Nursing Research on Stress and Coping Among Nurses

Virgen Milagrosa University Foundation 1
“The Home of God-Loving and Globally Competent Individuals”

Martin P. Posadas Avenue, San Carlos City, Pangasinan, 2420, Philippines
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CHAPTER I
INTRODUCTION
Nursing is an art: and if it is to be made an art, it requires an exclusive
devotion as hard a preparation, as any painter’s or sculptor’s work; for what is
having to do with dead canvas or dead marble, compared with having to do with
the living body, the temple of God’s spirit? It is one of the fine Arts: I had almost
said the finest of fine Arts.’’--- Florence Nightingale
Background of the Study
Nursing research will always be committed to the advancement of nursing
practice, advocacy and policy that affect people's quality of life. The researches
nurses undertake continue to translate in the improvement of the quality of care
as these reflect their commitment in the development of nursing profession (
Philippine Journal of Nursing 2016)
According to WHO (2018) Nurses have various roles within their work
description. The roles of a nurse include to manage and to treat the patients, to
work with families and communities involving health and health promotion.
Furthermore, nurses are expected to contribute to the improvement of the public
health and to promote health of individuals in the society .
Nurses make up one of the largest segments of the global healthcare
workforce. On a daily basis, many nurses work on the front lines providing care
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to patients while serving as a lifeline of information, encouragement, and
education to family members of patients. The challenges that nurses face in
practicing healthy behaviors are exacerbated by the fact that nurses have many
competing demands for their time, energy, and attention. Nurses must focus on
the health of their patients, the needs of patients’ family members, the demands
of physicians and supervisors, their own needs, and the concerns of their own
family members. The increasing demands faced by nurses impact all areas of
nurses’ personal and professional lives and increase their risks of chronic stress
and the very nature of nurses’ work can also induce stress. Nurses often
experience low levels of autonomy and low control over their job, are moved
among different patient care units, experience poor communication among
members of the health care team, and often deal with demanding and/or
uncooperative family members of patients. Such work-related stressors increase
nurses’ feelings and perceptions of being overworked and stressed (The Impact
of Perceived Stress and Coping Adequacy on the Health of Nurses: A Pilot
Investigation, Jordan, T. 2016)
National Institute of Occupational Safety and Health (2014) defined work
stress as harmful physical and emotional responses that occur when job
requirement do not match the worker's capabilities, resources, and needs.
Nursing is recognized as a stressful demanding occupation . Stress has been
observed among various professionals without exemption. Previous researches
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reported that nurses, regardless of workplace or culture, are confronted with a
variety of stressors. Indeed, nursing is considered as the highest stressful job
among 40 stressful professions (Mozhdeh et al., 2011)
Stress is a psychological and physical state that results when the
resources of the individual are not sufficient to cope with the demands and
pressures of the situation. It can be defined as a response to a demand that is
placed upon a person. It can be simply understood as “a condition where one
experiences a gap between the present and desired state.
Merriam Webster (2015) defined stress as a physical, chemical or
emotional factor that causes bodily or mental tension and may be a factor in
disease causation. It is a normal reaction when the brain recognizes a threat.
When the threat is perceived, the human body releases hormones that activate
its “fight or flight” response. Psychologist Richard S. Lazarus described stress as
“a condition or feeling that a person experiences when s/he perceive that the
demands exceed the personal and social resources the individual is able to
mobilize.”
Stress is the end result of an “individual’s perception to a stimulus,
interpreting this as overwhelming, and the inability to meet the challenge.
Perceived stress as the “perception that one’s life is unpredictable,
uncontrollable, and overloaded. Whenever an individual perceives the presence
of negative stressors, their cumulative stress levels rise (An assessment of

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nurses’ experiences of work related stress through self-reporting and hair cortisol
analysis, in a metropolitan hospital in Western Australia. Kim ,O 2017 ).
Job stress can be defined as the harmful physical and emotional
responses that occur when the requirements of the job do not match the
capabilities, resources, or needs of the worker which can lead to poor health and
even injury ( https://www.cdc.gov/niosh/docs).
Nurse stress is defined as the emotional and physical reactions resulting
from the interactions between the nurse and her/his work environment where the
demand of the job exceed capabilities and resources. Work stress is recognized
world-wide as a major challenge to workers’ health and the healthiness of their
organizations. The working environment is one of the most important recourses
of occupational stress. Nurse’s environment include an enclosed atmosphere,
time, pressures, excessive noise, sudden swings from intense to mundane tasks,
no second chance, unpleasant sights and sounds and long standing hours .
Nurses are trained to deal with these factors but stress takes a toll when there
are additional stressors. Stress is known to cause emotional exhaustion to
nurses and this leads to negative feelings toward those in their care
(Occupational stress among nurses in a Hospital Setting in Ghana, Adzakpha
G,2014 ).
The World Health Organization estimates the cost of stress and stress
related problems to organizations to be in excess of $150 billion annually. In the

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United States alone, the cost of stress had increased to US$350 billion (about
£220 billion) per year. Data from the European Union show that the cost of stress
calculated at 20 billion euro (about £16.5 billion) each year. It is estimated that
work-related stress costs UK industry around £6.7 billion each year in lost
income, and caused workers to lose 10.8 million working days .Stress related
cost, including absenteeism, costing the Australian economy AU$14.81 billion
(about £9.56 billion) a year, and directly costing employers AU$10.11 (about
£6.98 billion) billion a year with total of 3.2 days per worker lost per year. No
statistics are available about the monetary cost of occupational stress in Nigeria
and many developing nations of the world (Assessment of occupational related
stress among nurses in two selected hospitals in a city southwestern Nigeria,
Faremi,FA. Olatubi MI, Adeniyi K 2019).
World Health Organization has considered stress as a global epidemic,
which has recently observed to be associated with 90% of visits to physicians .
Work-related stress is one of the most important workplace health risks for
employees worldwide. Work-related stress results in substantial costs to
employees and organizations, related to employee’s absenteeism and turnover,
decreased productivity, physical illness, poor quality of health care services, and
increase risk of medical errors and Globally, the costs of work-related stress are
estimated to be $5.4 billion each year, which is one of the most frequently
reported occupational health problems. Work-related stress has recognized as
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the main challenge for the nursing profession throughout the world and has
negative emotional, physical, and psychological effects on the nurse. Research
evidence demonstrated that nurses suffer from high levels of work-related stress
are threatening their health, patients’ lives, compromise the quality of nursing
care, and increasing the cost of health care. Excessive occupational stress has
been found to reduce the quality of nursing care ( Baye, Y. et al 2020).
Moreover, Nurses’ reactions to the stress of the current pandemic must be
viewed from an occupational health and safety perspective. Stress and burnout
were recognized internationally as work hazards for nurses before the pandemic.
Although research suggests that both occupational and personality factors play a
role in burnout in 2019 the World Health Organization declared burnout an
occupational phenomenon—rather than a medical condition. Characterized by
feelings of exhaustion, disengagement from one’s job, and a sense of diminished
professional fulfillment, burnout is considered the result of chronic work stress
that the individual is not able to manage. The onset of the COVID-19 pandemic
has increased work stress among an already strained nursing corps, putting their
mental health and well-being at risk ( Arnetz et al 2020).
Further, occupational stress is a fast-growing cause of work-related
diseases and injury; specifically among Health Care Workers .Occupational
stress associated with COVID-19 is an essential indicator of mental illness as it
can lead to anxiety and depression in the confrontation of the co-occurrence of
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countless deaths, and long work shifts with the most diverse unknowns and
demands. During the global response to the epidemic, HCWs are undoubtedly
needed, but they represent one of the most vulnerable individuals in terms of
acquiring the highly contagious disease. Lots of HCWs serving on the front lines
of the COVID-19 pandemic have become infected and more have been in
quarantine after exposure .Keeping the health of nurses is of paramount
importance in managing infectious diseases as they have always played an
essential role in prevention and control during epidemics (Mo et al. 2020).
Aside from that, HCWs are very often susceptible to job burnout, with the
highest levels of job burnout reported among HCWs working in the emergency
and ICU environment where they are exposed to an overwhelming amount of
job-related stress. Known factors contributing to the high risk of job burnout
include intensive patient care, high mortality rate, and inappropriate job
conditions in terms of high workload coupled with lack of time to adequately
address the patient’s needs. Accordingly, the relevant HCWs experience stress
levels beyond their capacities, which may lead to job burnout. Job burnout has
been reportedly accompanied by reduced quality of care provided to patients and
by a high rate of absence and turnover among the HCWs, all of which is known
to cause irrecoverable consequences for the healthcare sector. The nurses in
ICUs are further exposed to high-risk, unpredictable, and highly variable
conditions. Being engaged with a handful of diseases, highly traumatic incidents,
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and emergency conditions, such nurses are provided with limited time for
recovery and rather experience job-related pressures constantly (Talaee N. et al
2020).
Moreover, various individual, social, environmental and organizational
factors have been associated with high level of occupational stress among
nurses. Halpin, Terry, and Curzio (2017) found out excessive workload was the
most frequently cited source of workplace stress among nurses in during
transition period. This was as result of the nursing shortage with fewer nurses to
care for numerous patients. Furthermore, work load, shift work, overtime, and
covering for absent colleagues were the most common identified stressors by
other researchers. The work environment and institutional settings themselves
have been associated with occupational stress.
The Department of Health Standards of nurse to patient ratio is 1:12 but in
the Philippines the nurse to patient ratio ranges 1:50 to 1:80 thus, there is
shortage of competent nurses. (H.B. No 1567-Comprehensive Nursing Law of
2019) In the Philippines, work-related stress has received very minimal attention.
There are only a few studies related to stress being done. It is important to look
at specific areas and to investigate those issues affecting the staff and our
patient as well in the organization. Nursing is a high-pressure job. As a nurse,
you have lots of responsibilities: helping patients, assisting in procedures,
updating paperwork and much more. Healthcare is incredibly important but there
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are currently many problems that cause issues for nurses. These are the six
biggest problems facing nursing; Staff Shortages, Meeting Patient Expectations,
Long Working Hours, Workplace Violence, Workplace Hazards and Personal
Health (https://blog.sfceurope.com/what-are-the-biggest-problems-facing-
nursing-today).
Emotional stress in nursing can be quite emotionally draining. This
combined with the many interpersonal relationships that develop at work
(colleagues, patients, families etc.) can also become catalysts of stress for many
nurses. Difficult or tragic situations, such as caring for and communicating with a
person who is dying, also present emotional challenges for nurses. While societal
changes, such as the increased risk of violent or aggressive patients, has also
created greater stress. The Physical Demands of Nursing Cause Stress as day
to day nursing is full of potential physical stressors, including frequent lifting and
bending, changeable shifts or rosters, noisy work environments, and long hours.
Nurses working night-shift may also suffer from disruption to their natural
circadian rhythms, which in turn, can predispose them to illness. As well, many
nurses face exposure to infection and toxic substances on a regular basis. The
sheer anxiety of contracting a disease, especially in the face of rising resistance,
can also play on a nurse’s mind. Finally, with the current median age of a nurse
being 45, many are simply not as physically resilient as they were in their
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younger years (https://www.google.com/search=challenges of nurses’ stress in
the Philippines).
Much has been written on the importance of a healthy work environment
of nurses towards positive patient outcomes. The researcher would like to
conduct on the nurses experiences in relation to their workload.
Importance of the Study
The results of the study will be beneficial to the following entities:
Nurses. This study will serve as a guidepost to be able for them to
deepen their patience and understanding of their profession in order to deliver a
quality healthcare services
Patients. This study may serve as an indicator that they also have to
understand and acknowledge the situation of the nature of work of the nurses
Hospital Administrators. This study will provide a better understanding
of the work of nurses and recognize their participation and due compensation for
their patience in serving patients to improve quality of care as well as improve
productivity of the organization.
Department of Health. This study will serve as avenue for higher
authorities to enhance their policies and give full support to the nurses since they
are considered as pivotal in healthcare setting.

