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Procedia - Social and Behavioral Sciences 84 (2013) 437 – 442

3rd World Conference on Psychology, Counselling and Guidance (WCPCG-2012)

Job Stress Management in Nurses

Marjan Laala
a
Tehran University of Medical Sciences, Sina Trauma & Surgery Research Center, Sina Hospital, Tehran 11555/3876, Iran

Abstract

An observational study, including 103 nurses of 2 hospitals in Sanandaj-Iran in 2007, carried out to determine how much nurses
coped with their stress and to define the factors affecting stress management. They responded to questionnaires based on
Adolescent Coping Orientation for Problem Experiences (A-COPE) with 3-Likert-scale responses. Stress management was
positive in 67.9% and negative in 38.8% of nurses. This study showed managing stress depends not only to personality, but
also to the work environment. Therefore, beside teaching nurses proper methods of stress management to strengthen their coping
resources, attempts should be done to arrange work environments how to reduce sources of stress.

© 2013 The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license.
© 2013 Published by Elsevier Ltd. Selection and peer review under the responsibility of Dr. Melehat Halat
Selection and peer-review under responsibility of Prof. Dr. Huseyin Uzunboylu & Dr. Mukaddes Demirok, Near East University, Cyprus
Key words: nursing, stress, management, job.

1. Introduction

Stress is the body's reaction to a change that requires a physical, mental or emotional adjustment or response as
defined in Wikipedia. Human beings experience stress early, even before they are born. A certain amount of stress is
normal and necessary for survival (Middlebrooks, J. S. & Audage, N. C., 2008). It is well accepted that nurses work
in a high stress environment and a large amount of research has focused on the sources of this stress (Munro, L., et
al., 1998).
Although everybody has the capacity to adapt to stress, not everyone responds to similar stressors exactly the
same (Timby, B. K., 2008, p. 941). Managing stress may assist persons in maintaining psychosocial adaptation
during stressful events as a stabilizing factor; hence the actual reaction to an environmental event may be as
important as the event itself (Garland, L., & Bush, C., 1982). Stress has a wide range of effects on worker behavior
including adaptive and maladaptive responses resulting in short- and long-term health implications, including
substance abuse, depression, anxiety, sleep disorders, and eating habits (Munro, L., et al., 1998).
Stress management (SM) has been described as positive or negative and also as active (dealing with actual
stressful situations or events) or reactive (reacting to an individual's own thoughts and feelings) which can be
positive or negative, depending on the situation and the content of the response (Shields, N., 2001). Research on
stress indicates that people tend to use a number of different methods rather than just one, to manage their stress
(Lazarus, R. S., 1993; Baum, A., et al., 1981). These strategies can be therapeutic and non therapeutic. Therapeutic
strategies usually help the person to acquire insight, gain confidence to confront reality, and develop emotional
maturity (Timby B. K., 2008, p.64). This study aimed to describe how much nurses managed their stressful events

* Corresponding author: Marjan Laal. Tel.: +98-216 671 7001; fax: +98-216 671 7009.
E-mail address: laal.marjan@gmail.com.

1877-0428 © 2013 The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license.
Selection and peer-review under responsibility of Prof. Dr. Huseyin Uzunboylu & Dr. Mukaddes Demirok, Near East University, Cyprus
doi:10.1016/j.sbspro.2013.06.581
438 Marjan Laal / Procedia - Social and Behavioral Sciences 84 (2013) 437 – 442

and to define the affecting factors regarding SM.

