Stress: Effects on nursing staff

Published Date: 23 Mar 2015 Last Modified: 08 May 2017

Job stress has become an increasingly common outcome of today's dynamic life. Stress in the workplace is better understood as the psychological state that represents an imbalance or inconsistency between an employee's perceptions of the demands and their ability to cope with those demands. Most jobs consist of situations or events that employees find stressful; however, some jobs encounter more job-related stress than others.

It is now an established fact that the profession of nursing is full of stress and challenges. Female nursing staff faces crying and dying patients on daily basis. The tasks performed by them are almost mundane and unrewarding. If measured by normal standards, nurse's job is disgusting and distasteful, degrading and frightening (Hingley, 1984). [i] "

The ILO has commissioned a manual on the job stress and its prevention among female nursing staff entitled "work relating stress in nursing, controlling the risk of health" by Dr. A. Griffiths, Professor S. Cox, due to its great significance. (ILO, 2001). [ii] 

1.2) THE MAIN SOURCES/CAUSES OF JOB STRESS AMONG NURSES:

The job of female nurses is daunting and daring. Everyday multiple and conflicting demands are imposed on nurses by their supervisor, managers, administrative staff and others. Such situation usually leads to work burden and role conflict. The role conflict is inherent in the job of female nurses due to goal oriented demands put on them such as "getting patients better very early". The nurses are given the task of providing emotional support and relieving stress of dying and crying patients. Role conflict is common among nurses looking after those patients who are critically ill and dying. It is worth mentioning here that intensive care unit and critical units of our hospitals attracted particular attention these days. Here, the female nurses faces, on daily basis, stark suffering, grief and death. It is now universally accepted that health care in the current era suffer high rate of violent behavior.

In recent times, many research studies have measured and determined the effects of job stress on health and well being of nurses in the hospital settings and elsewhere. Job stress detracts nurses from qualitative working lives, enhances psychiatric morbidity and contributes towards physical illness, such as musculoskeletal problems and depression. [iii] 

1.3) International council of nursing (ICN,2001) has reported that if we want to develop an optimum environment for the production of stress, a lot of stressors, we would include, would be obviously recognized by female nurses as events in the hospital settings which they confront on routine basis. The stressors are long hours, unpleasant noises, sights, undue quiet, sudden shift from intense to mundane tasks, time pressure, no second chance, and enclosed environment etc [iv] .

1.4) Stress usage in its historical perspective.

Stress is a recent term used frequently and generally after 1950s. It is semi-psychological term, always refers to hardship and coercion. In Middle English destress, in Latin stringere- to draw tight. In physics, stress is the internal distribution of a force exerted on a material body, resulting in strain. During the year 1920s and 1930s, stress is used in psychological circles; here it is mental strain or unwelcome happenings. The advocate of holistic medicine refers stress to harmful environmental agent, the implication of which is illness.

Following Hans Seyle's laboratory experience during 1930s, a new scientific usage of stress developed. Stress is the state of organism as it responded and adapted to the environment. Seyle's theories of universal non-specific stress response attracted great interest in the academic circle in physiology.

Seyle endeavored to assimilate stress to the non academic physician as well, by writing a good piece entitled "stress of life" for general public.

A thorough and detailed study of job stress would help employees achieve health and happiness by successfully responding to challenges and problems of the modern globalized world. Eustress is the positive stress as against destress which represents negative stress. Stressors are the causative events/ stimulus.

A large amount of research has been conducted during the late 1960s and early 1970s, to establish a link between stress and diseases of various kinds, stress and decline in performance. To better address the critical issue of stress, research on stress in medical circle has become a focal point during the recent years.

By 1990s, job stress has become significant segment of modern sciences, in all areas of physiology and human functioning. Focus, recently, developed on stress in certain settings, such as stress in work environment. And stress intervention and stress management techniques were developed (how to cope or handle stress).

Stress may be viewed as perceived difficulties in life or a way of referring to hurdles, impediments and eliciting sympathy without being explicitly confessional, just "stressed out".

Stress includes a wide rang of outcomes, from mild irritation to intense and severe problems that might give real breakdown of health. Generally any event or situation between these extremes could be termed as stressful.

The most critical and extreme situation result in burn out and the implication is post traumatic stress disorder (PTSD), an anxiety disorder that can develop after exposure to one or more frightening and terrifying events that result in great physical loss. PTSD is a critical and ongoing emotional reaction to an extreme psychological trauma. It is associated with some occupations such as emergency human resource departments, police personnel and army men etc.

These type of stressors may include events as someone actual death, threat to patient's life or someone else, serious physical injuries or partial or total disablement, threat to psychological integrity, over whelming usual psychological defenses coping. Sometimes, it may result from profound psychological and emotional trauma apart from any physical harm. Often, however, the two are combined.