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Medical Practitioners. This study will serve as an enlightenment that
nurses also need motivation to boost their strength and increase their morale in
the delivery of healthcare.
Philippine Nurses Association. This study will serve as a guide to the
organization to address the needs of the nurses as well as the stress that they
may encounter so that it will enhance their policies that focus also on the job
related stress that may affect nurses
Family Members of Nurses. This will help the family members to focus
on what to do so that they can also assist the informants and give motivational
support
Researcher Herself. This study will serve as an avenue of increasing
their patience and understanding of their chosen field of specialization in order to
improve and enhance their capacity to appreciate that their importance in serving
the humanity
Future Researchers. The finding from this research can also be used as
a reference material for other research who will likely carry out a study on a
related topic.
Researcher’s Background
I, Akubuo, Blessing Ezinwanne, a native of Umunam, Atta, Njaba Local
government area, Imo state, Nigeria. I am from majority tribes ‘‘Igbo’’ of Nigeria,
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which is one of the biggest and most inflectional ethnic group in Nigeria. Igbos is
well- known for their entrepreneurial endeavours both within Nigeria and around
the world. I am blessed with wonderful parents and siblings who will not let me to
give up on my goals. I graduated my Bachelor of Science in Nursing in a catholic
institution, Virgen Milagrosa University Foundation (VMUF). An institution that is
under the inspiration and patronage of our lady of the miraculous medal, affirms
its commitment to provide transformative catholic education relevant to national
and global needs.
As my journey during my internship, I have experienced providing quality
care to patients with proper supervision by my clinical instructors however, I had
also observed the task design and work conditions of nurses working in different
areas of hospitals including their duty working hours, caring one patient to
another while doing their charting and evaluation, I have also observed how they
eat beyond scheduled time and pressured when there are emergency cases. I
cannot even talk to them because of their busy schedule going around the
patients checking and monitoring patients’ vital signs, Intravenous and the
medication administration regularly. I have also observed that there are some
relatives requesting for assistance.
As a Nurse, wellbeing of the person I am caring for is what matters, to
promote and restore life through research, especially when it comes to stress –
free to promote a quality care. I believe that stressful nature of nursing can
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ultimately lead to burnout. there is no doubt that a nursing career can prove to be
one of the most challenging career paths that you can embark on- full of daily
obstacles and situations of extreme stress. It is important to consider nurses
perceptions of stress in order for appropriate work stress interventions to be
developed to address the issue. Through this research, I am hopeful that stress
among nurses and its impact on the productivity of nurses are well investigated
because nurses who are stressed tend to be aggressive on patients and this
affect the recuperation of patient.
Statement of the Problem
This study aimed to determine the experiences of nurses on job related
stress. This study specifically investigates the following sub questions:
1. How will you describe your experience as a nurse on job related stress?
2. What are the coping mechanisms have you used in times of work stress?
3. What lesson have you learned as a nurse?
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CHAPTER II
METHODLOGY
The research methodology used in the study is presented in this chapter.
These include research design, sources of data, research setting and sampling
research instrument, instrumentation and data collection, data gathering
procedure, trustworthiness, ethical considerations and data management and
analysis. This study is designed to describe and investigate the experiences of
nurses on job related stress.
Research Design
This study utilized qualitative-phenomenological research design.
According to Graveter and Forzano (2014), qualitative research is based on
making observations that are summarized and interpreted in a narrative form.
The study based upon a qualitative process of inquiry has the goal of
understanding a social or human problem from multiple perspectives (Denzin and
Lincoln 2015). Thus, qualitative researchers deploy a wide range of inter
connected interpretive practices, hoping always to get a better understanding of
the subject matter at hand. Additionally, they also explain that qualitative
research is conducted in a natural setting and involves a process of building a
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complex and holistic picture of the phenomenon of interest as well as being
inductive in nature.
Furthermore, in a phenomenological study such as this pursuit, the
meaning, the main data source is in depth conversations with the researcher and
participants as full co-participants. This helped the informants describe their lived
experiences towards their work stress experiences. Through in-depth
conversation, the researcher strived to gain entrance into the informants’ world,
to have full access to their experiences as lived (Polit and Beck, 2010).
Sources of Data
Research Setting
This study was conducted in two selected hospital in San Carlos city,
Pangasinan namely, Blessed family Doctor’s Hospital, Pangasinan Provincial
hospital. The two hospitals were considered to be the biggest hospitals in San
Carlos City Pangasinan, one being the private hospital while the other one is a
public hospital that cater also COVID patients.
Pangasinan Provincial Hospital (PPH) The hospital was founded in
1945 and a public institution located in Bolingit, San Carlos City, Pangasinan
which is one of the biggest hospitals in the province. It has more than 30 existing
buildings from just 7 buildings in 2006. It is a 400 bed capacity hospital under the
Provincial Government of Pangasinan. The hospital is a level 2 General Hospital.

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It is a premiere referral center, accredited in almost all services in their affiliated
societies as well as in the Department of Health. It is an ISO-certified institution.
Major services being offered include Internal Medicine, Surgery, Obstetrics and
Gynecological, Pediatrics, Radiology, Emergency Medicine, Anesthesiology,
Laboratory Medicine (Clinical and Anatomic Pathology), Out Patient Services,
Specialty Areas like ICU, Neonatal ICU and Dialysis Unit. PPH is committed to
sustain its mission of delivering responsive, efficient and equitable quality
healthcare services to its stakeholder, it started to a COVID 19 facility since
March 2020 with 8 isolation rooms and 7 rooms for COVID confirm cases. It has
1 chief nurse, 3 supervisors, 4 acting supervisors and 5 head nurses and 455
total nursing personnel.
Blessed Family Doctors General Hospital (BFDGH) This hospital is
located at Ilang, San Carlos City, Pangasinan. It has 75 bed capacity and it is
headed by Dr. Alfredo P. Bernal. According to Department of Health (DOH) on
September 30, 2020 the hospital is classified as level II general hospital. Its
Mission is to provide optimal healthcare for the people of Pangasinan through: -
Interdisciplinary and collaborative approach in rendering patient care. -Proactive
environment that ensures patient safety. -wide array of diagnostic services and
VISION is to exemplify quality patient care by providing comprehensive, efficient
and cost-effective healthcare services. It is a PhilHealth Accredited it is now
equipped with TB-DOTS, which helps people with tuberculosis be treated without
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a cost. The Laboratory also extends within the line of technology for accuracy. It
has an Emergency Room designed for the immediate, urgent and non-urgent
needs of the client. Nursing Department consist of 1 chief nurse, 3 supervisors, 5
head nurses and 75 nursing personnel.
Figure 1. Shows the map of the Pangasinan Provincial Hospital and
Blessed Family Doctors Hospital.
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Figure 1. Google Map of Pangasinan Provincial and Blessed General Family
Hospital
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Sampling
I utilized snowballing or chain sampling in this phenomenological inquiry.
These terms were used for an approach which involves asking people who have
already been interviewed to identify other people they know who fit the selection
criteria. It is a particularly useful approach for dispersed and small populations,
and where the key selection criteria are characteristics which might not be widely
disclosed by individuals or which are too sensitive for a screening interview
(Ritchie and Lewis, 2011).
This can be mitigated to some extent by specifying the required
characteristics of new sample members, by asking my study informants to
identify people who meet the criteria but who are dissimilar to them in particular
ways, and by avoiding family members or close friends. An alternative approach
would be to treat those identified by existing sample members as link people, not
interviewing them but asking them to identify another person who meets the
criteria.
Informants are viewed as typical cases or experts that provide enough
data to answer the research questions. Specifically, criterion sampling was used
that involved studying cases that met a predetermined criterion of importance.
The guiding principle in the selection of the sample for phenomenological study
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as this is that all participants must have experienced the phenomenon under
study and must be able to articulate what it is like to have lived that experience
(Polit and Beck, 2011).
Inclusion criteria for the informants were:
1. Nurses with 3 years’ experience
2. Either male or female
3. Willing to participate in the study
To ensure anonymity of the informants, they were assigned to a code
name based on Countries to hide their identity. There were no preset number of
participants; instead, data was exhausted until saturation point was reached.
This is a point in data gathering where no new data was obtained. Bowen (2008)
explains that selecting and arriving at the needed number of participants relies on
the nature of the research and how many are needed to answer the research
questions. Data gathering was done in the months of January to March 2021.
Table 1 depicts the profile of the respondent
Table 1. Informants’ Profile

Code Names Age Gender Designation
Philippines 28 Male OR Nurse
USA 26 Female Staff Nurse
France 29 Female Staff Nurse
Germany 30 Male Staff Nurse
Finland 28 Female ICU Nurse
Japan 27 Female Staff Nurse
Qatar 27 Male Staff Nurse
Australia 29 Female Staff Nurse
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Spain 28 Female Staff Nurse
Research Instrument
Instrumentation and Data Collection
Data on the inquiry of understanding and finding meaning from the job-
related stress experiences of nurses was gathered. Semi-structured one-on-one
interviews thru video call are the primary data source for this study. Interviews
are a key method of eliciting narratives, so that I can attempt to understand the
world from my participants’ point of view (Kvale & Brinkman, 2009, p. 1).
Interviews are particularly well suited for studying people’s understanding of the
meanings in their lived world, describing their experiences and self-
understanding, and clarifying and elaborating their own perspectives (Horrack &
King, 2010, p. 182).
Thus, researcher utilized interviews that are semi structured and which
offer interviewees opportunity to expand their answers and give complex
accounts of their experiences. Since there is restriction due to COVID 19
pandemic I utilized individual face to face interview through online via video call
or messenger whichever the informants are comfortable with. After approval by
the panel committee and follow the four ethical principles of this paper and upon
the recommendation of the Dean of Graduate School, the study proceeded on its
data collection phase.
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The interview process was semi structured; I engaged in conversation with
the nurses inviting them to tell their stories by asking open ended questions. The
interviews were recorded with the permission of my participants. To avoid the
distraction of the interviewer taking notes and enabled me to interact with my
informants. Reflective notes were made particularly at the end of the interviews.
This helped me to identify their strength and weaknesses and also give me some
prompts which helped in the transcribing (Whiting, 2010). Each interview lasted
about 45 minutes.
There is a natural conclusion to the interviews when the information
gathered is saturated that is repetition started to occur. The audio recorded
interview was transcribed by the researcher. This helped me in the analysis of
the data as the language of the informants was use to reflect as accurately as
possible, the meanings embedded in the experience.
Initially, I asked permission from my informants thru phone calls to allow
me to conduct my study and also as my prospective informants to secure
informed consent that contained full disclosure of the intent of the study and its
methods for voluntary participation in the study. The informed consent was
discussed, the purpose and significance of the study, methods and process to be
employ, the risks and discomforts that may cause to the informants, the right to
withdraw from participation at any given time, their benefits and their right to full
confidentiality and anonymity. Interviews was conducted on my informant’s

