Nursing stress

STRESS AMONG NURSING STAFF OF DIFFERENT HOSPITAL
OF SONIPAT (HARYANA)
Project report
For research academic purpose
MASTER IN HOSPITAL ADMINISTRATION
Submitted By:
PAWAN KUMAR
MHA (First year)
Roll No. 18001534012
Under the guidance of:
Dr.VANDNA SHARMA
Asst.Professor
DEPARTMENT OF MANAGEMENT STUDIES
DEENBANDHU CHOTU RAM UNIVERSITYOF
SCIENCE AND TECHNOLOGY
Murthal (Sonipat)
2019-2020

CERTIFICATE
This is to certify that the project work titled “Stress Among Nursing Staff
Of Different Hospital Of Sonipat (Haryana)” in partial fulfillment for the
research purpose from Guru Deenbandhu Chotu Ram University Of
Science and Technology, Murthal under my Guidance. The information
given is authentic and has not copied from any source. This work has not
been submitted in any other university.
Date: GUIDE:
Place: Dr. Vandna Sharma
Department of Management studies
DCRUST, Murthal

ACKNOWLEDGEMENT
I express my deep sense of gratitude to my advisor Dr. Vandana Sharma
Assistant professor , Department of Management studies, DCRUST
Murthal, for her constructive council, unmatchable suggestions, critical
appreciation and encouragement throughout my project. I also take this
opportunity to express my deep in depth to Dr. (Prof.) Rajbir Singh,
Chairman Department of Management Studies for the encouragement and
for providing necessary facilities during the course of this project.
I also thanks to my all subjects teachers for co-operating throughout my
survey.
Finally, I also feel completely ineffable to express my sincere regards to
my parents for their love, enthusiasm and constant encouragement during
the whole period of my project.
(PAWAN KUMAR)

CONTENTS
CERTIFICATE
ACKNOWLEDEMENT
CHAPTER 1 INTRODUCTION
CHAPTER 2 REVIEW OF LITERATURE
CHAPTER 3 RESEARCHMETHODOLOGY
 Type of study
 Place of study
 Sampling method used
 Sample size
 Objective of study
 Instruments
 About ENSS
 Sampling area
CHAPTER 4 RESULT/ DATA INTERPERTATION
CHAPTER 5 REFERENCE
APPENDICES
APPENDIX – A DATA COLLECTION FORM
.

DEDICATED
TO GOD
AND
MY FAMILY
&
FRIENDS
FOR THEIR
INVALUABLE
SUPPORT
GUIDANCE
LOVE
AND
BLESSING

Chapter-1 Introduction
Stress in the workplace is often referred to as occupational stress. The basic rational underpinning
the concept is that work situation has certain demands, and that problems in meeting these can lead
to illness or psychological distress. Occupational stress is a major health problem for both
individual employees and organizations, and can lead to burnout, illness, labour turnover,
absenteeism, poor morale and reduced efficiencyand performance Stress is the body's
reaction to a change that requires a physical, mental or emotional adjustment or response as defined
in Wikipedia. Stress is experienced by human being early, even before human are born. A small
amount stress is normal and necessary for surviving (Middlebrooks, J. S. &Audage, N. C. 2008) or
stress may be defined as change in body,s reaction which require a physical, emotional and mental
adjustment and response. Stress may come from different situation or response or ideas or filling
that makes a person feel frustrated, angry nervous or anxious.
Way back in 1960s, A Canadian endocrinologist and renowned stress theorist
Hans Selye noted, “No one can live without experiencing some degree of stress all the time”
In the European Union, stress is the most commonly found occupational risk. It comes after the
musculoskeletal and back pain. And it is also second most prevalent work associated health
problems. According to WHO Expert Committee (1985), work-related diseases are defined as a
“wide spectrum of diseases of multifactorial etiology, which are partly associated with profession
or working conditions”. Stress can influence all group of worker and all professional field.
In hospital, health care worker are highly exposed to higher level of occupational stress which
comes due to heavy work-loads, expending working hours and high level of pressure. Hospital
health care professional including physician and nurse, at the higher risk of affecting from mental
disorder as compare to the general population.
Nursing is a unique occupation which is characterized by the help of number of feature, which are
not experienced in other profession. These are not dealing only with situation, but dealing with
death and dying on regular basis.
In Karnataka (India), a study on work related stress of nurse is performed by the author Mr.
Shivaprasad (2013). The study result is problem relating to peer is (64%), death and dying (60%),
and problem relating to supervisors (56%). The investigators recommend that hospitals should take
counter measure to relive stress among nurses as nursing is regarded as apotentially stressful
occupation.

