In the years to come stress would find more place in our lives. One has to adopt specific skills to combat stress. Stress management is of paramount importance in organizational and individual practice. From the study it is evident that if stress management programmes are incorporated in the health care profession people who are working at various levels will be able to recognise the stress factors inherent in their work place. They will learn to develop various preventive methods for mitigation of these stressors. This would help to arrest the decline in job performance, burnout, high absenteeism, reduction of efficiency, poor performance in tasks and other family related problems.
5.2. ACHIEVEMENTS OF THE OBJECTIVES
The researcher by doing this study has fulfilled the objectives of the research.
To critically review the body of literature related to Occupational Stress of Nurses
The literatures referred for the purpose of the study after defining various concepts provided a detailed explanation of the sources of occupational stress, its impacts on mental, physical and behavioral wellbeing. The reviews elaborated the symptoms and the adverse impact of occupational stress in the personal life, professional life and health of nurses, and stated that Eustress is good as far as it prompts to do better. The study also provided with various stress management techniques to improve job stress related deformities. The occupational stress among the nurses is undoubtedly identified irrespective of the country they work.
To analyze the existing occupational Stress of the nurses, its sources and its impact in their profession
By the data collected from the nurses of the hospital selected for the study proved that there is an existence of occupational stress. The age, marital status, number of family members, job enviorment, poor interpersonal relationships and inability to manage the personal and professional life contributed to the stress. The data collected proved that there is an adverse impact of occupational stress in the discharging of quality care to the service providers.
To evaluate the effectiveness of the coping strategies adopted to handle stress by the respondents
Another objective of the research was to evaluate the effectiveness of the stress management strategies adopted by the nurses and the hospital itself. The data collected and the information gathered proved that majority of the programme adopted by the nurses are not effective strategies. Therefore the strategies need to be changed. The study found that the organizational help to the nurses to manage stress is not often utilised by them due to ignorance and negligence.
To make conclusions and possible recommendations for the effective management of occupational stress of the nurses
The study pointed out that effective management of stress if possible only through a two way responsibility. The responsibility lies in individual employees and the organization itself. The last chapter of this research report made some innovative recommendations of effective stress management for the hospital management and to the nurses to overcome occupational stress.
In the first part of this chapter, the researcher outlines possible recommendations for the management of occupational stress among the nurses, based on the findings of the research. The researcher has already stated that though there are various sources of stress, an effective management of occupational stress in the hospital can only be possible from a two way initiative that is an initiative from the individual nurses and the hospital management.
5.3.1. Recommendations to the Nurses
1. The nurses need to find sufficient time to make self assessment and become aware of the instances that contribute stress in their daily life. Once it is identified they need to avoid or minimise such instances regularly. It will provide them with a stable mind and body.
2. The nurses should always look for a good support system to turn to. This support system can be from within the family or outside. After developing this support system they should be able to ask regularly for a support when they feel that they are in need of it.
3. The Nurses need to get organized by themselves. An action plan for the day or for a week will make their days more organised. This will help them to carry out and organise their duties without getting exited or worried even in a very busy day. Nurses should make it as a regular programme for themselves.
4. There is an urgent need to start utilising the facilities provided by the hospital management to engage in various extra curricular activities. The weekly and monthly gatherings arranged for the entertainment of the nurses should be participated in full attendance.
5. The study proved that development of several of hobbies help people to keep away job related stress. The nurses could make use of the available opportunities at home and at the workplace to develop various hobbies, like reading, listening to music, writing diaries etc. Engaging in meaningful activities will help them to reactivate themselves even when they are tired and shattered.
6. Engaging in regular physical exercises help to maintain a good body. It will even provide a healthy mind. The nurses need to allocate time for physical exercises like yoga and other indoor and outdoor games. There are many indoor games facilities arranged in the hostel of the nurses.
7. Membership in a healthy and well balanced social net work helps the individuals to alleviate stress. The nurses in the hospital could widen their social network which will in turn make them to more sociable. It will make them to widen the horizons of their thinking.
8. Individuals need to understand that two factors such as misunderstandings and mismanagements, are usual in any organization. The nurses should be able to take the organizational changes as part of their positive professional development. They need to get adapted to the new situation rather than remaining isolated and stubborn. This will help them to be part of a good organizational culture.
9. If stress is identified as major hindrance to the normal performance of the profession, a nurse should make personal initiative to overcome it. Once a person identifies that she or he is suffering from stress related problems, personal initiatives need to be taken to overcome it. A professional assistance from a psychiatric social worker or counsellor will help her to overcome this situation in life.
