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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 3  |  Page : 229-232

A cross-sectional descriptive study of effects of occupational stress on mental health of staff nurses of a tertiary care hospital in a metropolitan city


1 Department of Community Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
2 Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India

Date of Submission03-Nov-2021
Date of Acceptance05-Dec-2021
Date of Web Publication31-Oct-2022

Correspondence Address:
Dr. Sagar Karia
OPD 21, New OPD Building, 2nd Floor, Lokmanya Tilak Municipal Medical College and G.H., Sion, Mumbai - 400 022, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_133_21

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  Abstract 


Background: Compared to other professions, nurses experience the greatest degree of job stress. Persistent stress is harmful to physical and mental health resulting in apathy, sleep disturbance, frequent absence from work, drug abuse, feelings of inadequacy, physical and nutritional problems, increased health-care cost, and loss of job satisfaction. Hence, this study was done to find the prevalence of occupational stress and its effect on mental health of nurses working in a tertiary care center. Materials and Methods: This was a cross-sectional study conducted among staff nurses after approval from the Institutional Ethics Committee. Sociodemographic data along with their occupational history was collected in a semistructured pro forma. The Professional Life Stress Scale by David Fontanna (PLSS) was used for evaluating occupational stress, and the Mental Health Questionnaire was prepared for evaluating mental health issues. Results: One hundred and eighty-seven nurses were included in the study, with a mean age being around 40 years and mean duration of service being around 18 years. About 45% of them had stress as per DFPS and departments in which they were working did not affect the stress levels. 8.5% of them had elevated paranoia scores and 7.4% had high depressive scores. DFPS had no significant correlation with age of staff nurses and years of experience but had a significant correlation with scores of all domains of mental health. Conclusions: It is concluded from the present study that professional stress has a great impact on health of staff nurses. There is a need for hospital management to develop appropriate intervention programs to reduce workload, make regular shift schedules, and provide positive reinforcements for nurses to reduce anxiety, stress, and depression.

Keywords: Anxiety, depression, mental health, occupation, staff nurses, stress


How to cite this article:
Khade D, Gokhe SB, Karia S, Shah N. A cross-sectional descriptive study of effects of occupational stress on mental health of staff nurses of a tertiary care hospital in a metropolitan city. Ann Indian Psychiatry 2022;6:229-32

How to cite this URL:
Khade D, Gokhe SB, Karia S, Shah N. A cross-sectional descriptive study of effects of occupational stress on mental health of staff nurses of a tertiary care hospital in a metropolitan city. Ann Indian Psychiatry [serial online] 2022 [cited 2022 Dec 10];6:229-32. Available from: https://www.anip.co.in/text.asp?2022/6/3/229/360073




  Introduction Top


In a work environment, where human communication and contacts are required, the degree of stress rises and nursing profession is mostly based on human relation and communication.[1] Psychological stress may relate to job and various types of demands, which results in conflicts and lead to physical, mental, and behavioral problems in association with poor job performance.[2]

Compared to other professions, nurses experience the greatest degree of job stress.[3] Several studies have indicated different levels of job burnout among nurses, and experts find the prevalence of burnout being associated with daily stress due to organizational mismanagements, role ambiguity, role conflict, and lack of positive reinforcement at workplace.[4] Stress and anxiety are closely related, and anxiety alone is a vague discomfort defined as a sense of skepticism toward unknown factors. This uncomfortable sense maybe associated with physiological, emotional, and psychological symptoms and exhibited as a sense of intense emotion.[5] Depression is a disorder that causes loss of interest in life, sadness, low energy, impaired concentration, sleep disturbance, decreased or increased appetite, ambiguous physical pains such as headaches, back pain, and digestive disorders, in addition to impaired personal and social relationships.[6] Anxiety and depression are provoked by life stresses as an ubiquitous part of daily activities related to past, present, or future concerns.[7] Persistent stress is harmful to physical and mental health and can result in apathy, sleep disturbance, frequent absence from work, drug abuse, feelings of inadequacy, physical and nutritional problems, increased health-care cost, and loss of job satisfaction.[8] Mental health is considered one of the most important indicators of health in a community, and poor mental health can lead to many other problems for an individual.[9]

