A Research proposal on

“Stress and Management Practice Among Staff Nurses Working in NPI Hospital”

Researcher Advisor Prepared by student

Ms Reetu Ghimire Monika Malla

Lecturer, NPI Roll No 20

TABLE OF CONTENT

Chapter I Introduction

1.1 Background of the study

1.2 Rational for the study
1.3 Objectives of the study
General objectives
Specific objectives
1.4 Significance of the study
1.5 Conceptual framework
1.6 Research variable
1.7 Operational Definition
1.8 Delimitation of the study
CHAPTER II REVIEW OF RELATED LITERATURE
2.1 Introduction
2.2 Review of Related Literature
2.3 Summary of Reviewed Literature
CHAPTER III
Research methodology
3.1 study design
3.2 study population
Setting/ place of the study
Inclusion criteria
Exclusion criteria
Sampling criteria
Sample size calculation
3.3 instrument
Validity and Reliability
Ethical consideration
3.4 plan for data collection
3.5 plan for data analysis
3.6 References
Work plan
Budgeting plan
Appendices
consent form
CHAPTER I

INTRODUCTION

Background of the Study

Stress is the biological response to events that threaten to overwhelm the individual capacity to cope
satisfactorily in the environment. (Oyendira. 2004). Nurse’s Professionals experience an overwhelming
level of stress due to socio demographic and work place related factor. (Baniya A , Paudel A.K, Chhetri
M.R, Thapa P 2021).

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

This study aimed to describe how much nurses managed their stressful events and to define the affecting
factors regarding stress management with regards to nurse working in psychiatric units, a review showed
that a variety of factors are influencing the stress factors and job satisfaction of nurse.particularly
important to these are clinical leadership and quality inter professional collaboration. It was found out that
the job satisfaction of nurses is influenced by psychological stress and the quality of the clinical
leadership (konstantinos and ouzouni 2008)

In a study conducted by AbuALRub (2004) regarding the effect of stress on the job performance of
nurses, as well as the revelance of support system, it was found out that social support system is important
at the work place as it enhances the level of job performance and decreased the level job stress being
reported.The result also demonstrate that nurses that are reported with moderate level of job stress
perform their jobs better rather than those with high or low level of stress.

Nursing is a stressful profession with long working hours, ethical dilemmas, and pressure of having
responsibility for patients' life support care. Stress causes behavioral, professional, social and economic
impact on person’s under stress for long time. Current review focuses on stress in nursing profession and
strategies that are found effective in coping against the stress. Awareness regarding stress and its
management is important for nurses so that they can take preventive corrective measure as stress in
nursing profession is inevitable. Nurses must recognize the sign and symptoms of stress to aid personal
coping, as well as to design stress management interventions for their clients and families.(Sharma p,
Maheshwari S.K 2018).

According to Code of Ethics for nurses, ‘’the nurse promotes, protects, and advocates for human rights,
shares the responsibility and supporting human needs, provides the quality of health and patient’s safety’’
(ICN Code 2012). Therefore, it is important to search for sources that could promote the quality of
healthcare delivery by nurses such as the stress management.

The stress management interventions studies conducted in the UK established that :

• Training in behavioural techniques improved work satisfaction and levels of sickness and reduced strain
in psychiatric nurses. The behavioural training therapy that was provided aimed to improve nurses’
preparation for therapeutic tasks by helping them to develop skills and knowledge so that they could more
effectively deal with patient problems. The areas that the training covered included behavioural
assessment and learning and behavioural therapy (Milne et al. 1986).

• Personal stress management relaxation techniques significantly improved psychiatric nurses’ ability to
cope with anxiety and stress. The relaxation training used was Jacobsen’s progressive muscle relaxation.
The participants were also introduced to other forms of relaxation, including clinically standardized
meditation, biofeedback, autogenics and self-hypnosis, and asked to choose which method they felt most
suitable to them. They then used that method for the period of the study (Watson 1986).