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availability and most convenient time. In this study all informants were
interviewed in a convenient time where untoward interruptions are minimized.
Data gathering was continued until no new findings were discovered and
saturation of categories was achieved.
I ensure anonymity by giving them code names using different countries
instead of using their real names. When the interview and observation process
was done, I express my gratitude of each of the informants participation in this
study; I informed them of the results of the study. A token was given to each of
the informants and they were also be benefited more from this study. The audio
recorded information was destroyed after reviewing them to ensure
confidentiality.
Trustworthiness
A rigorous approach to research is crucial in order to lead the methods
choices that researchers must make during their research and to set the
reasoning by which they conduct data collection and data analysis (Creswell,
2014). It concerns the ‘‘truth value’’ of qualitative data, analysis and
interpretation. Trustworthiness is one way researcher can persuade themselves
and readers that their research findings are worthy of attention (Lincoln and
Guba, 2015).
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According to (Lincoln and Guba, 2015) redefined the concept of
trustworthiness by introducing the criteria of credibility, transferability,
dependability and confirmability to group various procedures together under
larger aims, and to offer alternative terms to positivist concepts and qualitative
research requires far more documentation research in order to establish
trustworthiness.
Credibility
The credibility is involved in establishing that the results of the research
are believable. This is a classic example of ‘quality not quantity’. It depends more
on the richness of the information gathered, rather than the amount of data
gathered. In reality the informants/readers are the only ones who can reasonably
judge the credibility of the results (Trochim, 2006).This will be ensure by
gathering of data using semi structured questionnaire that enables my informants
to openly express their views and perspective without any restrictions. The
interview will be recorded with the approval of the informants to ensure that all
information specified in the study can be interpreted for data analysis and can be
requested clarifications of data entry. To protect credibility within data, the
methods used is recording via mobile phone and note taking to supplement the
interviews of the nurses. The circular and interpretative analysis of data are done
through listening and re-listening to the audio recorded, and by writing and re-
writing descriptive data until saturation or redundancy occurred. The intention is
to share the final results with the informants of the study for validation.
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Transferability
Transferability, or external validity, refers to the degree in which the
research can be transferred to other contexts; this section is defined by readers
of the research. The reader notes the specific details of the research situation
and methods, and compares them to a similar situation that they are more
familiar with. If the specifics are comparable, the original research would be
deemed more credible. It is essential that the original researcher supplies a
highly detailed description of their situation and methods (Trochim, 2006).
This assumes that the research method, analytic categories and
characteristics of phenomena and groups are identified sufficiently and explicitly
that comparisons can be made between interviews or fieldworks. It also refers to
the applicability of findings to other situations and other people (Freeman et.al.,
2007). They will have an opportunity to validate interpretations of the data and
exemplars, share comments and new insights, and clarify discrepancies and
ambiguities in interpretation.
Dependability
Dependability, the counterpart of reliability in a quantitative research,
ensures that the research findings are consistent and could be repeated. This is
measured by the standard of which the research is conducted, analyzed and
presented. Each process in the study should be reported in detail to enable an
external researcher to repeat the inquiry and achieve similar results. This also
enables researchers to understand the methods and their effectiveness

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(Trochim, 2006). To achieve dependability, I will have established rapport to the
informants by calling them before commencing to the online actual data
gathering.
Confirmability
According to Trochim (2006), confirmability, or objectivity, questions how
the research findings are supported by the data collected. This is a process to
establish whether the researcher has been biased during the study; this is due to
the assumption that qualitative research allows the research to bring a unique
perspective to the study. An external researcher can judge whether this is the
case by studying the data collected during the original inquiry. To enhance the
conformability of the initial conclusion, an audit trail is completed throughout the
study to demonstrate how each decision will be made.
Figure 2 shows the audit trail of the study. It can be gleaned from the audit
trail that the study was initiated through determination of research objectives in
the process of conceptualization. After thorough evaluation and investigation
establishment of research background follows to justify if there is a need to
conduct the study in order to build the gap. Based on the background of the
study, the researcher will determine the appropriate research methodology to be
used that includes appropriate research design, identification and availability of
research participants and locale of the study. Formulation of semi structured
open ended questionnaire as a research instrument follows in order to serve as a
guide by the researcher during interview process will be generated, this guided
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questionnaire was subject for validation and evaluation by the research adviser.
With the approval of the Graduate School Dean, the adviser and the panel
members (research experts), data gathering procedures will be instigated
utilizing the appropriate procedures, data analysis and interpretation with related
studies and literature for substantiation of the results. Furthermore, based on the
findings of the data gathered, conclusions and recommendations were formed.
Conceptualization and Determination of Research
Establishment of the Background of the Study Related to

Job Related Stress
Selection of Research Design and Determining the
Source,Locale and Availability of Informants
Formulation of Guide Questionnaire in the Format of
Semi Structured
Data Collection
Transcription of Audio Recorded Interviews to Field

Notes
Establishment of Saturation
Analysis and Interpretation of Informants Responses
Development of Themes, Subthemes and Concepts

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Figure 2 Audit Trail of the Study
Ethical Considerations
All research studies present a number of ethical and moral dilemmas
which must be identified and addressed prior to carrying out any research study
in order to protect all informants from potential harm (Academia, 2016). This
research commenced once ethical approval has been achieved from the
research ethics committee. The following four ethical principles was tracked to
ensure no harm to the informants.
Beneficence and Non-maleficence
The proposed study findings benefited and cause no harm to the
informants and society. According to Burns and Grove (2016), risks that may be
encountered in research include physical, psychological, emotional, social and
financial ones The researcher aims to contribute to the study of the nurses
experiences on job related stress. Privacy and confidentiality are maintained at
all times, all findings are portrayed in a confidential manner no personal or
identifiable information was recorded or printed in the study. Voice recording
interviews are transcribed verbatim, thus no names are recorded during the
interviewing process. After transcription, the data was stored in password
protected folders with restricted access and stored on an external hard drive
which only the researcher will have access to (Academia, 2016). The Data
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Protection Act 2012 requires that data held on a computer must be accurate and
up-to-date; it also allows the informants to view the information regarding them
and to correct any errors if they wish to. It is very difficult to maintain anonymity
when an organization grant permission for such a study to be carried out, thus all
interviews are coded and no names used so as informants’ responses are not
identifiable.
Autonomy
I will respect the human right of free choice and will ensure informed
consent was completed before carrying out any of the interviews to observe the
data privacy act 2012. Procedure of consent was carried out, which enables the
researcher to renegotiate features of the consent form derived from the changing
description of the inquiry (Munhall, 2001). All informants are reassured that the
option to withdraw from the research at any time without penalty or repercussions
is upheld. Kelly and Simpson (2001) recommend that researchers maintain close
consultation and inclusion of all informants throughout the research process as
there are some who may feel impervious to change. The potential benefits and
risk was provided by explaining the benefits and risk of the study.
Justice
All findings and results presented was that of actual facts stated in the
interviews. All participants’ experiences and perceptions are portrayed as they
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will be doing so in the interviews, no false information or accusations are
included in the final report (Academia, 2016).
Ethical issues may arise at any point during any study regardless of the
scrupulous planning, therefore it is important that possible ethical issues are
identified, prevented, and reviewed as best as possible prior to, during and after
the study (Academia, 2016). Ethical principles pave the way for possible issues
not answers.
Data Management and Analysis
The interviews was audio-recorded, with permission from the informants,
and then the recorded data was transcribed verbatim. The process of
Interpretative Phenomenological Analysis by Jonathan A. Smith and Mike
Osborn (2007) was employed in this inquiry.
The Collaizi (1978) methodological approach was utilized to investigate
the phenomena of interest because it identifies the lived experiences of nurses
towards job related stress. It also facilitates and access to implicit and explicit
meanings embedded in the participants description through constant validation of
responses as the meaning and essence of phenomenon emerge, the seven
steps data analysis was followed in this phenomenological approach, namely: All
transcriptions was read thoroughly by the researcher, Significant statements that
directly pertained to the investigated phenomenon was extracted, The meaning

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of each significant statements was formulated with creative insights, All
formulated meanings was organized in clusters of themes, Results was
integrated into an exhaustive description of the investigated topic, The
description of investigated phenomenon was formulated into statement of
identification of the fundamental structure and participants was asked about the
findings, thus far in a single interview session.
The audio recorded data gathered from the informants was transcribed
with the help of a Filipino, compared from each informant responses and was
presented in narrative form. Answers to be obtained during interview was
compared among all informants to distinguish similarities and differences and the
meaning of their experiences, Responses of the participants obtained during the
interview was compared on all other informants to discriminate resemblances
and alterations. The aim of this constant comparative method of this study was to
generate theory from the saturation of their responses which would describe the
lived experiences of nurses. The method of analysis of data to be used in this
study depend on the related literature during transcription.
The transformation of initial notes into themes continued through the
whole transcript. Similar themes emerged as going through the transcript and the
same theme title was repeated. I am also disciplined in discerning repeating
patterns but also acknowledge new issues emerging as I worked through the
transcripts. Thus, respect convergences and divergences in the data –

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recognized ways which accounts from participants were similar but also different.
The objective of this comparison was to generate theory from the saturation of
responses which would describe the challenges experience by nurses. Field
notes during the interview was incorporated in the analysis of (voice) recorded
data for validation of responses as non-verbal cues conveyed messages
pertinent to interpretation of data.
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CHAPTER III
RESULTS AND DISCUSSIONS
Presented in this chapter are the findings and results of the study using
Colaizzi’s methodology. I have identified themes and subthemes and correlated
them according to the responses of the participants regarding Nurses lived
experiences on job related stress.
I. THE FIGHT AMIDST CHALLENGES AND ADVERSITIES
a. Increased Workload
b. Psychosomatic Experiences
c. Role Characteristics and interpersonal relationship
d. Fear of being infected
II. STRIVE AND THRIVE BEYOND CHALLENGES AND
ADVERSITIES
a. Active problem focus strategy
b. Spiritual Engagement
c. Motivational influence
III. BREAKING A NEW GROUND
a. Inner resilience
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b. Self determination
c. Positive mindsets
I. THE FIGHT AMIDST CHALLENGES AND ADVERSITIES
Every nurse’s experience challenges and adversities that viciously force
all their might and cause to fall apart, but they are necessary elements of nurse’s
growth and reveal their true potential. As saying says that storms hit the
weakness, but unlock the true strength. The tests nurses face in life's journey are
not to reveal their weaknesses but to help discover the inner strengths.
A. Increased Workload
The informant’s phrased that they had a lot of patients in combination with
few nurses, this was uttered to affect not only stress in the nurses but affect the
quality of care that they would give to the patients. Below are their shared
experiences:
Philippines.”Sa ngayon pandemic mahirap yong sitwasyon kasi lalong

nadagdagan yong wokload naming, minsan palipat lipat ng area,dumami
din yong pasyente” ( As of this pandemic, the situation is hard because of
the increased workload, sometimes, there are changes of reas assigned
to us and there is also increment of patients).
France:” One of the challenges is the workload demand especially this

time of pandemic, we have limited resources and understaff. Sometimes,
there is a need to extend your duty hours which I cannot avoid”.
USA: “Having limited resources and understaffing, nadagdagan yung

workload hindi lang sa pasyente pati na rin sa paperworks”
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(Having limited resources and understaffing, workload also increases not

only the patients but also the paperworks).
Spain: “ yong workload talaga, lalo na pag madami pasyente, wala ka ng

time sa family mo at yong takot din na pag uwi mo baka may dala kang
sakit na puede mong itransfer sa pamilya mo.”
(It is really the workload especially when there are lots of patients, you
don’t have time for your family and your fear that when you go back home,
you might have the disease that you can transmit to your family).
Australia: “ nakakapagod yung halos umabot ka ng more than 8 hours

duty na madami ung pasyente.”
(It is exhausting that you even have your duty hours for more than 8 hours
and with many patients)
Japan: “most of the times nagkakroon ka din ng conflict sa mga

