Problem Statement
The contemporary working environment is characterized by stress. In all professions, people experience stress as a result of the demands of their works. Equally, nurses experience stress as a result of the demands of their job. Consequently, this affects their performance. Findings of previous studies indicate that stress levels of nurses have increased in the last decade and that this has been implicated on their performance.
Moustaka and Constantinidis (2010) point out that stress has been increasingly affecting nurses in the last decade. Although some causes of stress are specific to the institution and the role and type of work, it has been identified that other roles are general. They argue that, “High levels of stress result in staff burnout and turnover and adversely affect patient care” (p. 1). Therefore, it is evident that stress could lead to underperformance that would affect the way patients receive care and management of their conditions.
Considering this, it is therefore necessary that the causes of stress are identified. By understanding the causes of this stress, policy makers can design appropriate means of reducing the stress level and hence implicating positively on the performance of the nurses which would result to improved patient care. The study will hence focus on the main causes of stress among practicing nurses. Stress leads to poor performance by nurses. This leads to inadequate care for patients. Consequently, it leads to further complications that require much input in terms of time and finances. In addition, there is increased physical, psychological and emotional pain to patients.
Research Objectives
Given the impact of stress on the overall wellbeing of patients, this study intends to identify the overall stress level among nurses. Then, the study will try to pinpoint specific causes of stress among practicing nurses. Specific objectives of this study include identifying whether there is a relationship between other factors at home and workplace stress.
Research Questions
To attain the mentioned objectives, the following questions will be necessary. First, given the Holmes and Rahe Stress Scale, how many nurses score beyond the 300 mark? This question will assist in identifying the stress level of individual nurses and the overall institutional or role level. What factors in their lives do they find most pressing and occupying most of their thoughts? This question is necessary because it will identify the main causes of stress by the specific individuals. Do other factors outside the workplace have impact on the performance of the nurse? This question is important because it will assist in identifying role of work specific stress factors and other factors that do not work specific.
Significance and rationale
As argued earlier by Moustaka and Constantinidis (2010), stress has been increasing among nurses for the last one decade. Unfortunately, increase in stress means decrease in performance. It is therefore necessary to identify the main causes of stress so that a solution can be defined from these revelations. It is necessary to know a cause to find a solution.
Literature Review
Clancy and McVicar (2002) argue that workplace stress can be defined in terms of the perception of demand and the perception of their capacity to meet these demands. When there appears a mismatch between these two, the individual’s threshold becomes overstepped hence stimulating a response to the situation. Consequently, an individual’s chances of being stressed depend on the capacity of the threshold. This can be determined by his characteristics, the experiences that he has undergone in life, and the context of the demands. Given this argument, it is thus not true to argue that a single factor might act as a stressor in all nurses. Neither can a single factor be a stressing factor for a nurse at all time (MacKenzie, 2002).
In their argument on the effect of stress on performance, Healy and McKay (1999) argue that not all stages of stress can be detrimental. They emphasize the transition point that leads to severe distress. At this point, they argue, is where most detrimental and work inhibiting qualities of the nurse begin to appear. They conclude by highlighting the importance of identifying factors that promote transition. Being the most dangerous stage of stress, identifying factors that promote it would enable policy makers design ways of avoiding these factors. Consequently, fewer nurses will be subjected to these factors leading to fewer instances of severe stress and hence increased productivity.
In their argument, Plant, Plant and Foster (1992) argue that stress is an aspect that should be approached as a continuum. He identifies the four steps as psychological or physical indicator; this is the event that leads to excitement or fear. This leads to the second step which is eustress. This involves the increase in arousal or mental acuity. From this step, there is distress which is the third step of the continuum. This is the result of the reaction to mental acuity or arousal. It includes signs of emotional inclinations like unease, emotional instability, sadness, apprehension, fatigue, increased levels of alcohol consumption and smoking.
This leads to the final step of the continuum, severe distress. This leads to burnout. McGowan (2001) and Tyler & Ellison (1994) point out to the role of this continuum to an individual’s performance. In his argument, he argues that problems with performance start from the transition point between distress and severe distress. It leads to chronic absenteeism, poor health outfit, problems in retention of staff (Phillips, 1996).
Smith, Brice, Collins Mathews and McNamara (2000) point out on the importance of identification of stressing factors. In their argument, they purport that any stress intervention approach by any organization must be in position to identify the root cause of stress. Given the unpredictability of the nature of stressors in nursing, it is however difficult to identify the stressing factors in general. This finding is echoed by Healy and McKay (1999) who stress on the important role played by the transition to severe distress. They argue that the best stressors whose intervention can lead to reduction of stress level are those that lead to transition to severe distress (Smith & Gray, 2001).
French, Lenton, Walters and Eyles (2000) contribute to the importance of identification of stressing factors that would lead to severe distress. They offer a wide range of possible stressors within the greater field of nursing. Among them was friction with physicians, lack or insufficient preparation before undertaking a task, misunderstandings with peers, collision with supervisor, intensity of workload, cases of discrimination, patients’ death and family issues.