• Stress management workshops were effective in reducing levels of burnout for psychiatric nurses. Those
offered looked at concepts of stress and burnout, principles of stress management and progressive
muscular relaxation. After a period of discussion, the various strategies that had been attempted formed
the basis of a further session and participants were given the opportunity to talk through any difficult
situations that they had encountered (Kunkler& Whittick 1991).

• Social support-based programmes for psychiatric nurses’ offered no significant advantage over feedback
only. The intervention presented a social support model which examined the impact of life events and
stress and asked participants to identify individuals who provide social support and to draw up a social
support network (Carson et al. 1998).

• Levels of psychological distress and burnout significantly decreased following attendance at a 15-week
training course in therapeutic skills. There was no further benefit attained from attending a casework
discussion group. The aim of this intervention was to impart type A therapeutic skills based on Egan’s
three stage model of counselling, and then to offer a safe forum for the exploration of clinical work
(Lemma 2000).

• Training a group of forensic mental health nurses in psychosocial interventions had a significantly
positive effect on levels of burnout. The aim of psychosocial interventions is to help clinicians to
conceptualize their patient’s problems within a more empathetic framework, and to train them in the skills
to intervene effectively (Ewers et al. 2002).

Rational for the study

Stress is an emotional and physical reaction and is caused by imbalance between individual’s priorities
and resources. As nurses are concerned, stress among them is prone to take place since they have to
perform monotonous and complex nature of task repeatedly. Nursing profession is a highly stressful
profession and stress among nursing professionals is becoming a crucial issue in health care delivery
system. Factors such as age, marital status, workload, sleeping hours, working hours, procedural injustice,
role ambiguity, conflicts in family or at workplace and environment affect mental health and job
performance. However, there is a research on level of stress among working nurses in Nepal including
developing countries. So, this is cross-sectional hospital-based study was done to assess level of stress
and influencing factors among working nurses of Hospital in Kathmandu, Nepal. (Baniya A , Paudel
A.K, Chhetri M.R, Thapa P 2021).

A study done hospitals of Kathmandu found that large majority (79.6%) of nightshift working nurses had
moderate level of perceived stress, followed by low level stress (15.5%) and high level of perceived stress
(4.9%). So, moderate, level stress among nightshift working nurses in Hospitals of Kathmandu, Nepal is
found alarming. There is significance association between sleeping hours of the nurses and stress. Longer
hours of working in nightshift, shorter hours of sleeping, unequal and overloaded duty were the main
factors related to higher rates and severity of self-reported stress among nurses, which seeks immediate
attention. This finding has also some clear implications for mental health policy and for hospital
management. There is urgent need to develop workplace mental health policies, workplace mental health
promotion programs and effective supports within workplaces for nurses experiencing significant mental
health problems. These developments are essential for improving quality of services and safety of patients
and staff in high pressure environments in hospitals. Nepal (Baniya A , Paudel A.K, Chhetri M.R, Thapa
P 2021).

A study done in USA found that 92 percent of the nurses had moderate-to-very high stress levels and 78
percent of them slept less than 8 hours of sleep per night; cross sectional study done in India noted 1%
mild stress, 39.5% moderate stress and 59.5% severe stress among the nurses;23 the higher the job stress
scores were, the worse the quality of sleep among the nurses in China;24 significant correlation was
observed between stress and sleep (Spearman Analysis; r = 0.21318; p = 0.0026) in Brasil25 and 59.3%
of nurses experienced moderate level stress, 36.8% severe, 2.4% experienced very severe stress in Goa of
India.26 Based on these review, it is clear that the results of current study is found compatible with
previous studies; however finding of this study were not well-matched with some of the previous results
because of variances in study design, sampling method, data collection tool and age of the respondents .
(Baniya A , Paudel A.K, Chhetri M.R, Thapa P 2021).
A study revealed that stress can directly contribute towards absenteeism, decreased work performance
and ultimetly burnout.Nurses encountering ongoing stress are more likely to eat poorly, smoke and abuse
alcohol and drugs, all of which can lead to negative health conditions affecting personal wellbeing errors
( Jones, Tasnigawa and Weiss, 2003).

