Stressor and Ways of Coping utilized by nurses

Stressor and Ways of Coping Utilized Nurses

I. Introduction
Nursing has been identified as an occupation which has high levels of stress. In addition, nurses, who work in Intensive Care Unit (ICU), emergency, and pediatric have higher levels of stress (Yunyan , 2006). They mostly face high stressful condition in their daily job, such as: using high - technology medical equipment, delivering nursing care for patients with complex diseases and needs, and experiencing life and death events. Therefore, nurses, particularly who work in higher stressful workplace, need to cope with those stressful condition physically and psychologically. The effective coping mechanisms and reduce stress can improve the quality of patient care and safety. The study about stressor and coping in nursing is important due to the significance related to job satisfaction, stress, coping skills (Hays, 2006).

Nurses deliver their care 24 hours per day, 7 days per week. They have to deliver qualified nursing care starting from assessing, diagnosing, planning interventions, implementing nursing actions, evaluating and doing documentation. In addition, nurses do not only interact with the patients, but also with their families while they also have to interact with other health care team. ICU nurses have to be able to work in rapid rhythm, regarding to emergency cases. They also have to be well – acquaintanced with high tech machines. The nurses also often experience life and dead events.

II. Discussion
Stress according to Selye as cited in Hays (2006) is “a set of bodily defenses against any form of noxious stimuli, physical or psychological”. Selye labeled his theory as “General Adaptation Syndrome”. In his theory, Selye discussed, if people perceived stressor, their body will alert or activate an alarm reaction, “to fight or to flight”. If the stressor still resisted, the body will adapt and defend. Furthermore, if the stress continues, the body will be exhausted, and diseases can affect people easily. Stressor could be from environment and situation. Lambert (2004) conceptualized job stress, which include into environmental stressor, as “the outcome of disparity that exists between an individual’s perception of the characteristics of a specific role and what the person is achieving when currently carrying out the specific role” (Yunyan , 2006).

Some expert says stressors can be viewed positively and can be looked as challenge to deal in individual’s daily life. On the other hand, stressful condition may have negative impact; long term and negatively perceived stressor can affect one’s health, physically and mentally ( Lazarus and Forman, cited in Yunyan , 2006). ICU nurses have to experience high workplace stressor in their daily life, include complex diseases, deliver complex patients care, use well advanced and high tech medical equipment, and often face death – life condition. They may perceive stressor negatively due to prolonged stressful workplace they face, and it may affect them physically and mentally.

Coping can be defined as” the cognitive and behavioral efforts maintained to manage external and/or internal demands, which were perceived as taxing to an individual “. In addition, Lazarus and Folkman as cited by Hays (2006) define coping as “a response to a demand, not an automatic response to the environment “. Managing or altering the needs, which occur internally within oneself and externally in the environment, is the function of coping, Hays (2006). The purpose of utilizing coping itself, is not to control the needs, but to abide, minimize, accept, or neglect them. Individual’s coping may different over the time, it relates to the change of the needs and environment (Hays, 2006).

There are two types of coping, which can be utilized when one perceived stressful condition. The first type is problem – focused coping. The aim of problem – focused coping is to subjugate the needs of the situation or to extend the resources to deal them. Problem – focused coping is used when one thinks that the demand is changeable. This type of coping include; planful – problem solving and confrontive coping. The planful – problem solving is utilized when people analyze the situation to attain solutions then they take direct action to correct the problem. In addition, confrontive coping can defined as admitting assertive action when anger and risk is involved (lecture, ). Healy and Mc Kay (2000) add that problem – focused coping related to less mood disturbance.

The second type of coping is emotion-focused coping. The aim of the emotion – focused coping is to control the emotional response to stressor. It can be utilized both behaviorally (using drug, alcohol, social support and distraction) and cognitively (modifying the meaning of stressors). People often utilize emotion – focused coping when they think the can not change the demand or have lack of resources to change the demand. It includes seeking social support, escape-avoidance, distancing, self – control, accepting responsibility and positive reappraisal. Seeking social support actually can be both problem – solving and emotion – focused coping. People use distancing as their cognitive attempt to come off. Escape – avoidance is a wishful thinking or taking action to escape or avoid the stressor, while self – control is an effort to regulate feelings in response to the stressor. However according to Healy and Mc Kay (2000), using avoidance coping is associated with an increasing in mood disturbance. Another type of emotion – focused coping is accepting responsibility, it is used as coping when one’s recognizes his/her role in the situation while trying to put things right. One utilizes positive reappraisal as his coping when he creates positive meaning (Introduction to health psychology )

So what are the stressors for nurses and in what ways nurses can deal with? Stressor in the workplace can vary from one hospital to another, and the way the nurses perceive the most and the least stressful workplace stressor also vary as well. According to Hays (2006), there are several stressors for ICU nurses related to work environment, for example: noisy work environment, lack of staff, unnecessary prolongation of life, issues concerning patient families, feeling of inadequacy, fear of making error treatment, exposure to death and dying, critical unstable patient, responsibility/decision making. Hays (2006) states the most stressful stressor for US nurses, who works in ICU is the shortage of staff.

