How Nurses are affected by Stress in Psychiatric Unit of Somers Ward - Research Paper Example

? “How Nurses are affected by Stress in Psychiatric Unit of Somers Ward?” By Devika Nurses are currently facing great challenges in their practice that may affect significantly the patients’ care and their future when left unresolved. Nurses are “short-handed, understaffed, and overworked” and to some extent, burnout. The emotional stress they carry watching their patients die and see grieving families oftentimes add up the physical stress of overstretching themselves to work on double shifts to cater understaffed hospitals. Looking back, severe shortage of nursing staff working at bedside is not a new problem in the health care arena since this had started even during the time of Florence Nightingale in the barracks of Scutari amidst the Crimean War. Stress has affected nurses in several ways in terms of manpower shortages and excess in the number of working hours. Nurses are also underpaid, abused at work, and taken for granted emotionally. Work stress has originated from work itself. The purpose of this research study is to find out whether newly hired nurses without any work experience are in a stressful environment in Somers psychiatric unit provided that they are in a probationary period, and would soon be evaluated in their workmanship. This study also aimed to find out how nurses with working experience respond and cope to their current stressful situations and to investigate if they assist their colleagues in adjusting their roles in the ward. Background: Nurses are currently facing great challenges and dilemma in their field of practice to date. This is foreseen to affect significantly the delivery of patient’s care and health of the nurses in the future when left unresolved. Nurses are “short-handed, understaffed, and overworked” (Milleken, et al, 2007) and to some extent, burnout. The emotional stress they carry watching their patients die and see grieving families oftentimes add up the physical stress of overstretching themselves to work on double shifts to cater understaffed hospitals (Milleken, et al., 2007). As a result, new nurses are recruited from different parts of the world, and are placed on probationary period. This period can be very stressful also to both nurses, old and new, taking into consideration the culture shock, the expectations, and language barriers that adds up to being stressed from the hospital work. Looking back, severe shortages of nursing staff working at bedside is not a new dilemma in the health care arena since this problem had already started even during the time of Florence Nightingale in the barracks of Scutari amidst the Crimean War (Milleken, et al., 2007). During that time, significant shortages of trained personnel to take care of the dying young men from the battles and diseases were already noted. But despite of the existing problems, nursing profession continued to thrive until this date. However, Milleken, et al (2007) cited that the stressful circumstances and repeated challenges that face the nursing staff contribute to organizational problem in the future that may endanger the health care system. The Rationale of Doing this Research: The continuous shortage of nursing staff all over the world has not exempted the facility where I worked in. Somers ward is an 18-bed unit, and is the only acute psychiatric facility in the Bermuda Island. Being the only specialized facility in the island, it is expected that the nursing staff will be outnumbered by the number of patients who are coming for admission. To date, the nurse to patient ratio is 1:8, where only one nurse is assigned to take charge to 8 patients per shift. Every day, I’ve experience this event happening in the ward, and as a nurse, I’ve seen how overloaded we are with our respective responsibilities, and sometimes, we are required to extend the number of hours at work because we are short-staffed. I felt the frustrations, anxiousness, and together with my co – workers, we have a cry to put a stop on this scenario. Otherwise, all of us will get drained, burned out, and just vanished. I specifically have chosen to do this research study in order to investigate work – related stress in my workplace. I will personally facilitate the data collection as well as collate and analyze the details from this study, Definition of Burnout: Since stress and burnout are interrelated, and are often used in this study, it is therefore, important to know the exact meaning of burnout. Jenning (undated) defined burnout as a “syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment.” In nursing practice, stress and burnout in the workplace remain a substantial concern in the workforce since this affects significantly the individual, organisational structure, and relationship in the working environment (Jennings, undated). Stress at work seriously affects the health care organisation since this may result to staff absenteeism and rapid turnover. In effect, this