A study revealed stress related physical illness includes heart disease, migraines, hypertension, irritable
bowel syndrome, muscle , back and joint pain and duodenal ulcer (Moustaka and Constantinidis,2010).

A Study conducted in Brazil revealed that 24% of participants were not stressed, 34% were mildly stress,
while 28% were averagely stressed and 12% were much stressed. Only 25% were extremely stressed.
Task conflict, coercive power and age were considered to be the main cause for occupational stress which
accounted 36% ( costa abd Martins, 2011).

Data reports that 75-90% of adults visit to primary care physicians are for stress related problems. Studies
show that stress at work results sleep problems and mental health impairment (Benoliel et al., 1990
survey has reported that 75% of the general population experiences at least "some stress
essays/management/introduction vref=1.)". Women who work full the age of 13 report the greatest stress
worldwide (https://www.ukessays.com/ essays/management/introduction to-stress-management. php?
vref=1. Nurses experiencing the highest stress related to the pressure of having responsibility for patients'
life support care (Fagin et al., 1996).

A study conducted in the Netherlands investigated the effectiveness of primary nursing on levels of
burnout. The intervention involved the introduction of an innovation in nursing care delivery, with a
special focus on primary nursing. The principles of primary nursing are that each patient is assigned to a
nurse and the nurse takes 24-hour responsibility for that patient’s care, with care being focused on the
needs of the patient rather than the needs of the ward. Burnout was measured using the Dutch version of
the MBI 1Æ5 years before primary nursing was introduced and then 1 year afterwards. A random sample
of 492 of a potential 725 nurses working on 35 long-stay wards from 43 psychiatric hospitals were
surveyed. The response rate was 73% (n ¼ 361). Only 161 (49%) completed the measures at all three
time points and, of those, 60 received the intervention. There were no further details provided of how the
sample was divided into the intervention and control wards. The sample was a mixed sample of unit
leaders, mental health nurses, practical nurses Integrative literature reviews and meta-analyses Stress
management interventions for mental health nurses , practical nurses and nurses’ aides. Result showed
that levels of burnout did not change. The authors recognized the limitations of their study. They reported
that attrition was a serious problem, which resulted in loss of participants at different time points, that the
control groups could have been affected by the interventions, and that the period of intervention might
have been too short (Melchior et al. 1996).

Objectives of the study

General objectives

To assess the stress and management practice among staff nurses working in npi hospital.
Specific objectives

To identify the level of stress among staff nurses working in NPI hospital.

To identify the factors affecting the level of stress.

To find out which stress contributing factors effect on stress and which factor affect least.

To find the remedial measures to prevent stress .

Significance of the study

The research finding will provide information about the level of stress among working nurses, the factor
associated and stress and management practice.

The findings might be helpful to the hospital managers and staffs to adopt various measures and
techniques to prevent and manage stress and assure quality work performance.

The findings will provide basis for future researches.

 Conceptual framework
Management of work stress
Socio demographic factors : age, ethnicity, marital status, educational status, work experience
Personal approach:
Time management
Physical exercise
Relaxation exercise
Social support

cian related, peers related, supervision related, workload, death and dying, patient and family, inadequate emotional status

WORK STRESS

Organizational approach:
Selection and placement
Goal setting
nstitution related factors: Area of working, uncertainty concerning treatment services, discrimination Job redesign
Participative decision making
Organizational communication
Welfare programs

Figure 1: Conceptual Framework

Research variable

Work stress

Research questions

What is the level of stress among working nurses ?

What are the factors affecting the level of stress?

What is the association between the stress of working nurses and the factors affecting the level of stress?

What are the stress and management practice among staff nurses working in NPI hospital?