Life is full of stressful events. We frequently confront challenges and obstacles, and sometime the pressure put on us is very hard to cope with. When we are definitely unsure of how to meet demands set for us, we experience stress. It is worth mentioning here that in small amount stress can be a good thing. It can give us the push, we need, motivating us and to concentrate and remain conscious, focus and alert. [v] 

Stress keep us on our toes during presentation or it stimulate us to curiously study for exam and stay focused when we would be rather in cinema. But when the stress become too hard and the life's demands exceed our capabilities to handle, then our physical and emotional well being is threatened.

We always consider the stressors as being negative, such as rocky relationship, death of near one, over work, an exhausting schedule etc. However, anything that compels us to accommodate and to cope can be a stressor. Stress includes as well, positive events such as promotion, transfer to new post, getting married and changes etc. Regardless of whether an event is positive or negative, if the changes it brings strain, our handling ability and adaptive resources are stimulated, the implication is the subjective feeling of being stressed and the biological stress response of the body.

The sources of stress are manifold. Our stress may be associated to outside factors such as working environment, conditions of the world, family affairs etc. Sometime, stress may be the outcome of our own irresponsible behavior, unrealistic goal, negative perception, and attitude etc.

The causes of the stress are highly individual. What we think stressful is associated with many factors, including our personality outlook on life, problem solving skills and social support system of our society. Sometimes, that is stressful to us may not be stressful for others. For example, our morning journey may make us worry that traffic jam will make us late, others, however, may find the trip relaxing because they allow more than enough time and enjoy talking, viewing and listening to music or reading books. (NIOSH 1987) [vi] 

Stress experienced by the masses in our modern and industrialized society mainly originates in the Enterprises; much of the stress that originates elsewhere affects our behaviour and performance in this enterprises-spill over effect.

Stress means different thing to different peoples. From the perspective of layman, stress can be described as feeling tense, anxious or worried or having the blues. Scientifically such feelings are indication of the stress experience, an intriguingly complex programmed response to perceived threat that can have negative or positive implication. The term stress has been defined in multiple ways in the research and professional literature. All the definitions can be placed in two categories, stimulus and response.

According to stimulus definition, stress is an event, situation or characteristic that result in potentially disruptive circumstances.

In physics, stress refers to the external force applied to an object, for example a bridge girder. The response is strain, which is the impact the force on the girder.

In a response definition, stress is seen partially as a response to some stimulus, called a stressor. A stressor is a potentially harmful or threatening external event or situation. Stress is more than simply a response to a stressor. However, in a response definition stress is the consequence of an interaction between an environment stimulus (a stressor) and an individual's response. That is, stress is the result of a unique interaction between stimulus condition in the environment and an individual's predisposition to respond in a particular way. (Ivancevich, 2001) [vii] 

1.5) Stress Defined:-

One of the complicating issues in understanding stress is the fact that it has been defined in a multitude of ways.

An adaptive response moderated by individual differences, that is a consequence of any action, situation or event that places special demands on a person.( Ivancevich,Olekalns,2008) [viii] 

Stress is a psychological and physiological response to events that upsets our personal balance in some way. These events or demands are known as stressors.(NIOSH, 2010) [ix] 

Stress is the general term applied to the pressures, people feel in life.(Newstorm,Devis, 2002) [x] 

Any adductive demand caused by physical , mental or emotional factors that requires coping behavior(Bohlander,Snell, 2004) [xi] 

A dynamic condition in which an individual is confronted with an opportunity, constraints or demand related to what he or she desires and for which the outcome is perceived to be both uncertain and important.( Robbins, 2001) [xii] 

Stress is a complex pattern of emotional states, physiological reactions and related thoughts in response to external demands.(Greenberg, Baron, 2000) [xiii] 

The interaction between individual and environment characterized by physiological and psychological changes that cause a deviation from normal performance.

A situation where in job-related factors interact with a worker to change his or her psychological and/or physiological condition such that the person is force to deviate from normal functioning.(Bernardin, 2003) [xiv] 

Some environmental force affecting the individual, which is called a stressor.

The individual's psychological or physical response to the stressor.

In some cases, an interaction between the stressor and the individual's response.