Chapter-2 Review of literature
A study was done by Dragana MILUTINOVIC, Boris GOLUBOVIC (2012) at all, on the nurses in
the Serbia, to identify and analyse professional stress in the nurse of Serbia. The research designed
as a cross study. Expended nursing stress scale (ENSS) was used as ainstrument . In this study the
respondent grouped according to their age (20 to29), 30 to 39, 40 to 49, 50 and over). For study
analysis ANOVA, means, standard devation are used as statistical tools. After the analysis death
and dying situations are most stressful, M=2.87; SD=0.92, where the problem with peers grouped
situations are rated M=2.09 and were considered the least stressful. The results also shows that
nurse in age category 30 to 39 years experienced a higher stress level as compare to younger co-
worker.
In Macao, a study was done by Ming Liu, Ken Gu at all (2015), The title of the study was
“perceived stress among Macao nursing students in the clinical learning environment”. Across
section study designed was used and the sampling size is 203 nursing students of higher education
institute of Macao.
To measure the nursing stress the stressors in nursing students Scale-Chinese version (SINS-CN).
The result showing overall SINS-CN mean score was 3.33 (SD=0.49),score of different
dimensions were: clinical, 3.44 (SD=0.54), education, 3.35 (SD=0.62), finance and time,3.31
(SD=0.72),confidence,3.21 (SD=0.60). and personal problem, 3.03 (SD=0.68).
Conclusion of this study was the Macao students ,experienced stress in clinical learning
environment. The most common stressors were related to educational and clinical dimensions.
In Taiwan, a study was done by Yueh-Chi and Chieh-Hsing Liu (2010).The title of the study was
“Factor and symptoms associated with work atress and health-promoting lifestyle among hospital
staff: aapilot study in Taiwan”
The study was done on the health wirker including physicians,nurses,medical technicians and
administrative staff.The study was conducted from may 1, 2010 to july 30,2010. The sample size of
the study was 775 professional health care worker. The instruments used in this study, Chines
version of job Content questionnaire (C-JCQ) and the health promoting lifestyle profile (HPLSP).
Result of this study was indicating that work related stress included 64.4% of subjects reporting
nervousness, 33.7% nightmares, 44.1% irritability. 40.8% headaches, 35.0% insomnia, and 41.4%
gastrointestinal upset.
The conclusion of this study, the researcher found that little decision-making authority, and low
level of social support were associated with the development of stress related symptoms.

Chapter-3 Research Methodology
Objective of study
To find out stress in nurse of different hospital of sonipat
Study design
The study was cross-sectional descriptive design using expended nursing stress scale (ENSS)
For data collection
Sampling and setting
The research was carried in the ICU,CCU,Ward,operation theatre, private room of the three
hospital namely Nidaan multispecialty hospital Sonipat, Civil hospital Sonepat, Tulip
multispecialty hospital Sonipat.The comprised of staff nurse working in multispeciality hospital
which mention above. Non probability convenient sampling technique was used for selection of 62
staff nurses.
Instruments
To evaluate and assess the stress among the nurses staff in different hospital of sonipat, we using
the expended nursing stress scale(ENSS).
About expended nursing stress scale (ENSS)
The ENSS is an advanced version of nursing stress scale (NSS). The NSS having 34 items,The NSS
is supported by the psychological model of the stress which are described by Appley and Trumbull
(1967), Lazarus (1966), and Lazarus and Folkman (1984).
The model develop a dynamic relationship between the person, the environment, and cognitive
appraisal of social demand as endangering well-being.
59 item ENSS was developed by Gray-Toft and Anderson (1981). Researcher use 59 item ENSS
which are related to physical, psychological, and social working environment All of 59 items are
arranged into Likert response scale which include following point;
Does not apply (0)
Never stressful (1)
Occasionally stressful (2)
Frequently stressful (3)
Extremely stressful (4)
The response (0) is specify that the respondent had never faced this type situation.
The response (1) indicated that respondent face particular but never stressed.
The response (2) indicated that respondent face particular situation and stress some time.
The response (3) indicate that respondent face situations and stress generally and at a time of
occurring of situation
The response (4) indicate that the respondent highly stressed when he or she faced the situation.
Data collection/procedure