These are identified as major factors that lead to stress among practicing nurses. MacKenzie (2002) builds on these factors by pointing out that they contribute greatly on transition to severe stress. However, he argues that it is necessary to understand that the effect of these factors varies from one individual to the other. Furthermore, there are expected temporal changes within the factors. This could further lead to variability of their effect on the individual.
Methodology
This study will involve a random sampling where nurses will be chosen randomly from different institutions. Practicing nurses from both gender and will be used in this study. Individual ages of the nurses will not be a great factor, but the period of service will be considered. This will be important in identifying the level of experience that the nurse has. The nurses will also be required to specify their marital statuses.
This will be relevant in identification of domestic roles in stress determination. It will be important to identify the level of stress within married nurses and their single counterparts. In addition, married nurses with children will be measured against married nurses without children. There will also be the identification of the level of education and the job scale. It will involve nurses on the whole continuum of service. It will involve senior nurses down to the student nurses. This will be necessary to identify whether the level of career can contribute to stress or not.
Given that the chosen data collection method is the use of interviews and questionnaires, identification of pertinent question that would lead to answering of the research questions is necessary. To properly meet the research objectives, the questions will be arranged in two major groups. The first will be personal information and the second will be professional information. Identification of personal information is necessary because it will allow the researcher to know the way the nurse lives at home. It is through such information that some stresses that originate from domestic environment will be separated from actual workplace stress.
The questions in this category will include marital status, number of children if any, profession of husband, age of children, et cetera. Professional part will include questions pertinent to the type of work done. This will include the number of years she has been in service, the level of her education, the type of patients he deals with, the shift in question et cetera.
Design Model
The main objective of the study was identification of the causes of stress for practicing nurses, the most important step was a model to identify the level of stress. Nurses will be required to answer some questions that will be assessed upon the Holmes and Rahe Stress Scale to identify the level of stress that the respondent has. The scale will be necessary for the identification of stress level which will be a variable in the whole study. It will be determined against causes to identify the role of a cause and its intensity on the individual.
Respondents will then be made to identify the factors that they think would affect their productivity. The effects of these factors will further be placed within a continuum that will identify the factors as very weak, weak, strong and very strong. Within this scale, it will be possible to identify the effect of the given factor in relation to the level of stress. Increased level of stress will be analyzed to show the main causes that would have led to increased stress.
Being a qualitative research, the study shall employ the use of structured questionnaires to identify the position of respondents. Respondents will be given a chance to identify causes and the intensity of their impact on the working ability of the respondent. The received data shall be analyzed on the scale of that will identify very, weak, strong or very strong. The intensity and impact of each cause shall be identified depending on its rating on the response from the respondent. This shall be compared with the respondent’s measure on the Holmes and Rahe Stress Scale. The identified impact will be used against the number of time it appears in the respondent’s daily schedule.
This will then be followed by the determination of frequency of the factor. All these variables shall be measured against the level of stress. Using this approach, it shall be possible to identify main causes of stress on practicing nurses.
Summary and Conclusion
The effect of stress on performance is great and negative. It is therefore necessary to avoid stress among nurses to avoid underperformance that leads to deaths among patients. On the other hand, not all stages of stress cause negative effects. Studies point out that stress should be taken as a continuum. It contains various stages that vary in impact. The most destructive stage is the transition towards severe stress. To avoid negative effects of stress, it is necessary to avoid every factor that tends to promote this transition. By curbing the development of stress, it will be possible to reduce the rate of deaths that occur as a result of negligence of nurses. It will also reduce absenteeism and employee turnover. It is therefore necessary that policy makers ensure that factors that cause stress are identified.
Reference List
Clancy, J. & McVicar, A. (2002). Physiology and Anatomy: A Homeostatic Approach. London: Arnold.
French S.E., Lenton R., Walters V. & Eyles J. (2000) An empirical evaluation of an expanded nursing stress scale. Journal of Nursing Measurement 8, 161–178.
Healy, C. & McKay, F. (1999). Identifying sources of stress and job satisfaction in the nursing environment. Australian Journal of Advanced Nursing, 17, 30 – 35.
MacKenzie L. (2002) Lessons from the past. Nursing Standard 16, 20–21.
McGowan B. (2001) Self-reported stress and its effects on nurses. Nursing Standard 15, 33–38.
Moustaka, E. & Constantinidis, T. (2010). Sources and effects of work related stress in nursing. Health Science Journal, 4(4), 210-216.
Phillips S. (1996) Labouring the emotions: expanding the remit of nursing work? Journal of Advanced Nursing 24, 139–143.
Plant, L., Plant, A. & Foster, J. (1992). Stress, alcohol, tobacco, and illicit drug use among nurses: A Scottish study. Journal of Advanced Nursing, 17, 1057-1067.
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Smith A., Brice C., Collins A., Mathews V. & McNamara R. (2000) The Scale of Occupational Stress: A Further Analysis of the Input of Demographic Factors and Type of Job. Norwich: HSE Books.
Smith P. & Gray B. (2001) Reassessing the concept of emotional labor in student nurse education: role of link lecturers and mentors in time of change. Nurse Education Today 21, 230–237.
Tyler P.A. & Ellison R.N. (1994) Sources of stress and psychological well-being in high-dependency nursing. Journal of Advanced Nursing 19, 469–476.