Today, mental illness, anxiety, stress, and depression are very common and widespread for vulnerable individuals facing everyday problems.[10] The prevalence of mental health among nurses is registered at 48.8% with minor psychiatric disorder.[11] In addition, nurses are exposed to various degrees of environmental, social, economic, cultural, and family stressors during work hours and in contrast to a positive level of stress, which serves as a motivating factor for learning and maintaining physical and mental health; excessive stress has a negative influence across the lifespan.[12] Stress can cause several physical and emotional problems including dissatisfaction with self, a sense of failure, severe anxiety, tension, frustration, and depression.[13]

The issues of occupational stress, coping, and burnout among nurses are of universal concern to all managers and administrators in the area of health care. Nurses and their managers should strive to create workplaces where working practices promote nurses' health and well-being or at least are configured to minimize deleterious effects. With the above issues in mind, we undertook this study to find the prevalence of occupational stress and its effect on mental health of nurses working in a tertiary care center.


  Materials and Methods Top


A descriptive cross-sectional study was conducted among staff nurses of the age group of 25 years and above of a tertiary cares hospital in a metropolitan city of Maharashtra from April 2018 to November 2019. The study was approved by the Institutional Ethics Committee. Staff nurses were identified based on their duty patterns, i.e., straight, G and F, and circle duty. Staff nurses from each duty pattern were approached after seeking permission from the matron. The data were collected with the help of pretested predesigned questionnaire by interview method. The questionnaire consisted of sociodemographic data of staff nurses along with their occupational history. The Professional Life Stress Scale by David Fontanna (PLSS) was used for evaluating occupational stress, and the Mental Health Questionnaire was prepared for evaluating mental health issues. The DFPS is adapted from Managing Stress, the British Psychological Society, and Routledge Ltd, Leicester, England, 1989. It consists of 24 questions covering different variables such as personality perception by others, optimism for life, satisfaction to self and work, adjustment with the professional environment, and so on. The total score is 60. The score is interpreted as 0–15, no stress; 16–30, moderate stress; 31–45, severe stress; and 45–60 stress as a major problem, and emergency action needs to be taken.[14]

The Mental Health Status Questionnaire included 30 questions related to mental health, which were adopted from the Symptom Checklist-90 Scale.[15] These questions were then divided into five most common mental health disorders, i.e., somatic disorder, anxiety disorder, depressive disorder, paranoid disorder, and obsessive-compulsive disorder. Mean and standard deviation (S.D.) of each disorder for total sample was calculated, and those staff nurses having more than 2 S.D. were considered having mental health issues.


  Results Top


[Table 1] describes the demographic details and professional details of study samples such as years of experience, job rank, and type of duty they are doing. The mean score of PLSS in the study population was 14.65 ± 5.52. Of 187 nurses, 102 (54.54%) had no stress, whereas 84 (44.91%) had moderate stress, and only one had severe stress. [Table 2] shows that stress level was not statistically significant among nurses of various departments, but those working in medical and surgical wards had maximum stress score. [Table 3] shows the scores of each domain of the Mental Health Symptom Questionnaire and number of nurses having significant mental health issues as per score. It is seen that 8.5% of them had elevated paranoia scores and 7.4% had high depressive scores.
Table 1: Demographic and professional details of the study population (n=187)

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Table 2: Association of PLSS with departments of staff nurses

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Table 3: Scores of Mental Health Symptom Questionnaire

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[Table 4] shows the correlation of PLSS with various factors revealing that DFPS had no significant correlation with age of staff nurses and years of experience but had a significant correlation with scores of all domains of mental health.
Table 4: Correlation of DFPS with various professional factors

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  Discussion Top


The present study was carried out among staff nurses of a tertiary care hospital of a metropolitan city with the objective to study the effects of occupational stress on physical and mental health status of staff nurses. Maximum study subjects 81 (43.31%) belonged to 25–35 years of age group with a mean age of 40.05 years (SD = 11.53). Parul Sharma et al. found in their study that 91% of staff nurses were younger than 35 years (15–25 years and 25–35 years) with a mean age of 27.41 years (SD = 7.06).[15] These observations are quite similar to the present study. Ali Mohammad et al. found in their study that the average age of staff nurses was 34 years (SD = 8.31) with the youngest 21 years and oldest 65 years.[16] These observations are quite similar to the present study. There was a moderate professional stress score in around 45% of staff nurses, and stress was not correlated with the department where they were working or with age or duration of working years. Zeinhom et al. found in their study that younger staff nurses of age <30 years reported relatively high levels of perceived stress.[17] Abhishek Nair in his study found that younger staff nurses are having more stress than older staff nurses. There was a significant association between age group and professional stress.[18] Fariba Borhani et al. found in their study that there was a significant correlation between moral distress and number of years in service (P < 0.05, r = −0.3) and between professional stress and number of years in service (P < 0.05, r = −0.4). These findings are similar to the present study.[19] Our study shows that they had paranoia and depression as main mental health issues followed by OCD, somatic complaints, and anxiety disorders. Moreover, the present study shows that professional stress was correlated with mental health symptoms. Anbazhagan et al. found in their study that depression was found in 24% of the individuals, and Godwin et al. found in their study that 60% of the nurses experienced frustration as emotional type of stress, followed by anxiety and overreaction in 16%.[20],[21]