The questionnaire was delivered to all nursing staff (62), after this sample was collected same day
or next day. The questionnaire was protected in locked cabinet. The information related to nursing
staff was not share with any one. Information collected regarding to nursing staff only for research
purpose.Questionnare was discarded after the use in the research.
Sample size
Sample size is 62 participants both male and female nurse of different hospital of sonipat.
Sample area
Researcher select the three hospital of sonipat namely
1. Tulip multispeciality hospital
2. Nidaanmultispeciality hospital
3. Civil hospital
Source of data collection
Primary data collection is the source of data collection

Chapter-4 Result / data interpretation
Frequencies
Frequency Table
Age (Year)
Frequency Percent Valid Percent
Cumulative
Percent
Valid 20-29 41 66.1 66.1 66.1
30-39 18 29.0 29.0 95.2
40-49 2 3.2 3.2 98.4
>50 1 1.6 1.6 100.0
Total 62 100.0 100.0
Maximumfrequencyforthe age of respondentsare (20-29) and minimumfrequencyforage of
respondentsare (>50)
Maximum percentage for the age (20-29) is 66 and minimum percentage for age (>50) is only 1.6
Statistics
Age (Year) Name of Hospital Gender Marital status Edu.level Work Exp (Year)
Working
unit
N Valid 62 62 62 62 62 62 61
Missing 0 0 0 0 0 0 1
Mean 1.40 1.84
Std. Deviation .639 .793 .
Name of Hospital

Rrespo
ndent
from the Tuip multispeciality hospital is 25 (40.3%), Rrespondent from the Nidaan multispeciality
hospital is 22 (35.5%), Rrespondent from the Civil hospital is 15 (24.2)
Gender
Cumulative
Percent
Valid male 14 22.6 22.6 22.6
female 48 77.4 77.4 100.0
Total 62 100.0 100.0
Male respondents are 14 (22.6%),Female respondents are 48 (77.4%)
Married respondents are 42, unmarried respondents are 20
Edu.level
Cumulative
Percent
Valid Diploma 45 72.6 72.6 72.6
Graduation 17 27.4 27.4 100.0
Total 62 100.0 100.0
Level of education “Diploma”respondents are 45
Level of education “Graduation”respondents are 17
Cumulative
Percent
Valid tulip multispecialityhospital
(sonipat)
25 40.3 40.3 40.3
nidaan multispeciality
hospital (sonipat)
22 35.5 35.5 75.8
civil hospital (sonipat 15 24.2 24.2 100.0
Total 62 100.0 100.0
Marital status
Cumulative
Percent
Valid married 42 67.7 67.7 67.7
unmarried 20 32.3 32.3 100.0
Total 62 100.0 100.0

Work Exp (Year)
Cumulative
Percent
Valid 0 4 6.5 6.5 6.5
<1 13 21.0 21.0 27.4
2-5 15 24.2 24.2 51.6
6-10 14 22.6 22.6 74.2
11-15 11 17.7 17.7 91.9
16-20 1 1.6 1.6 93.5
21-25 1 1.6 1.6 95.2
26-30 2 3.2 3.2 98.4
8 1 1.6 1.6 100.0
Total 62 100.0 100.0
Maximum work experience of respondents are “2-5 year”are 15 (24.2%)
Maximum respondents work in ward 20 (32.3%)
Minimum respondents work in Private room 1 (1.6%)
Bar Chart
Working unit
Cumulative
Percent
Valid ICU 14 22.6 23.0 23.0
CCU 12 19.4 19.7 42.6
Ward 20 32.3 32.8 75.4
Operation room 14 22.6 23.0 98.4
Private room 1 1.6 1.6 100.0
Total 61 98.4 100.0
Missing System 1 1.6
Total 62 100.0

Reliability
Case Processing Summary
N %
Cases Valid 53 85.5
Excludeda
9 14.5
Total 62 100.0
a. Listwise deletion based on all variables in the
procedure.
Reliability Statistics
Cronbach's
Alpha N of Items
.909 59
Frequency Table