2.1. Material and method

A total number of 103 nurses, working in two medical centers of Sanandaj-Iran (Tohid and Besat hospitals),
entered an observational study in 2007. The participants represented all grades of registered nursing staff. They
responded to 50 items questionnaires including coping strategies based on A-COPE developed by Patterson &
McCubbin in 1986, with 3-Likert-
Demographic variables including: gender, age, marital status, position, tenure status, shift of work and hospital,
were included in the analyses. Position variable was composed of junior staff (assistant nurses) and senior staff
(clinical nurse, nurse manager). Tenure status constituted of two officials (permanent) and experimental (causal)
types. Positive SM were: visiting family or friends, listening to music, shopping(alone or with friends), watching
TV(films), reading, writing, singing(composing), dozing, hiking, sporting, table arrangement at work, repairing at
home, joining to game groups or participating in conferences or concerts, walking in parks (nature) , travelling in
mountains, sitting alone in a quiet space, playing with animals, praying(meditation), relaxation exercises, gardening,
painting, taking bath, talking about problems with someone (mum, peer, friend or colleague), chess, playing with
computer games, getting busy with home works. Negative SM included: disputing, profanity or insulting, shouting,
having self negative speeches, overdrinking tea, coffee or alcohol, smoking, drug abuse, suicide thoughts,
impatience, speedy driving, overeating or eating too small, isolation, looking forward to bad ending, crying a lot,
tossing objects and nail chewing. Two items were allotted for other methods (both positive and negative) might be
used by participants.
We marked never, sometimes, and often as the following degrees: 0, 1 and 2. The achieved positive management
degrees of 0-21, 22-33, 34-48, were marked as weak, moderate and good, and negative ones of 0-18, 19-26 and 27-
36 as low, medium and high, accordingly. We used SPSS for windows, version 18 for data analysis. For categorical
2
test and chi-square method were used. The significance level was set at .

2.1.1. Results

One-hundred three nurses were included in this study. They were between 22 to 49 years old with the mean of
36. Demographic characteristics of participants were explained in table 1.
Table1. Demographic characteristics of 103 nurses
Profile of patients Number Percent (%) Profile of patients Number Percent (%)
Age range Position
20-29y* 27 26.2 Senior 84 81.6
30-39y 64 62.1 Junior 19 18.4
40-49y 12 11.7 Work shift
Gender Morning 36 35
Female 59 57.3 Evening and night 42 40.8
Male 44 42.7 Rotating 25 24.3
Marital status Job experience
Single 53 51.5 <1y 19 18.4
Married 37 35.9 1-4y 7 6.8
Divorced 13 12.6 5-9y 58 56.3
Employment 10-15y 13 12.6
Causal 55 53.4 6 5.8
Permanent 48 46.6 Hospital
Besat 48 46.6
Tohid 55 53.4

*=year

In general, positive SM in nurses was as the following: good 19(18.4%), moderate 51(49.5%) and weak
33(32%). Nurses managed their stress negatively as low 36(35%), medium 27(26.2%) and high 40(38.8%). Figures
1 and 2, displays positive and negative SM, accordingly.
 Marjan Laal / Procedia - Social and Behavioral Sciences 84 (2013) 437 – 442 439

Fig.1. Positive SM in 103 nurses

Fig.2. Negative SM in 103 nurses

Participants used several strategies in order to cope with the stressful situations at work. Three ranges of age
showed significant difference (p=0.008) with positive SM, as displayed in figure 3. Generally, 60(58.3%) nurses
applied reading books, newspapers and magazines for SM. Nurses of 30-39 years old, more applied this technique
for SM (p=0.034). No significance (p=0.5) was between applying negative methods of SM and 3 age ranges. In this
study, gender of participants was a significant factor (p=0.003) in relation to applying positive methods of SM.
Fifty-nine (57.3%) nurses applied method of talking to mom, peers, friends or colleagues about their problems to
manage their stress. Forty-seven female nurses (79.7%) applied talking, but only 12 men (27.3%) used this
440 Marjan Laal / Procedia - Social and Behavioral Sciences 84 (2013) 437 – 442

technique. The difference was significant (p=0.000). We also found a significant relationship between gender and
negative responses to stress (p=0. 003). Males were more disputer and aggressive (P=0.018).
Positive SM also showed significant difference with tenure status (P =0.000), job experience (p=0.008), shift of
work (p=0.002) and workplace (p=0.000). Those officially employed and staff with job experience of 5-9 years (as
presented in figure 4), more positively coped with stress. Nurses with job experience of 5-9 years, more practiced
hiking 54(52.4%), and listening to music 56(54.4%), with significant differences of (P=0.000) and (p=0.014),
accordingly. Also, nurses worked in the morning shift (p=0.002) and staff in Tohid hospital (P=0.000), more
successfully managed their stress; they were dealing with elective and more stable patients. Neither significant
difference was between marital status (p=0.415), nor was between position (senior and junior) of nurses (p=0.063)
with applying positive SM techniques.

