district hospital, to identify the degree of job stress and its sources among
Palestinian nurses working in Northern West Bank district hospitals, also to explore
the role of study variables (sex, academic qualification, years of experience, marital
status, place of living, kind of hospital, place of hospital, kind of word ). A 62-items
questionnaire which was validated by a number of referees and based on literature
review was used. It was found that the total degree of general average of job stress
sources among Palestinian nurses working in Northern West Bank district hospital
was moderate . Also no differences according to sex, qualification, years of
experience , social status ,residence for nurses . but theirs significant differences
according to type of hospital and found that there are differences between
Government and private hospitals, with the Government hospitals high from private.
According to limitation, researcher focused on the north of Palestine and the finding
was generalized on all worker in government hospital and private, researcher tacked
just few number of hospital in north and this lead to weakness in finding of research.
Also sample contained large number female from male and that lead to be an reality
to measure some of the stressor like (age, gender , work load).
 - Gap in knowledge:

Some of the reviewed studies were not appropriate for generalization due to many
limitations and weaknesses which different from one study to other:

1. Psychosomatic symptoms and stressful working conditions among

Palestinian nurses: a cross-sectional study (2016):
Sample technique and tools of data collection, that a cross-sectional designee
has several potential biases and limitation. Also that all of the nurses in their
study were younger than 45 years which may had influenced their reporting
of psychological complaints . And the questionnaire that used to assessing
the stress level ,they use a questioner that developed in a country (Hungary)
that is different from Palestine in several ways.

2. The impact of shift work on mental health measured by GHQ-30: a

comparative study (2012) :
The cross-sectional study design has certain limitations and weaknesses. Also
the association between exposures and mental distress as an outcome for non-
participants is unknown and this could be a potential of selection bias.

3. Relationship between burnout and psychosomatic symptoms among staff

nurses in intensive care units (2018) :
The cross-sectional study design has certain limitations and weaknesses.
Also sample size and setting, that they included just 86 nurses from two
hospitals.

4. Burnout among physicians and nursing staff working in the emergency

hospital of Tanta University, Egypt (2015) :
A cross-sectional study is not considered the ideal tool to study the causes
of burnout syndrome.

5. Sources of stress among female nurses (field study in the hospitals of the
Ministry of higher education in the province of Damascus (2008) :
They only included female nurses in the hospitals of the Ministry of higher
education, and not studied male nurses or nurses in general hospitals. So the
study limited to a type of sample.

6. Stress and Coping Mechanism among Nurses in Palestinian Hospitals

(Pilot study)(2013):
Sample, sitting and the questionnaire ;Response rate was low, the study was
conducted in Nablus hospitals while other hospitals were not included , and
several other variables were not included in the coping questionnaire and the
association of stress with other demographic variables.
 7. Job Stressors, Coping and Resilience among Nurses in Gaza Strip (2017) :
Sample size was too small, also not included the methodology that used in the
study.

8. Job Stress Sources Among Palestinian Nurses Working in Northern West

Bank District Hospitals (2003):
The researcher focus on the north of Palestine, also female was more than
male sample which made bias in result.

8.2. Occupational stress and psychosomatic symptoms in other

countries:

1. Lindegard,. et al, 2014: The influence of perceived stress and

musculoskeletal pain on work performance and work ability in Swedish
health care workers :

An ongoing longitudinal cohort study, aimed to evaluate the influence of

perceived stress and musculoskeletal ache/pain, separately and in combination, at
baseline, on self-rated work ability and work performance at two-year follow-up
(2008_2010) was conducted by Lindegard et al (2014). It was doneamong
employees in two human service organizations in the south-west part of Sweden.
Survey data were collected from 770 participants. The main finding were that there
was a combination of frequent musculoskeletal pain and perceived stress
constituted the highest risk for reporting decreased work performance, and reduced
work ability at follow-up. Separately, frequent pain, but not stress, was clearly
associated with both outcomes. However, employees from only one organization
were included in this study, which could be a limitation to this study.

2. Mojoyinola, 2008: Effects of Job Stress on Health, Personal and Work

Behavior of Nurses in Public Hospitals in Ibadan Metropolis, Nigeria:

The study was carried out among 153 nurses working in two public hospitals in
Ibadan Metropolis, Nigeria. To investigated the effects of job stress on the physical
health, mental health personal and work behaviors of nurses. And to addressing the
issue of how stress at work can be effectively managed, reduced, or prevented by the
government and hospital management boards in order to enhance the health of the
nurses, as well as improving their personal and work behaviors. Exposit-facto
research design was adopted for the study. And a single questionnaire tagged “Stress
Assessment Questionnaire for Hospital Nurses (SAQFHN) was developed and used
for the study. The study established that job stress has significant effect on physical
and mental health of the nurses. It also established that there was a significant
difference in personal and work behavior of highly stressed nurses and less stressed
nurses. Based on these findings, it was recommended that the government (Federal or
State) and Hospital Management Boards should improve the welfare of the nurses. It
was also recommended that their morale should be boosted by involving them in
policy or decision-making concerning their welfare or care of their patients. Their
salary should be reviewed and that they should be promoted as at when due.

3. Lin, Huang, & Wu, 2007 : Association Between Stress at Work and
Primary Headache Among Nursing Staff in Taiwan :

To understand the prevalence of primary headache among nursing staff in Taiwan,

and to realize the correlation between stress at work and primary headache in this
population. Also to evaluate the different sources of stress which might contribute to
this kind of headache, a cross-sectional, hospital-based study was conducted. They
represent 900 nursing staffers who working in a tertiary medical center in southern
Taiwan. A self-administered questionnaire was administered and followed by face-to-
face interviews by a neurologist to exclude organic abnormalities. They found that
49.6% of responders had experienced primary headaches in the previous year, and
48.1% had episodic-type headaches. Headache sufferers had more stress at work than
non-headache sufferers .Also the youngest and least experienced of the nursing staff,
the unmarried, and those with a lower level of education had a higher level of stress.
And the methods used to deal with headaches were sleep, taking medicine, taking a
rest, visiting the doctor, and seeking psychological help. Nurses commonly used
acetaminophen (panadol-500 mg) to relieve their pain.The significant weaknesses of
this study include the lack of multivariate statistics to adjust the possible confounders,
such as dietary content, inconsistent meals, work schedule demands, or sleep hygiene
during work, all of which could potentially bias the results. In addition, the analysis of
headache either as a migraine or a tension headache related to stress at work, and the
mood state (ie, depression, anxiety) of the personnel using the standard psychological
test were also lacking.

4. Malinauskienė, Leišytė, &Malinauskas, 2009 : Psychosocial job

characteristics, social support, and sense of coherence as determinants of
mental health among nurses:

To explore the associations between psychosocial job characteristics, social

support, and internal resources as determinants of mental health status in Kaunas
district nurses, a survey was conducted in 2008–2009 among the nurses of Kaunas
district community. A total of 638 nurses were randomly selected (response rate,
58.3%). They used three questionnaire to collect data, a Mental distress was
measured using the Goldberg 12-item General Health Questionnaire and
psychosocial job characteristics using the Swedish version of the Karasek
Demand-Control questionnaire. And sense of coherence was measured by the
 three-item version questionnaire. The main finding of this study was that Less
than one-third (23.0%) of nurses had symptoms of mental distress, 31.9% of
nurses had weak sense of coherence,and mental distress among the nurses of
Kaunas district was associated with adverse psychosocial job characteristics. Also
job strain-low social support at work was the strongest risk factor for mental
distress among nurses.

5. Sveinsdottir, 2006:Self-assessed quality of sleep, occupational health,

working environment, illness experience and job satisfaction of female
nurses working different combination of shifts :

A cross-sectional study , aimed to describe and compare the self-assessed quality

of sleep, occupational health, working environment, illness experience and job
satisfaction among female nurses working different combinations of shifts in
Iceland . they represent 348 nurses who working in hospitals, and primary health
care centers, as well as those working in various other capacities within health
care sector (response rate was 65.7%). A self-administered questionnaire,
measuring occupational health, quality of sleep, the illness experience, job
satisfaction and working environment was used . No difference was found
between participants based on type of shift with regard to the illness experience,
job satisfaction and quality of sleep. Nurses working rotating day/evening/night
shifts reported a longer working day, more stressful environmental risk factors,
more strenuous work and that they were less able to control their work-pace. In
general, the nurses reported low severity of symptoms; however, nurses working
rotating days/evenings shifts experienced more severe gastrointestinal and
musculoskeletal symptoms as compared to the others. This was explained by the
short rest period provided for between evening and morning shifts.

6. Kane, 2009 : Stress causing psychosomatic illness among nurses in India :

This study was conducted to establishing the existence and extent of work stress in
nurses in a hospital setting, and identifying the major sources of stress, also finding
the incidence of psychosomatic illness related to stress. A questionnaire relating to
stressors and a list of psychosomatic ailments used among nurses who worked in two
hospitals managed by a private foundation.106 nurses responded( from 120 nurses)
and they were all included in the study. Moderate levels of stress are seen in a
majority of the nurses. Incidence of psychosomatic illness increases with the level of
stress. Also the most important causes of stress were jobs not finishing in time
because of shortage of staff, conflict with patient relatives, overtime, and insufficient
pay. Psychosomatic disorders like acidity, back pain, stiffness in neck and shoulders,
forgetfulness, anger, and worry significantly increased in nurses having higher stress
scores. Increase in age or seniority did not significantly decrease stress.
 7. Gholami, HeidariPahlavian, Akbarzadeh, Motamedzade,
HeidariMoghadam, &KhaniJeihooni,2016 :Effects of Nursing Burnout
Syndrome on Musculoskeletal Disorders:

A cross-sectional study conducted between February and May 2013, aimed to

show the relationship between intensity of musculoskeletal disorders in different body
regions and burnout syndrome dimensions in Hamedan, Iran. A questionnaire survey
was carried out among 415 nursing personnel in five educational hospitals in
Hamedan, Iran. Data were collected through two unnamed questionnaires including
Maslach Burnout Inventory, Visual Analogue Scale (VAS).The results showed that
there is a statistical correlation between the three dimensions of burnout and severity
of musculoskeletal disorders in various parts of the body.

8. Lin, Huang, & Wu, 2007: Association Between Stress at Work and
Primary Headache Among Nursing Staff in Taiwan:

A cross-sectional study conducted among 900 nursing staffers in a tertiary

medical center in southern Taiwan. A semi-structured questionnaire was administered
to realize the association between stress and headache, and the means of coping with
this kind of headache. As a result, 386 out of 779 responders (49.6%) had experienced
primary headaches in the previous year, and 374 (48.1%) had episodic-type
headaches. A careful neurological interview of the latter group revealed that 222
(28.5%) had migraine, 104 (13.4%) had tension headache, 37 (4.8%) had mixed
migraine and tension headache, and 11 (1.4%) had other causes of headache. There
were no demographic differences between the sufferers and nonsufferers, although a
statistically significant difference was noted in selfreported sources of stress .
Headache sufferers had more stress at work than non headachesufferers . The
youngest and least experienced of the nursing staff, the unmarried, and those with a
lower level of education had a higher level of stress. The methods used to deal with
headaches were sleep, taking medicine, taking a rest, visiting the doctor, and seeking
psychological help. Nurses commonly used acetaminophen (panadol-500 mg) to
relieve their pain.The significant weaknesses of this study included the lack of
multivariate statistics to adjust the possible confounders, such as dietary content,
inconsistent meals, work schedule demands, or sleep hygiene during work, all of
which could potentially bias the results. In addition, the analysis of headache either as
a migraine or a tension headache related to stress at work, and the mood state (ie,
depression, anxiety) of the personnel using the standard psychological test were also
lacking.

9. Kawano, 2008 :Association of job-related stress factors with psychological

and somatic symptoms among Japanese hospital nurses: effect of
departmental environment in acute care hospitals:
Across-sectional study, self-administered anonymous questionnaire was distributed to
1,599 full-time nurses at four acute care hospitals in Japan, to examine degrees of job-
related stress factors as well as mental and physical symptoms among Japanese
hospital nurses in various departments, and clarified associations of departments and
job-related stress factors with those symptoms. The survey included demographic
factors, and the Brief Job Stress Questionnaire. Among 1,599 nurses who completed
all items relevant to the present study, analyzed data from 1,551 female nurses ( the
49 male excluded because of their small number) . The results showed that working
in operating rooms was associated with fatigue, that working in intensive care units
(ICU) was associated with anxiety, and that working in surgery and internal medicine
was associated with anxiety and depression independently of demographic factors and
job-related stress factors. The physical and mental health of nurses might affect their
time off, quality of nursing care and patient satisfaction in acute care hospitals. As
limitation for this study it focused on female nurses and exclude male sample.

10. Dagget, Molla, &Belachew, 2016: Job related stress among nurses
working in Jimma Zone public hospitals, South West Ethiopia: a cross
sectional study:

Cross sectional study was conducted in three public hospitals found in Jimma
Zone, Oromia Regional state from March 10 to April 10, 2014, to assess job related
stress and its predictors among nurses working in Jimma Zone public hospitals,
South-West Ethiopia . 360 nurses were included in the study, a structured self-
administered questionnaire used in collected data. as result, This study indicated that
33.4 % of nurses had low stress, 34 % moderate stress and 32.7 % had high stress.
The highest level of job related stress was on the sub scale of dealing with death &
dying mean score of 62.94 % followed by uncertainty regarding patient treatment
57.72 % and workload 57.6 %. While job related stress from sexual harassment had
the lowest mean score of 46.19 %. as limitation in this study , that the generalization
of the findings is limited to nurses working in public hospitals. Hence, it is not
generalizable for nurses who are working in health center & private clinics.