Performing procedures that patients experience as painful
Cumulative
Percent
Valid Does notapply 6 9.7 9.7 9.7
Never stressful 16 25.8 25.8 35.5
Occasionallystressful 24 38.7 38.7 74.2
Frequently stressful 12 19.4 19.4 93.5
Extremly stressful 4 6.5 6.5 100.0
Total 62 100.0 100.0
Criticism by a physician
Cumulative
Percent
Total 62 100.0 100.0
Feeling inadequately prepared to help with the emotional needs of a patient's family
Cumulative
Percent
Total 62 100.0 100.0
Lack of opportunity to talk openly with other personnel about problems in the work setting.
Cumulative
Percent
Total 62 100.0 100.0

Conflict with a supervisor
Cumulative
Percent
Total 62 100.0 100.0
Breakdown of computer
Cumulative
Percent
Total 62 100.0 100.0
Inadequate information from a physician regarding the medical condition of a patient
Cumulative
Percent
Total 62 100.0 100.0
Patients making unreasonable demands
Cumulative
Percent
Total 62 100.0 100.0

Being sexually harassed
Cumulative
Percent
Total 62 100.0 100.0
Feeling helpless in the case of a patient who fails to improve.
Cumulative
Percent
Total 62 100.0 100.0
Conflict with a physician
Cumulative
Percent
Total 62 100.0 100.0
Being asked a question by a patient for which I do not have a satisfactory answer
Cumulative
Percent
Total 62 100.0 100.0

Lack of opportunity to share experiences and feelings with other personnel in the work
setting
Cumulative
Percent
Total 62 100.0 100.0
Floating to other units/services that are short-staffed
Cumulative
Percent
Total 62 100.0 100.0
Unpredictable staffing and scheduling
Cumulative
Percent
Total 62 100.0 100.0
A physician ordering what appears to be inappropriate treatment for a patient
Cumulative
Percent
Total 62 100.0 100.0

Patients' families making unreasonable demands
Cumulative
Percent
Total 62 100.0 100.0
Experiencing discrimination because of race or ethnicity
Cumulative
Percent
Total 62 100.0 100.0
Listening or talking to a patient about his/her approaching death
Cumulative
Percent
Total 62 100.0 100.0
Fear of making a mistake in treating a patient
Cumulative
Percent
Total 62 100.0 100.0

Feeling inadequately prepared to help with the emotional needs of a patient
Cumulative
Percent
Total 62 100.0 100.0
Lack of an opportunity to express to other personnel on the unit my negative feelings
towards patients
Cumulative
Percent
Total 62 100.0 100.0
Difficulty in working with a particular nurse (or nurses) in my immediate work setting
Cumulative
Percent
Total 62 100.0 100.0
Difficulty in working with a particular nurse (or nurses) outside my immediate work setting
Cumulative
Percent
Total 61 98.4 100.0
Total 62 100.0

Not enough time to provide emotional support to the patient
Cumulative
Percent
Total 62 100.0 100.0
A physician not being present in a medical emergency
Cumulative
Percent
Total 61 98.4 100.0
Total 62 100.0
Being blamed for anything that goes wrong
Cumulative
Percent
Total 62 100.0 100.0
Experiencing discrimination on the basis of sex
Cumulative
Percent
Total 62 100.0 100.0

The death of a patient
Cumulative
Percent
Total 62 100.0 100.0
Criticism by a supervisor
Cumulative
Percent
Total 62 100.0 100.0
Disagreement concerning the treatment of a patient
Cumulative
Percent
Total 62 100.0 100.0

Not enough time to complete all of my nursing tasks
Cumulative
Percent
Total 62 100.0 100.0
Not knowing what a patient or a patient's family ought to be told about the patient's
condition and its treatment
Cumulative
Percent
Total 62 100.0 100.0
Being the one that has to deal with patients' families
Cumulative
Percent
Valid
Having to deal with violent patients
Cumulative
Percent
Total 62 100.0 100.0
Does notapply 6 9.7 9.7 9.7
Total
62 100.0 100.0

Being exposed to health and safety hazards
Cumulative
Percent
Total 62 100.0 100.0
The death of a patient with whom you developed a close relationship
Cumulative
Percent
Total 62 100.0 100.0
Making a decision concerning a patient when the physician is unavailable
Cumulative
Percent
Total 62 100.0 100.0
Being in charge with inadequate experience
Cumulative
Percent
Total 62 100.0 100.0