Operational definition

Stress and management practice among staff nurses working in npi hospital-For the purpose of this study
refers to the possession of facts or informations regarding stress and management practice among staff
nurses working in hospital.

It refers to the stress experienced in terms of working hours, working loads stressors, releation with peers
stressors, supervisor stressors, physician , patient and family stressors, uncertainty to treatment stressors,
inadequate emotional preparation stressors, death and dying stressors and as well as discrimination
stressors which will be measured by using Standard Expanded nursing stress scale. Total score related to
stress will be obtained by using Standard Tool Expanded Nursing Stress Scale which determines the
stress level based on nine different stressors as mentioned above.

Scores ≤50 would be considered as no stress.

Scores ranging from 51-100 would be considered as mild stress.

Scores ranging from 101-150 would be considered as moderate stress.

Scores ranging from 151-200 would be considered as severe stress.

Delimitation of study

This study will be limited to working staff nurses of NPI Hospital.

CHAPTER II

Introduction

A literature review is a critical analysis of published sources, or literature, on a particular topic. It is an

assessment of the literature and provides a summary, classification, comparison and evaluation. Review
of literature is a broad, comprehensive, in depth , systematic and critical summary of topic of interest by
seeking pertinent literatures on Google scholars, journals, Pub med and Hinari by using key words.

Review of Literature
The stress issue is a common datum. Magnitude of it is differs from country to country, industry to
industry, occupation to occupation and also according to the make-up of the work force. The problem of
stress not only affects the industry but also on health of the employees and social life of their families.
The stress take very often affects the working of worker & service provided by the hospital. It is one of
the utmost significant wide spread hurdle to working environment. It hampers the working environment
as well as the health of the employees. Primarily the causes of it must be identified and dealt carefully so
as to maintain holistic and sustainable development of the society. (Mahajan Y.P, 2018)

A study done in hospitals of Kathmandu found that large majority (79.6%) of nightshift working nurses
had moderate level of perceived stress, followed by low level stress (15.5%) and high level of perceived
stress (4.9%). So, moderate, level stress among nightshift working nurses in Hospitals of Kathmandu,
Nepal is found alarming. There is significance association between sleeping hours of the nurses and
stress. Longer hours of working in nightshift, shorter hours of sleeping, unequal and overloaded duty
were the main factors related to higher rates and severity of self-reported stress among nurses, which
seeks immediate attention. This finding has also some clear implications for mental health policy and for
hospital management. There is urgent need to develop workplace mental health policies, workplace
mental health promotion programs and effective supports within workplaces for nurses experiencing
significant mental health problems. These developments are essential for improving quality of services
and safety of patients and staff in high pressure environments in hospitals. (Baniya A , Paudel A.K,
Chhetri M.R, Thapa P 2021).

Seventy percent of nurses applied proper methods of stress management. Nursing staff possessed high
level of negative responses to stress (49%). This study showed significant affecting factors relating to
stress management as; age of respondent, gender, job experience, tenure status, shift of work and
workplace, factors relating to negative stress management were: gender, marital status and less job
experience. We concluded the way of responding to stress depends not only on the personality and one’s
defensive style but also in the workplace. It is preposterous to suppose any individual separately from
workplace thus more research is needed to identify how personal circumstances exacerbate workplace
stress, how they may possibly be used to reduce stress. In the proceed of seeking health and coping, the
specification of appropriate strategies ought to be developed and enhanced. (Laal M, 2013)