11. Karimi, Adel-Mehraban, &Moeini, 2018: Occupational stressors in

nurses and nursing adverse events:

A descriptive correlation study was conducted to determine the relationship

between nursing adverse effects and occupational stress in nurses in centers
affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, in 2015. So
209 individual through random and quota sampling methods was selected to
complete a three-part questionnaire consisting of a demographic
characteristics form, the Occupational Stressors Questionnaire, and the
Nursing Adverse Events Scale. According to the results of this study,
 moderate to high levels of job stress were observed among nurses.
Administrative factors had the highest impact; subsequently followed, by
environmental factors and interpersonal factors. The mean score of AEs was
reported as 30 cases per year. There was a significant correlation between the
overall mean score of occupational stress and AEs (r = 0.12, p = 0.04).A
limitation of this study was that despite the use of the Occupational Stressors
Questionnaire, the effect of nonoccupational factors in the completion of the
questionnaire and in the calculation of stress cannot be overlooked. Another
limitation of the study was study population to nurses in educational hospitals.

12. Najimi, Goudarzi, &Sharifirad, 2012: Causes of job stress in nurses: A

cross-sectional study :

A descriptive-cross sectional study, 189 nurses from Kashan hospitals of different

wards were answered the Occupational Stress Inventory-Revised , to determine the
causes of job stress in nurses of Kashan, Iran. The research findings indicated that the
majority of sample communities, about 87.5% of men and 94.6% of women have
normal stress. In total, 3.2% of nurses do not have job stress and 93.1% have normal
job stress and 3.7% have intense job stress. Alsojob factors were more involved in job
stress than demographic and other factors.The most important factor of making job
stress in female nurses were range of roles, role duality and physical environment and
in men, were range of roles, physical environment and responsibility. One of the most
effective factors which decrease job stress is participation in making decisions which
make some mutual relations between bosses and employees

- Gap in knowledge:

Some of the reviewed studies were not appropriate for generalization due to many
limitations and weaknesses which different from one study to other:

1. The influence of perceived stress and musculoskeletal pain on work

performance and work ability in Swedish health care workers (2014) :
Sample sitting was limited that was all data from only one organization.

2. Effects of Job Stress on Health, Personal and Work Behavior of Nurses in

Public Hospitals in Ibadan Metropolis, Nigeria (2008) :
Sample size and setting, that they included just 152 nurses from tow hospitals.

3. Association Between Stress at Work and Primary Headache Among

Nursing Staff in Taiwan (2007) :
Sample technique and tools of data collection, that a cross-sectional designee
has several potential biases and limitation.
4. Psychosocial job characteristics, social support, and sense of coherence as
determinants of mental health among nurses (2009) :
Responses rate was low (58.3%). And the questionnaire that used to
assessing the psychosocial job characteristics ,they use a Swedish version of
a questioner that is may different from Kaunas district in several ways.

5. Self-assessed quality of sleep, occupational health, working environment,

illness experience and job satisfaction of female nurses working different
combination of shifts (2006) :
Sample technique and tools of data collection, that a cross-sectional designee
has several potential biases and limitation. Also they use the mail in collecting
data from nursing didn’t responded and that has high rate of bias.

6. Stress causing psychosomatic illness among nurses in India (2009) :

Sample sitting was limited that was all data from only two hospital.

7. Effects of Nursing Burnout Syndrome on Musculoskeletal Disorders

(2016) :
The cross-sectional study design has certain limitations and weaknesses.

8. Association Between Stress at Work and Primary Headache Among

Nursing Staff in Taiwan (2007) :
The cross-sectional study design has certain limitations and weaknesses.

9. Association of job-related stress factors with psychological and somatic

symptoms among Japanese hospital nurses: effect of departmental
environment in acute care hospitals (2008) :
The cross-sectional study design has certain limitations and weaknesses, also
the sample type exclude all male sample.

10. Job related stress among nurses working in Jimma Zone public hospitals,
South West Ethiopia: a cross sectional study (2016) :
The generalization of the findings is limited to nurses working in public
hospitals. Hence, it is not generalizable for nurses who are working in health
center & private clinics.

11. Occupational stressors in nurses and nursing adverse events (2018) :

Sample size was too small

12. Causes of job stress in nurses: A cross-sectional study (2012) :

Sample size was too small, also the study didn't provide any
recommendations.
9. Methodology:

This section presents the study design, setting of the study and population,
sample, inclusion criteria, exclusion criteria, data collection tools and data
analysis process are outlined.

9.1. Study design :

A quantitative, cross-sectional descriptive study will be adopted in this study . A

research design is a blueprint for conducting the study that maximizes control over
factors that could interfere with the validity of the findings.A quantitative descriptive
design is suitableto provide an objective assessment of the occupational stress to
which nurses are exposed to , and to identify the psychosomatic compliant that nurses
have. And cross-sectional will be usebecause it can compare different population
groups at a single point in time. Also a survey can give big amount of information in
quickest and cheapest method.

9.2. Setting of the study:

The study will be conductedin oncology units at four hospitals in west bank
(BeitJala ,Al-Watany, Al-Najah, and Augusta Victoria) , These hospitals were chosen
because they are the only hospitals that have oncology units in west bank.

9.3. study population:

The study population is the entire nurses who are working in the four hospitals in west
bank ,who they are131nurseas illustrated in the Table1, with at least one years of
practice.

Table 1: Distribution nurses among hospitals which have oncology center :

Hospital Nurses number

BeitJala 25
Al-Watany 9
Al-Najah 26
Augusta Victoria 71

9.4. Sample and sampling technique :

In this study, the sample will comprise the whole study population. A convenience
sample 131 will select to constitute the present study subjects from the selected units
of the four selected study hospitals that included oncology units & convenience
sample choose due to study the characteristics of people who present at a certain point
in time, and simply because the sample are the easiest to access.

Inclusion criteria:

Nurses who have been working in hospital during the study,and agreed to participate
in this study, and are able to participate in this study. Are defined as participants.
Should the participants have at least practical level of education . So , there are
question in questionnaire ask about them ,also be employed in more than one hospital,
they needed to respond only once, so a question was added to the questionnaires
asking if they worked in one or more than one hospital and indicating that an answer
was required in relation to one employment site only. They will ask to give details of
their other employment in terms of the hours worked.

Exclusion criteria :

Nurses who exclude from the study a nurses who changed or left the selected
hospitals before conduct the study. Any nurse who start working in hospitals for a
duration less than one year. nurses with diploma degree will be also excluded. And
those who were on vacation during the study period.

9.5. Data collection:

Prior commencing in this study, a questionnaire will be developed by the researcher
from reviewing the exiting literature.

Data collection tools:

In this study, three questionnaires will be developed:

At first a questionnaire about socio-demographic data will be developed in order to

collect information about: sex, age, education level, place of residence, name of the
institution, years of experience and qualifications, and an inquiry about health-related
information including smoking, drug abuse and stress-related physical symptoms.

The second tool will assess the stress level among nurses. The study will adopt
theNursing Stress Scale (NSS) that was developed byGray-Toft& Anderson (1981). It
consists of 35 items that describe conditions that have been identified as causing
stress for nurses in the performance of their tasks. It requires two Likert type
responses; first for frequency of stressors which ranges from 0 (Never) to 2 (Often)
and second for severity of stressors which ranges from 0 „Not at all‟ to 4 „Extremely
stressful‟ according to their perception. Higher scores on the NSS indicate more
frequently experienced stress.
 The third tool will examine the Psychosomatic Symptoms Scale (Pikó et al. 1997).
The scale was constructed from seven underlying items scored out of four points (0-
21). Higher scores represented increased symptom occurrences.

9.6. Ethical consideration :

Permission: This proposal will be submitted to Research ethics committee at Al Quds
University in order to have their permission to conduct the study. furthermore, before
beginning the study written permission will obtain from the directors of hospitals.

Informed consent:After the permission and take the approval from each hospital , all
nurses will receive information sheet that explain the aim of study and its objectives
and then they will be asked to sign the consent inform. provide informed consent.

They will inform that their participation will be voluntary and that they has the
opportunity to terminate or to withdraw from the study at any time without having to
provide a reason. Additionally, they can refuse to answer any questions, and there will
no adverse consequences for refusing to participate.

Confidentiality:All information will treat with strict confidentiality and use only for
research purpose.
Anonymity: Will ensure the questionnaire require no names of respondents.

9.7. Data analysis:

The independent variable will be demographic variables, social and interpersonal
variables. occupational stress and psychosomatic symptoms will use as the
dependant variable.

The data will be analyze using SPSS version 18.0, through the following statistical
tests:
 Descriptive Statistics: Frequency and Percentage will be used for analysis of

demographic variables.

 Mean and Standard Deviation will be used for assessing the level of

Psychosomatic Symptoms occurrence.

 Inferential Statistics: One sample T- Test, Two samples T- Test, One way

ANOVA and Correlation, will be used to find out association between Psychosomatic

Symptoms occurrence and selected variables and factors.

 9.8. Summary :

This chapter has considered the methodology that informs this study and the rationale
for the use of quantitative method. It outlines how the chosen approach complements t
methods approach which is used in this study. It focuses on the standard
questionnaires used in quantitative part and how to be used in west bank oncology
nurses . It outlines the different techniques on data analysis in order to answer the
study questions. The next chapter reports the findings elicited from the data collected
and how this relates to existing issues and future practice and research.

10.Results :
The total population of oncology nurses in the west-bank hospitals in Palestine which

is the sum of a 131 nurse was covered, of which 116 questionnaires were returned

with a respondent rate of 88.5%.

Cronbach’s alpha value was as illustrated in the following Table (1):

Cronbach’s Alpha Value Variable

71.7% Frequency of stressor occurrence

95.4% Level of stress

88.1% Psychosomatics Symptoms

The table above shows the values of Cronbach’s alpha test for each of the three main

variables in the questionnaire. Since all the values are higher than 70% we can state

that all of the elements of each variable are reliable and the researcher will continue to

the next step that is Statistical Analysis of the gathered data, which we will be

discussing in the following parts.

Since this study's main focus is to investigate the psychosomatic symptoms among

oncology nurses in Palestine. The researcher will go through the discussion in the
 same order of the study objectives and questions. First, we will describe the sample

using frequencies and percentages.

First: Sample Description (Demographic Factors):

The sample included four hospitals in which there is an oncology unit, Al-Njah

Educational Hospital (26 Nurses with a percentage of 22.4%), Al-Watani Hospital (9

Nurses with a percentage of 7.8%), Augusta Victoria (Al-Mutalaa') Hospital (58

Nurses with a percentage of 50%) and Beit-Jala Governmental Hospital (23 Nurses

with a percentage of 19.8%), as illustrated in Table (2)

The name of the hospitals where the nurses work (Basic) / Table (2)

Cumulative Percent Valid Percent Percent Frequency .B.H

22.4 22.4 22.4 26 .Al-Njah E.H

30.2 7.8 7.8 9 .Al-Watani H

Augusta Victoria (Al-

80.2 50.0 50.0 58
Mutalaa')

100.0 19.8 19.8 23 .Beit-Jala G.H

100.0 100.0 116 Total

With some of the Nurses working in additional Hospitals as detailed in the following

Table (3):

The name of the hospital where you work (Additional) / Table (3)

A.H. Frequency Percent Valid Percent Cumulative Percent

None 109 93.9 97.6 93.9

Hadassah Medical Center 5 4.3 4.3 98.2

Red Cross Hospital 1 0.9 0.9 99.1

Istishari Arab Hospital 1 0.9 0.9 100.0

Total 116 100.0 100.0

In addition, some of them were working in additional Hospital sections other than the

oncology unit including those seen in Table (4):

Name of the additional section you work in / Table (4)

A.H.S. Frequency Percent Valid Percent Cumulative Percent

None 71 61.2 61.2 61.2

Internal Care 5 4.3 4.3 65.5

Surgery 4 3.4 3.4 69.8

Oncology 18 15.5 15.5 85.3

Oncologyand Pediatric 10 7.8 7.8 93.1

Simulation Lab 1 0.9 0.9 94

Pediatric 7 6.0 6.0 100

Total 116 100.0 100.0

The sample consisted of 116 nurses, 48 of which were Males with a percentage of

(41.4%) and 68 of which were Females with a percentage of (59.6%) as Table (5):

Gender / Table (5)

Gender Frequency Percent Valid Percent Cumulative Percent

Male 48 41.4 41.4 41.4

Female 68 59.6 59.6 100

 Total 116 100.0 100.0

Table (6) describe the sample by the Age factor which was divided into five

categories; 20 years to 24 years (25 Nurses with a percentage of 21.6%), 25 years to

29 years (46 Nurses with a percentage of 39.7%), 30 years to 34 years (18 Nurses

with a percentage of 15.5%), 35 years to 39 years (9 Nurses with a percentage of

7.8%), and 40 years and over (18 Nurses with a percentage of 15.5%).

Age in years / Table (6)

Age Frequency Percent Valid Percent Cumulative Percent

20-24 25 21.6 21.6 21.6

25-29 46 39.7 39.7 61.3

30-34 18 15.5 15.5 76.8

35-39 9 7.8 7.8 84.6

40 and over 18 15.0 15.4 100.0

Total 116 100.0 100.0

Depending on Marital Status the sample included; 33 Single Nurses with a percentage

of (28.4%), 74 Married Nurses with a percentage of (63.8%), 5 Divorced Nurses with

a percentage of (4.3%) and a one Widowed Nurse with a percentage of (0.9%) as

Table (7):

Marital Status / Table (7)

Marital Status Frequency Percent Valid Percent Cumulative Percent

Married 74 63.8 65.5 65.5

Single 33 28.4 29.2 94.7

Divorced 5 4.3 4.4 99.1

Widowed 1 0.9 0.9 100.0

Missing 3 2.6

Total 116 100.0

The places of Residence were divided into three different categories as in Table (8) 41

of the Nurses lived in the Cities with a percentage of (35.3%), 61 of the Nurses lived

in Villages with a percentage of (52.6%), 10 of the Nurses lived in Camps with a

percentage of (8.6%), and only 2 of the Nurses lived in Other places with a low

percentage of (1.7%).

Place of residence / Table (8)

Residence Frequency Percent Valid Percent Cumulative Percent

City 41 35.3 36.0 36.0

Village 61 52.6 53.5 89.5

Camp 10 8.6 8.8 98.2

Others 2 1.7 1.8 100.0

Missing 2 1.7

Total 116 100.0

The Nurses were divided into five Categories depending on their Educational Degree

as detailed in Table (9); Diploma of 2 years (11 Nurses with a percentage of 9.5%),

High diploma of 3 years (3 Nurses with a percentage of 2.6%), Bachelor degree (85

Nurses with a percentage of 73.7%) and Master degree (12 with the percentage of

10.3%), and other educational degrees (5 Nurses with a percentage of 4.3%).