Lack of support by nursing administrators
Cumulative
Percent
Total 62 100.0 100.0
Too many non-nursing tasks required, such as clerical work
Cumulative
Percent
Total 61 98.4 100.0
Total 62 100.0
Not enough time to respond to the needs of patients' families
Cumulative
Percent
Total 62 100.0 100.0
Being held accountable for things over which I have no control
Cumulative
Percent
Total 62 100.0 100.0

Physician(s) not being present when a patient dies
Cumulative
Percent
Total 61 98.4 100.0
Total 62 100.0
Having to organize doctors' work
Cumulative
Percent
Total 62 100.0 100.0
Lack of support from other health care administrators
Cumulative
Percent
Total 62 100.0 100.0
Difficulty in working with nurses of the opposite sex
Cumulative
Percent

Total 61 98.4 100.0
Total 62 100.0
Demands of patient classification system
Cumulative
Percent
Total 62 100.0 100.0
Having to deal with abuse from patients' families
Cumulative
Percent
Total 61 98.4 100.0
Total 62 100.0
Watching a patient suffer
Cumulative
Percent
Total 62 100.0 100.0
Criticism by nursing administration
Cumulative
Percent

Total 62 100.0 100.0
Having to work through breaks
Cumulative
Percent
Total 60 96.8 100.0
Total 62 100.0
Not knowing whether patients' families will report you for inadequate care
Cumulative
Percent
Total 61 98.4 100.0
Total 62 100.0
Having to make decisions under pressure
Cumulative
Percent
Total 62 100.0 100.0

Chapter-5 Reference
1.Tao Hong, Ellenbacker H. Carlo, et al(2015). Examining perception of job satisfaction and
intention to leave ICU nurses among ICU nurses in China,International journal of nursing sciences
(141-148)
2.French.E.Susan, Lenton Rhonda, et al, An empirical evaluation of an expanded nursing stress
scale.Journal of nursing measurement,Vol 8 (161-178)
3. Milutinovic Dragana, Golubovic Boris (2012), et al. Professional stress and health among
critical care nurse in Serbia.Arh Hig Toksikol 2012;63:171-180
4. Amati Monica, Tomasetti Marco, et al (2009). Relationship of job satisfaction, psychological
distress and stress-related biological parameters among healthy nurse: a longitudinal study.
Journal of occupational health (1-19).
5.Ming Liu,Gu Ken, et al (2015) .Perceived stress among macao nursing students in the clinical
learning environment. International journal of nursing sciences (128-133)
6.Rogers E. Ann, Hwang Wel-Ting, et al (2004). The working hours of hospital staff nurses and
patient safety. Health affairs-vol 23 (202-212)
7. Laal Marjan (2013), job stress management in nurses. Procedia- social and behavioral science 84
(437-442)
8. Tsai Yueh-Chi,Liu Chieh-Hsing (2012). Factors and symptoms associates with work stress and
health-promoting lifestyle among hospital staff: a pilot study in Taiwan Tsai and Liu BMC Health
services research (1-8)
9.A.H. Shivprasad.,PGCDE, RN.Work related stress of nurses. Journal of psychiatric nursing (53-
58)

Appendix
APPENDIX (A): EXPANDED NURSING STRESS SCALE
Age: …………..
What is your Gender?
A) Male
B) Female
What is the highest level of nursing education that you have?
A) Diploma
B) Graduation
c) Post graduate
In which type of setting do you work?
A) ICU
B) CCU
C) Ward
D) Operation Room
E) Private room
F) Other
What is your marital status?
A) Married
B) Unmarried
Name of hospital……………………………………………….
Below is a list of situations that commonly occur in a work setting. For each situation you
Have encountered in your presenting work setting, would you indicate how stressful it has
Been for you:
1 = Never stressful.
2 = occasionally stressful.
3 = frequently stressful.
4 = extremely stressful.
0 = doesn’t apply.