There is currently little knowledge on the coping mechanisms used by nurses to manage the stress and
adverse effects of a shift working schedule. This study provides important insights into the range of
individual coping strategies and organisational supports used by shift working nurses, highlighting
opportunities to promote constructive coping strategies in order to foster wellbeing. Individual coping
strategy themes supported the promotion of the benefits of social support, hobbies, time management,
mindfulness, exercise, diet, and sleep practices, while increasing awareness of the possible dangers of
social isolation and overreliance on substance use. Findings also suggest that, rather than simply
improving nurses’ abilities to employ effective coping strategies, workplaces also play a key role in
facilitating nurses’ wellbeing. The importance of organisational support highlights the need for
workplaces to consider shift workers’ preferences and needs, facilitating schedule requests and effective
support networks. Given that shift work is vital for health services and the work schedule of nurses, it is
important for nurses to adopt effective coping strategies to help handle the high demands associated with
the job, as well as in handling the adverse effects (e.g., excessive sleepiness and possible psychological
distress) of a shift working schedule, in order to foster wellbeing and ultimately sustainability in the
profession. (Savic M, Ogeil R.P, Sechtig M.J, Tobin P.L 2019).

A study conducted on stress among nurses working in critical areas at a tertiary care teaching hospital
Nepal revealed that majority of the respondents 56% had moderate stress followed by mild stress 34%,
sever stress 6%, whereas very less number of respondents 4% had no stress in their job setting(Mehta,
2014).

A study conducted in Gaza revealed a high prevalence of psychological distress (63%),

depression(59.7%) and trauma (69.4%) (Allahajar, 2013).

In Dubai , a study revealed 95% experienced different amount of stress due to their work, 86% of nurses
reported severe job stress less than age 36yrs (AL Rasasi, AL Faisal, EL Sawaf, Hussian, and
Wasfy,2015).

A study conducted in india on job stress and job satisfaction among nursing personnel through census
method incorporating 210 respondents showed that experienced nurses have more stress when compared
to other nurses.Stress score significantly differed across the departments; nurses working in ICU have
more stress when compared to nurses working in other departments (Aktharsha et al., 2011).

Summary of review literature

After going through various studies and literature related to stress level among the wprking nurses,
researcher here conclude that ICU,Oncology/ hemato oncology being the most sensitive areas. Nurses
have to do a laborious job and go through a stressful condition. Long working hours, dealing with dying
and death patients, work overloads; organizational barriers make their job more hectic to perform.

The causes of stress are needed to be dealt and coping strategies are needed to be applied to reduce the
stress and prevent or early detect the psychological disabilities among nurses.

CHAPTER III

Research Methodology

Research design

Descriptive cross – sectional research design will be used to find out the stress among nurses working in
NPI Hospital.

Study setting and population

Population _ All the nurses working at NPI Hospital.

Setting _ The study will be conducted at NPI Hospital .

Sampling _ Simple random sampling technique will be used to collect data.

Sampling size

The sample size will be calculated by using sample size formula :

n= zα2 pq/d2 (Daniel and Terrell, 1994)

where, prevalence of stress(p) = 56%= 0.56 (Mehta, 2014)

q= 1-p=1-0.56=0.44

sample frame (N) =130

zα (deviate corresponding to desired reliability level (5% of significance) =1.96

maximum tolerable error percentage(d)= 5%=0.05

Now using formula,

2
Z α pq
Sample size ( n0 )= 2
d
2
1.96 x 0.56 x 0.44
= 2 = 378.64
0.05

n0
Now, required Sample ( n r )=
[ 1+ ( n0 −1 ) / N ]
378.64
= = 96.92 ~ 97
[ 1+ ( 378.64−1 ) /130 ]
Actual required sample = n+10% (non response error =97+10=107

Thus, sample size will be 107.

Selection Criteria

Inclusion Criteria : All the registered nurses working at npi hospital with the qualification of
PCL and BSC nursing and BN who are ready to participate.

Exclusion Criteria : Those who are not willing to participate and those working at higher
authorities as ward supervisors and ward in charge.

Research Instrument

The instrument will be developed by reviewing literature, receiving comments and consulting
research advisor. A semi-structured self- administrated questionnaire will be developed.

The first part of the questionnaire included demographic information, the second part included
the level of stress which was determined will the help of standard tool ‘Expanded Nursing Stress
Scale’ and the third part included factors influencing level of stress and the fourth part included
assessment of stress management practice.