Educational Degree / Table (9)

E. Degree Frequency Percent Valid Percent Cumulative Percent

Diploma 2 years 11 9.5 9.5 9.5

High diploma 3 years 3 2.6 2.6 12.1

Bachelor degree 85 73.3 73.3 85.4

Master degree 12 10.3 10.3 95.7

Others 5 4.3 4.3 100.0

Total 116 100.0 100.0

The Nurses’ Experience Categories included; 1 year to 5 years (45 Nurses with a

percentage of 38.8%), 6 years to 10 years (39 Nurses with a percentage of 33.6%), 11

years to 15 years (10 with a percentage of 8.6%), and More than 15 years of

Experience (19 Nurses with a percentage of 16.4%) as clear in Table (10) :

Years of experience as a nurse / Table (10)

Experience Frequency Percent Valid Percent Cumulative Percent

1-5 45 38.8 39.8 39.8

6-10 39 33.6 34.5 74.3

11-15 10 8.6 8.8 83.2

More than 15 19 16.4 16.8 100

Missing 3 2.6

Total 116 100.0

Depending on the Monthly Income Factor and as shown in Table (11) , the nurses

included only one Nurse with an income of less than 1000 NIS with a percentage of

(0.9%), 11 Nurses with an income between 2001 NIS and 3000 NIS with a percentage
of (9.5%) and 97 Nurses with an income of more than 3000 NIS with a percentage of

(83.6%).

Monthly income (in NIS) / Table (11)

Monthly Income Frequency Percent Valid Percent Cumulative Percent

Less than 1000 1 0.9 0.9 0.9

2001-3000 11 9.5 10.1 11.0

More than 3000 97 83.6 89.0 100.0

Missing 7 6.0

Total 116 100.0

As illustrated in Table (12), the Nurses had various numbers of Monthly Night Shifts

at the Hospital with the most number of them having 22 shifts with the percentage of

(24.1%) and 20 shifts with percentage of (18.1%).

Number of monthly shifts / Table (12)

Number of Shifts Frequency Percent Valid Percent Cumulative Percent

2 1 0.9 1.1 1.1

4 3 2.6 3.2 4.2

5 6 5.2 6.3 10.5

6 2 1.7 2.1 12.6

7 1 0.9 1.1 13.7

8 3 2.6 3.2 16.8

9 1 0.9 1.1 17.9

10 1 0.9 1.1 18.9

12 2 1.7 2.1 21.1

15 1 0.9 1.1 22.1

18 1 0.9 1.1 23.2

20 21 18.1 22.1 45.3

21 1 0.9 1.1 46.3

22 28 24.1 29.5 75.8

23 1 0.9 1.1 76.8

24 4 3.4 4.2 81.1

25 6 5.2 6.3 87.4

26 1 0.9 1.1 88.4

28 2 1.7 2.1 90.5

29 1 0.9 1.1 91.6

30 4 3.4 4.2 95.8

32 1 0.9 1.1 96.8

33 1 0.9 1.1 97.9

35 1 0.9 1.1 98.9

40 1 0.9 1.1 100.0

Missing 21 18.1

Total 116 100.0

Second: Descriptive Statistics and One-Sample T-test for NSS-F,

NSS-S and Psychosomatic Symptoms:

1. Personal Variables:

In Table (13) we find that the answers for the two statements concerning

howFrequent does the nurse feel unprepared to care for the emotional needs of a

patient and his family were mostly (occasional) with percentages of 52.6% and

47.4%, and by looking at the sig. (2-tailed) P-values; it is found to less than (α=0.05)

in both statements, this indicates rejecting the null hypothesis "that there is no

statistical difference between the samples means of personal variables and the test
value (2)", and accepting the alternative hypothesis that there is acceptable statistical

differences.

As for the answers for the two statements regarding how Stressful does the nurse

find being unprepared to care for the emotional needs of a patient and his

familyillustrated in Table (14), these answers lean towards it being (Moderately

Stressful), and the sig. (2-tailed) P-values for both statements is less than (α=0.05),

indicating that the null hypothesis "that there is no statistical differences between the

samples means of personal variables and the test value (3)" must be rejected, and the

alternative hypothesis that there are acceptable statistical differences must be

accepted.
 Descriptive Statistics for Personal NSS-F / Table (13)

Never Occasional Often Mean SD CV Sig.* T**

Statement
F % F % F %

Feeling inadequately prepared to help

with the emotional needs of a patient's 32 27.6 61 52.6 13 11.2 1.82 0.63 34.5 0.004 -2.932
family

Feeling inadequately prepared to help

40 34.5 55 47.4 12 10.3 1.74 0.65 37.3 0.000 -4.170
with the emotional needs of a patient

Descriptive Statistics for Personal NSS-S / Table (14)

Not at all S. Slightly S. Moderately S. Very S. Extremely S.

Statement Mean SD CV Sig. T
F % F % F % F % F %

Feeling inadequately prepared

-
to help with the emotional 23 19.8 21 18.1 29 25.0 16 13.8 6 5.2 2.59 1.21 46.6 0.001
3.315
needs of a patient's family

Feeling inadequately prepared

-
to help with the emotional 26 22.4 19 16.4 27 23.3 16 13.8 6 5.2 2.54 1.24 48.9 0.001
3.573
needs of a patient
*Sig.: Sig. (2-tailed)

**T: One-Sample T-Test

2. Social Variables:

As illustrated in Table (15) for how Frequent do Social Variables affect the

nurse’s stress levels we find that the statements’ answers were mostly (occasional)

with percentages between (30.2%) and (56%) except for the “Physician not being

present when a patient dies” statement in which the answers were mostly (Never) with

a percentage of (51.7%). As for the one-sample T-test’s results most of the statements

had sig. (2-tailed) P-values of less than (α=0.05) which indicates rejecting the null

hypothesis that "there is no statistical differences between the samples means of

Social variables and the test value (2) in these statements" and to accepting the

alternative hypothesis that there is acceptable statistical differences, except for the six

statements high-lighted (blue) in table (15) which have sig. (2-tailed) P-values of

more than (α=0.05) meaning the acceptance of the null hypothesis in these six

statements.

In Table (16) which shows how Stressful do Social Variables make the nurses; all

answers lean towards it being (Moderately Stressful or above) with percentages

varying between the low percentage of (33.7%) and the higher percentage of (62.9%).

The one-sample T-test’s results for most of the statements in table (16) had sig. (2-

tailed) P-values less than (α=0.05) which indicates rejecting the null hypothesis that

"there is no statistical differences between the samples means of Social variables and

the test value (3)" in these statements, and accepting the alternative hypothesis that

there is acceptable statistical differences.Except for the statements high-lighted

(blue) in table (16) which have sig. (2-tailed) P-values of more than (α=0.05)

meaning the acceptance of the null hypothesis in these statements.

Descriptive Statistics for Social NSS-F / Table (15)

Never Occasional Often

Statement Mean SD CV Sig.* T**
F % F % F %

Breakdown of intercom or Telephone 36 31.0 62 53.4 9 7.8 1.75 0.60 34.29 0.000 -4.349

Physician not being present when a

60 51.7 35 30.2 11 9.5 1.54 0.68 44.09 0.000 -7.014
patient dies

Disagreement concerning the treatment

36 31.0 59 50.9 8 6.9 1.73 0.60 34.51 0.000 -4.619
of a patient

Inadequate information from a

physician regarding the medical 35 30.2 58 50.0 13 11.2 1.79 0.64 35.92 0.001 -3.322
condition of a patient

Floating to other units that are short-

37 31.9 48 41.4 22 19.0 1.86 0.73 39.41 0.050 -1.979
staffed

Difficulty in working with a particular

26 22.4 65 56.0 14 12.1 1.89 0.61 32.22 0.057 -1.922
nurse (or nurses) outside the unit

Unpredictable staffing and Scheduling 14 12.1 65 56.0 23 19.8 2.09 0.60 28.66 0.140 1.488

A physician ordering what appears to be 29 25.0 65 56.0 12 10.3 1.84 0.60 32.83 0.007 -2.735
inappropriate treatment for a patient
Descriptive Statistics for SocialNSS-F / Table (15) “Continuation”

Never Occasional Often

Statement Mean SD CV Sig. T
F % F % F %

Too many non-nursing tasks required, such

25 21.6 48 41.4 32 27.6 2.07 0.74 35.60 0.356 0.927
as clerical work

Not enough time to provide emotional

24 20.7 53 45.7 29 25.0 2.05 0.71 34.59 0.495 0.685
support to a patient

Not enough time to complete all of my

25 21.6 62 53.4 18 15.57 2.22 0.64 28.83 0.288 -1.068
nursing tasks

A physician not being present in medical

39 33.6 57 49.1 10 8.6 1.73 0.63 36.13 0.000 -4.504
Emergency

Uncertainty regarding the operation and

40 34.5 55 47.4 10 8.6 1.71 0.63 36.90 0.000 -4.639
functioning of specialized equipment

Not enough staff to adequately load cover

28 24.1 57 49.1 20 17.2 1.92 0.68 35.16 0.250 -1.157
the Unit

Lack of drugs and equipment required for

36 31.0 53 45.7 15 12.9 1.80 0.67 37.44 0.003 -3.056
nursing care

*Sig.: Sig. (2-tailed) **T: One-Sample T-Test

 Descriptive Statistics for Social NSS-S / Table (16)

Moderately Extremely
Not at all S. Slightly S. Very S. Mean SD CV Sig. T
Statement S. S.

F % F % F % F % F %

Breakdown of intercom or
24 20.7 18 15.5 19 16.4 24 20.7 9 7.8 2.74 1.34 49.1 0.069 -1.842
Telephone

Physician not being present

40 34.5 17 14.7 14 12.1 11 9.5 14 12.1 2.40 1.48 61.8 0.000 -3.991
when a patient dies

Disagreement concerning the

26 22.4 17 14.7 25 21.6 19 16.4 7 6.0 2.62 1.29 49.2 0.005 -2.883
treatment of a patient

Inadequate information from

a physician regarding the 22 19.0 22 19.0 26 22.4 22 19.0 4 3.4 2.63 1.19 45.3 0.003 -3.088
medical condition of a patient

Floating to other units that are

25 21.6 14 12.1 21 18.1 21 18.1 13 11.2 2.82 1.41 49.9 0.216 -1.247
short-staffed

Difficulty in working with a

particular nurse (or nurses) 18 15.5 21 18.1 25 21.6 26 22.4 4 3.4 2.76 1.18 42.7 0.047 -2.011
outside the unit

Unpredictable staffing and

4 3.4 17 14.7 33 28.4 16 13.8 24 20.7 3.41 1.18 34.5 0.001 3.418
Scheduling
 A physician ordering what
appears to be inappropriate 21 18.1 22 19.0 27 23.3 15 12.9 10 8.6 2.69 1.27 47.3 0.021 -2.339
treatment for a patient

Descriptive Statistics for SocialNSS-S / Table (16) “Continuation”

Not at all S. Slightly S. Moderately S. Very S. Extremely S. Mean SD CV Sig. T

Statement
F % F % F % F % F %

Too many non-nursing tasks

15 12.9 21 18.1 22 19.0 21 18.1 18 15.5 3.06 1.35 44.0 0.652 0.453
required, such as clerical work

Not enough time to provide

13 11.2 23 19.8 25 21.6 20 17.2 15 12.9 3.01 1.28 42.4 0.936 0.080
emotional support to a patient

Not enough time to complete all of

16 13.8 24 20.7 21 18.1 23 19.8 10 8.6 2.86 1.27 44.3 0.293 -1.059
my nursing tasks

A physician not being present in

26 22.4 17 14.7 21 18.1 17 14.7 11 9.5 2.67 1.38 51.5 0.025 -2.274
medical Emergency

Uncertainty regarding the 24 20.7 29 25.0 23 19.8 13 11.2 7 6.0 2.48 1.21 49.0 0.000 -4.204
operation and functioning of
specialized equipment

Not enough staff to adequately

15 12.9 25 21.6 22 19.0 15 12.9 17 14.7 2.94 1.34 45.7 0.646 -0.461
load cover the Unit

Lack of drugs and equipment

27 23.3 20 17.2 22 19.0 19 16.4 7 6.0 2.57 1.29 50.4 0.002 -3.252
required for nursing care

*Sig.: Sig. (2-tailed)

**T: One-Sample T-Test

3. Interpersonal Variables:

Looking at Table (17) which shows the answers for the statements concerning how

Frequent do Interpersonal variables affect the nurse’s stress levels; it is noticed

that the statements’ answers were mostly (occasional) with percentages between

(36.2%) and (61.2%) except for the “Watching a patient suffer” statement in which

the answers were mostly (often) with a percentage of (47.4%). The one-sample T-

test’s results shows that most of the statements had sig. (2-tailed) P-values of less than

(α=0.05) which indicates rejecting the null hypothesis that "there is no statistical

differences between the samples means of Social variables and the test value (2)" in

these statements, and accepting the alternative hypothesis that there is acceptable

statistical differences. That is in the exception of the four statements high-lighted

(blue) in table (17) which have sig. (2-tailed) P-values of more than (α=0.05)

indicating the acceptance of the null hypothesis in these statements.