coworkers din lalo na pag dumadami na yong gagawin mo. Tapos nalilipat
ka pa ng area, pati yong oras mo kulang kulang na, nakakastress.”
(Most of the time, there is also a conflict with your coworkers especially if
there is an increase in workload. Afterwards, there is a change of area
assigned, even the time is lacking, stressful).
This supported the study conducted by Selamu, M , Thornicroft, G,
Fekadu A. & Hanlon, C. on Conceptualization of job-related wellbeing, stress and
burnout among healthcare workers in rural Ethiopia: a qualitative study which
aimed to explore the conceptualizations of wellbeing, stress and burnout among
healthcare workers in primary healthcare settings in rural Ethiopia in order to
inform the development of contextually appropriate interventions which revealed
that Most participants conceptualized wellbeing as absence of stress rather than
as a positive state. For facility-based workers, the main stressors were
inadequate supplies leading to fears of acquiring infection and concerns about
performance evaluation. Workload and economic self-sufficiency were a concern.
Burnout and its symptoms were recognized and reported by most as a problem
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of other healthcare workers. Derogatory and stigmatizing terms, such as
“chronic”, were used to refer to those who had served for many years and who
appeared to have become drained of all compassion. Most participants viewed
burnout as inevitable if they continued to work in their current workplace without
career progression. Structural and environmental aspects of work emerged as
potential targets to improve wellbeing, combined with tackling stigmatizing
attitudes towards mental health problems.
B. Psychosomatic Experience
Nurses pointed that they experience some psychosomatic manifestations.
Psychosomatic refers to real physical symptoms that arise from or are influenced
by the mind and emotions rather than a specific organic cause in the body (such
as an injury or infection), psychosomatic illness originates from or is aggravated
by emotional stress and manifests in the body as physical pain and other
symptoms. This subtheme gives us an awareness of those physical
manifestation felt as they provide quality care for their patients. The informants
share some of their experience as:
USA:” Nakakramdam na ako ng back pain tsaka sumasakit ulo ko lalo

nap ang mainit yung area mo.”
(I felt backpain and headache especially when your area assigned is too
hot).
France: “lagi na rin akong nagbaback pain ngayon, inaantok kulang na

rin sa tulog lalo na pag pang gabi yung shift”
(I always felt backpain, sleepy,lack of sleep especially if night shift)
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Philippines: “Upper neck and back pain and sometimes stomach

acidity,minsan di ko na oobserve yang proper body mechanics sa dami na
rin ng pasyente and workloads.”
(Upper neck and back pain and sometimes stomach acidity, sometimes I
do not observed proper body mechanics because of many patients and
workloads).
Germany: “Ahmm pag napunta ka sa area na kulang yung ventilation,

mainit,nakaksakit ng ulo,nakakstress din.”
( Ahmm, once you are assign in an area that lacks ventilation, its hot that
make you feel headache, it is also stressful).
Finland: “Sumasakit ulo ko kasi hindi lang naman actions lang, you also
have to do paperworks para yung susunod sa yon a nurse, maayos at
tama din yong susundan nya na interventions.”
(Feeling of headache because it is not just actions, you also have to do
paper works so that the next duty nurses will have an appropriate
interventions to follow).
Qatar:”At the end of the duty hour’s parang pagod na pagod ako, maybe
because of the many patients that is assigned to me and all i want to do is
to relax and sleep.”
(At the end of the duty hours, as if I am so tired, maybe because of many
patients that is assigned to me and all I want to do is to relax and sleep)
Australia: "nakakapagod yung halos umabot ka ng more than 8 hours

duty na madami ung pasyente.”
(It’s tiring, you even more than 8 hour’s duty with many patients)
Japan: “Hayy most of the time I suffered neck and back pain at minsan
inaantok din.”
(Hayy… Most of the time I suffered neck and back pain and sometimes
sleepy).
Spain: “masakit sa ulo yung wala kang tigil na nag checheck ng pasyente,
ng paperworks” (Continue checking of patients and paper works make me
fell headache).
In relation to the study conducted by Bishwadeep P. 2018 on Study on
Job Stress and Related Health Problems Among Hospital Nurses in India , and
extent of work stress in nurses in a hospital setting, to identify the major sources
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of stress, and to find the incidence of psychosomatic illness related to stress. In
addition it was attempted to examine relationship between perception of work-
related stress and ill-health symptoms among the study sample which revealed
that there exists a significant positive correlation between perception of
occupational stress and psychosomatic symptoms among nurses.
Psychosomatic disorders like backache, neck stiffness, and increased
consumption of caffeinated products significantly increased in nurses having
higher stress scores.
C. Role Characteristics and Interpersonal Relationship
Nurses have various roles within their work description. The roles of a
nurse include to manage and to treat the patients, to work with families and
communities involving health and health promotion. Furthermore, nurses are
expected to contribute to the improvement of health and to promote health of
individuals in the society. Nurses are also expected to take on a significant
amount of responsibility within their roles so as to recognize their roles in their
workplace as well as the conflict among coworkers and demanding relatives can
stress my informants and affect their health when there is nothing more they can
do for the patient. The nurses are being affected both physical and emotional to
these situations and the situation becomes unhealthy for them.
Nurses’ stress out that role recognition by the higher authorities was not
given attention, demanding relatives and the conflict among other coworkers.
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This subtheme provides as an insight on how the role of nurses affects them
especially when their effort has not been recognized;
Germany. “No matter how I try to exert effort with my work, I still felt that it
was not really recognize. Ahmm. This is my personal perception, maybe
because I know for myself that I am doing my best in providing quality
care as well as doing my job as a nurse.”
Philippines. “I believed the social acknowledgement of our profession,

yong you are doing your best to render quality care and yet you are still
not given recognition,being a front liner, hindi ganun kadali ung trabaho
naming perro sana naman makita ng mga tao yung hirap din naming,yung
puyat naming,ung pagod naming, minsan pati pagkain naming,madalian.
At saka ung. Di mo maiiwasan yong magkaroon ng hindi kasundo na
ibang kasama sa trabaho.”
( I believed that social acknowledgement of our profession, you are doing
your best to render quality care and yet you are still not given recognition,
being a front line, our role is not easy, hoping that the people can see our
effort and our sleepless nights and sometimes we eat in a fast manner.
And also, you can never avoid of having conflict with other coworkers).
Qatar: Hindi na napapansin yung effort mo as a nurse, mababa pa rin

yong incentives. I mean yong narereceive mo benefits, parang kulang
para sa sarili at pantulong sa pamilya.”
(Our effort is not recognized as a nurse, our incentives is still low, I mean
the benefits we receive is not enough for ourself and to help our family).
Japan. “High expectation from your supervisors, kaya dapat maging

consistent ka sa lahat ng pinapakita mo sa pag provide ng quality care sa
pasyente..At dapat merun kang self-determination para magawa mo ng
maayos yung role mo.”
(High expectation from your supervisor, so, you have to be consistent in
all of what you are doing in providing quality care with the patient. And you
also have the determination so that you can do your role effectively).
Finland. “ Minsan nagkakaroon ng conflict sa mga kasama mo at s ibang

healthcare workers. Kung pagod ka na kasi, unconsciously,hindi mon a
napapansin yung sinasabi ng iba mong kasama”.
(Sometimes, there is a conflict with the coworkers and other healthcare
workers, when you are tired, you are unconsciously aware with what your
coworkers telling you).
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Japan: “Demanding yong relatives ng pasyente,yong isang tawag nila,

gusto nila anjan ka agad kahit may ginagawa ka pang ibang trabaho,
aysus, akala mo sila lang may pasyente.”
( The relatives of the patients are demanding, for just one call, they
wanted you to be there even you still have other work, as if they are the
only one who had patient).
Spain: “May mga relatives na mataas din ang expectations sa amin na

nurses,dapat lahat ng ginagawa mo,they demand for an explanations”
(There are some relatives who had high expectations among us nurses,
all the things that you are doing, they demand for an explanations).
It is parallel to the study Nurse Reports of Stressful Situations during the
COVID-19 Pandemic: Qualitative Analysis of Survey Responses which aims was
to explore perceptions of the most salient sources of stress in the early stages of
the coronavirus pandemic in a sample of U.S. nurses. One of the results showed
include Work-related problems, including relationships with coworkers, perceived
workplace administrative failings, and failure to provide Supplies and training.
D. Fear of Being Infected
One of the roles of nurses in providing quality care is not to discriminate
the type of patient that they have, most of them had a greater chance of being
infected especially during this pandemic that they don’t know whom are having
the illness, though there are also other infectious that might as well affect them.
Spain: “Nakakaparanoid if you are assigned to patients with

communicable diseases lalo na ngayon pandemic, your fear of being
infected tapos I’rather have siguro my own boarding house for the sake of
my family.”
(I felt paranoid if you are assigned to patients with communicable diseases
especially now this pandemic, your fear of being infected, I’d rather have
my own boarding house for the sake of my family).
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Philippines: “Fear of having been infected once na ang pasyente mo

communicable disease lalo ngayon maraming COVID 19 patients, though
may PPE provided,I still have the feeling that I may be infected.”
(Fear of having infected once your patient had communicable disease
especially now, there are many COBID 19 patients, though there are
PPEs provided, I still have the feeling that I may be infected).
Japan: “Everytime na nagduduty ako, hindi din maalis yung takot na

baka mag assign ako sa ward na may mga infectious diseases,kasi
Malaki yung chances na mahawaan ka.Nagyon pandemic, hindi mon a rin
alam kung sino na kaharap mo ngayon kahit na mga relatives di mo alam
kung asymptomatic sila. It’s either ako o sila ang makakahawa.”
(Every time I am on duty, I have this fear that I maybe assign to the ward
with infectious diseases because there is a greater chances that I might
be infected his pandemic, you don’t even know, whom you are with even
they are your relatives, you don’t even know if they are asymptomatic, its
either you or them will be infected).
Australia: “Takot ako mahawaan syempre,iniisip ko rin kasi pag

nahawaan ako pati pamilya ko damay lalo na ngayong pandemic”
(Of course I am afraid of being infected because it will also affect my
family especially now this pandemic).
Germany:”, sa panahon ngayong pandemic kahit kumpleto ka sa PPEs,di

mo pa rin masasabi lalo na madami na sa mga frontliners na nurses ang
naapektuhan ng COVID 19.Kaya kahit na hindi talaga ako assigned sa
COVID facility, yung kaba at takot hindi lang para sa sarili kopati na rin sa
pamilya ko.”
(As of now, this pandemic even you are complete with PPEs, you cannot
say especially that, there are many frontline nurses affected by COVID 19.
Even I am not assigned in COVID 19 facility, the fear for myself and for my
family).
Finland: “Providing quality care of different patients make it also

satisfying on my part as a nurse, however, I also felt nervous and afraid of
the possibility of being infected with those patient with infectious
diseases”.
As supported by the study of Bernal AJ, 2020 on Facing the Unseen:
Lived Experiences of Nurses Handling Corona Virus Disease-19 Positive
Patients which aimed to understand and uncover the live experiences of