detracts the health care quality and increase the crisis in the workforce inside the hospitals in the near future if not given consideration. Effect of Stress to Work: Jennings (undated) stated in her study that since the mid – 1950s, stress has been cited a significant problem in health, and regarded eventually as an occupation hazard. In the 1960s, four sources of anxiety were identified among nurses and were eventually assessed as work related stress in nursing. These are identified as stress related to the patient care, decision making, taking responsibility, and change. The physical labour, sufferings in human, irregular working hours, staffing, and interpersonal relationship had caused the role of the nursing staff a stress filled activities (Jennings, undated). Jennings added that work stress among nurses had escalated in 1980s due to innovations in nursing care that includes the use of diagnostic technologies, rising costs in health care, and disturbance in working area. A study to justify the effect of stress in the workplace was made by Ahsan, et al. (2009) on a study entitled Job Stress on Job Satisfaction among University Staff in Malaysia aimed to investigate the correlation between job stress and satisfaction with role in management, interpersonal relationship, pressure with increased workload, home interface, role ambiguity, and performance when pressured, as job stress determinants investigated in this study. The public university academicians from Klang Valley in Malaysia were the sample population used in this research study. The results have shown a significant negative relationship between stress at work and job satisfaction. However, Ahsan, et al. (2009) noted that to reinstate and motivate the employees, constant appraisal programs and appreciation must be provided, and the key factor that Ahsan, et al identified to affect job stress among the employees is the motivation. Hence, Ahsan, et al. (2009) concluded in their study that highly motivated employees are happier and are much willing to work than those who are not. Ahsan, et al added that employer and employees are both responsible in handling stress issue at the end of the day, and although the employers are the ones causing the stress, but it’s the employees, who face and experience it. Another study on work – related stress was done by Lambert and Lambert (2008) stating that the Global Advisory Group of the World Health Organization (WHO) has recognised a universal shortage of nurses that results to the increase of stressors encountered by the nurses in the workplace. This had added up to the current stressor of population age increase, intensity of the problems in the health care and chronic illness incidence. Lambert and Lambert (2008) noted that nurses assigned in palliative care unit has an increased risk of acquiring work – related stress because of the emotional stressors dealt with in the workplace. Lambert and Lambert (2008) also stated that stress in the workplace increases the cost in a work setting. This is exemplified in its correlation with absenteeism, rapid turn – over of employees, short and long – term disability claims, expenses in medications, accidents in the workplace, and claims and lawsuits in relation to workers’ compensation. Lambert and Lambert (2008) cited the result of Lluminari Landmark Study noting that 1 in 5 workers examined were at risk for health problems related to stress, 2 out of 5 are experiencing distress because of too much mental fatigue or pressure in the workplace, 1 out of 10 were exhausted in the workplace that they have lost their pleasure to enjoy their time outside the workplace, and lastly, 1 out 5 employees reported that their responsibilities at home and quality time with their family were decreased because of too much demand at work. Lambert and Lambert (2008) further stated that one country spends over 300 million dollars annually to deal with issues related in the workplace and another country with less population spent 12 billion dollars annually in work – related issues. At the end of their study, Lambert and Lambert (2008) recommended to try different strategies in identifying the best approach of managing stress in the workplace, and to identify which among the strategies is considered as the most effective approach. Justification for the research proposal: In order to avoid a stressful environment that may cause the nurses to get burned-out, the following are recommended to help and keep the staff nurses to get going: 1. Reward and shifting of work assignments is necessary to keep the nursing staff get going. This is applicable especially to the staff nurses who have been working in the hospital wards for more than two years. Most of these staffs consider their work as a routine that even to a very minute irritant of stress is a big deal for them. To get away from this issue, an alternative that can displace their attention towards the negative things while at work must be highly considered (McVicar, 2003). 