Validity and Reliability

The 57- item ENSS (Expanded Nursing Stress Scale) showed improved reliability α= 0.96

Individual subscale reliability ranged from α= 0.88 (problems with supervisor) to α= 0.65
(discrimination) which shows consistently higher Crohbach’s alpha values providing evidence of
internal reliability.

Crohbach’s alpha of each sub scale;

Conflict with physician (α=0.78)

Inadequate emotional preparation (α=0.74)

Problems with peers (α=0.70)

Problems with supervisors ( α=0.88)

Workload (α=0.86)

Uncertainty concerning treatment (α=0.83)

Patients and families (α=0.87)

Discrimination (α=0.65)

The majority of the correlations are modest, ranging from 0.7 to 0.17(French, lenton, Walters and
Eyles, 2000).

Data collection plan

Before data collection, permission for research will be taken from higher authorities of NPI-NSH
Nursing college and from the concerned administrative authorities of NPI Hospital. The list of
sample frame will be obtained from the administrative department of NPI Hospital.

Sample will be selected by lottery method and verbal permission will be taken prior data
collection from the respondents. Afterwards, verbal and written informed consent will be taken
from participants and questionnaires will be distributed among the different departments.
Anonymity will be maintained by giving coding number instead of name. the participants will be
assured that confidentiality will be maintained by not disclosing the information at the present as
well as in the future. Respondent’s dignity will be maintained by giving them rights to
discontinue from the interview at any time. Filled questionnaire will be collected back on the
same day of data collection.

Data Analysis plan

 The collected data will be checked for accuracy and completeness and then organized by coding.

Then the data will be entered in Epi data version 3.2 cleaning and was transferred in SPSS
version 20 for statistical analysis. Data will be analyzed by using descriptive as well as inferential
statistics. For descriptive statistics frequency, percentage, mean and standard deviation will be
used whereas, for inferential statistics chi square test will be used. The findings will be presented
in the form of table.

References

Work plan

SN Activities 1st 2nd 3rd 4th 5th 6th 7th 8th 9th
week week Week week week week week week week
1 Literature
Review
2 Problem
Selection
3 Topic
presentation
4 Proposal
Presentation
5 Instrumentation

6 Data collection

7 Data analysis

8 Report writing

9 Report
Budgeting plan

Sn Description Cost (Nrs)

1 Stationary 5000
2 Communication 500
3 Transportation 500
4 Ethical approval cost 500
5 Other miscellaneous 2000
Total 8500

APPENDIX A

AFFILIATED TO PURBANCHAL UNIVERSITY

NEPAL POLIYTEHNIC INSTITUTE

COLLEGE OF NURSING

Bharatpur- 11, Chitwan

Consent form

Research title: Stress and Management Practice Among Staff Nurses Working In NPI Hospital.

Objectives : To assess stress and management practice among staff nurses working in npi hospital.

Namaskar, I am Monika Malla, PBBN third year student of Nepal polytechnic Institute, Nursing College.
This Study is beind conducted for the partial fulfilment of the course objective of PBBN 3 rd year. The
purpose of the study is to find out the stress and management practice among staff nurses working in npi
hospital. Although this research will not benefit you directly, it will provide information about the stress
management practice among staff nurses working in hospital and the factors associated to the and the
stress level. The study and its procedure have been approved by NPI-NSH.

Respondents are kindly requested to attend the questions by making TICK (√) for your view. It will take
around 10 minutes. The information you supply would be used for the academic purpose and would be
kept very confidential. I would like to inform you that your participation in the study is voluntary. You
are free to terminate the questionnaire at any time without penalty or permission. The study data will be
coded and your identify will not be revealed and your confidentiality will be maintained when study
findings will be reported or published.

For the subject: I understand and got answer to my queries and agree to participate as research subject.

Signature of participant signature of investigator

............................................

.................................

Date ...............................