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nurses handling COVID 19 positive patients wherein the nurses are exposed
to different challenges and findings shows that one of the subthemes under
the theme battle battle within COVID 19 ward is the fear of contagion which
indicates that most of the nurses claimed the possibility of being infected due
to the reason that they are the one handling the COVID 19 patients.
Table depicts the 1st theme “The Fight Amidst Challenges and
Adversities” with four subthemes namely: Increased Workload,
Psychosomatic, Role Characteristics and interpersonal relationship and Fear
of being infected.
Table 2. First Theme and Subthemes
Theme Subthemes
The Fight Amidst the Increased Workload
Challenges and Adversities Psychosomatic
Role Characteristics and interpersonal
relationship
Fear of being infected
A. STRIVE AND THRIVE BEYOND CHALLENGES AND ADVERSITIES
E. Active Problem Focus Strategy
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This strategy requires focusing on ways to adjust to the situation,
environment, or demand in order to reduce the negative outcomes to the nurses.
It also requires the nurses to be aware of what the stressor is, and then
implement a problem solve approach to reduce the perceived stress. Below are
the shared experiences of nurses on they strategize to reduce their stress;
Philippines. Pag inaantok ako,gumagawa ako ng paraan para kahit

makatulog ako ng konti lang ok na yun, lalo nap ag ang kasama mo on
duty, parehas kayo ng hinaing,salitan ng tulog ginagawa namin.”
(When I am sleepy, I make a way to sleep even just a short time,
especially when you coworker on duty have the same sentiments, we
sleep alternately).
USA: Pag lumalabas kami magkaibigan, inoopen ko yung mga

experience ko, minsan pag may nakikinig nakakawala na rin ng stress.”
(When I go out with my friends, I opened out my experiences, sometimes
when there are someone listening, the stress I felt was relieved).
Japan: “Sa dami ng pasyente, di mo maiiwasan yon pero, kailangan mo

pag isipan maigi ano puede gawin para kahit papano, makapgpahinga at
marelax, sa akin nakikipagkwentuhan ako,voice out ko yung
nararamdaman ko,halos pare parehas din naman kami, magtatwanan na
lng,kahit papano yung pagsabi mo,nakakrelax din”.
( With many patients, you cannot avoid it, you need to think clearly what
are you going to do to take a rest and relax, For me, I talk and voice out
what I felt and we all have the same sentiments, through that we just
laugh and with that you can say that, it is somewhat relaxing).
Finland: “Learning to live and adjust with the stressor, this is my

responsibility, my role as a nurse, why should I be defeated with the
stressor, I just think that what I am doing is for the sake of patients and it
is also self-satisfying when your patient and the relatives will show
gratitude.”
Australia: “Focus na lang sa trabaho, isipin na lng na nakaktulong kasi

pag gumaling at nadischarge ung mga pasyente, di ka rin nila
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makaklimutan, pag nakaksalubong ka. Maliit man ang incentives, focus na

lang sa positive side ng ginagawa naming as a nurse.”
(Focus with my work, thinking that I am helping because once the patient
wee discharge and free from disease, they will not forget you once you’ve
see them again. Even if it is low incentives, focus on the positive side as a
nurse).
Spain: “Parang, Bakit parang nakakstress yung work ko.Iniisip ko na lng

kahit nakakapagod at maliit sweldo, marami naman natutulungan, learn to
live with this kind of profession kasi pinili ko to, ibig sabihin kailangan
maging strong ako physically and emotionally.”
(It seems that, why my work is stressful, Id rather think that even my
salary is exhausting and low salary, I am helping a lot, learn to live with
this kind of profession because this is what I have chosen which means
that I need to be strong physically and emotionally).
Qatar: “Learn to love your profession as you love yourself. In time of

stress, I always think that this is what my role is, I need to adopt with this
kind of situation otherwise it will affect my health that might also affect my
family.”
France: “If I have time, sumasama ako lumalabas sa mga barkada, kaht
papano, navovoice out ko yung nararamdaman ko, and they are very
supportive and motivated me to keep going lalo na daw ngayon, in need
talaga ng nurses.”
( If I have time, I go out with my friends, I can even voice out my feelings
and they are very supportive and motivated me to keep going especially
now that nurses are in need).
b. Spiritual Engagement
Constant connection with God will always be the nurses’ armor in fighting
the battle against stress especially during this pandemic. Their faith and prayers
keeps them going and continue to work in spite of different stressor that they
have experience;
Philipppines: “Lagi akong nag ppray lalo pag feeling ko may kulang na
sa ginagawa ko, parang tinatamad ako. I always ask God’s guidance kasi
alam ko at sa lahat ng ginagawa ko anjan sha.”
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(I always pray especially when I felt that there’s is lacking of what I am

doing or I’m lazy, I always Gods guidance because I know in everything
that I do, God is there).
Spain: “I always find time para magdasal, humingi ng blessings kasi sa

araw na araw na trabaho, alam ko marami akong haharapin na alam kong
mahirap but with God’s grace I know I can”.
(I always find time to pray to ask for a blessing because for every work, I
know I will face a lot of challenges but with God’s grace I know I can).
Finland: “Prayers. Submit all your worries to God, I am sure, I can work
and face all the challenges and adversities in my work as a nurse.”
Japan: “Nagdadasal muna ako bago pumasok,nagdadasal ako parati to

keep me safe and sound”
(I always pray before I go to work to keep me safe and sound)
Australia: “Una dapat malakas yung faith mo at patuloy ung pagdarasal

kasi dun ako kumukuha rin ng lakas”.
(First, you have strong faith and continuous prayer because that is where I
get my strength)
Qatar: “Prayers ang pinaka importante, bago ako magtrabaho at kahit sa

pagkatapos ng trabaho ginagawa ko yun parati.”
(Prayers is the most important before and after work, I always do it)
France: “For as long as you have the strong faith to God and always pray,
I know I can surpass all the stress that I am int”.
C. Motivational Influence
These are the driving force of the nurses to fuel them to continue working
despite of the challenges that they may experience. It is the desire to act in
service of a goal;
Philippines: “Pamilya ko syempre, sila yung motivation ko to keep

going. Sila yung sumusuporta sa akin parati.”
(Of course my family, they are my motivation, they always supported me).
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France: “Merun akong pamilya na malawak yung pang unawa, sila yung
motivation ko at pati na rin yung mga pasyente ko, kung nadidischarge
ang pasyente na ok, pakirandan ko I have done something worthwhile”
(I have my family who has a profound understanding, they are my
motivation and also my patients, if they were discharge, I felt that I have
done something worthwhile).
Finland: “My family is always my motivation to keep on working in spite

of the stress that I have experience being a nurse. They always support
me and take care of me as well.”
Qatar: “Yung mga pasyente, sila yung motivation ko kasi everytime na

nakikita ko sila parang I felt the need to work for them, para kasing
kailangan nila ako.”
(My patients, they are my motivation, every time I see them.as if I felt the
need to work for them, it seems that they need me).
Japan: “Anjan ang family ko para suportahan ako, sila yung dahilan bakit
motivated akong magtrabaho and also with Gods guidance.”
(My family is there to support me, they are the reason why I am motivated
to work and also with Go’s guidance).
Australia: “Ang pamilya ko na walang sawang sumusuporta sa akin,

tapos ang mga pasyente, they keep me motivated para patuloy kong
gawin yung trabaho ko.”
(My family who never cease on supporting me and my patients, they are
my motivation to keep me doing my work).
Germany: “Laging anjan angpamilya ko na nagsisilbing motivation ko.”

(My family is always there that serve as my motivation).
Table presents the 2nd theme categorized as Strive and Thrive Beyond
Challenges and Adversities with three subthemes such as Active problem focus
strategy, Spiritual Engagement and Motivational influence
Table 3. Second Theme and Subthemes
Theme Subthemes
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Strive and Thrive Beyond Active problem focus strategy
Challenges and Adversities Spiritual Engagement
Motivational influence
III.BREAKING A NEW GROUND
The role of a nurse is to advocate and care for individuals and support
them through health and illness, however, there are various other responsibilities
of a nurse. With all of the role and responsibilities, there are also challenges and
adversities the nurses may encounter which is inevitable, In order to surpass all
the challenges, they also have their way to break a ground to face the reality of
their chosen profession or do something completely different.
A. Inner Resilience
It is about becoming conscious of how our worldview influences our
judgement and behavior Nurses need the ability to maintain their individual
identity and recover from setbacks in a rapidly changing environment. Another
important aspect of inner resilience is to deal with disruptions in our own life
creatively and to overcome setbacks, turning the lessons of failure into the
opportunity to develop a more successful approach and adapt to changes in our
living conditions. it is also about seeing the beauty, collaboration, compassion,
care and love that is all around us.
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Philippines: “Lesson from myself with this situation, kailangan mong mag
reflect at pag sisipan maigi yung possivity ng gingagwa mo.”
(Lesson from myself with this situation, you need to reflect and think the
passivity of what you are doing).
Japan: “Natutunan kong maging strong sa pagharap sa mga stressor

kaya kailangan talaga merun focus sa lahat ng ginagawa mo.”
(I have learned to become strong in facing the stressor, and it really needs
focus with all the things that you are doing).
Finland: “Being a nurse, you need to rethink and reflect so that you can
easily discern all the stressor and learn what to do with it.”
France. “Ang ginagawa ko nagrereflect muna ako tapos pinag iisipan ko

paulit ulit kung ano puede to gawin.”
( I reflect then I repetitively think on what will I do).
Australia: “Focus lang sa sarili at sa trabaho at lalo na sa mga taong

nagbibigay ng motivation at supporta.”
(Focus with yourself and work and also to those people who gives
motivation and support).
B. Self Determination
This is the nurse’s own ability to manage themselves, to make confident
choices, and to think on their own. Given how self-determination can help with
achieving independence, this concept plays an essential role not only in the
overall well-being of the individual, but also their overall health. Because self-
determination puts the individual in the driving seat, it makes the person both
responsible and potentially culpable for whatever happens.
Philippines. “Ito yung pinili kong profession kaya kailangan pursigido ka

rin patunayan hindi lang para sa sarili ko kundi para na rin sa pamilya at
sa mga pasyente na nagsisilbing motivation ko.“
(This is the profession that I have chosen then you need to be determined
and proved not only fofr yourself but also to the family and your patients
that serve as my motivation)
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France: “Sa profession naming, madami stressor kaya dapat pursigido ka

na labanan eto at kailangan matapang ka at malakas ka kasi pag
nagkataon, compromise ang health mo”
(With this kind of profession, there are lots of stressor, you need to be
determined to fight these and a need to be brave and strong otherwise
your health will be compromise).
Japan: “di mo maiiwasan ma stress sa nature ng trabaho naming,,stress

sa coworker, sa pasyente, sa bahay, ibang health professionals, pag wala
kang courage and determination to fight all the stressors that you may
encounter, puede kang magkasakit.”
(You cannot avoid to experience stress with the nature of our work, stress
with coworkers, with patients, at home and other healthcare professionals,
if you don’t have the courage to fight all the stressors that you may
encounter, you may get sick).
Australia.” Naranasan ko ng masigawan , pagod ka na sa dami ng

nagging pasyente , umiyak na lang ako at sabi ko sa sarili ko kaya ko to,
kailangan magpursige para magpatuloy kasi hindi lang eto sigurado ang
mararanasan ko”
( Have you experienced of being scolded, exhausted with many patients,
just cried and tell myself, I can do it, you need to become determine to
continue because this is not the only thing that I may be experienced).
Finland.” I think..ahmm…I am determined to follow my oath as a nurse in

providing quality care to my patient that no matter how hard it is, I will be
able to surpass every challenges.”
Japan. “High expectation from your supervisors, kaya dapat maging

consistent ka sa lahat ng pinapakita mo sa pag provide ng quality care sa
pasyente..At dapat merun kang self-determination para magawa mo ng
maayos yung role mo”
(High expectation from your supervisor, you need to be consistent with the
things that you have shown in providing quality care to your patient. An
also you have the self determination to make your role).
C. Positive Mindset
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Positive mindset actually means approaching life’s challenges with a
positive outlook. It does not necessarily mean avoiding or ignoring the bad
things; instead, it involves making the most of the potentially bad situations,
trying to see the best in other people and in work environment, and viewing
yourself and your abilities in a positive light. Below is a shared experiences of
nurses on how they think the stressor in a more positive way.
Philippines: “Iniisip ko na lang na yung ginagawa ko para makatulong sa

pasyente tsaka sa akin na rin kasi marami rin akong natutunan kahit na
nurse ka na, kailangan mag improve ka pa rin.”
(I rather think that what I am doing is to help my patients and also to
myself for my professional growth, even I am already a nurse, continuous
learning for improvement).
Japan: “Ang paraan ko jan, tinitgnan ko na lang yung magandang

maidudulot nito kesa naman stressin ko sarili ko ah.”
(My way is to look at the good things that brought to it rather than
stressing myself).
France: “Maging positive lang pag na stress lalo na sa mga nakaksama

sa trabaho na toxic.Iniisip ko na tong mga taong to, tinutulungan nila
akong maging strong.”
(To be more positive when you are stress especially those toxic people
you are working with, I only think that these people are helping me to
become strong).
Australia: “Bilang isang nurse, daming problema sa trabaho lalo na