2. It is highly recommended that nurses are also given some time to have team building. To go out as a team, and share nothing but positive things in the hospital. However, the negative issue must also be tackled and handled positively. 3. Managers can approve the final research proposal to actually carry out the research. 4. To improve the morale of the nursing staff and encourage newly hired staff to stay in Bermuda. 5. To use the point of approach on how this study can improve conditions or decrease stress. Literature Review: Several strategies were used in searching information on work related stress. This includes the usage of the most powerful search engine in the internet to date, the Google search engine, the Medscape, and PubMed in looking for e-journals, articles, and e-books. The key words that were used in searching were: “work-related stress,” “stress,” “nurses,” “burned out,” “stress and literature review,” “somers ward,” “ethical issues,” “methodology,” “data analysis,” and “research,” The researcher aimed to formulate a proposal guided by a hypothesis that correlates, contradicts, and prove that the hypothesis is true or not. Bermuda Island is a little island with approximately 60,000 inhabitants; therefore, confidentiality and ethical issues during or after the research is observed strictly. A Literature Review for Nursing Stress Interventions by Ross (2008) states that in the nursing profession, stress becomes a well – known and well identified problem, and stress levels of nurses goes up when the situations becomes uncontrollable and less predicted. In effect, as stress levels of nurses goes up, their satisfaction towards their work inversely goes down. This is followed by decreased satisfaction of their job, and eventually, towards their outlook and quality of life (Ross, 2008). This pattern contributes potentially to nurses leaving their respective profession, and consequently, results to shortages in nursing staff (Ross, 2008). From this time on, the cycle of nursing shortages and stress in the ward goes on. Ross (2008) noted that the stress – related nature of nursing profession is considered as the number one stressor in the nursing world. Not counting the intense working environment, the long extended working hours especially on weekends, night time, and during holidays where everyone must be enjoying. All of which including the shifting working schedules are physically and mentally taxing that leads to depression among nurses. From this review of literature, it was established that work related stress has produced nurses who are indifferent and disconnected to their job. Additionally, other factors such as emotional support expected from the nurses for the patient and family has add up to the burden of stress carried by the nurses in the ward as well as their exposures to pain and traumatic life events of their patients contributed much to work stress and often leads nurses to being diagnosed as emotionally exhausted, which will contribute to psychological stress and again, the cycle goes on (Ross, 2008). This phenomenon has resulted one to question interventions that could be implemented to support the nurses at work and to decrease their stress by increasing coping mechanism to stress through programs that may contribute to coping mechanism (Ross, 2008). Ross (2008) reported that based from the literatures gathered and reviewed, a common thread of intervention is available and effective. This can be implemented and made as a part of coping mechanism of a practicing healthcare nurse. Programs which were proven to be effective, simple, and inexpensive are also available and this can be considered as potential stress preventive measures. Ross (2008) noted that these programs can be offered through hospitals and organisation related to medical employment. As a result, these programs provides benefits in the profession of nurses as well as measures that are anticipatory in nature for stress reduction, and increase satisfaction at work leading to increase retention of nurses (Ross, 2008). Another literature was reviewed on Nurse Staffing and Quality of Patient Care by Kane, et al (2007) aimed to assess nurse to patient ratio and number of working hours that may affect the acute care outcome of patients. Nurse staff policies and nurse staffing strategies are factors that were considered to influence and improve the outcome of patients in this study. In their study, Kane, et al (2007) used data sources from PubMed, Cinahl, Cochrane Databases, EBSCO research database, BioMed Central, Federal reports, National Database of Nursing Quality Indicators, National Centre for Workforce Analysis, American Nurses Association, American Academy of Nurse Practitioners, and Digital Dissertations. Observational studies were reviewed in this study to examine the relationship between staffing and outcomes of nurses. The consistency of the association between staff nurses and outcomes of the patients, classes of patient, and characteristic of the hospital