As for Table (18) for how Stressful do Interpersonal Variables make the nurse;

all of the statements’ answers lean towards it being (Moderately Stressful or above)

with percentages varying between the low percentage of (37.9%) and the higher

percentage of (69.8%). As for the one-sample T-test’s results for the Interpersonal

Variables; most of the statements had sig. (2-tailed) P-values of lower than (α=0.05)

indicating the rejection of the null hypothesis that "there is no statistical differences

between the samples means of Interpersonal variables and the test value (3)" in these

statements, and the acceptance of the alternative hypothesis. With the exception of

the six statements high-lighted (blue) in table (18) that have sig. (2-tailed) P-values

of more than (α=0.05) meaning the acceptance of the null hypothesis in those.
Descriptive Statistics for InterpersonalNSS-F / Table (17)

Never Occasional Often Mean SD CV Sig. T

Statement
F % F % F %

0.6 -
Criticism by a physician 36 31.0 54 46.6 15 12.9 1.80 37.3 0.003
7 3.055

Performing procedures that patients

14 12.1 50 43.1 39 33.6 2.24 0.68 30.3 0.000 3.632
experience as Painful

Feeling helpless in a case of a patient

16 13.8 68 58.6 22 19.0 2.06 0.60 29.1 0.333 0.973
who fails to improve

Conflict with a supervisor 35 30.2 57 49.1 12 10.3 1.78 0.64 35.8 0.001 -3.536

Listening or talking to a patient about

31 26.7 49 42.2 26 22.4 1.95 0.74 37.7 0.510 -0.661
his/her approaching death

Lack of an opportunity to talk openly

with other unit personnel about 34 29.3 51 44.0 19 16.4 1.86 0.70 37.8 0.039 -2.094
problems in the unit

The death of a patient 19 16.4 50 43.1 35 30.2 2.15 0.71 32.9 0.029 2.218

Conflict with a physician 23 19.8 69 59.5 11 9.5 1.88 0.57 30.1 0.039 -2.091

Fear of making a mistake in treating a

21 18.1 62 53.4 23 19.8 2.02 0.65 32.0 0.765 0.300
patient
Descriptive Statistics for InterpersonalNSS-F / Table (17) “Continuation”

Never Occasional Often Mean SD CV Sig. T

Statement
F % F % F %

Lack of an opportunity to share

experiences and feelings with other 36 31.0 52 44.8 17 14.7 1.82 0.69 37.9 0.008 -2.686
personnel in the unit

The death of a patient with whom you

42 36.2 46 39.7 16 13.8 1.75 0.71 40.4 0.000 -3.606
developed a close relationship

Listening or talking to a patient about

31 26.7 49 42.2 26 22.4 1.95 0.74 37.7 0.000 -4.659
his/her approaching death

Being asked a question by a patient for

which I do not have a satisfactory 27 23.3 69 59.5 10 8.6 1.84 0.57 31.0 0.005 -2.890
answer

Making a decision concerning a patient

27 23.3 71 61.2 8 6.9 1.82 0.55 30.2 0.001 -3.364
when the physician is unavailable

Watching a patient suffer 11 9.5 42 36.2 55 47.4 2.41 0.67 27.8 0.000 6.317

Criticism by a supervisor 39 33.6 59 50.9 10 8.6 1.73 0.62 35.9 0.000 -4.496
 Difficulty in working with a particular
32 27.6 60 51.7 14 12.1 1.83 0.64 35.0 0.007 -2.734
nurse (or nurses) on the unit

Not knowing what a patient or a

patient's family ought to be told about 24 20.7 68 58.6 15 12.9 1.92 0.60 31.3 0.150 -1.449
the patient's condition and its treatment

*Sig.: Sig. (2-tailed)**T: One-Sample T-Test

Descriptive Statistics for InterpersonalNSS-S / Table (18)

Not at all Moderately Extremely

Slightly S. Very S. Mean SD CV Sig. T
Statement S. S. S.

F % F % F % F % F %

Criticism by a physician 23 19.8 23 19.8 26 22.4 15 12.9 11 9.5 2.67 1.30 48.6 0.014 -2.489

Performing procedures that

13 11.2 15 12.9 36 31.0 24 20.7 12 10.3 3.07 1.18 38.5 0.555 0.592
patients experience as Painful

Feeling helpless in a case of a

9 7.8 22 19.0 28 24.1 28 24.1 12 10.3 3.12 1.16 37.3 0.302 1.037
patient who fails to improve

Conflict with a supervisor 25 21.6 27 23.3 27 23.3 16 13.8 4 3.4 2.46 1.16 47.0 0.000 -4.614

Listening or taking to a patient

23 19.8 11 9.5 29 25.0 17 14.7 18 15.5 2.96 1.41 47.5 0.774 -0.287
about his/her approaching death
 Lack of an opportunity to talk
openly with other unit personnel 21 18.1 26 22.4 25 21.6 18 15.5 4 3.4 2.55 1.16 45.5 0.000 -3.733
about problems in the unit

The death of a patient 7 6.0 18 15.5 27 23.3 21 18.1 20 17.2 3.31 1.23 37.0 0.016 2.456

Conflict with a physician 22 19.0 21 18.1 31 26.7 14 12.1 9 7.8 2.66 1.24 46.7 0.008 -2.701

Fear of making a mistake in

13 11.2 18 15.5 30 25.9 23 19.8 14 12.1 3.07 1.24 40.3 0.569 0.571
treating a patient

Descriptive Statistics for Interpersonal NSS-S / Table (18) “Continuation”

Moderately Extremely
Not at all S. Slightly S. Very S. Mean SD CV Sig. T
Statement S. S.

F % F % F % F % F %

Lack of an opportunity to share

experiences and feelings with other 25 21.6 26 22.4 23 19.8 17 14.7 9 7.8 2.59 1.28 49.4 0.002 -3.203
personnel in the unit
The death of a patient with whom you
28 24.1 14 12.1 19 16.4 18 15.5 16 13.8 2.79 1.47 52.8 0.167 -1.394
developed a close relationship

Lack of an opportunity to express to

other personnel on the unit my negative 22 19.0 24 20.7 31 26.7 12 10.3 6 5.2 2.54 1.17 45.9 0.000 -3.874
feelings toward patients

Being asked a question by a patient for

which I do not have a satisfactory 17 14.7 26 22.4 29 25.0 17 14.7 6 5.2 2.67 1.15 43.2 0.007 -2.759
answer

Making a decision concerning a patient

19 16.4 24 20.7 31 26.7 14 12.1 4 3.4 2.57 1.11 43.3 0.000 -3.749
when the physician is unavailable

Watching a patient suffer 5 4.3 8 6.9 27 23.3 28 24.1 26 22.4 3.66 1.13 30.9 0.000 5.651

Criticism by a supervisor 28 24.1 22 19.0 25 21.6 15 12.9 4 3.4 2.41 1.20 49.6 0.000 -4.747

Difficulty in working with a particular

21 18.1 20 17.2 28 24.1 20 17.2 7 6.0 2.71 1.23 45.4 0.022 -2.322
nurse (or nurses) on the unit

Not knowing what a patient or a

patient's family ought to be told about
15 12.9 28 24.1 25 21.6 16 13.8 10 8.6 2.77 1.22 44.1 0.066 -1.857
the patient's condition and its
treatment

*Sig.: Sig. (2-tailed)**T: One-Sample T-Test

4. Psychosomatics Symptoms Variables:

Table (19) details the answers for the seven statements concerning how Frequent do

the Psychosomatics Symptoms affect nurses; it is noticed that all except one of the

statements’ answers lean towards it being (Occasional or Often) with percentages

varying between the low percentage of (44.0%) and the high percentage of (80.2%).

As for the high-lighted (orange) statement in table (19): "How often did you have

tension diarrhea that is (as you think) related to your work"; this statements'

answers lean toward (Never) with a percentage of (41.4%).

The one-sample T-test’s results for the Psychosomatics Symptoms variables show that

most of the statements had sig. (2-tailed) P-values of lower than (α=0.05) which

indicates rejecting the null hypothesis that "there is no statistical differences between

the samples means of Psychosomatics Symptoms variables and the test value (2.5)" in

these statements, except for the two statements high-lighted (blue) in the table (19)

that have sig. (2-tailed) P-values more than (α=0.05) meaning the acceptance of the

null hypothesis in those two statements.

 Descriptive Statistics for Psychosomatics Symptoms / Table (19)

Never Seldom Occasionally Often

Statement Mean SD CV Sig. T
F % F % F % F %

How often did you have a back pain that is

10 8.6 8 6.9 43 37.1 50 43.1 3.20 0.92 28.8 0.000 7.973
(as you think) related to your work

How often did you have tension headaches

13 11.2 17 14.7 52 44.8 32 27.6 2.90 0.94 32.4 0.000 4.581
that are (as you think) related to your work

How often did you have sleeping problems

10 8.6 18 15.5 43 37.1 43 37.1 3.04 0.94 31.1 0.000 6.149
that are (as you think) related to your work

How often did you have chronic fatigue

13 11.2 16 13.8 43 37.1 41 35.3 2.99 0.99 33.0 0.000 5.293
that is (as you think) related to your work

How often did you have stomach acidity

30 25.9 27 23.3 36 31.0 21 18.1 2.42 1.07 44.3 0.433 -0.787
that is (as you think) related to your work

How often did you have tension diarrhea

48 41.4 24 20.7 25 21.6 16 13.8 2.08 1.10 53.0 0.000 -4.051
that is (as you think) related to your work

How often did you have palpitations that

35 30.2 26 22.4 30 25.9 21 18.1 2.33 1.11 47.6 0.109 -1.617
are (as you think) related to your work

*Sig.: Sig. (2-tailed)**T: One-Sample T-Test

Third: Two-Sample T-test (Independent Sample T-test):

The Gender Factor:

Table (20) shows the independent Two Sample T-Test results which compares the

means between two samples (upon the gender factor; male and female) and their

effect on how Frequent do the Psychosomatics Symptomsaffect nurses, and as

illustrated in the table, it is noticed that the (sig.) P values of all the statements

except one is higher than (α=0.05) then the sig. (2-tailed) P-values equal variances

assumed should be looked at, and since this value is higher than (α=0.05) in all of

these statements, this indicates accepting the null hypothesis that "there is no

statistical differences between the samples means of Psychosomatics Symptoms

variables upon the gender factor".

As for the exception statement “How often did you have tension headaches that

are (as you think) related to your work” and as highlighted in table (20), it is

found to has (sig.) P value of less than (α=0.05), and so the sig. (2-tailed) P-values

equal variances not assumed must be checked, since this value is higher than

(α=0.05), then the null hypothesis that "there is no statistical differences between the

samples means of how frequent do Psychosomatics Symptoms variables affect the

nurses upon the gender factor" must be accepted.

 Independent Samples T-test Results for Psychosomatics Symptoms (Gender
Factor) / Table (20)

Levene’s Test for

Equality of t-test for Equality of Means
Statement Variances

Sig. (2-
F Sig. t df
tailed)

How often did you have Equal Variances

0.014 0.905 -0.883 102 0.379
a back pain that is (as Assumed
you think) related to Equal Variances
your work - - -0.882 90.164 0.380
Not Assumed

How often did you have Equal Variances

4.857 0.030 -0.119 105 0.906
tension headaches that Assumed
are (as you think) Equal Variances
related to your work - - -0.124 103.238 0.902
Not Assumed

How often did you have Equal Variances

0.299 0.586 -0.731 105 0.466
sleeping problems that Assumed
are (as you think) Equal Variances
related to your work - - -0.738 95.764 0.462
Not Assumed

How often did you have Equal Variances

2.564 0.112 0.238 104 0.813
chronic fatigue that is Assumed
(as you think) related to Equal Variances
your work - - 0.245 101.455 0.807
Not Assumed

How often did you have Equal Variances

0.140 0.709 -0.170 105 0.866
stomach acidity that is Assumed
(as you think) related to Equal Variances
your work - - -0.171 94.475 0.865
Not Assumed

How often did you have Equal Variances

0.745 0.390 -0.163 104 0.871
tension diarrhea that is Assumed
(as you think) related to Equal Variances
your work - - -0.165 96.001 0.869
Not Assumed

How often did you have Equal Variances

0.000 0.996 0.473 103 0.637
palpitations that are (as Assumed
you think) related to
Equal Variances - - 0.475 89.043 0.636
 Not Assumed
your work
 Fourth: One-Way ANOVA:

a. The Age Factor:

Looking at Table (21), it is found that sig. P value are higher than (α=0.05) in all the

statements, then "there are no statistical differences indication between the means of

how frequent do Psychosomatics Symptoms affect nurses upon their age", in

other words the differentiation is attributed to the coincidence factor, thus, the null

Hypothesis is accepted in all of the statements.

One-Way ANOVA Test Results for Psychosomatics Symptoms (Age Factor) /

Table (21)

Sum of Mean
Statements df F Sig.
Squares Square

Between
2.339 5 0.468 0.522 0.759
Groups
How often did you have a back
pain that is (as you think) Within
90.539 101 0.896 - -
related to your work Groups

Total 92.879 106 - - -

Between
3.554 5 0.711 0.784 0.564
How often did you have Groups
tension headaches that are (as
Within
you think) related to your 94.346 104 0.907 - -
Groups
work
Total 97.900 109 - - -

Between
8.930 5 1.786 2.141 0.066
How often did you have Groups
sleeping problems that are (as
Within
you think) related to your 86.743 104 0.834 - -
Groups
work
Total 95.673 109 - - -

Between
2.754 5 0.551 0.566 0.726
Groups
How often did you have
chronic fatigue that is (as you Within
100.237 103 0.973 - -
think) related to your work Groups

Total 102.991 108 - - -

Between
10.222 5 2.044 1.820 0.115
Groups
How often did you have
stomach acidity that is (as you Within
116.832 104 1.123 - -
think) related to your work Groups

Total 127.055 109 - - -

 Between
10.187 5 2.037 1.707 0.139
How often did you have Groups
tension diarrhea that is (as
Within
you think) related to your 122.896 103 1.193 - -
Groups
work
Total 133.083 108 - - -

Between
9.553 5 1.911 1.597 0.167
Groups
How often did you have
palpitations that are (as you Within
123.199 103 1.196 - -
think) related to your work Groups

Total 132.752 108 - - -

b. The Marital Status Factor:
Table (22) shows that the sig. P values for all of the statements except two are

higher than (α=0.05), then "there are no statistical differences indication between

the means of how frequent do Psychosomatics Symptoms affect nurses

depending on their Marital Status", in other words the differentiation is attributed

to the coincidence factor, thus, the null Hypothesis is accepted in these statements.