ngayon pandemic but I don’t take it seriously kasi ako din mahihirapan,
tinitignan ko na lang na parang challenge lang para ma improve ko pa
yung sarili ko, di ba.”
(Being a nurse, there are many problems in work especially now
pandemic but I do not take it seriously because it will only make it harder
for me, I see to it as a challenge to improve myself).
Finland: “I know that being a nurse is not easy, you have to establish
confidence for yourself in order to carry out your role effectively, there
may be some challenges that may encounter but you have to look it into a
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brighter side in a more positive way, take it as a challenge to become a

better one.”
Germany: “Ahmmm I take it as a challenge in improving myself. Kasi

tinitgnan ko na ln gung magandang puedeng idulot nito kesa isipin na
nahihirapan ako”
(Ahmm. I take it as a challenge in improving myself, I look at the good
things brought by it rather that thinking that it makes me having a hard
times).
Table 3 presents the 3rd theme known as; Breaking a New Ground with
three subthemes such as Inner resilience, Self-determination and Positive
mindsets
Table 4. Third Theme and Subthemes
Theme Subthemes
Breaking a New Ground Inner resilience
Self determination
Positive mindsets
Limitations and Implications
The study utilized qualitative phenomenological research design to
explore the lived experiences of nurses on job related stress. Due to safety
measures and the researcher cannot meet them personally, an in dept interviews
were conducted through video call.
Though this study can examine the lived experiences of nurses in
considerable depth, the collection and especially the analysis of the data attained
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from them can be time consuming. I have managed to maximize my time and
aligned my schedule where I can secure the availability of my informants. After
securing their permission, their convenient time were discussed where I can
interview them through video call and also ask if I could possibly bring a Filipino
friend with me during the interview so that I can easily express my queries with
them There were problems encountered during my interview. Some of them were
hesitant to have a conversation with me, maybe because I am a foreigner.
However, some of them were given me a chance to allow me to conduct my
interview.
Additionally, qualitative research generally comprises relatively small
number of participants and it is not generalizable which is consider to be the
limitation of qualitative research and this can mean that it is likely to be taken
seriously by other academic researchers. Subsequently, I have made use of only
9 participants whom I have gathered data from them; it may incriminate frailer
findings in accordance to their experiences. Nevertheless, I have quarried
deeper into their responses and formed stable results by analyzing them until
concrete themes and subthemes were formulated. Figure 3 depicts the
conceptual map on experiences of nurses on job related stress which includes
the three themes namely challenges and adversities, strive and thrive beyond
challenges and adversities and breaking a new ground with their respective
subthemes such as increase workloads, psychosomatic experiences, role
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characteristics and interpersonal relationship and fear of being infected as well
as active problem focused strategy, spiritual engagement and motivational
influence. Further, inner resilience, self-determination and positive mindset was
also includes as subthemes.
FINDING CALM IN THE REALM OF

UPHEAVAL: NURSES EXPERIENCES ON
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THE FIGHT AMIDST

CHALLENGES AND
ADVERSITIES
Role
Characteristic
s and
Interpersonal
Relationship Positive
Mindset
Fear of being
Infected
Figure 3
Concept Map of Nurses Experience on Job Related Stress
CHAPTER IV
REVIEW OF LITERATURE AND STUDIES
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This chapter discusses the related literature and studies both foreign and
local and how they are synthesized with the current study.
Related Literature
What is Job related Stress
Job-related stress is the response people may have when presented with
work demands and pressures that are not matched to their knowledge and
abilities and which challenge their ability to cope. Stress occurs in a wide range
of work circumstances but is often made worse when employees feel they have
little support from supervisors and colleagues, as well as little control over work
processes. There is often confusion between pressure or challenge and stress,
and sometimes this is used to excuse bad management practice. Pressure at the
workplace is unavoidable due to the demands of the contemporary work
environment. Pressure perceived as acceptable by an individual may even keep
workers alert, motivated, able to work and learn, depending on the available
resources and personal characteristics. However, when that pressure becomes
excessive or otherwise unmanageable it leads to stress. Stress can damage an
employees' health and the business performance( WHO 2020)
Work-related stress can be caused by poor work organization (the way we
design jobs and work systems, and the way we manage them), by poor work
design (for example, lack of control over work processes), poor management,
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unsatisfactory working conditions and lack of support from colleagues and
supervisors. Research findings show that the most stressful type of work is that
which values excessive demands and pressures that are not matched to workers’
knowledge and abilities, where there is little opportunity to exercise any choice or
control, and where there is little support from others. Employees are less likely to
experience work-related stress when demands and pressures of work are
matched to their knowledge and abilities, control can be exercised over their
work and the way they do it, support is received from supervisors and
colleagues, and participation in decisions that concern their jobs is provided
(WHO 2020).
Stress related hazards at work can be divided into work content and
work context.
Work Contents includes job content (monotony, under-stimulation,
meaningless of tasks, lack of variety, etc); work load and work pace (too much or
too little to do, work under time pressure, etc.); working hours (strict or inflexible,
long and unsocial, unpredictable, badly designed shift systems); and participation
and control (lack of participation in decision-making, lack of control over work
processes, pace, hours, methods, and the work environment).
Work Context includes career development, status and pay (job
insecurity, lack of promotion opportunities, under- or over-promotion, work of low
social value, piece rate payment schemes, unclear or unfair performance

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evaluation systems, being over- or under-skilled for a job); the worker’s role in
the organization (unclear role, conflicting roles); interpersonal relationships
(inadequate, inconsiderate or unsupportive supervision, poor relationships with
colleagues, bullying/harassment and violence, isolated or solitary work, etc.);
organizational culture (poor communication, poor leadership, lack of behavioural
rule, lack of clarity about organizational objectives, structures and strategies);
and work-life balance (conflicting demands of work and home, lack of support for
domestic problems at work, lack of support for work problems at home, lack of
organizational rules and policies to support work-life balance), Poor
communication, low levels of support for problem solving and personal
development, lack of definition of organizational objectives.
Examples of Sources of Stress
Task Design
This includes workload (overload and underload), pace / variety /
meaningfulness of work, adequate time to complete a task, autonomy (e.g., the
ability to make your own decisions about our own job or about specific tasks),
shiftwork / hours of work, skills / abilities do not match job demands and lack of
training and/or preparation (technical and social), lack of appreciation, isolation at
the workplace (emotional or working alone)
Role in the organization and Work-Life Balance
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This include role conflict (conflicting job demands, too many roles, multiple
supervisors/managers), uncertain job expectations/role ambiguity (lack of clarity
about responsibilities, expectations, etc.) and level of responsibility,
ole/responsibility conflicts and family exposed to work-related hazards.
Relationships at Work
This includes supervisors (conflicts or lack of support), coworkers
(conflicts or lack of support), threat of violence, harassment, etc. (threats to
personal safety), lack of trust, lack of systems in workplace available to report
and deal with unacceptable behavior and prejudice or discrimination.
Effect of Job Related Stress in the Body
Stress can have an impact on the overall health. Our bodies are designed,
pre-programmed if you wish, with a set of automatic responses to deal with
stress. The problem is that our bodies deal with all types of stress in the same
way. Common effects of stress on the body include: headache, muscle tension
or pain, chest pains, increased heart rate and blood pressure, weakened immune
system, fatigue / insomnia, stomach and digestive issues and high blood sugar.
Stress can also affect your mood or thinking by increasing forgetfulness, anxiety,
restlessness, irritability, defensiveness, mood swings, hypersensitivity, anger,
etc., decreasing ability to think clearly or focus.
What Can Be Done About Job Stress?