were separately analysed and were tested using the Meta – analysis. From the study of Kane, et al. (2007), it was established that hospital – related mortality was lessened when registered nurse staffing is increased. Also, failure to rescue, cardiac arrest, hospital - acquired pneumonia, and other adverse events were decreased as well. Increased staffing of registered nurses had a positive effect on the safety of the patients in the specialized units such as in the intensive care units and surgical units. Also, quality time that the nurses spent with the patients had decreased death of patients in the hospital and shortened the length of stay of the patient. On the other hand, Kane, et al. (2007) noted that limited evidence gathered from the data that suggests that higher registered nurses in the hospitals are related to failure to rescue the patients in their respective units. Also, there was limited evidence that could attest that higher number of hours spent by the nurses with their patients is associated with increased risk of hospital acquired diseases, infections, and to some extent mortality. Kane, et al (2007) concluded in their paper that lower hospital – related mortality, failure to rescue patients, and other negative outcomes of the patients while being admitted in the hospital are directly associated with increased hospital nursing. The increased ratio of registered nurse to patient corresponds to reduction in the relative risk of the patient while being admitted in the hospital and this has been consistent all throughout the study. Lastly, better outcomes were observed in the intensive care units and surgical patients with greater number of staff nurses at bay (Kane, et al., 2007). A study on work – related stress by European Foundation for the Improvement of Living and Working Conditions (2007) aimed to identify work – related stress prevalence and development of indicator on the representative data gathered from the country within European Working Conditions Observatory (EWCO). This study also aimed to identify causal process behind these developments that are already proven or still suspected, elaborate the involved costs, and discuss the required preventive actions. This study was inspired from the concept that work – related stress is a reaction pattern that results when the work demands presented to the workers do not match to their knowledge, skills or abilities, which challenges their coping ability. In this study, demands identified as time pressure related, quantity and difficulty of work that results to emotional demands, oftentimes produce physical demands. Imbalance between the abovementioned demands oftentimes lead to a state of stress where an individual became more focused on their concerns and became less vigilant and efficient in the tasks they performed. It was noted in this study that learning and development situations may arise from imbalance of demands, abilities, and knowledge. European Foundation for the Improvement of Living and Working Conditions (2007) added that when people are exposed to risk factors at work, it oftentimes result to stress reaction identified as emotional, behavioural, and physical in nature, and eventually leads to chronic fatigue, burnout, musculoskeletal problems, and cardiovascular diseases that are distinguished as less reversible health outcomes. Personality, values, goals, age, gender, educational level, and situations in family influence the ability of nurses to cope challenges at work. However, when they are less favourable, it contributes to severity of work stress experienced by the nurses. Hence, as result, the stress models such as “effort-reward imbalance model” came out. The European Foundation for the Improvement of Living and Working Conditions (2007) concluded in their study that for years, the risk of work stress is increasing and in European countries, the identification and management of work – related stress issue has been receiving increasing consideration. As a result, work – related stress agreement was carried out, and EU level social partners was signed off recently to establish theoretical account so that representatives from employers and employees can join forces to prevent, identify and combat work stress (European Foundation for the Improvement of Living and Working Conditions, 2007). Figure1. Conceptual Framework (Schematic Diagram) Stress affects newly hired nurses in terms of manpower shortages and excess in the number of working hours. Nurses are underpaid, abused at work, and taken for granted emotionally. Thus, one can say that work related stress is caused by none other than work itself. Due to shortage of nurses in the Somers ward, many nurses from all over the world are hired and employed to fill in the shortages of manpower. When these nurses are placed in a probationary period, they are evaluated in regards of their workmanship in the clinical settings and how they respond and fit in to stressful environment. This too, can be a very stressful