APPENDIX B

AFFILIATED TO PURBANCHAL UNIVERSITY

NEPAL POLYTECHNIC UNIVERSITY

COLLEGE OF NURSING

Bharatpur 11, Chitwan

Code No..................... Date of interview................................

Title: Stress management practice among staff nurses working in NPI Hospital.

Direction: please tick(√) the best options for each item and write your response in the space provided.

PART I

DEMOGRAPHIC CHARACTERITICS OF THE PARTICIPANTS.

1. What is your age? .........

2. Marital status
 Married
 Separated
 Divorced
  Single
3. How many children do you have? ........
4. Which type of family you belong to?
 Nuclear
 Joint
 Extended
5. What are your educational qualifications ?
 PCL Nursing
 BN
 BSC Nursing
 MN
6. Which ward are you currently working in?
.........
7. Have you ever performed supervisory role?
 Yes
 NO

8. Do you think that staffs are adequate for each shift?

 Yes
 No
9. Are you satisfied with your salary?
 Yes
 No

10. Do you have conflicts with colleagues working togther?

 Yes
 No

PART II Expanded Nursing Stress Scale

Below is a list of situations that commonly occur in a work setting. Please respond carefully
based on your perception regarding each item. This information will be kept confidential and
will be used for the research purpose only.

0 = Doesn’t apply 1= Never stressful 2= occasionally stressful

3= frequently stressful 4= Extremly stressful
 Expanded nursing stress scale (ENSS)
Please circle the one number for each question that comes closed to reflecting

Frequently stressful
Occasional stressful

Extremely stressful
your opinion about it.

Never stressful
Doesn’t apply
1 Workload stressor
1.1 Not enough time to provide emotional support to the patient. 0 1 2 3 4
1.2 Not enough time to respond to the need of patient’s families. 0 1 2 3 4
1.3 Not enough staff to adequately cover the unit. 0 1 2 3 4
1.4 0 1 2 3 4
Too many non- nursing tasks required, such as clerical work.
1.5 Not enough time to complete all of my nursing tasks. 0 1 2 3 4

1.6 Having to work through breaks 0 1 2 3 4

1.7 Having to make decisions under pressure 0 1 2 3 4
1.8 Not enough equipment supply / not functioning well 0 1 2 3 4
2 Problems with supervision stressors
2.1 Conflict with a supervisor 0 1 2 3 4
2.2 Lack of support from immediate supervisor 0 1 2 3 4
2.3 Criticism by a supervisor 0 1 2 3 4
2.4 Lack of support by nursing administrators 0 1 2 3 4
2.5 Being held accountable for things over which I have no control 0 1 2 3 4
2.6 Lack of support from other health care administrators 0 1 2 3 4
3 Problems with peers stressors
3.1 Lack of opportunity to talk openly with other personnel about problems 0 1 2 3 4
in the work setting.
3.2 Lack of opportunity to share experiences and feelings with other 0 1 2 3 4
personnel in the work setting.
3.3 Lack of opportunity to express to other personnel on the unit about my 0 1 2 3 4
negative feelings towards patients.
3.4 Difficulty in working with a particular nurse (or nurses) in my 0 1 2 3 4
immediate work setting.
3.5 Difficulty in working with a particular nurse (or nurses) outside my 0 1 2 3 4
immediate work setting.
3.6 Difficulty in working with nurses of the opposite sex. 0 1 2 3 4
4 Conflict with physician stressors
4.1 Criticism by a physician 0 1 2 3 4
4.2 Conflict with a physician 0 1 2 3 4
4.3 Disagreement concerning the treatment of a patient 0 1 2 3 4
4.4 Making a decision concerning a patient when the physician is 0 1 2 3 4
unavailable
 4.5 Having to organize doctor’s work 0 1 2 3 4