As for the two highlighted (blue) statements in table (22) in which the null Hypothesis

is rejected and the alternative hypothesis that there is a significant statistical

differentiation of psychosomatics symptoms occurrence in the nurses upon their

marital status in those two statements.

c. The Educational Degree Factor:

From Table (23) and Since sig. P values are higher than (α=0.05) for all of the

statements, then "there are no statistical differences indication between the means

of how frequent do Psychosomatics Symptoms affect nurses depending on their

E. Degree", in other words the differentiation is attributed to the coincidence factor,

thus, the null Hypothesis is accepted in these statements.

 One-Way ANOVA Test Results for Psychosomatics Symptoms (Marital Status
Factor) / Table (22)

Sum of Mean
Statements df F Sig.
Squares Square

Between
1.271 3 0.424 0.534 0.660
Groups
How often did you have a back
pain that is (as you think) Within
82.470 104 0.793 - -
related to your work Groups

Total 83.741 107 - - -

Between
4.415 3 1.472 1.810 0.150
Groups
How often did you have tension
headaches that are (as you Within
87.009 107 0.813 - -
think) related to your work Groups

Total 91.423 110 - - -

Between
2.319 3 0.773 0.919 0.434
Groups
How often did you have sleeping
problems that are (as you think) Within
89.952 107 0.841 - -
related to your work Groups

Total 92.270 110 - - -

Between
1.073 3 0.358 0.380 0.768
Groups
How often did you have chronic
fatigue that is (as you think) Within
99.845 106 0.942 - -
related to your work Groups

Total 100.918 109 - - -

Between
5.544 3 1.848 1.650 0.182
Groups
How often did you have
stomach acidity that is (as you Within
119.826 107 1.120 - -
think) related to your work Groups

Total 125.369 110 - - -

How often did you have tension Between 12.601 3 4.200 3.695 0.014
 Groups

diarrhea that is (as you think) Within

120.490 106 1.137 - -
related to your work Groups

Total 133.091 109 - - -

Between
10.343 3 3.448 2.957 0.036
Groups
How often did you have
palpitations that are (as you Within
122.409 105 1.166 - -
think) related to your work Groups

Total 132.752 108 - - -

One-Way ANOVA Test Results for Psychosomatics Symptoms (Educational D.

Factor) / Table (23)

Sum of Mean
Statements Df F Sig.
Squares Square

Between
0.582 5 0.116 0.131 0.985
Groups
How often did you have a back
pain that is (as you think) related Within
93.058 105 0.886 - -
to your work Groups

Total 93.640 110 - - -

Between
8.376 5 1.675 1.976 0.088
Groups
How often did you have tension
headaches that are (as you think) Within
91.563 108 0.848 - -
related to your work Groups

Total 99.939 113 - - -

Between
4.162 5 0.832 0.930 0.464
Groups
How often did you have sleeping
problems that are (as you think) Within
96.619 108 0.895 - -
related to your work Groups

Total 100.781 113 - - -

How often did you have chronic Between

6.897 5 1.379 1.446 0.214
fatigue that is (as you think) Groups
related to your work
Within 102.094 107 0.954 - -
 Groups

Total 108.991 112 - - -

Between
9.067 5 1.813 1.622 0.160
Groups
How often did you have stomach
acidity that is (as you think) Within
120.722 108 1.118 - -
related to your work Groups

Total 129.789 113 - - -

Between
6.018 5 1.204 0.989 0.428
Groups
How often did you have tension
diarrhea that is (as you think) Within
130.265 107 1.217 - -
related to your work Groups

Total 136.283 112 - - -

Between
2.150 5 0.430 0.338 0.889
Groups
How often did you have
palpitations that are (as you think) Within
134.627 106 1.270 - -
related to your work Groups

Total 136.777 111 - - -

 d. The Experience Factor:

Looking at Table (24); it is found that the sig. P values are higher than (α=0.05) in all

of the statements except for the two highlighted statements, then there are no

statistical differences indication between the means of how frequent do

Psychosomatics Symptoms affect nurses depending on their Experience, thus, the

null Hypothesis is accepted except in the two highlighted statements in table (24) in

which it is rejected and the alternative hypothesis that there is a significant

differentiation of how frequent do psychosomatics symptoms affect nurses upon their

experience is accepted.

One-Way ANOVA Test Results for Psychosomatics Symptoms (Experience

Factor) / Table (24)

Sum of Mean
Statements df F Sig.
Squares Square

Between
2.778 4 0.694 0.811 0.521
Groups
How often did you have a back
pain that is (as you think) Within
88.139 103 0.856 - -
related to your work Groups

Total 90.917 107 - - -

Between
1.708 4 0.427 0.491 0.742
How often did you have Groups
tension headaches that are (as
Within
you think) related to your 92.202 106 0.870 - -
Groups
work
Total 93.910 110 - - -

Between
8.413 4 2.103 2.493 0.047
How often did you have Groups
sleeping problems that are (as
Within
you think) related to your 89.443 106 0.844 - -
Groups
work
Total 97.856 110 - - -

Between
1.111 4 0.278 0.286 0.886
Groups
How often did you have
chronic fatigue that is (as you Within
101.880 105 0.970 - -
think) related to your work Groups

Total 102.991 109 - - -

How often did you have Between

8.693 4 2.173 2.020 0.097
stomach acidity that is (as you Groups
think) related to your work
Within 114.063 106 1.076 - -
 Groups

Total 122.757 110 - - -

Between
5.374 4 1.344 1.154 0.336
Groups
How often did you have
tension diarrhea that is (as you Within
122.298 105 1.165 - -
think) related to your work Groups

Total 127.673 109 - - -

Between
14.123 4 3.531 3.186 0.016
Groups
How often did you have
palpitations that are (as you Within
115.271 104 1.108 - -
think) related to your work Groups

Total 129.394 108 - - -

Fifth: Correlation Test (Pearson):

a. Correlation between Social variables and Psychosomatics

Symptoms:

Looking at Table (25) which shows the Correlations test results between the

frequency of Social Variables and Psychosomatics Symptoms occurrence, a

significant number of highlighted (Yellow) correlations between these two factors

can be noticed. The correlations are marked by the SPSS with one or two stars

depending on the level of sig. (2-tailed); all of which show Weak Positive

Correlations taking values between (0.201) and (0.370).

Table (26) details the Correlations test results between the stress level of Social

Variables and Psychosomatics Symptoms occurrence, it is clear that there is a few

number of highlighted (Blue) correlations between these two factors. These

correlations are marked by the SPSS with one or two stars depending on the level of

sig. (2-tailed) and all show Weak Negative Correlations to Weak Positive

Correlations taking values from (-0.234) to (0.245).

 Correlations’ Results between Social variables (how frequent) and Psychosomatics Symptoms / Table (25)

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

C.C -0.028 0.119 -0.070 0.016 0.078 0.103 0.204*

SI (1) Sig. (2-tailed) 0.778 0.227 0.480 0.872 0.430 0.300 0.039

N 103 105 105 104 105 104 103

C.C -0.133 -0.085 -0.152 -0.042 0.137 0.076 0.111

SI (13) Sig. (2-tailed) 0.183 0.394 0.125 0.676 0.166 0.445 0.266

N 102 104 104 103 104 103 102

C.C 0.048 -0.040 -0.131 -0.013 0.141 -0.042 0.148

SI (14) Sig. (2-tailed) 0.633 0.690 0.188 0.896 0.156 0.680 0.142

N 100 102 102 101 102 101 100

C.C 0.088 0.057 0.137 0.145 0.047 0.017 0.069

SI (17) Sig. (2-tailed) 0.382 0.562 0.162 0.141 0.631 0.867 0.486

N 102 105 105 104 105 104 103

SI (20) C.C 0.086 0.061 0.144 0.155 0.150 0.206* 0.171

Sig. (2-tailed) 0.390 0.536 0.140 0.114 0.125 0.035 0.082

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

N 103 106 106 105 106 105 104

C.C -0.085 -0.023 0.024 0.137 0.002 0.119 0.049

SI (22) Sig. (2-tailed) 0.401 0.816 0.809 0.167 0.982 0.231 0.626

N 101 104 104 103 104 103 102

C.C 0.065 -0.057 0.114 0.191 0.066 0.077 0.045

SI (25) Sig. (2-tailed) 0.526 0.574 0.256 0.057 0.514 0.446 0.661

N 98 101 101 100 101 100 99

Correlations’ Results between Social variables (how frequent) and Psychosomatics Symptoms / Table (25) "Continuation"
 Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

C.C 0.000 0.095 0.057 0.132 0.293** 0.232* 0.201*

SI (26) Sig. (2-tailed) 1.000 0.337 0.562 0.180 0.002 0.018 0.041

N 102 105 105 104 105 104 103

C.C 0.107 0.108 0.173 0.212* 0.165 0.096 0.153

SI (27) Sig. (2-tailed) 0.284 0.275 0.078 0.030 0.092 0.331 0.123

N 102 105 105 104 105 104 103

C.C 0.168 0.094 0.152 0.206* 0.079 -0.012 0.165

SI (28) Sig. (2-tailed) 0.090 0.340 0.120 0.035 0.423 0.900 0.094

N 103 106 106 105 106 105 104

C.C 0.261** 0.189 0.237* 0.270** 0.356** 0.321** 0.370**

SI (30) Sig. (2-tailed) 0.008 0.054 0.015 0.006 0.000 0.001 0.000

N 102 105 105 104 105 104 103

C.C -0.076 -0.009 -0.142 -0.008 0.344** 0.224* 0.183

SI (31) Sig. (2-tailed) 0.445 0.928 0.147 0.934 0.000 0.021 0.063

N 103 106 106 105 106 105 104

 C.C 0.168 0.171 0.045 0.160 0.334** 0.208* 0.168

SI (33) Sig. (2-tailed) 0.091 0.081 0.648 0.104 .000 0.035 0.091

N 102 105 105 104 105 104 103

C.C 0.297** 0.243* 0.232* 0.288** 0.292** 0.173 0.354**

SI (34) Sig. (2-tailed) 0.002 0.013 0.017 0.003 0.002 0.080 0.000

N 102 105 105 104 105 104 103

SI (35) C.C 0.075 0.120 0.036 0.000 0.296** 0.250* 0.253*

Sig. (2-tailed) 0.454 0.226 0.718 0.997 0.002 0.011 0.010

N 101 104 104 103 104 103 102

*Correlation is significant at the 0.05 level (2-tailed) **Correlation is significant at the 0.01 level (2-tailed)

Correlations’ Results between Social variables (how stressful) and Psychosomatics Symptoms / Table (26)

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

SI (1) C.C 0.043 0.172 -0.026 0.021 0.084 0.087 0.105

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

Sig. (2-tailed) 0.688 0.102 0.803 0.846 0.427 0.413 0.323

N 89 92 92 92 92 91 90

C.C -0.138 -0.090 -0.221* -0.146 -0.041 -0.017 0.011

SI (13) Sig. (2-tailed) 0.191 0.389 0.032 0.162 0.695 0.874 0.920

N 91 94 94 94 94 93 92

C.C -0.174 -0.163 -0.234* -0.206* -0.045 -0.098 -0.025

SI (14) Sig. (2-tailed) 0.102 0.119 0.024 0.047 0.670 0.355 0.812

N 90 93 93 93 93 92 91

C.C 0.041 -0.039 -0.005 -0.079 -0.004 0.020 -0.084

SI (17) Sig. (2-tailed) 0.697 0.707 0.958 0.446 0.969 0.847 0.421

N 93 95 95 95 95 94 93

C.C 0.095 0.021 0.086 -0.005 0.019 0.080 0.130

SI (20) Sig. (2-tailed) 0.370 0.840 0.413 0.966 0.857 0.446 0.220

N 91 93 93 93 93 92 91

SI (22) C.C -0.035 -0.027 -0.062 0.002 -0.001 0.069 -0.013

 Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

Sig. (2-tailed) 0.738 0.796 0.555 0.982 0.994 0.515 0.904

N 91 93 93 93 93 92 91

C.C 0.033 -0.026 -0.006 -0.002 -0.130 -0.127 -0.081

SI (25) Sig. (2-tailed) 0.753 0.801 0.956 0.986 0.216 0.226 0.448

N 91 93 93 93 93 92 91

Correlations’ Results between Social variables (how stressful) and Psychosomatics Symptoms / Table (26) "Continuation"

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

SI (26) C.C 0-.037 0.028 -0.104 -0.110 0.181 0.174 0.055

 Sig. (2-tailed) 0.723 0.788 0.318 0.289 0.080 0.093 0.600

N 93 95 95 95 95 94 93

C.C 0.102 0.150 0.190 0.118 0.087 0.045 0.062

SI (27) Sig. (2-tailed) 0.324 0.144 0.062 0.248 0.399 0.665 0.552

N 95 97 97 97 97 96 95

C.C 0.240* 0.177 0.150 0.192 0.098 -0.008 0.181

SI (28) Sig. (2-tailed) 0.020 0.084 0.145 0.061 0.340 0.939 0.081

N 94 96 96 96 96 95 94

C.C 0.193 0.243* 0.186 0.100 0.148 0.201 0.245*

SI (30) Sig. (2-tailed) 0.065 0.018 0.073 0.337 0.155 0.053 0.018

N 92 94 94 94 94 93 92

C.C -0.185 0.004 -0.233* -0.154 0.104 0.102 0.085

SI (31) Sig. (2-tailed) 0.081 0.972 0.025 0.144 0.325 0.337 0.427

N 90 92 92 92 92 91 90

SI (33) C.C 0.010 0.062 -0.130 -0.137 0.130 0.164 0.078

Sig. (2-tailed) 0.926 0.550 0.206 0.183 0.206 0.113 0.456

 N 94 96 96 96 96 95 94

C.C 0.220* 0.230* 0.061 0.103 0.171 0.101 0.225*

SI (34) Sig. (2-tailed) 0.035 0.026 0.560 0.325 0.100 0.337 0.031

N 92 94 94 94 94 93 92

C.C 0.055 0.041 -0.098 -0.069 0.184 0.197 0.175

SI (35) Sig. (2-tailed) 0.599 0.693 0.344 0.509 0.074 0.058 0.094

N 93 95 95 95 95 94 93

*Correlation is significant at the 0.05 level (2-tailed) **Correlation is significant at the 0.01 level (2-tailed)
b. Correlation between Interpersonal variables and Psychosomatics

Symptoms:

From Table (27) which shows the Correlations test results between Psychosomatics

Symptoms and the frequency of Interpersonal variables, it is noticed that there is a

significant number of highlighted (Green) correlations between these two factors. These

correlations are marked by the SPSS with one or two stars depending on the level of sig. (2-

tailed), and all show Weak Positive Correlations varying in values from (0.197) to

(0.316).