10. Certain type of reactions can bring people closer and some other type of reaction alienation. If one identifies that certain types of reactions in the daily life bring forth stressful events in life, the ways need to be changed to reduce stress. It is important to be aware that extreme reactions bring forth stress. The nurses need to be guard of their reactions to the peers, the superiors and supervisors.
11. One needs to accept changes. The nurses need to understand that hospital is an organization and it is a system that manages many individuals. So every individual interest can not be addressed with equal importance as each one has his own or her own interests. Importance should be given to the interest of the hospital when compared to the personal interests.
12. A well balanced status of personal life and professional life is mandatory to have proper management of occupational stress. For this the nurses need to make a good budgeting of family relationships and the personal expenses if there are only limited earning members in the family. A well defined job responsibilities, time allotments in the hospital duties and a due availability for the fulfilment of the family commitments are important for the smooth functioning of the life of nurses. Availability to the members of the family, husband, children, parents etc need to be duly made.
13.Role conflicts always caused stress among the nurses. The nurses should prior to the engagement of their duty need to get the answers of ‘who’, ‘what’, ‘where’, ‘how’ etc. Clarity in the discharge of the duties will bring less confusion. This clarity will provide job satisfaction and role clarity. This will take away the occupational stress of the nurses.
14. The nurses should give importance to their spiritual life understanding the philosophy of the profession of nursing . They need to be aware of the commitment to the patients and to the entire humanity. So a clear understanding of the goals and responsibilities of their profession, vision and mission of the hospital, and ethical responsibilities to the profession of nursing need to be properly understood. They need to find time to maintain their spiritual activities, meditation etc.
17. Developing of a good interpersonal relationship is an important factor for the nurses to have a relaxed life. A good relationship to the companions, cordial professional relationship with the superiors and supervisors are important factors in the life of a nurse. Nurses should develop good friendships with people who are not criticizing and judging but accepting you as one is.
5.3.2. Recommendations to the Hospital Management
1. The hospital management need to understand and become aware of the existing occupational stress among the nurses employed in the hospital and the impact of it in the discharge of the nursing duties.
2. It is found that there is an urgent need to develop a better management-employee relationship in the hospital. As seen from the responses of the nurses it is evident that the hospital management need to look at the nurses as not just workers but members of an extended family. It can make the nurses more committed.
2. The hospital should arrange more opportunities to develop their nursing career by providing them opportunities to attend advance courses and trainings. Hospital can arrange career development and refresher programme for the nurses occasionally.
3. The hospital management can provide the nurses with programme that are beneficial to the employees. The free, confessional or subsidised medical facilities to the family members, educational loans or assistance to the children, housing benefits, pension and other benefits for the nurses can be a boosting to the nurses’ welfare.
4. The study proved that there is an urgent need to promote a conducive work culture in the hospital by providing the nurses certain freedom of expression. This work culture should be reviewed and evaluated in the due course of intervals. This will provide the nurses with capacity for self assertion.
5. The working condition is an important factor to maintain good job enviorment. Hospital needs to upgrade and update regularly the working condition of its employees. When the employees are provided with suitable working enviorment the output increase. It is a benefit to the hospital.
6. The hospital management need to provide more reward and recognition programme for the nurses. The talents, abilities and commitment of the nurses need to be recognised with more reward for performance programme. This will provide extra performance interest among the nurses.
7. The management of the hospital need to provide with sufficient time for the employees to reduce the existing stress. The hospital management should try to give personal attention to the individual cases of the nurses. The management should be available to the nurses for the hearing of their grievances. The nurses should be provided with an assistance of a grievance cell.
8. The hospital can change and alter the work enviorment to help the nurses to contribute to an effective health care. The hospital should be open for a change of work culture in the hospital. Changes should be made in keeping in accordance with the interests of the employees.
9. The emergency and causality sections need to be provided with more resident doctors for night shifts mainly during holidays and weekends. This can provide clarifications to many doubts and clarifications when a nurse is given sole responsibility for the admission, first aid and primary diagnosis in the late hours in casuality.
10. The hospital should make sure that only qualified nurses are on main duty. The student nurses may assist the duty nurses in discharging their duties. The hospital by appointing more staff nurses, other than utilising the student nurses for the important and busy emergency ward duties, may help to reduce job stress of the staff nurses.
11. The hospital management need to monitor the existing facilities of indoor games, outdoor games and other recreational activities and the attendance to it. The study found that the majority of the nurses do not seriously the facilities offered by the hospital to reduce stress.
