Purpose: This study is aimed at comparing the level of occupational stress, ways of coping and the quality of life among nurses. Methods: Descriptive explanatory design was used with 278 nurses working in King Abdul Aziz Hospital in Jeddah, Mental Health Hospital in Jeddah, and Dr. Suleiman Fakeeh Hospital in Jeddah. Findings: Psychiatric nurses experience greater occupational stress than general nurses (p = 0.001). There was no statistically significant difference between the psychiatric and general nurses in relation to coping strategies (p = 0.38). Conclusion: Healthcare institutions should adapt stress evaluation and coping models specific to their unit. Practical Implication: Implementation of programs in each healthcare unit to educate nurses how to deal with work stressors and their negative effects.
Occupational stress in nursing is common worldwide, ranging from 9.2% to 68%. Caring for the weak, sick, and traumatized client can impose a stress on the nurse [
Occupational stress has become one of the most severe health problems in the contemporary world [
Habib and Shirazi pointed out that nursing is a stressful job and identified the stressors as workload, close interaction with patients, high emotional involvement and being responsible of patients’ life [
Stress causes mental health disorders for psychiatric nurses, some common stressors include poor working relationships between nurses and doctors and other health care professionals, demanding communication and relationships with patients and relatives, emergency cases, high work load, understaffing and lack of support or positive feedback from senior nursing staff [
Zeller and Levin [
There are several traditional means of managing everyday stress. This evolves physical exercise, emotional and psychological therapies, change in work approach or medications. The choice of management procedure adopted is usually subjective to the source, nature of the stress and the resources available to the individual under stress (Cohen et al., 2002). It is believed that the best management practice of stress is to learn how to cope with it using healthy and positive coping strategies. The first step of effective stress management is to understand one-self better and understand stress triggers and how one can react to stressful situations. In the nursing field, the ability to render high quality health and nursing services to the patients in spite of occupational stress is considered as an effective coping [
Availability of social support also helped in reducing the negative effect of the stress on their performance. Consequently, social support was identified as an effective coping strategy. Sharma, Sharp [
Quality of life (QOL) is one of the most important aspects of human health, which is embedded in physical, cultural, and social contexts. Various studies have indicated that favorable QOL depends on working conditions and family life [
The design of the study was used descriptive explanatory design.
The target sample of this study was 400 nurses and the final sample consisted of 278 nurses (response rate 69.5%) working in King Abdul Aziz Hospital (KAAH) in Jeddah, Mental Health Hospital in Jeddah, and Dr. Suleiman Fakeeh Hospital in Jeddah.
・ Nurses and nurses’ assistants.
・ Both male and female.
・ Working in the general and psychiatric hospital.
・ Able to read and speak English language.
・ Nurses who did not able to read and speak English language.
Ethical approval was obtained from the Institutional Review Board (IRB) committees in the Ministry of Health and from the Dr. Suleiman Fakeeh hospital. The author placed an A3 paper in the ward noticed-board to announce the study. The author met each potential participant providing them with an informational sheet about the study, purpose, and expected tasks. Verbal explanation is given alongside informed consent, then they were requested to return signed consent form. It was explained to the participants that they can withdraw at any time without harm from the study. It was also made clear that there was no financial or any other form of gain from the participation of study. The author distributed and collected the questionnaire to those who volunteered to participate in the study paper.
A pre-designed structured interviewing questionnaire including the following items:
Age, sex, marital status, level of education, hospital category (government, private) and work setting (general, psychiatric).
ENSS is an expanded and updated revision of the classic Nursing Stress Scale (NSS) developed by Gray-Toft and Anderson [
The 59 items were arranged in a 5-point Likert response scale. The responses were “never stressful” [
It was developed by Charles S. Carver in 1997. It has 28 questions divided in 14 subscales. The aim of the BC is to evaluate people coping abilities during times of stress (Carver, 1997). Scoring for the 28 questions is as follows: 1 = I haven’t been doing this at all; 2 = I have been doing this a little bit; 3 = I have been doing this a medium amount; and 4 = I have been doing this a lot. Cronbach’s Alpha was used to assess reliability. Subscale Items Cronbach’s Alpha: self-distraction 0.77, active coping 0.63, denial 0.64, substance use 0.79, use of emotional support 0.51, use of instrumental support 0.68, behavioral disengagement 0.74, venting 0.74, positive reframing 0.75, planning 0.75, humor 0.75, acceptance 0.77, religion 0.81 and self-blame 0.61.
This scale was originally designed by a psychologist, Flanagan in 1975 and measured a person’s sense of well-being (Burkhardt & Anderson, 2003). The tool has been adapted to assess different populations such as the chronically ill, and professionals who provide care. The reliability for the subscale―Trauma/Compassion Fatigue has an alpha score of 0.80.