5 Death and dying stressors

5.1 Performing procedures that patients experience as painful 0 1 2 3 4
5.2 Feeling helpless in the case of a patient who fails to improve 0 1 2 3 4
5.3 The death of a patient 0 1 2 3 4
5.4 The death of a patient with whom you developed a close relationship 0 1 2 3 4
5.5 Physician’s not being present when a patient dies 0 1 2 3 4
5.6 Watching a patient suffer 0 1 2 3 4
6 Inadequate emotional preparation stressors
6.1 Feeling inadequately prepared to help with the emotional needs of a 0 1 2 3 4
patient’s family.
6.2 Being asked a question by a patient for which i do not have a 0 1 2 3 4
satisfactory answer
6.3 Feeling inadequately prepared to help with the emotional needs of a 0 1 2 3 4
patient
7 Uncertainty concerning treatment stressors
7.1 Inadequate information from a physician regarding the medical 0 1 2 3 4
condition of a patient.
7.2 A physician ordering what appears to be inappropriate treatment for a 0 1 2 3 4
patient.
7.3 Fear of making a mistake in treating a patient. 0 1 2 3 4
7.4 A physician not being present in a medical emergency. 0 1 2 3 4
7.5 Feeling inadequately trained for what I have to do. 0 1 2 3 4
7.6 Not knowing what a patient or a patient’s or a patient’s family ought to 0 1 2 3 4
be told about the patient’s condition and its treatment.
7.7 Uncertainty regarding the operation and functioning of specialized 0 1 2 3 4
equipment.
7.8 Being exposed to health and safety hazards 0 1 2 3 4
8 Patient and family stressor
8.1 Patient’s families making unreasonable demands 0 1 2 3 4
8.2 Being blamed for anything that goes wrong 0 1 2 3 4
8.3 Being the one that has to deal with patient’s families 0 1 2 3 4
8.4 Having to deal with abuse from patient’s families 0 1 2 3 4
8.5 Not knowing whether patient’s families will report you for inadequate 0 1 2 3 4
care
9 Discrimination stressors
9.1 Being sexually harassed 0 1 2 3 4
9.2 Experiencing discrimination because of race or ethnicity 0 1 2 3 4
9.3 Experiencing discrimination on the basis of gender 0 1 2 3 4

PART III

Please give your opinion / suggestion how stress of nurses working in critical care areas can be
decreased?
...................................................

....................................................

PART IV

Question related to assessment of stress management practice

1) Do you feel that you are stressed to much?

 Yes
 No
2) What do you think is the main reason for your stress?
 Personal reasons
 Working reasons
 Both
 None
3) If working are main cause of your stress. What do you think is the most important working factor
that is responsible for your stress?
 Time management
 Strict attitude of staff
 .......................( any other please mention)
4) If personal problems are the main cause of your stress. Mention the main reason for your stress.
Adjustment with friends / problems with friends
 Financial problems
 Health problems
 Any other.....
5) Which of the following stress management techniques do you follow? ( can select multiple)
 Yoga
 Meditation
 Exercise
 .........( any other)
6) Did you participate in yoga day organized in our working?
 Yes
 No
7) Do you have habit of using any of the following to fight with stress?
Smoking
 Alcohol
 Anti depressant drugs
 Anti anxiety drugs
 ...........( any others please mention)
8) Do you have habit of using any of these to stay awake during hectic duty?
 Tea
 Coffee
 Psychoactive drugs (like amphetamine ,Ephedrine , Modafinil etc.)
 ..............(any other please mention)
9) Do you share your problems with any one?
  Yes with family/ relatives
 Yes, with friends
 No
 ...................( any other please mention)
10) What change do you want in this working to make it a stress – free working place?
 Mandatory yoga / exercise classes
 Frequent working counselling
 Accessibility of staff
 .....................(any other please mention)
11) Which of the following symptoms do you experience during stress?
 Loss of appetite
 Sadness
 Muscle aches
 Nausea
 Insomnia
 Dry mouth
 Continuous headache
 ................... (any other please mention)

THANKYOU