12. The counselling cell can be upgraded with more counsellors and the counsellors need to be guided by the hospital to have proper family intervention of the nurses.
14. The training programme conducted by the hospital need to be made mandatory yet made with pay.
15. The patient-nurse ration needs to be regularly monitored to provide proper employee and patient satisfaction.
Nursing profession is a stressful occupation and there is an emerging body of work stress, this study has shown that there are various factors responsible for the occupational stress which has a negative impact on their profession. The study tried to investigate the impact of job stress among the nurses in the selected hospital and found that there is a considerable amount of prevailing job stress resulting low work performance. The employees and the employers are responsible to create a conducive atmosphere in their work place, keeping the objectives of the institution in mind, and working for the institution by adopting coping stress methods and effectively utilizing them. The analysis of the study found that the stress management strategies and facilities that the hospital provides to the nurses are not effectively utilized by them. The researcher has made innovative recommendations to the hospital management and to the individual nurses to make effective stress management strategies. Finally, we need to remember that a personal positive attitude towards life and readiness to encounter the difficulties are the important natural methods to alleviate the stressful situations from the private life of each employee.
The coping methods and facilities which the hospitals are providing are not effectively utilized by them, which have prevented them from entering into a mental distress as well as adverse health problems. The employers are equally responsible to create a conducive atmosphere in their work place, by keeping the objectives of the institution in mind, and working for the institution, adopting coping stress methods so that they can prove that they are the efficient work force. Therefore, difficulties are the boosting power to work more for the welfare and development of nation and any institution.
The findings, through this study on occupational stress among nurses are the following:
The stress level and the age of the respondents are very much related, the staff nurses who have more responsibilities in their work place and family and also who have the responsibility as Pharmacists experience relatively more stress in their work place.
The married Nurses experience more stress as they have the responsibility to look after the family, the spouse as well as the children.
The Nurses who have children also experience higher stress. The number of children and stress level are related; especially those who have two and above two children have higher stress level.
When the spouse of the nurses are unemployed the nurses experience a higher rate of stress as they are the only earning member in their family and also have the burden to meet the needs of the family, children and also the spouse.
Though this study, it has become clear that there are various factors responsible for occupational stress such as role overload, role ambiguity, role conflict, group pressure, responsibility for persons, under participation, powerlessness, poor peer relations, intrinsic impoverishment, low status, strenuous working condition and Un profitability. It is significant from the study that role over load and work load has tremendously influencing the nurses employed in the hospital, most of the time they have to do lot of work in their job, at time over time work creates stress among them. The salary is another cause for the stress, most of them are paid less in the hospitals, comparing to the qualification that they have.
The Increased job specialization has made it more difficult for the nurses into move to higher positions in the hospital. Specialized jobs are also stressful for the them.
There is also poor peer relation prevailing among the nurses which leads to stress among nurses. The nurses who are able to build good relationship with their colleagues are able to handle their stress well and are able to carryout the assignments responsibly.
Through the study the researcher found that the hospital authorities take up keen interest in the various extra activities and also provide various forms of facilities to handle their work stress in the hospital.
There are the facilities provided by the hospital authorities to facilitate the needs of health care professionals , such as prayer hall, personal counselling, games and sports, training programmes, seminars and get-together etc. Most of the times the training programmes are organized in the hospital are with the consent of them.
The private hospitals also look into the spiritual aspects of Nurses, by providing them spiritual support, through prayer hall and other religious activities. Often they are utilized by them especially who are highly stressed and have a lot of responsibilities in hospital.
The Nurses are also taking few measures in coping up with the stress by sharing their stressful situation with the colleagues, friends, and family members. Secondly they also take up few activities such as reading, games, writing, personal prayer, cooking, sleeping, yoga exercise, and listening to music etc.
The majority of the Nurses are focusing on their personal goals, and they are able to see the stressful situations as a means to fulfil their goals.
5.2 Suggestions and Recommendations
1. The stress level of the Nurses can be reduced, following strictly the coping methods which are adopted by the different hospitals.
2. The management can take enough care to break monotony and role ambiguity among them .
3. The establishment of a counselling cell for the Nurses in all the hospitals can reduce the job related stress among Nurses, and it can create a better relationship with the employees and the authorities
6. The rating scale methods could be often used in hospitals, which can help in assessing stress level health care professionals and through which management can take appropriate measures to handle stress.
This study has fulfilled the objectives of the researcher, especially understanding the stress level of the Nurses employed in Jubilee hospital and its relationship with the socio- economic life . This study has also shown the various coping strategies taken by the individual themselves and the hospital authorities
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