Table (28) detailing the Correlations test results between Psychosomatics Symptoms and

the stress levels of Interpersonal Variables, shows a few number of highlighted (Light

Purple) correlations between these two factors. The correlations are marked by the SPSS

with one or two stars depending on the level of sig. (2-tailed) and all show correlations

varying from Weak Negative to Weak Positive ones taking values between (-0.238) and

(0.302).
Correlations’ Results between Interpersonal variables (how frequent) and Psychosomatics Symptoms / Table (27)

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

C.C 0.117 0.200* 0.039 0.072 0.206* 0.133 0.228*

IP (2) Sig. (2-tailed) 0.244 0.043 0.698 0.474 0.037 0.181 0.022

N 101 103 103 102 103 102 101

C.C 0.013 -0.128 -0.151 -0.107 -0.151 -0.080 -0.088

IP (3) Sig. (2-tailed) 0.902 0.201 0.132 0.291 0.131 0.430 0.384

N 99 101 101 100 101 100 99

C.C -0.013 -0.004 -0.086 -0.047 -0.011 -0.043 0.011

IP (4) Sig. (2-tailed) 0.897 0.968 0.384 0.638 0.912 0.664 0.909

N 102 104 104 103 104 103 102

C.C 0.136 0.235* 0.131 0.171 0.316** 0.209* 0.213*

IP (5) Sig. (2-tailed) 0.179 0.018 0.191 0.087 0.001 0.036 0.033

N 100 102 102 101 102 101 100

IP (6) C.C 0.122 0.058 0.014 0.078 0.119 0.036 0.104

 Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

Sig. (2-tailed) 0.221 0.560 0.886 0.436 0.230 0.719 0.299

N 102 104 104 103 104 103 102

C.C 0.186 0.118 0.137 0.207* 0.247* 0.113 0.289**

IP (7) Sig. (2-tailed) 0.062 0.237 0.167 0.037 0.012 0.258 0.003

N 101 103 103 102 103 102 101

Correlations’ Results between Interpersonal Variables (how frequent) and Psychosomatics Symptoms / Table (27) "Continuation"

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

C.C 0.056 0.076 0.091 0.100 0.107 0.091 0.242*

IP (8) Sig. (2-tailed) 0.577 0.446 0.362 0.319 0.281 0.362 0.015

N 101 103 103 102 103 102 101

IP (9) C.C 0.079 0.188 0.006 0.100 0.191 0.159 0.298**

Sig. (2-tailed) 0.435 0.058 0.954 0.321 0.054 0.111 0.003

 N 100 102 102 101 102 101 100

C.C 0.165 0.302** 0.315** 0.212* 0.127 0.184 0.166

IP (10) Sig. (2-tailed) 0.097 .002 0.001 0.032 0.198 0.063 0.095

N 102 104 104 103 104 103 102

C.C 0.134 0.089 0.080 0.020 0.136 0.060 0.160

IP (11) Sig. (2-tailed) 0.180 0.372 0.421 0.840 0.170 0.548 0.111

N 101 103 103 102 103 102 101

C.C 0.103 0.079 0.088 -0.007 0.185 0.074 0.198*

IP (12) Sig. (2-tailed) 0.310 0.430 0.381 0.943 0.062 0.463 0.048

N 100 102 102 101 102 101 100

C.C 0.108 0.197* 0.019 0.199* 0.311** 0.074 0.192

IP (16) Sig. (2-tailed) 0.281 0.045 0.845 0.044 0.001 0.457 0.053

N 101 104 104 103 104 103 102

 Correlations’ Results between Interpersonal Variables (how frequent) and Psychosomatics Symptoms / Table (27)
"Continuation"

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

C.C 0.047 0.003 0.081 0.081 0.199* 0.081 0.145

IP (18) Sig. (2-tailed) 0.637 0.975 0.410 0.416 0.042 0.414 0.144

N 102 105 105 104 105 104 103

C.C -0.108 0.074 0.049 0.064 0.236* 0.068 0.299**

IP (19) Sig. (2-tailed) 0.282 0.455 0.617 0.515 0.016 0.495 0.002

N 102 105 105 104 105 104 103

C.C 0.014 0.038 0.131 0.147 -0.175 -0.124 -0.031

IP (21) Sig. (2-tailed) 0.887 0.700 0.177 0.132 0.071 0.207 0.754

N 104 107 107 106 107 106 105

C.C -0.051 -0.022 0.017 0.004 0.116 0.094 0.038

IP (24) Sig. (2-tailed) 0.609 0.820 0.865 0.970 0.234 0.338 0.703

N 104 107 107 106 107 106 105

C.C 0.084 0.134 0.008 0.065 0.255** 0.277** 0.283**

IP (29) Sig. (2-tailed) 0.396 0.170 0.936 0.512 0.008 0.004 0.004

N 103 106 106 105 106 105 104

 C.C 0.162 0.112 0.136 0.140 0.268** 0.247* 0.287**

IP (32) Sig. (2-tailed) 0.101 0.249 0.164 0.152 0.005 0.011 0.003

N 104 107 107 106 107 106 105

*Correlation is significant at the 0.05 level (2-tailed) **Correlation is significant at the 0.01 level (2-tailed)

Correlations’ Results between Interpersonal Variables (how stressful) and Psychosomatics Symptoms / Table (28)

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

C.C 0.099 0.090 -0.021 -0.015 0.056 -0.003 0.073

IP (2) Sig. (2-tailed) 0.346 0.381 0.837 0.882 0.591 0.977 0.483

N 93 96 96 96 96 95 94

C.C -0.006 0.089 -0.125 -0.118 -0.014 0.054 -0.066

IP (3) Sig. (2-tailed) 0.955 0.386 0.221 0.248 0.891 0.602 0.523

N 95 98 98 98 98 97 96

C.C -0.071 0.066 -0.132 -0.152 -0.048 -0.043 -0.005

IP (4) Sig. (2-tailed) 0.497 0.518 0.198 0.138 0.644 0.675 0.965

N 94 97 97 97 97 96 95

IP (5) C.C 0.003 0.181 0.002 0.022 0.057 0.018 0.037

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

Sig. (2-tailed) 0.973 0.076 0.986 0.833 0.579 0.864 0.721

N 94 97 97 97 97 96 95

C.C 0.023 0.042 -0.157 -0.161 -0.007 0.014 -0.005

IP (6) Sig. (2-tailed) 0.824 0.686 0.128 0.117 0.947 0.892 0.963

N 93 96 96 96 96 95 94

C.C 0.147 0.202 0.081 0.165 0.228* 0.126 0.302**

IP (7) Sig. (2-tailed) 0.170 0.053 0.442 0.117 0.029 0.235 0.004

N 89 92 92 92 92 91 90
 Correlations’ Results between Interpersonal Variables (how stressful) and Psychosomatics Symptoms / Table (28)
"Continuation"

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

C.C -0.024 0.148 0.049 0.000 -0.054 -0.040 0.104

IP (8) Sig. (2-tailed) 0.828 0.161 0.646 1.000 0.613 0.711 0.332

N 88 91 91 91 91 90 89

C.C 0.108 0.134 -0.079 -0.069 0.036 0.039 0.031

IP (9) Sig. (2-tailed) 0.308 0.195 0.448 0.507 0.726 0.712 0.770

N 92 95 95 95 95 94 93

C.C -0.019 0.088 -0.038 -0.042 0.042 -0.008 0.067

IP (10) Sig. (2-tailed) 0.856 0.392 0.714 0.686 0.686 0.937 0.520

N 93 96 96 96 96 95 94

C.C 0.066 0.129 -0.050 -0.002 0.199* 0.119 0.188

IP (11) Sig. (2-tailed) 0.525 0.205 0.626 0.984 0.049 0.247 0.067

N 95 98 98 98 98 97 96

C.C 0.112 0.032 0.094 -0.035 0.093 0.042 0.162

IP (12) Sig. (2-tailed) 0.292 0.758 0.370 0.739 0.377 0.688 0.124

N 90 93 93 93 93 92 91
 C.C 0.090 0.152 -0.080 -0.018 0.243* 0.165 0.127

IP (16) Sig. (2-tailed) 0.391 0.143 0.444 0.864 0.018 0.114 0.228

N 92 94 94 94 94 93 92

Correlations’ Results between Interpersonal Variables (how stressful) and Psychosomatics Symptoms / Table (28)
"Continuation"

Statements as Numbered in The Questionnaire PsychA PsychB PsychC PsychD PsychE PsychF PsychG

C.C -0.050 0.103 -0.130 -0.159 0.083 0.051 0.018

IP (18) Sig. (2-tailed) 0.635 0.322 0.212 0.125 0.425 0.624 0.864

N 92 94 94 94 94 93 92

C.C -0.137 -0.002 -0.238* -0.198 0.144 0.071 0.083

IP (19) Sig. (2-tailed) 0.202 0.988 0.023 0.060 0.173 0.509 0.442

N 89 91 91 91 91 90 89

C.C 0.125 0.091 0.041 0.067 -0.172 -0.162 -0.085

IP (21) Sig. (2-tailed) 0.237 0.384 0.696 0.523 0.100 0.122 0.422

N 91 93 93 93 93 92 91

IP (24) C.C 0.008 0.042 -0.082 -0.112 0.041 0.093 -0.004

Sig. (2-tailed) 0.940 0.692 0.435 0.285 0.694 0.380 0.973

 N 91 93 93 93 93 92 91

C.C 0.129 0.167 -0.019 -0.014 0.131 0.244* 0.227*

IP (29) Sig. (2-tailed) 0.214 0.103 0.851 0.895 0.203 0.017 0.028

N 94 96 96 96 96 95 94

C.C -0.009 0.047 -0.080 -0.115 0.002 0.045 0.052

IP (32) Sig. (2-tailed) 0.930 0.652 0.444 0.272 0.988 0.671 0.625

N 92 94 94 94 94 93 92

*Correlation is significant at the 0.05 level (2-tailed) **Correlation is significant at the 0.01 level (2-tailed)
 11. Discussion:

Depending on the previous discussion of the data statistical analysis; the degree to

which the study’s objectives were achieved will be assessed through answering

the study’s questions as following:

Question (1): “What is the level of stress among oncology nurses in Palestine?”

In general, the mean percentages of the stress degree of the different variables were as

illustrated in the following Table (29).

The Mean of the Percentages for the NSS Variables / Table (29)

Statement
Not at Extreme Total
Slightly Moderatel Very ’s
How Stressful all ly Level of
stressful y stressful stressful answers
stressful stressful Stress
Mean

Personal Variables 21.1 17.25 24.15 13.8 5.2 60.4 2.6

Interpersonal
16.1 17.86 23.8 15.95 9.2 66.8 2.8
Variables

Social Variables 18.16 17.66 19.9 16.2 9.76 63.5 2.8

Weighted Averages 65.0 2.8

This table shows the average percentages of the occupational stress levels regardless

of the degree of the stress for each NSS variable, and according to these average

percentages, the occupational stress is moderately prevalence among oncology

nurses. It also shows the weighted average of the stress levels percentages, which

is (65.0%), meaning that occupational stress is –in general- moderately prevalence

among oncology nurses with a moderate weighted mean of (2.8).

 This finding supported by a number of studies such asJaradat study (2012) , which

found that mental distress symptoms were significantly more prevalent among

rotating shift workers than fixed day-workers.And Maryam study ( 2008), showed

that there was a very high percentage of nurses experiencing the pressures of

professional stress. Also Elqerenawi study (2017), reported that the mean score of

nurses work stressors was 88.7. Moreover, YahiaJodah study ( 2003), that the total

degree of general average of job stress sources among Palestinian nurses working in

Northern West Bank district hospital was moderate . And Karimi study (2018),

showed moderate to high levels of job stress were observed among nurses.

Question (2): “What is the prevalence of psychosomatic symptomsamong

oncology nurses in the West-Bank?”

As for the frequency of the Psychosomatics Symptoms; the mean percentages of all

the statements were as illustrated in the following Table (30).

The Mean of the Percentages for the Psychosomatics Symptoms / Table (30)

Total Level
Neve Occasionall Statement’s
How Stressful Seldom Often of
r y answers Mean
Occurrence

Psychosomatics Symptoms 19.6 16.8 33.5 27.6 77.9 2.7

This table shows that regardless of the frequency of occurrence, a percentage of

(77.9%) of the oncology nurses suffered from Psychosomatics Symptoms during

the last 12 months, which indicate that Psychosomatics Symptoms have a

moderately high prevalence among oncology nurses in the West Bankwith a

Moderately High average mean of (2.7).

This finding similar for SafaaAbdelazem study (2018), whichdocumented a high

prevalence of psychosomatic symptoms among intensive care units (ICUS)

nurses.Also Sveinsdottir study (2006), found that nurses working rotating

days/evenings shifts experienced more severe gastrointestinal and musculoskeletal

symptoms as compared to the others.

Question (3): “Is there any relationship between level of occupational stress and

psychosomatic symptoms among oncology nurses in Palestine?”

According to the correlations' results table in the previous discussion; a few number

of correlations between the stress level of Social Variables and Psychosomatics

Symptoms is found, these correlations range from Weak Negative Correlations to

Weak Positive Correlations taking values between (-0.234) and (0.245).

As for the relationship between Psychosomatics Symptoms and the stress levels of

Interpersonal Factors, a significant number of correlations between these two

factors is noticed, ranging from Weak Negative Correlations to Weak Positive

Correlations and taking varying values from (-0.238) to (0.302).And Kane study (

2009), documented thatModerate levels of stress are seen in a majority of the nurses.