APPENDIX (A): EXPANDED NURSING STRESS SCALE (ENSS).
Please circle the one number for each question that
comes closest to reflecting your opinion About it.
Neverstressful
Occasionallystressful
Frequentlystressful
Extremelystressful
Doesn’tApply
1
Performing procedures that patients experience as painful 1 2 3 4 0
2 Criticism by a physician 1 2 3 4 0
3 Feeling inadequately prepared to help with the emotional
needs of a patient's family
1 2 3 4 0
4
Lack of opportunity to talk openly with other personnel
about problems in the work setting.
1 2 3 4 0
5 Conflict with a supervisor 1 2 3 4 0
6 Breakdown of computer 1 2 3 4 0
7 Inadequate information from a physician regarding the
medical condition of a Patient
1 2 3 4 0
8 Patients making unreasonable demands 1 2 3 4 0
9 Being sexually harassed 1 2 3 4 0
10 Feeling helpless in the case of a patient who fails to
improve
1 2 3 4 0
11 Conflict with a physician 1 2 3 4 0
12 Being asked a question by a patient for which I do not
have a satisfactory answer
1 2 3 4 0
13 Lack of opportunity to share experiences and feelings
with other personnel in the work setting
1 2 3 4 0
14 Floating to other units/services that are short-staffed 1 2 3 4 0
15 Unpredictable staffing and scheduling 1 2 3 4 0
16 A physician ordering what appears to be inappropriate
treatment for a patient
1 2 3 4 0
17 Patients' families making unreasonable demands 1 2 3 4 0
18 Experiencing discrimination because of race or ethnicity 1 2 3 4 0

19 Listening or talking to a patient about his/her approaching
death
1 2 3 4 0
20 Fear of making a mistake in treating a patient 1 2 3 4 0
21 Feeling inadequately prepared to help with the emotional
needs of a patient
1 2 3 4 0
22 Lack of an opportunity to express to other personnel on
the unit my negative feelings towards patients
1 2 3 4 0
23 Difficulty in working with a particular nurse (or nurses) in
my immediate work Setting
1 2 3 4 0
24 Difficulty in working with a particular nurse (or nurses)
outside my immediate work setting
1 2 3 4 0
25 Not enough time to provide emotional support to the
patient
1 2 3 4 0
26 A physician not being present in a medical emergency 1 2 3 4 0
27 Being blamed for anything that goes wrong 1 2 3 4 0
28 Experiencing discrimination on the basis of sex 1 2 3 4 0
29 The death of a patient 1 2 3 4 0
30 Disagreement concerning the treatment of a patient 1 2 3 4 0
31 Feeling inadequately trained for what I have to do 1 2 3 4 0
32 Lack of support from my immediate supervisor 1 2 3 4 0
33 Criticism by a supervisor 1 2 3 4 0
34 Not enough time to complete all of my nursing tasks 1 2 3 4 0
35 Not knowing what a patient or a patient's family ought to
be told about the patient's condition and its treatment
1 2 3 4 0
36 Being the one that has to deal with patients' families 1 2 3 4 0
37 Having to deal with violent patients 1 2 3 4 0
38 Being exposed to health and safety hazards 1 2 3 4 0
39 The death of a patient with whom you developed a close
relationship
1 2 3 4 0
40 Making a decision concerning a patient when the
physician is unavailable
1 2 3 4 0
41
Being in charge with inadequate experience 1 2 3 4 0
42 Lack of support by nursing administrators 1 2 3 4 0
43 Too many non-nursing tasks required, such as clerical
work
1 2 3 4 0
44 Not enough staff to adequately cover the unit 1 2 3 4 0

45 Uncertainty regarding the operation and functioning of
specialized equipment
1 2 3 4 0
46 Having to deal with abusive patients 1 2 3 4 0
47 Not enough time to respond to the needs of patients'
families
1 2 3 4 0
48 Being held accountable for things over which I have no
control
1 2 3 4 0
49 Physician(s) not being present when a patient dies 1 2 3 4 0
50 Having to organize doctors' work 1 2 3 4 0
51 Lack of support from other health care administrators 1 2 3 4 0
52 Difficulty in working with nurses of the opposite sex 1 2 3 4 0
53 Demands of patient classification system 1 2 3 4 0
54 Having to deal with abuse from patients' families 1 2 3 4 0
55 Watching a patient suffer 1 2 3 4 0
56 Criticism by nursing administration 1 2 3 4 0
57 Having to work through breaks 1 2 3 4 0
58
Not knowing whether patients' families will report you for
inadequate care
1 2 3 4 0
59
Having to make decisions under pressure 1 2 3 4 0

Nursing stress

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