The ethical approval was obtained from the research and ethical committee in X. The participants were informed about the voluntary nature of participation and they then had a full right to withdraw at any point. Participants privacy and confidentially were assured and their names would not appear on any documents in the study.
Data entry and statistical analysis were done by using the Statistical Package for the Social Sciences (SPSS) version 23. Statistical significance was set at p < 0.05. Descriptive and inferential statistical techniques were utilized to analyze the collected data. These techniques included (frequencies, percentages, mean value and standard deviations). In addition, Chi Square test and/or independent sample t test was applied to examine differences among participants in general and psychiatric hospitals.
A total of 400 questionnaires were distributed to nurses in each of intensive care unit (ICU), emergency unit (ER), surgical unit, medical unit, operation room (OR), outpatient unit, inpatient unit, and nursing office. The total number of returned questionnaires was 278 (response rate is 69.5%). As presented in
Socio-demographic Characteristic | General Nurses (%) N = 171 | Psychiatric Nurses (%) N = 107 |
---|---|---|
Gender: Male Female | 37 (21.6%) 134 (78.4%) | 44 (41.1%) 63 (58.8%) |
Age (years): 20 - 29 30 - 39 40 - 49 50 - 59 | 56 (32.7%) 76 (44.4%) 33 (19.3%) 6 (3.5%) | 55 (51.4%) 40 (37.4%) 12 (11.2%) 0 (0.0%) |
Marital status: Single Married Widowed Divorced | 75 (43.9%) 84 (49.1%) 3 (1.8%) 9 (5.3%) | 40 (37.4%) 56 (52.3%) 0 (0.0%) 11 (10.3%) |
Education level: Diploma Bachelor Degree Postgraduate | 34 (19.9%) 133 (77.8%) 4 (2.3%) | 12 (11.2%) 95 (88.8%) 0 (0.0%) |
Hospital category: Governmental Hospital Private Hospital | 149 (87.1%) 22 (12.9%) | 83 (77.6%) 24 (22.4%) |
Department: Inpatient Outpatient ICU ER Surgical Medical OR Nursing Office | 0 (0.0%) 39 (22.8%) 24 (14%) 21 (12.3%) 40 (23.4%) 21 (12.3%) 6 (3.5%) 6 (11.7%) | 58 (54.2%) 37 (34.6%) 0 (0.0%) 4 (3.7%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 8 (7.5%) |
nurses. For instance, approximately 45% of general nurses were aged between 30 to 39 years and about half of the psychiatric nurses were aged ranged from 20 to 29 years. In addition, the majority of the study sample in both groups were married. Moreover, the highest percent of nurses in both groups had attained a bachelor’s degree in nursing science.
The maximum score of occupational stress is 236 with a mean score of 148.8 and a standard deviation of 35.22. Independent sample t test was used to compare the occupational stress level between psychiatric nurse and general nurses. There was significant difference between nurses regarding the work setting at the hospital level (p < 0.05), as indicated in
In
Occupational Stress | Mean | SD | P value |
---|---|---|---|
Psychiatric Hospital | 157.6 | 26 | 0.001 |
General Hospital | 143.3 | 39 |
SD: Standard Deviation.
Occupational Stress Subgroup | Sample | Mean | SD | P value |
---|---|---|---|---|
Death and Dying | General Nurses Psychiatric Nurses | 2.5 2.25 | 0.62 0.79 | 0.007 |
Conflict with Physicians | General Nurses Psychiatric Nurses | 2.40 2.755 | 0.90 0.57 | 0.001 |
Inadequate Emotional Preparation | General Nurses Psychiatric Nurses | 2.17 2.35 | 0.80 0.60 | 0.034 |
Problems Relating to Peers | General Nurses Psychiatric Nurses | 1.98 2.21 | 0.75 0.56 | 0.006 |
Problems Relating to Supervisors | General Nurses Psychiatric Nurses | 2.64 2.87 | 0.90 0.43 | 0.04 |
Work Load | General Nurses Psychiatric Nurses | 2.71 2.46 | 0.61 0.88 | 0.011 |
Patients and their Families | General Nurses Psychiatric Nurses | 2.43 2.85 | 0.96 0.62 | 0.001 |
Uncertainty Concerning Treatment | General Nurses Psychiatric Nurses | 2.34 2.85 | 0.79 0.54 | 0.001 |
Discrimination | General Nurses Psychiatric Nurses | 2.10 2.89 | 1.19 0.88 | 0.001 |
significant variation between general nurses and psychiatric nurses where independent t test value (p < 0.05). The significant variation includes death and dying approach (p = 0.007), conflict with physicians approach (p = 0.001), inadequate emotional preparation approach (p = 0.034), problems relating to peers approach (p = 0.006), problems relating to supervisor approach (p = 0.04), work load approach (p = 0.011), patients and their families approach (p = 0.001), uncertainty concerning treatment approach (p = 0.001), discrimination approach (p = 0.001).