Incidence of psychosomatic illness increases with the level of stress.Also Mojoyinola

study ( 2008), established that job stress has significant effect on physical and mental

health of the nurses. It also established that there was a significant difference in

personal and work behavior of highly stressed nurses and less stressed nurses.

Question (4): “Is there an association between social source of stress (That

include Workload, type of shift, shift long) and psychosomatic symptoms?”

The correlations test results show a significant number of Weak Positive

Correlations between the frequency of Social Variables and Psychosomatics

Symptoms, these Correlations take values from (0.201) to (0.370).Against

Malinauskienė study (2009), which found that job strain-low social support at work

was the strongest risk factor for mental distress among nurses.Also Sveinsdottir

study ( 2006), showed nurses working rotating days/evenings shifts experienced more

severe gastrointestinal and musculoskeletal symptoms as compared to the others.

Question (5): “Is there an association between interpersonal source of stress

(That include conflict, relationship with peers, emotions (to the death, dying))

and the psychosomatic symptoms?”

Correlations test results between Psychosomatics Symptoms and the frequency of

Interpersonal variables, clearly shows a significant number of correlations between
these two factors, these Correlations all show Weak Positive values ranging from
(0.197) to (0.316).Also Kane study ( 2009), showed incidence of psychosomatic
illness increases with the level of stress.And the most important causes of stress were
jobs not finishing in time because of shortage of staff, conflict with patient relatives,
overtime, and insufficient pay. Psychosomatic disorders like acidity, back pain,
stiffness in neck and shoulders, forgetfulness, anger, and worry significantly increased
in nurses having higher stress scores. And Malinauskienėstudy (2009), found that
job strain-low social support at work was the strongest risk factor for mental distress
among nurses.

Question (6): “Is there an association between psychosomatic symptoms and

selected demographic variables (including gender, age, education, years of

experience and marital status) among oncology nurses?”

Studying the Two-Sample T-test and ANOVA tables in the discussion above, it is
found that the null hypothesis that "there is no statistical differences between the
samples means of how stressful the variables are upon the Gender Factor, Age
Factor and Educational Degree Factor is accepted for all the
statementsrepresenting the psychosomatics symptoms", so it is clear that depending
on these factors; the Psychosomatics Symptoms occurrence in oncology nurses is
not affected at all.Against for Lin study (2007), which showed that the youngest and
least experienced of the nursing staff, the unmarried, and those with a lower level of
education had a higher level of stress.

As for the other two demographic factors (Marital Status and Experience) the

null hypothesis that "there is no statistical differences between the samples means of

Psychosomatics Symptoms occurrence upon these two demographic factors" is

accepted for all the statements except few, which means that -in general- there is

no effect of the demographic factors on the occurrence of Psychosomatics

Symptoms in oncology nurses except for the few sentences mentioned in the

Tables (31 and 32) below, in which there was a significant statistical difference

between the sample means.

Conclusions (for question 6): first; as previously illustrated –in general- there are

no significant statistical differences between the samples means of

Psychosomatics Symptoms occurrence upon the different demographic factors.

Secondly; after studying tables (31 and 32)regarding the few statements with

statistical differences in psychosomatic symptoms occurrence upon the marital

status and experience factors, it is found that there are no clear relationships

between Psychosomatics Symptoms occurrence and these two factors.

It is clear that through answering the study’s questions, the study’s

..objectives were achieved

 Statements affected upon The Marital Status Factor / Table (31)

Marital Status Factor

Statement’s answers
Statement Never % Seldom % Occasionally % Often %
Mean

Singl Marri Divorc Singl Marri Divorc Singl Marri Divorc Singl Marri Divorc Singl Marri Divorc
M.S.
e ed ed e ed ed e ed ed e ed ed e ed ed

How often did you

have tension
diarrhea that is (as 21.2 52.7 - 30.3 17.6 20.0 27.3 17.6 40.0 15.2 12.2 20.0 2.4 1.9 3.0
you think) related
to your work

How often did you

have palpitations
that are (as you 12.1 36.5 40.0 21.2 25.7 - 36.4 21.6 20.0 21.2 14.9 40.0 2.7 2.2 2.6
think) related to
your work

* The widowed status had been ignored because there was only one participant with that status.
 Statements affected upon The Experience Factor / Table (32)

Experience Factor

Statements Never % Seldom % Occasionally % Often % Statement’s answers Mean %

Exp. A B C D A B C D A B C D A B C D A B C D

How often did you have

sleeping problems that are 10. 15. 11. 10. 40. 21. 33. 38. 30. 52. 42. 46. 20. 10.
8.9 5.1 3.1 3.3 2.6 2.6
(as you think) related to your 0 8 1 3 0 1 3 5 0 6 2 2 0 5
work

How often did you have

37. 15. 60. 26. 22. 17. 10. 42. 17. 35. 30. 26. 17. 25.
palpitations that are (as you - 5.3 2.2 2.8 1.7 2.1
8 4 0 3 2 9 0 1 8 9 0 3 8 6
think) related to your work

A= 1-5 years of experience B= 6-10 years of experience C= 11-15 years of experience D= More than 15 years of experience
12. Strengths :

1. This is the first study in the west bank as it was targeted the oncology
nurses .
2. The use of well validated measure NSS and PSS at Arabic language
from great study of Bashir Al-hajjar and YousefJaradat,in the same area
of west bank .
3. The highly response rates (88.5%),help to ensure that survey results are
representative of the target population.
4. Some previous study on the same study was weak according the
Hawker-assessment tool and done at different area about west bank and
outside the countries.
5. Ethical consideration were maintained : committees was assess this study
and accepted it .

13. Limitation:

1. The type of the population work is continuous shifting, so the choosing of

sample and completing the questionnaire was so exhausting process.
2. Difficulties in sharing and completing the questionnaires from the sample.
3. Difficulty in choosing the sample away from bias.
4. Far areas and the difficulty to arrive it and need to be much time such as
Nablus.
5. Hospitals requirements for approval of the study were numerous and
taking much time,some approval needed to two weeks to receive it ,this
delayed of data collection.
6. Convenient sample is weak due to quickly and convenience is a specific
type of non-probability sampling method that relies on data collection
from population members who are conveniently available to participate in
study.

14.Recommendations :
Upon the results the following are the most important recommendations:

 Holding retrospective meetings in order to improve the relationships between

team members through understanding the other, and therefore minimizing

criticism and conflicts upon them.

 Providing training courses for improving the knowledge and communication skills

of the oncology nurses in different aspects, specially fulfilling the patients’ needs,

in order to increase their satisfaction levels.

 Committing to the job description of the oncology nurses by their supervisors and

colleagues.

 Discussing the patient’s treatment plan with the different staff members, to ensure

that the plan is fully understood by the oncology nurses.

 Providing enough staff to adequately load-cover the oncology unit.

 Ensuring the continuous presence of physicians - especially during emergencies -

to supervise the work of the oncology nurses.

 Each hospital must have a psychology clinic for the nurses to deal with their

emotional needs.

 Increasing the number of nurses in each shift, in order to decrease the workload of

each nurse.

 Providing the oncology unit with equipment that will facilitate the nurses’ work.

 Organizing entertaining events and increasing the nurses’ annual vacations in

order to give them a stress relief opportunity.

 Carrying out more in-depth future research regarding the subject.

15.References list :

(1) Abdo, S. A. M., El-Sallamy, R. M., El-Sherbiny, A. A. M., &Kabbash, I. A. (2015).

Burnout among physicians and nursing staff working in the emergency hospital of
Tanta University, Egypt. Eastern Mediterranean Health Journal, 21(12).
(2) Ali, S. A. O., &Eissa, A. K. A. RELATION BETWEEN BURNOUT AND
PSYCHOSOMATIC SYMPTOMS AMONG STAFF NURSES IN INTENSIVE CARE
UNITS.
(3) Arafa, M. A., Nazel, M. W. A., Ibrahim, N. K., &Attia, A. (2003). Predictors of
psychological well‐being of nurses in Alexandria, Egypt. International journal of
nursing practice, 9(5), 313-320.
(4) Aoki, M., Keiwkarnka, B., &Chompikul, J. (2011). Job stress among nurses in public
hospitals in Ratchaburi province, Thailand. Journal of Public Health and
Development, 9(1), 19-27.
(5) Bamber, M. R. (2006). CBT for occupational stress in health professionals:
introducing a schema-focused approach. Routledge.
(6) Brassai, L., Piko, B. F., & Steger, M. F. (2011). Meaning in life: Is it a protective factor
for adolescents’ psychological health?. International journal of behavioral
medicine, 18(1), 44-51.
(7) Bressi, C., Manenti, S., Porcellana, M., Cevales, D., Farina, L., Felicioni, I.,
...&Pescador, L. (2008). Haemato-oncology and burnout: an Italian survey. British
Journal of Cancer, 98(6), 1046.
(8) Cropanzano, R., Rupp, D. E., & Byrne, Z. S. (2003). The relationship of emotional
exhaustion to work attitudes, job performance, and organizational citizenship
behaviors. Journal of Applied psychology, 88(1), 160.
(9) Dagget, T., Molla, A., &Belachew, T. (2016). Job related stress among nurses
working in Jimma Zone public hospitals, South West Ethiopia: a cross sectional
study. BMC nursing, 15(1), 39.
(10) Edwards, D., &Burnard, P. (2003). A systematic review of stress and stress
management interventions for mental health nurses. Journal of advanced
nursing, 42(2), 169-200.
(11) Elqerenawi, A. Y., Thabet, A. A., &Vostanis, P. (2017). Job Stressors, Coping
and Resilience among Nurses in Gaza Strip. ClinExpPsychol, 3, 159.
(12) Feskanich, D., Hastrup, J. L., Marshall, J. R., Colditz, G. A., Stampfer, M. J.,
Willett, W. C., &Kawachi, I. (2002). Stress and suicide in the Nurses' Health
Study. Journal of Epidemiology & Community Health, 56(2), 95-98.
(13) Gholami, T., HeidariPahlavian, A., Akbarzadeh, M., Motamedzade, M.,
HeidariMoghadam, R., &KhaniJeihooni, A. (2016). Effects of nursing burnout
syndrome on musculoskeletal disorders. International Journal of Musculoskeletal
Pain Prevention, 1(1), 35-39.
(14) Jaradat, Y., Nijem, K., Lien, L., Stigum, H., Bjertness, E., &Bast-Pettersen, R.
(2016). Psychosomatic symptoms and stressful working conditions among Palestinian
nurses: a cross-sectional study. Contemporary nurse, 52(4), 381-397.
(15) Jaradat, Yousef, Rita Bast-Pettersen, KhaldounNijem, EspenBjertness, Lars
Lien, PetterKristensen, and Hein Stigum. "The impact of shift work on mental health
measured by GHQ-30: A comparative study." Middle East Journal of Psychiatric and
Alzheimer 3, no. 1 (2012): 8-16.
(16) Jennings, B. M. (2008). Work stress and burnout among nurses: Role of the
work environment and working conditions.
 (17) Joudeh, Y. A. A. D. (2003). Job Stress Sources Among Palestinian Nurses
Working in Northern West Bank District Hospitals.
(18) Jourdain, G., &Chênevert, D. (2010). Job demands–resources, burnout and
intention to leave the nursing profession: A questionnaire survey. International journal
of nursing studies, 47(6), 709-722.
(19) Kane, P. P. (2009). Stress causing psychosomatic illness among
nurses. Indian Journal of occupational and environmental medicine, 13(1), 28.
(20) Karimi, A., Adel-Mehraban, M., &Moeini, M. (2018). Occupational stressors in
nurses and nursing adverse events. Iranian journal of nursing and midwifery
research, 23(3), 230.
(21) Kawano, Y. (2008). Association of job-related stress factors with
psychological and somatic symptoms among Japanese hospital nurses: effect of
departmental environment in acute care hospitals. Journal of occupational
health, 50(1), 79-85.
(22) Khamisa, N., Peltzer, K., & Oldenburg, B. (2013). Burnout in relation to
specific contributing factors and health outcomes among nurses: a systematic
review. International journal of environmental research and public health, 10(6), 2214-
2240.
(23) Lee, I., & Wang, H. H. (2002). Perceived occupational stress and related
factors in public health nurses. The journal of nursing research: JNR, 10(4), 253-260.
(24) Lin, K. C., Huang, C. C., & Wu, C. C. (2007). Association Between Stress at
Work and Primary Headache Among Nursing Staff in Taiwan: CME. Headache: The
Journal of Head and Face Pain, 47(4), 576-584.
(25) Lindegård, A., Larsman, P., Hadzibajramovic, E., &Ahlborg, G. (2014). The
influence of perceived stress and musculoskeletal pain on work performance and
work ability in Swedish health care workers. International archives of occupational
and environmental health, 87(4), 373-379.
(26) Lu, L., Shiau, C., & Cooper, C. L. (1997). Occupational stress in clinical
nurses. Counselling Psychology Quarterly, 10(1), 39-50.
(27) Madhura, S., Subramanya, P., &Balaram, P. (2014). Job satisfaction, job stress
and psychosomatic health problems in software professionals in India. Indian
journal of occupational and environmental medicine, 18(3), 153.
(28) Malinauskienė, V., Leišytė, P., &Malinauskas, R. (2009). Psychosocial job
characteristics, social support, and sense of coherence as determinants of mental
health among nurses. Medicina, 45(11), 910-917.
(29) Maryam, R. (2008). Sources of stress among female nurses (field study in the
hospitals of the Ministry of higher education in the province of Damascus. Magazine
Damascus University, 24(2).
(30) Maslach, C. Burnout: The Cost of Caring; Malor Books: Cambridge, MA, USA, 2003;
pp. 25–121.
(31) Mojoyinola, J. K. (2008). Effects of job stress on health, personal and work behaviour
of nurses in public hospitals in Ibadan Metropolis, Nigeria. Studies on Ethno-
Medicine, 2(2), 143-148.
(32) Najimi, A., Goudarzi, A. M., &Sharifirad, G. (2012). Causes of job stress in nurses: A
cross-sectional study. Iranian journal of nursing and midwifery research, 17(4), 301.
(33) Nedd, N. (2006). Perceptions of empowerment and intent to stay. Nursing
economics, 24(1), 13.
(34) Spector, P. E. (1999). Individual differences in the job stress process of health care
professionals. Stress in Health Professionals: Psychological and Organizational
Causes and Interventions. Chichester, UK: John Wiley, 33.
 (35) Sveinsdottir, H. (2006). Self‐assessed quality of sleep, occupational health, working
environment, illness experience and job satisfaction of female nurses working different
combination of shifts. Scandinavian journal of caring sciences, 20(2), 229-237.
(36) Tucker, S. J., Harris, M. R., Pipe, T. B., & Stevens, S. R. (2010). Nurses' ratings of
their health and professional work environments. AAOHN journal, 58(6), 253-267.
(37) Tyler, P. A., Carroll, D., & Cunningham, S. E. (1991). Stress and well-being in nurses:
a comparison of the public and private sectors. International journal of nursing
studies, 28(2), 125-130.
(38) Van Den Tooren, M., & De Jonge, J. (2008). Managing job stress in nursing: what
kind of resources do we need?. Journal of advanced nursing, 63(1), 75-84.
(39) Umro, A. I. S. (2013). Stress and Coping Mechanism among Nurses in Palestinian
Hospitals, A pilot study (Doctoral dissertation).