Fig.3. Positive SM in different age ranges of 103 nurses

Fig.4. Positive SM in different job experiences of 103 nurses

 Marjan Laal / Procedia - Social and Behavioral Sciences 84 (2013) 437 – 442 441

Significant relationship was between negative SM with marital status (p=0.036), job experience (p=0.012) and
workplace (p=0.002). Single and divorced nurses were more drug abuser, over drinker and smoked (p=0.025).
P=0.021). There were no
significant differences between position, tenure status and shift of work with negative SM as following: (p=0.099),
(p=0.167) and (p=0.338), accordingly.

2.1.1.1. Discussion

In the 1930s, the endocrinologist Hans Selye first coined stress. Nowadays, stress has become a commonplace of
popular parlance (Selye, H., 1956). Caring for clients who are experiencing high levels of anxiety can be stress
provoking (White, L., 2000). A negative is influenced by a number
of personal factors. The total person is involved in responding and adapting to stress.
Goldenberg and Waddlle (1990) concluded that age of the respondent, number of years of full-time teaching and
tenure status were most often significant factors (< 0.05) relating to the level of stress implications. In this study,
significant difference was between tenure status and applying positive methods of SM.
One critical factor is the repertoire of coping skills the person already possesses and can use to adapt to the crisis.
The ability to adapt is decreased in the very young, the very old, and those with altered physical or mental health;
who do not have the necessary physiologic reserve to cope with physical changes (Saufl, N. M., 2004). In our study,
age, tenure status and job experience of respondents were significant factors (<0.05) for SM. Nursing staff of 30 to
39 years old more positively managed their stress than the younger or older ones. Nurses with 5-9 years job
experience more coped with stress than those with less job experience. Officially employed nurses more applied
positive techniques of SM than the experimentally ones, because of the job security they felt as Goldenberg
reported.
Shift of work, particularly night shifts, traditionally attracts pay enhancements but can have a significant effect on
personal and social life. Prolonged shift work, especially evening and night shift, also has a health risk as it produces
symptoms that correspond closely to those of mild or moderate distress (Efinger, J., et al., 1995), as our study
documented. Dr. Laal & Aliramaie (2010) reported no significant relationship between shift of work and SM.
The stress is even greater for the nurses who work in settings such as intensive care and emergency care (Crisp,
J., et al., 2005). The healthcare work environment as a source of overwork and stress has been implicated in today's
nursing shortage (Shirey, M. R., 2006). In this study, those nurses in Besat hospital, who were dealing with trauma
and emergent patients, significantly less positively managed their stresses and possessed more negative responses to
stress than those in Tohid center.
Taylor and colleagues wrote that stress creates emotional distress often with outward symptoms. Many people
consume legal or illegal drugs, drink or smoke to excess, or eat compulsively. These behaviours can be modified
and adaptive mechanisms strengthened through specific techniques aimed at managing stress (Taylor, C., et al.,
2008). In this study, males were more disputer; single or divorced nurses were more drug abusers, over-drinkers or
smoked ones. Nursing staff with less than 5 years job experience appeared to be more impatient and irritable.
The demand for organizational support and personal training in SM is clear. In order to identify how personal
circumstances exacerbate workplace stress and how they may be used to reduce stress, it is essential that
personal/workplace interactions be researched (Mc Vicar, A., 2003). Stress management techniques can thus be
divided into two sorts: environmental management, which attempts to arrange work environments to reduce the
sources of stress; and those approaches that aim to support personnel to deal effectively with a variety of stressful
situations (Mimura, C. & Griffiths, P., 2003).
Support services should be preventative, so that health problems for nurses can be averted. This requires more
research into identifying the way of detecting when individuals are experiencing early difficulties, and of improving
their SM techniques so as to prevent the transition to severe distress.

2.1.1.1.1. Conclusion

Seventy percent of our nurses applied proper methods of SM. Nursing staff possessed high level of negative
responses to stress (49%). This study showed significant affecting factors relating to SM as; age of respondent,
gender, job experience, tenure status, shift of work and workplace, factors relating to negative SM were: gender,
442 Marjan Laal / Procedia - Social and Behavioral Sciences 84 (2013) 437 – 442

marital status and less job experience. We concluded the way of responding to stress depends not only on the
personality and one`s defensive style but also in the workplace. It is preposterous to suppose any individual
separately from workplace thus more research is needed to identify how personal circumstances exacerbate
workplace stress, and how they may possibly be used to reduce stress. In the process of seeking health and coping,
the specification of appropriate strategies ought to be developed and enhanced.

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