The result of independent sample t test appeared that there was no statistically significant difference between the psychiatric and general nurses in relation to coping strategies (p > 0.05), as shows in
Coping Strategies | Mean | SD | P value |
---|---|---|---|
Psychiatric Hospital | 68.72 | 10.191 | 0.38 |
General Hospital | 67.44 | 13.869 |
SD: Standard Deviation.
Coping Strategies Subgroup | Sample | Mean | SD | P value |
---|---|---|---|---|
Approach Coping | General Nurses Psychiatric Nurses | 2.69 2.63 | 0.67 0.48 | 0.35 |
Avoidance Coping | General Nurses Psychiatric Nurses | 2.18 2.34 | 0.57 0.47 | 0.012 |
Altering Consciousness | General Nurses Psychiatric Nurses | 2.22 2.21 | 0.48 0.37 | 0.87 |
Seeking Support | General Nurses Psychiatric Nurses | 2.50 2.59 | 0.65 0.51 | 0.17 |
SD: Standard Deviation.
strategies subgroups such as approach of coping (p = 0.354), avoidance coping (p = 0.87) and seeking support (p = 0.17).
The findings of the analysis highlighted that quality of life score was lower in psychiatric nurses compared with their counterparts as indicated in
Nursing is a stressful profession that deals with intense human aspects of health and illness. General and psychiatric nurses experience different levels of occupational stress. In this study, compared to the nurses working in the general setting, those working in the psychiatric setting had a higher statically level of occupational stress (p = 0.001). There are several possible reasons that could explain psychiatric nurses had higher level of stress than general nurses. The main reason is that psychiatric nurses in this study worked in restricted environments, such as closed wards with isolation rooms that mainly serve acute and potentially violent patients [
Quality of Life | Mean | SD | P value |
---|---|---|---|
Psychiatric Hospital | 95.14 | 7.61 | 0.01 |
General Hospital | 97.12 | 13.06 |
SD: Standard Deviation.
of training is not universally implemented or inadequate in psychiatric hospitals. For example, a survey of 300 randomly selected nurses from five psychiatric hospitals in China found that 75.6% were not satisfied with the lack of continuing training on violence [
The finding is supported by a study conducted by Qi, Xiang [
Furthermore, Al Hosis et al. (2013) highlighted that the impact of occupational stress on the well-being of Saudi nurses working in the ministry of health hospitals (MOH) in AL-Qassim region in KSA found that nurses’ occupational stress was not affected by their educational level. Also, a significant relationship was found between work setting and communication subscale. This goes in coincidence with the research conducted by Flannery et al. (2007), Hanrahan et al. (2010) these studies explained that psychiatric nurses constantly manage patients and families from all levels of people and is essential to deal with manifold communications. Both hurts from work and verbal attacks from patients will increase psychiatric nurses’ occupational burnout. Yada et al. (2015) investigated the specificity and structures of occupational stress in psychiatric dementia nurses (PDNs) caring for elderly patients with serious behavioral and psychological symptoms of dementia occupational stress in PDNs revealed physical workload and work environment to be more significant stressors.
Coping strategies are used to help nurses who experience occupational stress. In the current study, results revealed that there was no statistically significant difference between the psychiatric and general nurses in relation to coping strategies (p > 0.05). This finding agreed with a study designed by Dawood, Mitsu [
The most used coping strategies by nurses in general and psychiatric nurses were problem focused or approach coping (mean score for general nurses was 2.69, mean score for general nurses was 2.63). This strategy corresponds to an active way to react to stressful situation, because coping, focused on the problem, is intended to remedy the stressful situation and is considered to be the most effective strategy to deal with stress (Bennett et al. 2001). This finding agreed with a study by conducted among community health agents, where problem focused, or approach coping was the most adopted approach to cope with occupational stress [
In contrast, Edwards and Burnard (2003) conducted a systematic review to determine the effectiveness of stress management methods that mental health nurses utilize. They reported that the most frequently reported coping strategies utilized by mental health nurses were seeking social support. Also, Happell et al. (2013), stated that the most popular form of coping mechanism among these nurses was the social support. However, the study by Zaki [
Nurses are a special professional that have a risk of suffering from occupational stress and insufficient coping strategies resources, which may lead to serious mental and physical health problems and a reduced QOL Asberg, Bowers [
The study showed that occupational stress is a global phenomenon and it affects the nurses in all the countries in which researches had been conducted on occupational stress. The results noted that there was variety in occupational stress level between nurses working in the general setting and nurses working in the psychiatric setting.
The authors declare no conflicts of interest regarding the publication of this paper.
Alharbi, S. and Hasan, A.A. (2019) Occupational Stress, Coping Strategies, and Quality of Life among Nurses in General and Psychiatric Setting in Jeddah City―KSA. Open Journal of Psychiatry, 9, 124-137. https://doi.org/10.4236/ojpsych.2019.92010