Work-related stress and coping: a survey on medical and surgical nurses in a Malaysian Teaching Hospital

Abstract

Background : A cross-sectional study on work-related stressors among nurses in a public teaching hospital had also attempted to explore functions of coping strategies in determining stress. Materials and Methods : A structured bilingual questionnaire (English-Malay) on symptoms and sources of stress, and coping style measure was disseminated to medical and surgical nurses working in a teaching hospital in Kuala Lumpur. Socio demographic information and stress management methods were inquired. Frequency in workplace stressors were assessed using Nursing Stress Scale. Stress symptoms and home-life stressors were evaluated using Personal Stress Inventory. Measurement of coping strategies was performed using Coping Orientation for Problems Experienced questionnaire. Results : A total of 181 questionnaires were disseminated and 151 (83.4%) were satisfactorily completed by nurses. It was found that the prevalence of work-related stress among medical and surgical nurses was 49.3% (N=74/150). Analysis of dichotomized outcome (between Stress and No stress group) illustrated high workload (t-value=4.122; p<0.001), concerns about death and dying (t-value=2.784; p<0.05) and conflict with physicians (t-value=3.821; p<0.05) as the highest stress contributing factors. Socio demographic factors such as age, marital status, salary per month and tenure of service were not significantly (p=0.05) associated with stress. Sources of stress from the home life were found to be significantly associated with stress experienced (t-value=3.971; p<0.05). Pearson’s correlation analysis between coping and stress scores demonstrate significant (p<0.05) positive association of avoidance, acceptance and venting of emotion with higher stress levels. Multiple linear regression analysis on selected variables demonstrates that high workload (B=1.052; p<0.05), conflicts with physicians (B=1.398; p<0.05), lack of support (B=0.346; p<0.05) and coping through venting of emotion (B=2.207; p<0.05) significantly contributes towards determining nurses stress. This model explains 44.8% (adjusted R square=0.448) in the variation of stress scores. Discussion : High workload as a stressor has been repeatedly mentioned in literature on work-related stress among health professionals, as in this study. Findings suggest that sources of work-related stress do not differ much from other nurses with different specialty. Other significant stressors were associated with death and dying concerns and conflicts with doctors. Coping by acceptance, venting of emotion and avoidance contribute significantly to stress and thus could be categorized as maladaptive instead of working as a buffering factor to reduce work-related stress. Conclusion : Findings of this study supports the hypothesis that workload is still the major source of work-related stress among the study population. Besides the usual recommendation for the management team to put effort to reduce the workload problem faced by nurses, stress management program if any should emphasize on educating nurses in selecting the most adaptive coping methods could be used at both personal as well as organizational levels in order to ameliorate the impact of work-related stress on job-related strain and health.