experience for neophyte nurses, taking into consideration the different factors such as culture shock, expectations, and language barriers. Other than that, newly hired nurses who have ample nursing experience are also believed to be stressed at work. Preceptor, the Role of Preceptors, Benefits from the Preceptor: A preceptor is the one who provide daily clinical teaching while meeting the expectations in the clinical practice (Burns, et al., 2006). It is expected from the preceptor to have updated skills and knowledge in the clinics, assist students to identify assumptions and be wise in management considerations. They are models in communicating effectively with the clients and demonstrate the importance of psychosocial aspect in providing concern to their clients (Burns, et al, 2006). Preceptors help solve the problems and engage in the process of learning of their students (The Association of Professors of Gynecology and Obstetrics, undated). PICO Format: The PICO format was used to help construct a research based question, and the table below shows a breakdown of the key elements (Moyer, 2008).). Moyer (2008) noted that PICO is an acronym wherein the elements of well – formed clinical questions are described. PICO questions are used to by several clinical researchers to guide their clinical research studies by answering the structured clinical questions formulated (Moyer, 2008). Hypothesis: 1. Does having a preceptor reduce the stress levels of the newly hired nurses as opposed to not being assigned a preceptor? 2. For newly hired nurses with working experience, does having a good interpersonal relationship in the workplace reduce their stress level or not? Objective of the Study: 1. The purpose of this research study is to find out whether newly hired nurses without any work experience are in a stressful environment in Somers psychiatric unit provided that they are in a probationary period, and would soon be evaluated in their workmanship. 2. To find out how nurses with working experience respond and cope to their current stressful situations and to investigate if they assists their colleagues in adjusting their roles in the ward. The Research Methodology: Design of Study: This is a mixed method investigative research study designed to investigate work – related stress among newly hired nurses with no working experience and newly hired nurses with working experiences being assigned or not being assigned to a preceptor. Participants This research study is designed to investigate 19 nurses who are currently working in a psychiatric unit in somers ward from 2011 to 2013. Ten newly hired nurses with working experience and 9 newly hired nurses with no working experience will be randomly selected to participate in this study. Sampling Data will be collected from the newly hired nurses with no working experience and newly recruited nurses with previous nursing experience. Tools and Method of Data Collection Variety of methods will be used in collecting data among the newly hired nurses in the psychiatric unit of somers ward. This includes the use of survey forms, questionnaires and interview sheets which will be provided to the participants. In the survey form, the basic questions regarding nurses’ personal information will be asked. In the questionnaires, questions such as previous work experience, work-related stress and coping mechanism, how does preceptor help them, and whether or not the presence of preceptors have helped them handle stress at work will be answered. Also, newly hired nurses who are assigned randomly with a preceptor and those who are not, will be provided exactly the same data sheet. The data will then be collected, compiled, and analysed. Future recommendations that will help the nurses in the ward will be based from the results of the collected data. Data Analysis: In this research study, the data obtained will be presented in a graph or chart so that the reader won’t be having a hard time understanding the result (Eysenck, 2004). Appropriate labels will be presented clearly in the graph or chart. A statistical test will be carried out in order to prove or discount any differences of the hypothesis that was presented (Eysenck, 2004). Eysenck (2004) noted that a statistical test provides a clearer idea on the meaning of the findings. . Ethical Issues Related to my Research Proposal: Ethical concerns are identified and considered when conducting a research survey. In dealing with the ethical issues of my research proposal and actual research study, I must make sure that the nurses who participated in this study will be voluntarily participating. No harm will be done towards my subjects, and that they will be assured for utmost anonymity and confidentiality. Also, the participants must also be oriented and be informed on the purpose of the study to gain their full participation. Informed consent An informed consent must be presented to the newly hired nurses who are the participants of this study. A signed consent will be obtained