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Stress Management. Theresa’s company is providing stress management
training and an employee assistance program (EAP) to improve the ability of
workers to cope with difficult work situations. Stress management programs
teach workers about the nature and sources of stress, the effects of stress on
health, and personal skills to reduce stress
Organizational Change. In contrast to stress management training and
EAP programs. This approach is the most direct way to reduce stress at work. It
involves the identification of stressful aspects of work (e.g., excessive workload,
conflicting expectations) and the design of strategies to reduce or eliminate the
identified stressors. The advantage of this approach is that it deals directly with
the root causes of stress at work.
Comprehensive Nursing Law of 2019
An Act Providing for a Comprehensive Nursing Law towards Quality
Healthcare System and Appropriating Funds. The policy of the state to uphold
the dignity of the nurses and assume responsibility for the protection, respect and
improvement of nursing profession by insisting measures towards competent and
relevant nursing practice for health and safety of the public just and humane
conditions of work and promotion of professional growth
Related Studies
Foreign
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In the study of Jordan,T. et al ( 2016) on “The Impact of Perceived Stress
and Coping Adequacy on the Health of Nurses: A Pilot Investigation,” This study
examined the relationship between stress, coping, and the combined influences
of perceived stress and coping abilities on health and work performance. A valid
and reliable questionnaire was completed by 120 nurses in a Midwestern hospital
in the USA. In general, the nurses were not healthy: 92% had moderate-to-very
high stress levels; 78% slept less than 8 hours of sleep per night; 69% did not
exercise regularly; 63% consumed less than 5 servings of fruits and vegetables
per day; and 22% were classified as binge drinkers.
When confronted with workplace stress, 70% of nurses reported that they
consumed more junk food and 63% reported that they consumed more food than
usual as a way of coping. Nurses in the “high stress/poor coping” group had the
poorest health outcomes and highest health risk behaviors compared to those in
other groups. The combined variables of perceived stress and perceived coping
adequacy influenced the health of nurses. Therefore, worksite health promotion
programs for nurses should focus equally on stress reduction, stress
management, and the development of healthy coping skills.
Another study conducted by Arnetz ,J et al (2020) on “Nurse Reports of
Stressful Situations During the COVID-19 Pandemic: Qualitative Analysis of
Survey Responses,” which aimed to explore perceptions of the most salient
sources of stress in the early stages of the coronavirus pandemic in a sample of
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U.S. nurses. A cross-sectional online survey was conducted among a sample of
695 U.S. nurses in May 2020. Content analysis was conducted on nurses’
responses (n = 455) to an open-ended question on the most stressful situations
they had experienced during the pandemic.
Six distinct themes emerged from the analysis: exposure/infection-self;
illness/death-others; workplace; personal protective equipment/supplies;
unknowns; opinions/politics. Two sub-themes concerned restrictions associated
with the pandemic and feelings of inadequacy/helplessness regarding patients
and their treatment. More than half of all comments concerned stress related to
problems in workplace response to the pandemic. Healthcare institutions should
provide opportunities for nurses to discuss the stress they are experiencing,
support one another, and make suggestions for workplace adaptations during
this pandemic.
In the study conducted by Chatzigianni, D et al. (2018) on “Occupational
Stress Experienced by Nurses Working in a Greek Regional Hospital: A Cross-
Sectional Study,” which aims to measure perceived stress levels among nurses
in a Greek public general hospital. Materials and Methods: A cross-sectional
study was conducted. A total of 157 nurses and nursing assistants took part. A
self-administered questionnaire including sociodemographics and Expanded
Nursing Stress Scale (ENSS) for stress assessment was used. Analysis was
performed using Statistical Package for the Social Sciences version 20.0.
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Total stress mean (SD) score ranged in medium levels [136.27 (47.80)].
The most stressful situations were dealing with death and dying [18.29 (5.59)];
patients' and their families' demands [20.90 (7.12)], and uncertainty concerning
treatment [22.19 (9.07)]. Discrimination [4.40 (4.25)] and conflicts with peers
[12.07 (5.10)] provoked less stress. There was a statistically significant
relationship between age and total stress (F = 4.23, p < 0.001) and all distinct
stressors. Nurses between 30 and 34 years expressed higher stress in all cases
except patients' and their families' demands stressor. Those nurses who were
divorced expressed higher stress in death and dying subscale (F = 2.93, p =
0.035). Nursing assistants expressing higher stress as far as workload (t =
−2.40, p = 0.017), conflicts with physicians (t = −2.19, p = 0.033), and problems
with peers (t = −2.63, p = 0.009) were concerned, compared to nurses. The
findings of the study are in line with other researchers' findings concerning
stressors among nursing personnel in Greece. Appropriate measures for the
prevention and management of specific stressors must therefore be taken.
Local
A study conducted by Dayrit,A. & Jabonete,F. ( 2017) on “Reported Work-
related Stressors among Staff Nurses in Metro Manila, Philippines,” in which A
descriptive-correlation and cross sectional design was used. The study was
conducted to hospital staff nurses in a tertiary government and non-government
hospital in Metro Manila. The predominant work-related stressor that occasionally
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occurs in the work setting was workload while discrimination stressors never
occur. Respondents reported moderate level of stress (M=2.66, SD=0.85) on the
nine subscale. Work-related stressors is significantly related to age (χ 2 = 20.05),
civil status (χ2 = 17.48) number of patients (χ2 = 16.11) and length of service (χ2 =
21.27). Sixty-six (58.41%) respondents claimed that there is stress management
program seminar offered in their hospital. Twenty-three (20.35%) respondents
claimed that there is no stress management program being conducted in their
hospital.
Nurses reported moderate level of stress in all subscale of the modified
expanded nursing stress scale. Effective coping mechanisms and stress
management program, and policies are emphasized. It is recommended to
revisit the staffing and scheduling plan and provide enough staff to cover the unit
to address workload stressors. It may be useful to consider teambuilding
activities between nurses and physicians to strengthen team work and
collaboration. A training program can be devised that culturally-fit and evidence-
based.
Another study conducted by Bernal AJ, (2020) on “Facing the Unseen:
Lived Experiences of Nurses Handling Corona Virus Disease-19 Positive,” which
aimed to provide an in depth understanding and uncover lived experiences of
nurses handling corona virus 19 positive patients utilizing qualitative
phenomenological study design using semi -structured interview guide. The
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collected data were tracked and analyze employing colaiizzi method for analysis
and come up with three themes, The battle within COVID 19 ward, Rising Up to
the Challenges and the COVID `19 warriors intangible gains which suggest that
the healthcare organizations and the concerned authorities must shift their
actions towards the empowerment and protection of nurses by providing physical
security, psychological assessment and counseling, maintain to provide safe
practice environment, ensuring sufficient adequate protective gear and emotional
support to the frontline nurses.
Another study conducted by DeCastro et al (2010) on “Occupational
Health and Safety Issues among Nurses in the Philippines,” which aim to
determine the occupational health and safety among nurses in the Philippines .
Work-related problems among a sample of nurses in the Philippines are
described. Cross-sectional data were collected through a self-administered
survey during the Philippine Nurses Association 2007 convention. Measures
included four categories: work-related demographics, occupational injury/illness,
reporting behavior, and safety concerns.
Approximately 40% of nurses had experienced at least one injury or
illness in the past year, and 80% had experienced back pain. Most who had an
injury did not report it. The top ranking concerns were stress and overwork.
Filipino nurses encounter considerable health and safety concerns that are
similar to those encountered by nurses in other countries. Future research should
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examine the work organization factors that contribute to these concerns and
strengthen policies to promote health and safety.
Synthesis
The relevance of the cited literature and studies have reinforced the
researcher to look into the findings that are deemed pertinent to the present
study.
In the study of Jordan,T. et al (2016). “The Impact of Perceived Stress and
Coping Adequacy on the Health of Nurses: A Pilot Investigation,” that examined
the relationship between stress, coping, and the combined influences of
perceived stress and coping abilities on health and work performance. When
confronted with workplace stress, 70% of nurses reported that they consumed
more junk food and 63% reported that they consumed more food than usual as a
way of coping however, the recent study focus on the experiences on job related
stress and their coping mechanism showed a motivational influences, spiritual
engagement and their active problem focus strategy to overcome stress.
Another study conducted by Arnetz ,J, et al (2020) on “Nurse Reports of
Stressful Situations During the COVID-19 Pandemic: Qualitative Analysis of
Survey Responses,” which aimed to explore perceptions of the most salient
sources of stress in the early stages of the coronavirus pandemic using cross
sectional design, while the recent study I a qualitative type of research using
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phenomenology as research design and address the experiences of nurses on
job related stress.
Further, In the study conducted by Chatzigianni, D, et al (2018) on
Occupational Stress Experienced by Nurses Working in a Greek Regional
Hospital: A Cross-Sectional Study,” which aims to measure perceived stress
levels among nurses in a Greek public general hospital. The recent study utilized
qualitative phenomenology that address the nurses’ experiences on job related
stress and not on perceived stress level.
In the study conducted by Dayrit,A. & Jabonete,F. ( 2017) on “Reported
Work-related Stressors among Staff Nurses in Metro Manila, Philippines.” in
which A descriptive-correlation and cross sectional design was used. The study
was conducted to hospital staff nurses in a tertiary government and non-
government hospital in Metro Manila. The predominant work-related stressor that
occasionally occurs in the work setting was workload while the recent study
utilized qualitative phenomenological inquiry on job related stress among nurses
which also showed that one of the subtheme that respondents experience in their
work setting is an increased workload.
Another study conducted by Bernal AJ, (2020) on “Facing the Unseen:
Lived Experiences of Nurses Handling Corona Virus Disease-19 Positive,” which
aimed to provide an in depth understanding and uncover lived experiences of
nurses handling corona virus 19 positive patients utilizing qualitative

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phenomenological study design using semi -structured interview guide while the
recent study addresses the experiences of nurses on job related stress utilizing
also qualitative phenomenological design.
Further, a study conducted by DeCastro et al (2010) on “Occupational
Health and Safety Issues among Nurses in the Philippines,” which address the
occupational health and safety of nurses in the Philippines using cross sectional
design and result that the top ranking concerns are stress and overwork while the
recent study address the experiences of nurses on job related stress using
qualitative phenomenological design and a semi structured question, in similarity
to the later study, the result also encompasses increase workload that may lead
to stress among nurses.
CHAPTER V
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
This chapter presents the study as a whole on summation of research
process, findings, conclusions and recommendations employed and discovered
in pursuit of understanding the experiences of nurses on job related stress.
Summary
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The research sought to explore and understand the lived experienced of
nurses on job related stress by answering the following questions: 1. How will
you describe your experience as a nurse on job related stress? 2. What are the
coping mechanisms have you used in times of work stress and 3. What lesson
have you learned as a nurse?
A qualitative phenomenology study design was employed to gather the
necessary data from the informants and snowball sampling was used in the
selection of samples from the population. A semi structured interview guide, face
to face, individual interviews via video call were utilized to capture and
understand the lived experiences of nurses. Subsequently the collected data
were transcribed and analyzed employing Colaizzi’s method.
Thorough interpretation of informants’ experiences on their job related
stress shaped the findings of the study which were formulated into themes and
subthemes. The themes are the fight amidst challenges and adversities, strive
and thrive beyond challenges and adversities and breaking a new ground. The
subthemes are (1) Increased Workload, Psychosomatic and Role Characteristics
and interpersonal relationship and Fear of being infected (2) Active problem
focus strategy, Spiritual Engagement and Motivational influence (3) Inner
resilience, Self-determination and Positive mindset.
The first theme, the fight amidst challenges and adversities, informants
pointed out their experienced on what are those stressful situations during duty
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hours however in spite of the experiences the informant’s managed to surpass all
the challenges and adversities that they encounter.
The second theme, strive and thrive beyond challenges and adversities, the
participants claimed that as they have the strategy and with their motivational
support from family friends as well as their engagement to God, nothing will be
impossible to continue providing quality care to their patients in spite of
everything.
The third theme, breaking a new ground, the informants claimed that their
inner resilience, self-determination and their positive viewpoint will help them and
be their guiding process in facing a new edge in their life.
Conclusions
Based on the responses of the informants, the researcher had come up
with an inference that nurses encountered difficulties and challenges in their work
and chosen profession.
With the three emerging themes, the challenges encountered by the
nurses affect them because of their task design that increase workload, their role
characteristics and interpersonal relationship with co-workers and the patients as
well as their fear of being infected which may lead to different psychosomatic
manifestations. Their defense mechanism is their strong motivational influence
by friend family and their spiritual connection as well as their active focus
strategy in combatting the challenges and difficulties they have encountered.
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Facing the reality of their nature of job, their inner reliance wherein their
capacity to rethink and reflect and their self-determination and positive mindset,
they were able to surpass all those challenges and become a better one.
Recommendations
Taking findings and conclusions in consideration, this study developed
recommendations as follows
1. Webinars on stress management and coping mechanism must be
organized by respective hospitals.
2. Regular counselling among nurses by respective hospitals.
3. Team building activities was also recommended among healthcare
nurses and other healthcare workers to strengthen team work and
collaboration.
4. For future research to explore the factors affecting health of nurses
due to job related stress in order to improve the nurse’s work-related
health.
BIBLIOGRAPHY
A. Books
Albrecht, T.L., and Halsey, J. (2014). Supporting the staff nurse under stress.
Nursing management
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Kvale, S., & Brinkmann, S. (2009). Inter Views: Learning the craft of qualitative
research interviewing (2nd ed.). Thousand Oaks, CA, US: Sage
Publications, Inc
Hammel and KW and Carpenter C. (2004), Qualitative Research in Evidence

Based Rehabilitation, Churchill Livingstone Elsevier
Lichtman, M. (2014), Qualitative Research for the Social Sciences, Thousand

Oaks, CA: SAGE
Patton (2002), Introduction to Qualitative Research. Thousand Oaks, CA: SAGE

Polit, D. & Beck, S., ( 2004), Nursing Research: Principles and Methods,
7th Ed; Philadelphia, USA: Lippincott Williams & Wilkins.
Ritchie J. and Lewis J, (2003), Qualitative Research Practice, Thousand Oaks,

CA: SAGE
B. Published Studies
Adzakpha, G.,(2014) Occupational stress among nurses in a Hospital Setting in

Ghana
Aguir, V.E., Pons, Echegaray, M.C, Romas, D.B., and Sanchez, R.G. (2014).
Stressors laborals y bienestar psicologico: Impacto en la Enfermeria
hospitalaria. (The impact of psychological welfare of nurses in hospitals
caused by work stress). Revista de Emfermeraia
Ahmed & Ramzan (2014) Effects of Job Stress on Employees Job Performance:
A Study on Banking Sector of Pakistan, IOSR
Akhtar, S & Lee, J.S (2017). Confirmatory factor analysis and job burnout
correlates of the Health professions Stress Inventory,
DOI: 10.2466/pr0.2002.90.1.243
Arnetz, J.et al (2020) Nurse Reports of Stressful Situations during the

COVID-19 Pandemic: Qualitative Analysis of Survey Responses ,
doi: 10.3390/ijerph17218126
Bakker, A. B., Killmer, C.H.Siegrist, J. and Schaufeli, W. B. (2015). Effort- reward

imbalance and burnout among nurses. Journal of advanced nursing 31(4),
884-891
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GRADUATE SCHOOL
Baye,Y et al Nurses’ work related stress and associated factors in governmental

hospitals in Harar, Eastern Ethiopia: A cross-sectional study, doi
0236782
Bishwadeep P. 2018 on Study on job stress and related health problems among
hospital nurses in india , and extent of work stress in nurses in a hospital
setting,
Cash, D. (2015). A study of the relationship of demographics, personality and

role stress in burnout in intensive care unit nurses. Ann Arbor, MI: UMI
Cassam, N. H., and Hackett, T. P. (2014). Sources of tension for the CCU nurse.
American Journal of Nursing, 72, 1426-1430
Chatzigianni, D et al. (2018) on Occupational stress experienced by nurses

working in a Greek Regional Hospital: A cross-sectional study
Celowitz, S.B. (2019). Burnout and coping strategies among hospital staff
nurses. Journal of advanced Nursing. 14,553-557.
Dayrit,A. & Jabonete,F. ( 2017) on Reported Work-related Stressors among Staff