16.Attachments :

Attachment (1)

Hawker’s et al (2002) tool for quality of research papers

Author and title:

Date:

Protocol Good =4 Fair=3 Poor=2 Very poor=1 Comment

1. Abstract and title Structured abstract Abstract with Inadequate No abstract

with full information most of the abstract
and clear title. .information

2. Introduction and aims Full but concise Some Some No mention of

background to background background aims /
discussion/study and literature but no aim / objectives No
containing up-to date review. objectives/q background or
literature review and Research uestions, OR literature
highlighting gaps in
questions Aims / review.
knowledge.
outlined. objectives
Clear statement of aim
but
and objectives
 including research inadequate
questions background

3. Method and data Method is appropriate Method Questionabl No mention of

and described clearly. appropriate, e whether method,
Clear details of the description method is AND / OR
data collection and could be appropriate Method
recording better. Data Method inappropriate,
described. described AND/OR No
inadequatel details of
y Little data.
description
of data

4. Sampling Details (age /gender Sample size Sampling No details of

/race /context) of who justified. Most mentioned sample
was studied and how information but few
they were recruited. given, but descriptive
Why this group was some missing details.
targeted. The sample
size was justified for
the study. Response
rates shown and
explained

5. Data analysis Clear description of Qualitative: Minimal No discussion

how analysis was Descriptive details of analysis
done. Qualitative discussion of about
studies: Description of analysis. analysis
how themes Quantitative
derived/respondent
validation or
triangulation.
Quantitative studies:
Reasons for tests
 selected hypothesis
driven / numbers add
up / statistical
significance discussed.

6. Ethics and bias Ethics: Where Lip service Brief No mention of

necessary issues of was paid to mention of issues
confidentiality, above issues
sensitivity, and
consent were
addressed. Bias:
Researcher was
reflexive and/or
aware of own bias.

7. Findings/results Findings explicit, easy Findings Findings Findings not

to understand, and in mentioned presented mentioned or
logical progression. but more haphazardly do not relate
Tables, if present, are explanation , not to aims.
explained in text. could be explained,
Results relate directly given. Data and do not
to aims. Sufficient presented progress
data are presented to relate directly logically
support findings. to results. from
results.

8. Context and setting of Some context Minimal No description

Transferability/generaliz the study is described and setting description of context /
ability sufficiently to allow described, but of context / setting
comparison with more needed setting
other contexts and to replicate or
settings, plus high compare the
score in Question 4 study with
(sampling). others, PLUS
fair score or
higher in
 Question 4

9. Implications and Contributes Two of the Only one of None of the

usefulness something new above (state the above above
and/or different in what is
terms of missing in
Understanding comments).
/insight or
perspective. Suggests
ideas for further
research Suggests
implications for policy
and / or practice

Total

Attachment (2) :
The Questionnaire (in Arabic)

‫الجزء األول‬

‫معلومات شخصية‬

‫□ أنثى‬ ‫□ ذكر‬ : ‫الجنس‬ -1

39-35□ 34-30□ 29-25□ 24-20 □: ‫العمر بالسنوات‬ -2

‫فما فوق‬-40□

‫ة‬/‫مطلقة□أرمل‬/‫آنسة□مطلق‬/‫ة □أعزب‬/‫□ متزوج‬: ‫الحالة االجتماعية‬ -3

‫□أخرى‬ ‫□ مخيم‬ ‫□قرية‬ ‫□مدينة‬: ‫مكان السكن‬ -4

 ‫□دبلوم ‪ 3‬سنوات‬ ‫اعلي درجة علمية حصلت عليها ‪□:‬دبلوم سنتان‬ ‫‪-5‬‬
‫□أخرى‬ ‫□ماجستير‬ ‫□بكالوريوس~‬

‫عدد سنوات الخبرة كممرض‪/‬ة‪:‬‬ ‫‪-6‬‬

‫سنوات ‪□1-5‬‬ ‫□‪ 10-6‬سنوات‬ ‫□‬

‫‪ 15-11‬سنة‬ ‫‪□.‬أكثر من ‪ 15‬سنة‬

‫‪ -7‬اسم المستشفى الذي تعمل فيه ‪ :‬األساسي~ ‪........................................... :‬‬

‫‪ : .....................................‬اإلضافي~ (إن وجد مستشفى‪/‬مركز~ صحي‪ /‬عيادة )‬

‫اسم القسم اإلضافي~ الذي تعمل فيه ‪......................................... :‬‬ ‫‪-8‬‬

‫□‪2000-1000‬‬ ‫□اقل من ‪1000‬‬ ‫الدخل الشهري (بالشيكل ) ‪:‬‬ ‫‪-9‬‬

‫□أكثر من ‪3000‬‬ ‫□‪3000-2001‬‬
‫عدد المناوبات التي تقوم بها شهريا‪.................................. :‬‬ ‫‪-10‬‬

‫الجزء الثاني ‪:‬‬

‫مقياس ضغوط التمريض (‪: )NSS‬‬

‫الرجاء األخذ بالحسبان الجوانب التالية ًفي عملك‪ :‬كم تتكرر ًفي قسمك~ وكم هًي ضاغطة علٌيك؟ الرجاء وضع دائرة على‬
‫إجابتين لكل جملة (‪ :) 35-1‬واحدة ًفي العمود (أ) وواحدة ًفي العمود (ب(‪:‬‬

‫(ب) كم ضاغطة‬ ‫كم تكرر‬ ‫(أ)‬

‫غ‬
‫ا‬
‫ل‬
‫بشكل بشكل كبير‬ ‫بشكل‬ ‫ب على‬
‫جدا‬ ‫كبير‬ ‫متوسط‬ ‫قليال‬ ‫ا اإلطالق‬ ‫أحيانا‬ ‫أبدا‬

‫‪.1‬‬

‫عطل هاتف القسم أو‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫االنتركوم‬
 ‫‪.2‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫االنتقاد من قبل الطبيب‬

‫القيام بإجراءات يعتبرها‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫المرضى مؤلمة‬ ‫‪.3‬‬

‫الشعور بالعجز في حالة‬

‫المريض الذي ال تتحسن‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫حالته‬ ‫‪.4‬‬

‫االختالف مع مشرف‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫التمريض‬ ‫‪.5‬‬

‫االستماع أو التحدث إلى‬

‫مريض مشخص بمرض‬
‫خطٌير (مثل السرطان) عن‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫كيفية موته‬ ‫‪.6‬‬

‫قلة الفرص للتحدث بانفتاح‬

‫مع أشخاص آخرين من‬
‫أقسام أخرى عن المشاكل في‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫القسم‬ ‫‪.7‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫موت المريض‬ ‫‪.8‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫االختالف مع الطبيب‬ ‫‪.9‬‬

‫الخوف من ارتكاب خطأ‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫خالل عالج المريض‬ ‫‪.10‬‬

‫قلة الفرص لمشاركة‬

‫الخبرات و المشاعر مع‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪ .11‬األشخاص من نفس القسم‬
 ‫موت مريض طورت معه‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫عالقة حميمة‬ ‫‪.12‬‬

‫عدم وجود الطبيب عند وفاة‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫المريض‬ ‫‪.13‬‬

‫‪1‬‬
‫عدم الرضا فيما يتعلق بعالج‬ ‫‪4‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫المريض‬ ‫‪.‬‬

‫الشعور بعدم االستعداد‬

‫الكافي للمساعدة في‬
‫‪1‬‬
‫الحاجات العاطفية ألسرة‬ ‫‪5‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫المريض‬ ‫‪.‬‬

‫قلة الفرص للتعبير‬

‫ألشخاص في نفس القسم عن‬
‫‪1‬‬
‫مشاعري السلبية اتجاه‬ ‫‪6‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫المرضى‬ ‫‪.‬‬

‫المعلومات غير كافية من‬

‫‪1‬‬
‫الطبيب للحالة الطبية‬ ‫‪7‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫للمريض‬ ‫‪.‬‬

‫كوني اسأل سؤاال من‬

‫‪1‬‬
‫المريض ال أجد له إجابة‬ ‫‪8‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫مرضية‬ ‫‪.‬‬

‫‪1‬‬
‫اتخاذ قرار يتعلق بالمريض‬ ‫‪9‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫عند عدم وجود الطبيب‬ ‫‪.‬‬

‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫االنتقال إلى أقسام أخرى‬ ‫‪2‬‬
‫‪0‬‬
‫بسبب نقص الطاقم‬
 ‫‪.‬‬

‫‪2‬‬
‫‪1‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫مالحظة معاناة المريض‬ ‫‪.‬‬

‫صعوبة العمل مع ممرض\ة‬

‫‪2‬‬
‫(أو ممرضين) من أقسام‬ ‫‪2‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫أخرى‬ ‫‪.‬‬

‫الشعور بعدم االستعداد‬

‫‪2‬‬
‫الكافي للمساعدة في‬ ‫‪3‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫الحاجات العاطفية للمريض‬ ‫‪.‬‬

‫‪2‬‬
‫االنتقاد من قبل مشرف‬ ‫‪4‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫التمريض‬ ‫‪.‬‬

‫‪2‬‬
‫‪5‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫جداول العمل غير المتوقعة‬ ‫‪.‬‬

‫‪2‬‬
‫وصفات الطبيب التي تبدو‬ ‫‪6‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫غير مالئمة للمريض‬ ‫‪.‬‬

‫الكثير من المهام غير‬

‫‪2‬‬
‫التمريضية المطلوبة مثل‬ ‫‪7‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫العمل الكتابي‬ ‫‪.‬‬

‫‪2‬‬
‫ال يوجد وقت كافي لتقديم دعم‬ ‫‪8‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫معنوي للمريض‬ ‫‪.‬‬
 ‫صعوبة التعامل مع‬
‫‪2‬‬
‫ممرض\ة (أو ممرضين)‬ ‫‪9‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫من نفس القسم‬ ‫‪.‬‬

‫‪3‬‬
‫ال يوجد وقت كافي إلنهاء‬ ‫‪0‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫كافة واجباتي التمريضية‬ ‫‪.‬‬

‫‪3‬‬
‫عدم وجود الطبيب في حالة‬ ‫‪1‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫الطوارئ الطبية‬ ‫‪.‬‬

‫عدم معرفة ما يجب إخباره‬

‫للمريض أو أسرته‬
‫‪3‬‬
‫بخصوص حالة المريض و‬ ‫‪2‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫عالجها‬ ‫‪.‬‬

‫عدم التأكد من تشغيل و‬

‫‪3‬‬
‫إدارة بعض األجهزة‬ ‫‪3‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫المتخصصة‬ ‫‪.‬‬

‫‪3‬‬
‫عدم وجود طاقم كافي‬ ‫‪4‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫لتغطية حاجات القسم‬ ‫‪.‬‬

‫‪3‬‬
‫نقص األدوية و التجهيزات‬ ‫‪5‬‬
‫‪4‬‬ ‫‪3‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫‪2‬‬ ‫‪1‬‬ ‫‪0‬‬ ‫الالزمة للعناية التمريضية‬ ‫‪.‬‬
 ‫الجزء الثالث ‪:‬‬

‫األعراض النفس جسمية ‪: Psychosomatics symptoms‬‬

‫هذا الجزء من االستبيان حول تكرار حدوث أعراض نفسية و جسمية حدثت لك\ي خالل (‪ 12‬شهر ) األخيرة‬
‫في مكان العمل ‪ ,‬أرجو اختيار اإلجابة التي تناسبك \ي ‪:‬‬

‫لم‬ ‫نادرا‬ ‫أحيانا‬ ‫دائما‬

‫يحصل‬

‫كم مرة عانيت من األلم في الظهر تعتقد أن‬ ‫‪.1‬‬ ‫‪0‬‬ ‫‪1‬‬ ‫‪2‬‬ ‫‪3‬‬
‫له عالقة بعملك ؟‬

‫كم مرة عانيت صداع تعتقد أن له عالقة‬ ‫‪.2‬‬

‫بعملك ؟‬

‫كم مرة عانيت من مشاكل في النوم تعتقد‬ ‫‪.3‬‬

‫أن له عالقة بعملك ؟‬

‫كم مرة عانيت من إرهاق مزمن تعتقد أن‬ ‫‪.4‬‬

‫له عالقة بعملك ؟‬

‫كم مرة عانيت من حموضة في المعدة‬ ‫‪.5‬‬

‫تعتقد أن له عالقة بعملك ؟‬

‫كم مرة عانيت من اإلسهال الناتج عن‬ ‫‪.6‬‬

‫الضغط النفسي تعتقد أن له عالقة بعملك ؟‬

‫كم مرة عانيت من خفقان في القلب تعتقد‬ ‫‪.7‬‬

‫أن له عالقة بعملك ؟‬