from the newly hired nurses after discussing and clearly explaining the details of the procedure to the newly hired nurses. Data Security All confidential information of the nursing staff will be kept under my care, will be taken cared of with utmost security, and will not be shared to anyone else. Strength of the Study: Quantitative research design used to investigate the effect of stress among the newly hired nursing staff working with and without working experience in somers psychiatric unit is an excellent way of analyzing the results that I will be generating in the future from the research investigation and to find out whether or not to prove or disapprove the hypothesis I made. Shuttleworth (2008) stated that for centuries, this research design has not changed as well as the standards and discipline in the scientific fields. The external factors that may contribute to the results of this study such as the current stressful situations of the nurses at home that may possibly contribute to stress at work is filtered in this study making this study real and not biased. Weakness of the Study: This research may take a lot of time to execute. Like in this study, the researcher planned to commence after the proposal is approved, and it is projected to take at least two years to finish its course on investigation because of the study design. Shuttleworth (2008) reported that quantitative research design has a little chance for grey areas since the design itself is geared to prove or unproved the test results. Dissemination of the Study: The ethical obligation of the researcher and the publisher will be practiced, especially in dealing with the sensitive issues of the subjects. The researcher is obliged and is responsible in preserving the accuracy of the research results during publication. Negative and positive results alike will be published so that this research study can make significant changes in the workplace of the newly hired nurses. Conclusion: The research proposal, once approved and carried out, would answer the question whether having a preceptor reduces stress levels of newly hired nurses as opposed to the newly hired nurses with no assigned preceptor. Once approved, the actual research study would be welcome by the management of the psychiatric unit of Somers ward as this will be foreseen as beneficial to the nursing staff, management, and patients. References: 1. Ahsan, N., Abdullah, Z., Fie, D., and Alam, S., 2009. A Study on Job Stress on Job Satisfaction among University Staff in Malaysia: Empirical Study. European Journal of Social Sciences, [Online] Available at: [Accessed 28 November 2011]. 2. The Association of Professors of Gynecology and Obstetrics, undated. The Effective Preceptor Series [pdf] Available at: [Accessed 30 November 2011]. 3. Burns, C., Beauchesne, M., Kause, P., and Sawin, K., 2006. Mastering the Preceptor Role: Challenges of Clinical Teaching. Journal of Pediatric Health Care, [E-journal], Available through: Medscape Database [Accessed 30 November 2011]. 4. European Foundation for the Improvement of Living and Working Conditions, 2007. Work – Related Stress. [Online] Available at: [Accessed 17 November 2011]. 5. Eysenck, M., 2004. Research Methods: Data Analysis. [online] Available at [Accessed 30 November 2011]. 6. Family Doctor, 2011. Stress: How to Cope Better with Life’s Challenges. [Online] Available at: [Accessed 18 November 2011]. 7. Jennings, B., Undated. Work Stress and Burnout Nurses: Role of the Work Environment and Working Condition. [Online] Available at: [Accessed 20 November 2011]. 8. Lambert V. and Lambert C., 2008. Nurses’ Workplace Stressors and Coping Strategies. Indian Journal of Palliative Care, [E-journal], 14(1), Available through: Medscape Database [Accessed 30 November 2011]. 9. Lamontagne, A., Keegel, T., Loiue, A., Ostry, A., and Landsbergis, A., 2007. A Systematic Review of the Job Stress Intervention Evaluation Literature, 1990 – 2005. International Journal of Occupational Environmental Health, [E-journal] 13(3), pp. 268 – 280. 10. Marrow, A., 2011. Stress Definition. [Online] Available at: [Accessed 19 November 2011]. 11. Melliken, T, Clements, P., and Tillman, J., 2007. The Impact of Stress Management on Nurse Productivity and Retention. [Online] Available at: < http://www.medscape.com/viewarticle/562717> [Accessed 18 November 2011]. 12. Moyer, V., 2008. Weighing the Evidence: PICO questions: What are they, and why mother. [Online] Available at: < http://aapgrandrounds.aappublications.org/content/19/1/2.full> [Accessed 30 November 2011]. 13. McVicar, A., 2003. Workplace Stress in Nursing: a Literature Review. Journal of Advanced Nursing, 44(6): 633-642. 14. Ross, C., 2008. Literature Review for Nursing Stress Intervention. [Online] Available at: < http://ezinearticles.com/?Literature-Review-For-Nursing-Stress-Interventions&id=1534683> [Accessed 20 November 2011]. 15. Reh, J., 2011. How to Help Reduce Stress at Work. [Online] Available at: [Accessed 19 November 2011]. Read More