  Conclusions Top


It is concluded from the present study that professional stress has a great impact on health of staff nurses. Various factors of staff nurses such as age, duty pattern, year of experience, rank in job, marital status, and working departments may have positive impacts with increasing professional stress. Stress is an important precursor for impaired mental health. It can be seen from the present study that as the age, year of service, and responsibilities of staff nurses increase, the symptoms related to somatic, anxiety, and depressive disorders also increase. There is a need for hospital management to develop appropriate intervention programs to reduce workload, make regular shift schedules, and provide positive reinforcements for nurses to reduce anxiety, stress, and depression.

Following recommendations, the authors would like to make:

  1. Medical colleges and hospital administration should arrange stress management workshops for every staff nurse in the campus on a regular basis
  2. Duty shifts time table should be made in such a way that after 5 working days, staff nurses should get compulsory 1 day holiday
  3. Formulation of information guide sheet should be done, so that newly joined staff nurses do not get confused with the heavy workload and performance pressure in tertiary care hospitals
  4. There should be arrangements for staff nurses to seek help for their mental health issues without being stigmatized and to treat them at the earliest
  5. These intervention strategies may help increase job satisfaction and demonstrate organizational commitment in nurses' health and well-being. Most importantly, reduced stress, anxiety, and depression among nurses can improve the quality of patient care.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Piper CN, Elder K, Olatosi B, Onsomu E, Williams EM, Sebastian N, et al. Beliefs and perception of risks of HIV among women that have never been tested for HIV in the United States. J Natl Med Assoc 2012;104:441-8.  Back to cited text no. 2
    
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Sorour AS, El-Maksoud MM. Relationship between musculoskeletal disorders, job demands, and burnout among emergency nurses. Adv Emerg Nurs J 2012;34:272-82.  Back to cited text no. 4
    
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O'Connell Smeltzer SC, Bare BG, Janice L. Hinkle JL. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. Vol. 1. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 2240.  Back to cited text no. 5
    
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Mohammadi MR, Davidian H, Noorbala AA, Malekafzali H, Naghavi HR, Pouretemad HR, et al. An epidemiological survey of psychiatric disorders in Iran. Clin Pract Epidemiol Ment Health 2005;1:1-8.  Back to cited text no. 9
    
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Yang MS, Pan SM, Yang MJ. Job strain and minor psychiatric morbidity among hospital nurses in southern Taiwan. Psychiatry Clin Neurosci 2004;58:636-41.  Back to cited text no. 11
    
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Winters N. The relationship between personality characteristics, tenure, and intent to leave among emergency nurses. J Emerg Nurs 2019;45:265-72.  Back to cited text no. 12
    
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[PUBMED]  [Full text]  
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Mosadeghrad AM. Occupational stress and turnover intention: Implications for nursing management. Int J Health Policy Manag 2013;1:169-76.  Back to cited text no. 16
    
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Zeinhom M, Higazee A, Rayan A, Khalil M. Relationship between job stressors and organizational support among Jordanian nurses. Am J Nurs Res 2016;4:51-5.  Back to cited text no. 17
    
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Nair A. A study to assess the occupational stress among staff nurses at selected private hospitals in Raipur. Int J Nurs Educ Res 2016;4:203.  Back to cited text no. 18
    
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Borhani F, Abbaszadeh A, Nakhaee N, Roshanzadeh M. The relationship between moral distress, professional stress, and intent to stay in the nursing profession. J Med Ethics Hist Med 2014;7:3.  Back to cited text no. 19
    
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Anbazhagan S, Ramesh N, Nisha C, Joseph B. Shift work disorder and related health problems among nurses working in a tertiary care hospital, Bangalore, South India. Indian J Occup Environ Med 2016;20:35-8.  Back to cited text no. 20
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