Nurses in Metro Manila, Philippines, Journal of Science Technology and
Arts , Vol 3
De Castro et al ( 2010) on Occupational Health and Safety Issues among

Nurses in the Philippines
Faremi,FA. et al ( 2019) Assessment of occupational related stress among

nurses in two selected hospitals in a city southwestern Nigeria
Jordan,T. et al ( 2016) on The Impact of Perceived Stress and Coping Adequacy

on the Health of Nurses: A Pilot Investigation
Kim ,O. ( 2017) An assessment of nurses’ experiences of work related stress

through self-reporting and hair cortisol analysis, in a metropolitan hospital
in Western Australia.
C. Unpublished Studies
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Bernal AJ, 2020 on Facing the Unseen: Lived Experiences of Nurses Handling
Corona Virus Disease-19 Positive
Beehr, T.A. & Newman, J. (2017) Job stress, employee health and organizational
effectiveness: A facet analysis, model, and literature
D. Others
https://www.osha.gov/laws-regs/standardinterpretations/1996-09-09
https://osha.europa.eu/en/legislation/guidelines/framework-agreement-on-work-
related-stress
(https://www.google.com/search=challenges of nurses stress in the Philippines)
Philippine Journal of Nursing 2016
APPENDIX A
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LETTER OF INTENT FOR THE DEAN
December 19, 2020
JOSE EMMANUEL C. MANDAPAT, D.A

Graduate School Dean
Virgen Milagrosa University Foundation
San Carlos City, Pangasinan
Dear Sir:
Greetings of Love and Joy!
I am AKUBUO BLESSING EZINWANNE currently enrolled in Thesis 1 and

conducting a qualitative study entitled ‘‘FINDING CALM IN THE REALM OF
UPHEAVAL:NURSES EXPERIENCES ON JOB RELATED STRESS,’’ for
Master in Public Health program of the Virgen Milagrosa University Foundation
(VMUF).
In this regard, may I request a permission that I will be allowed to conduct my
proposed study. Your approval will be greatly honored and appreciated.
Respectfully yours,
AKUBUO BLESSING EZINWANNE

Researcher
Noted By:
Maria Lyn P. Cortez, PhD

Adviser
APPENDIX B
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LETTER TO THE INFORMANTS
Dear Informant,
I am conducting a study entitled ‘‘FINDING CALM IN THE REALM OF

UPHEAVAL: NURSES EXPERIENCES ON JOB RELATED STRESS,’’ In this
regard, I would like to seek your participation as an informant to this scientific
undertaking. Upon completion of this study, the findings are envisioned to benefit
you through the insights that will be drawn from this study.
Rest assured that the information you will provide will be treated with
utmost confidentiality. It will be a great honor to have you as part of the fulfillment
of the study. Thank you, May the Lord bless you and your family.
Respectfully yours,
AKUBUO BLESSING EZINWANNE

Researcher
Noted By:
Maria Lyn P. Cortez, PhD

Adviser
APPENDIX C
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INFORMED CONSENT
Part I: Information Sheet
This informed consent form is for the Nurses working in Hospitals in San
Carlos City Pangasinan where I will be conducting my research study entitled,
“Finding Calm in the realm of Upheaval: Nurses Experiences on Job Related
Stress”.
Introduction
I am a student of Graduate School of Virgen Milagrosa University

Foundation and will be conducting a research entitled “Finding Calm in the realm
of Upheaval: Nurses experiences on job related stress.” I would like to invite you
to be a part of my study. Your participation will be a great help to me and those
who will benefit this study. Furthermore, I am also seeking your willingness or
volunteerism to participate in this study. Before you decide, you can talk to
anyone you feel comfortable with about the research. This consent form may
contain words you may not understand. Please feel free to ask me to stop as we
go through the information and I will take time to explain.
Purpose of the Research
Challenges experiences by nurses in their work are inevitable. Nursing

has been identified as one of the most stressful professions. Work-related stress
among nurses affects both individual and organizational functioning as well as
the healthcare provider. In this regard, I would like to conduct a research to
determine the experiences of nurses as regards to their work. I believe that you
can help me by giving sharing your lived experiences for the completion of our
study.
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Type of Research Intervention
This research will involve an administration of Semi-Structured Open-

Ended Interview Questions
Respondent Selection
You are being invited to take part in this research because I feel that your
experience as a nurse can contribute much to our understanding and knowledge
about our research study.
Voluntary Participation
Your participation in this research study is entirely voluntary. You have the
right to withdraw anytime if you are not comfortable with.
Duration
The research takes place over will be depending on the availability of your
time. Upon approval, one on one interview or online face to face interview will be
conducted for 20 minutes during a video call (mobile phone).
Risks
There is a risk that you may share some personal or confidential

information by chance, or that you may feel uncomfortable talking about some of
the topics. However, we do not wish for this to happen. You do not have to
answer any question or take part in the discussion/interview/survey if you feel the
questions are too personal or if talking about them makes you uncomfortable.
Benefits
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You will be beneficial in the sense that, you can help your fellow nurses to
be aware, but your participation is most likely a great help to us in the completion
of our study.
Reimbursement
You will not be provided any incentive to take part in the research.
However, we will be thankful for your given time and if by chance, there will be
disturbance in your finances on using the mobile phone by paying the load duting
interview , I am willing to pay or reimburse you have spent.
Confidentiality
We will not be sharing information about you to anyone outside of the

research team. The information that I will be gathered from this research project
will be kept private.
Sharing the Results
Nothing that you tell us today will be shared with anybody outside the
research team, and nothing will be attributed to you by name. The knowledge
that we get from this research will be shared with you only
Right to Refuse or Withdraw
You do not have to take part in this research if you do not wish to do so,
and choosing to participate will not affect your job or job-related evaluations in
any way. You may stop participating in the interview at any time that you wish
without your job being affected. We will give you an opportunity at the end of
answering the questionnaire to review your remarks, and you do not agree with
my notes or if I did not understand correctly.
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Part II: Certificate of Consent
I have been invited to participate for the research discussion entitled

“Finding Calm in the realm of Upheaval: , Nurses experiences on job related
stress”
I have read the foregoing information, or it has been read to me. I have
had the opportunity to ask questions about it and any questions I have been
asked have been answered to my satisfaction. I consent voluntarily to be a
respondent in this study
Printed Name of Respondent _________________________
Signature of Respondent _________________________
Date _________________________
Day/Month/Year
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APPENDIX D
SEMI STRUCTURED OPEN-ENDED QUESTIONNAIRE
FINDING CALM IN THE REALM OF UPHEAVAL: NURSES’ EXPERIENCES
ON JOB RELATED STRESS
1. How will you describe your experienced as a nurse on job related stress?
2. How do you cope with these experiences to be free from stress?
i. How do you deal with these challenges?
ii. What motivated you to keep on working in spite of stress that

you felt?
iii. How will you consider your support network be a part of your
motivation?
iv. How do you cope and manage your work stress?
v. In your own experience, what advice do you have to help
other nurses to cope with their stress in work
3. What lesson have you learned on your experience?
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APPENDIX F
To: Virgen Milagrosa University Foundation

Graduate School Studies
Thesis/Dissertation Committee
Dear Sir/Ma'am:
This is to certify that the semi-structured interview guide integrated into the
thesis "Finding Calm in the Realm of Upheaval: Nurses Experiences on Job
Related Stress" were reviewed and verified by the undersigned as not to inflict
harm on the respondents. Hence, any participant will be advised to seek
professional help if necessary.
LOTIS MAY L. MAGLAYA, RPm

Psychometrician
Lic. No.: 0020342
Valid Until: 29 May 2022
Contact Number: 09773962056
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CURRICULUM VITAE
PERSONAL INFORMATION
NAME: AKUBUO BLESSING EZINWANNE
DATE OF BIRTH: OCTOBER 31, 1993
PLACE OF BIRTH: IMO STATE
CIVIL STATUS: SINGLE
FATHERS NAME: AKUBUO HYGINUS
MOTHERS NAME: AKUBUO FLORENCE
MOBILE NO: 09772774529
E-MAIL: akubuoblessing18@gmail.com
EDUCATION BACKGROUND
Postgraduate
Year: 2020
Degree: Master in Public Health (MPH)
School: Virgen Milagrosa University Foundation, Philippines.
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Undergraduate
Year: 2019
Degree: Bachelor of Science in Nursing
School: Virgen Milagrosa University Foundation, Philippines.
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Virgen Milagrosa University Foundation 1

“The Home of God-Loving and Globally Competent Individuals”

Nursing is an art: and if it is to be made an art, it requires an exclusive

devotion as hard a preparation, as any painter’s or sculptor’s work; for what is

said the finest of fine Arts.’’--- Florence Nightingale

Background of the Study

Nursing research will always be committed to the advancement of nursing

nurses undertake continue to translate in the improvement of the quality of care

as these reflect their commitment in the development of nursing profession (

Philippine Journal of Nursing 2016)

Furthermore, nurses are expected to contribute to the improvement of the public

health and to promote health of individuals in the society .

Nurses make up one of the largest segments of the global healthcare

to patients while serving as a lifeline of information, encouragement, and

education to family members of patients. The challenges that nurses face in

among different patient care units, experience poor communication among

uncooperative family members of patients. Such work-related stressors increase

of Perceived Stress and Coping Adequacy on the Health of Nurses: A Pilot

Investigation, Jordan, T. 2016)

National Institute of Occupational Safety and Health (2014) defined work

requirement do not match the worker's capabilities, resources, and needs.

Nursing is recognized as a stressful demanding occupation . Stress has been

observed among various professionals without exemption. Previous researches

Tel Nos. (075) 632-4094, 955-5222, 532-

reported that nurses, regardless of workplace or culture, are confronted with a

variety of stressors. Indeed, nursing is considered as the highest stressful job

among 40 stressful professions (Mozhdeh et al., 2011)

Stress is a psychological and physical state that results when the

pressures of the situation. It can be defined as a response to a demand that is

placed upon a person. It can be simply understood as “a condition where one

experiences a gap between the present and desired state.

Merriam Webster (2015) defined stress as a physical, chemical or

disease causation. It is a normal reaction when the brain recognizes a threat.

its “fight or flight” response. Psychologist Richard S. Lazarus described stress as

Stress is the end result of an “individual’s perception to a stimulus,

interpreting this as overwhelming, and the inability to meet the challenge.

Perceived stress as the “perception that one’s life is unpredictable,

uncontrollable, and overloaded. Whenever an individual perceives the presence

of negative stressors, their cumulative stress levels rise (An assessment of

analysis, in a metropolitan hospital in Western Australia. Kim ,O 2017 ).

Job stress can be defined as the harmful physical and emotional

even injury ( https://www.cdc.gov/niosh/docs).

Nurse stress is defined as the emotional and physical reactions resulting

world-wide as a major challenge to workers’ health and the healthiness of their

organizations. The working environment is one of the most important recourses

of occupational stress. Nurse’s environment include an enclosed atmosphere,

are additional stressors. Stress is known to cause emotional exhaustion to

(Occupational stress among nurses in a Hospital Setting in Ghana, Adzakpha

related problems to organizations to be in excess of $150 billion annually. In the

cost, including absenteeism, costing the Australian economy AU$14.81 billion

and many developing nations of the world (Assessment of occupational related

stress among nurses in two selected hospitals in a city southwestern Nigeria,

Faremi,FA. Olatubi MI, Adeniyi K 2019).

World Health Organization has considered stress as a global epidemic,

which has recently observed to be associated with 90% of visits to physicians .

employees worldwide. Work-related stress results in substantial costs to

employees and organizations, related to employee’s absenteeism and turnover,

reported occupational health problems. Work-related stress has recognized as

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negative emotional, physical, and psychological effects on the nurse. Research

been found to reduce the quality of nursing care ( Baye, Y. et al 2020).

Moreover, Nurses’ reactions to the stress of the current pandemic must be