Yunyan (2006) adds other stressors for head nurses; high job demand, conflict with physician, poor relationship with supervisor. In addition, she states other stressful condition related to work environment due to lack of security and being moved among different patient-care units within the organization. Yunyan (2006), based on her study also states the highest workplace stressor according to Chinese head nurses is workload.

Perry (2005) states that workplace stressor faced by the nurses, especially anesthetic nurses in the US could be classified into two types, patient – related care and administrative stressor. The patient – care related stressors include certain surgical case, patient death and patient complications. While the administrative stressors are workload, production procedure, issue in staffing and workload.

Kingdon and Halvorsen (20006) find different finding of the most stressful stressor among perioperative nurses. The most stressful workplace stressor they perceive is patient dying events. In addition, they also perceive pressure to work faster and equipment that does not work as other stressor. The operating room nurses may perceive stressor differently from other nurses since their work depends on instruments, so if the instruments do not work properly it will be a stressor for them.

Based on the studies conducted by previous researchers, we can summarize that the most stressful workplace stressors (administrative stressors) are workload, shortage of staff and pressure in work. This conclusion shows that work place stressor perceived by nurses both in the Western and the Eastern culture is almost similar.

While being exposed to stressful workplace in their daily jobs, nurses must be able to cope well. There are two types of coping which nurses can utilize, problem- solving coping and emotion – focused coping. Margaret A, Hays, et al (2006) states from their study that the most ICU nurses in the US use emotion – focused coping as their way to deal with the stressor. Mostly, they use escape – avoidance coping, means that they think wishfully or take action to escape the stressors or avoid them. Unfortunately, using avoidance coping could increase mood disturbance, (Healy and Mc Kay, 2000). Other nurses utilize positive reappraisal and self- controlling, which means they regulate to create respond to stressor or they create meaning of the stressor they face positively.

A similar coping also utilized by Chinese nurses, as reported by Yunyan (2006). There are three top ways of coping used by nurses in China, however they do not only use emotion – focused coping which utilized mostly by the US nurses, but they also use problem – solving coping. The first preferred coping is positive reappraisal; means that nurses in China create the meaning of the stressors positively. The second preferred coping is planful – problem solving, which means Chinese nurses analyze the situation to make solutions of the problem then they take action directly to correct it. Another ways of coping used by Chinese nurses is self – control, they try to regulate their feeling in response to stressor. In addition, there was changing in coping utilized by the US nurse managers within two decades, from planful- problem solving in 1980’s to escape – avoidance in 2000’s (Shirey, 2006).

III. Conclusion
In conclusion, the ICU nurses have higher level of job stress in term of delivering complex nursing care, utilizing high- technology medical equipment and experience life –death events. The most stressful workplace stressors perceived by nurses are workload and shortage of staff. Nurses have to deal with those stressor by utilizing appropriate coping. Most nurses use emotion - focused coping, such as creating positive meaning (reappraisal), thinking wishfully and taking action to escape or avoid the stressor (escape avoidance), and regulating their feeling in response to stressor. Another coping utilized by nurses is planful – problem solving (analyzing the situation or the problem to make solutions and taking action to correct it directly). In my opinion, the nurses should be train to use appropriate coping, especially problem – focused coping due to its impact in less mood disturbance.

Reference:
Hays, M.A., et al (2006). Reported Stressors And Ways Of Coping Utilized By Intensive Care Unit Nurses. Dimensions Critical Care Nursing, 25 (4), pp 185 – 193. Available at: http://www.search.ebscohost.com

Healy, M.C., Mc Kay, M.F. (2000). Nursing Stress: the Effects of Coping Strategies and Job Satisfaction in a sample of Australian Nurses. Journal of Advanced Nursing, 31 (3), pp 681 – 688 . Available at: http://www.search.ebscohost.com

Kingdon, B., Halvorsen, F. (2006). Perioperative Nurses’ Perception of Stress in Workplace. Association of Operating Room Nurses AORN Journal, 84,4. Available at : http://proquest.umi.com/pqdweb?index=9&did=1144882421&SrchMode=1&sid=2&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1190350117&clientId=44687

Perry, R.T. (2005). The Certified Registered Nurse Anesthetist: Occupational Responsibilities, Perceived Stressor, Coping Strategies, And Work Relationships. AANA Journal, 73 (50) pp 351 – 356. Available at: http://www.search.ebscohost.com

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Introduction to Health Psychology. Available at: http://www.psych.umn.edu/courses/spring07/kramerm/psy3617/lectures/lecture_23_health_psychology.pdf

Yunyan, X., Lambert, A.V (2006). Investigation Of The Relationships Among Workplace Stressors, Ways Of Coping And The Mental Health Of Chinese Head Nurses. Nursing and Health Science, 8, pp 147 – 155