Stress is a dynamic condition in which an individual is confronted with an Opportunity, demand, or resource related to what the individual desires and for which the outcome is perceived to be both uncertain and important.(Robbins, Timothy, 2007) [xv] 

(11) Behr and Newman define job stress as" a condition arising from the interaction of people and their jobs and characterized by changes within people that force them to deviate from their normal functioning".(Pfeffer, 1992) [xvi] 

(12) When a person is confronted with a situation which poses a threat or demand, and perceives that she or he does no have the capability or resources to match or exceed the stressor, the imbalance that results at that point in time is termed stress.( Luthan, 2005) [xvii] )

(13) An Individual's adaptive response to a situation that is perceived as challenging or threatening to the person's wellbeing.(Mc Shane, Travaglione, 2004) [xviii] 

(14) Stress is an individual's physiological and emotional response to stimuli that place physical or physiological demands on the individual and create uncertainty and lack of personal control when important outcomes are at stake. (Samson, Richard, 2003) [xix] 

(15) Stress is the excitement, feeling of anxiety, and/or physical tension that occur when the demands place on an individual are thought to exceed his ability to cope. (Hellriegel, John 2004) [xx] 

(16) "Stress is a negative emotional state occurring in response to events that are perceived as taxing or exceeding a Person's recourse or ability to cope". (Hockenbury, 2003) [xxi] 

For our purposes, we think it is useful to view stress as the response a person makes and to identify the stimulus conditions (actions, event or situation) as stressor. This allows us to focus our attention on aspects of the organizational environment that are potential stress producers. Whether stress is actually felt or experienced by a particular individual will depend on that individual's unique characteristics. Furthermore, note that this definition emphasizes that stress is an adaptive response. The great majority of our responses to stimuli in the work environment does not require adaptation and thus are not really potential sources of stress.

In the context of our stress definition, stress is the outcome of handling something that places 'special' demands on the individual. Special here means unusual, physically or psychologically threatening, or outside an individual's usual set of behaviors. Starting a new assignment, changing bosses, having a flat tier, missing a plane, making a mistake at work, having a performance evaluation meeting with the boss, giving a speech - all of these are actions, events or situations that may place special demands on individuals. In that sense, they are potential stressors. Not all stressors will always place the same demand on all people.

In order 0f an action, event or situation to result in stress, it must be perceived by the individual to be a source of threat, challenge or harm. If there are no perceived consequences - good or bad - there is no potential stress. At least three additional factors play a role in determining whether what an individual is experiencing is likely to result in stress. These factors are; importance, uncertainty and duration. Importance is related to how significant the event is for the individual. For example, let us suppose that an employee is facing a job lay-off. The more significant or important that event is to the individual, the greater the stress potential. If the employee expects such an event to be followed by a period of prolonged unemployment, it will probably be viewed as a more important event than if immediate employment is assured

Uncertainty refers to a lack of clarity about what will happen. Rumors of an impending lay-off may be more stressful for some people than knowing for certain that they will be laid off. At least in the latter case, they can make plans for dealing with the situations. Frequently, 'not knowing' places more demands on people than knowing, even if the known result is perceived as negative.

Finally, duration is a significant factor. Stressor can be either acute or chronic. Acute stressors are major events in our lives that have a relatively short time frame. Getting married, losing your job or failing in exams are all events that leave a big impact on us, but they do not endure overtime (we do not fail an exams every day). Chronic stressors have a less profound impact on us when they occur, but we are exposed to them on an almost continual basis. They are represented by daily hassles that fit with seyle's representation of stress as the 'wear and tear of every day life'. Such things as shopping, cooking or finding a study space in the library are all minor irritation that we face on an almost daily basis. They may not affect us at a time, but their affect slowly built over time. Generally speaking, the longer special demands are placed on us, the more stressful the situation. Giving an unpleasant job assignment that lasts for only a day or two may be mildly upsetting, while the same assignment lasting for months may be excruciatingly painful. Although there are some acute stressors in the workplace (job loss or transfer, promotion or demotion, and entering or leaving the job market), most of the work place stressor are better thought of as daily hassles.

1.6) THE GENERAL ADAPTATION SYNDROME (GAS)

Stress includes both psychological and physical components. Dr. Hans's Seyle, the pioneer of stress research was the first to conceptualize the psycho physiological responses to stress. Seyle consider stress a non-specific response to any demand made upon an organism. He labeled the three phases of the defense reaction that a person establishes when stressed as the general adaptation syndrome (GAS). Seyle called the defense reaction 'general' because stressor had effects on several areas of the body.

Adaptation refers to a stimulation of defenses designed to help the body adjust to or deal with, the stressor. And syndrome indicates that individual pieces of the reaction occur more or less together. The three distinct phases, which can be seen in exhibit no.1, are called alarm, resistance and exhaustion.

The alarm stag is the initial mobilization by which the body meets the challenges posed by the stressor. When a stressor is recognized, the brain sends forth a biochemical message to all the body's systems. Respiration increases, blood pressure raises, pupils dilate, muscles tense up and so forth.

If the stressor continues, the GAS proceeds to the resistance stage. Sign of being in the resistance stag include fatigue, anxiety and tension. The person is now fighting the stressor. While resistance to a particular stressor may be high during this stag, resistance to other stressor may be low. A person has only finite sources of energy, concentration and ability to resist stressors. Individuals are often more illness-prone during periods of stress than at other times.

The final GAS stage is exhaustion. Prolonged and continual exposure to the same stressor may eventually use up the adaptive energy available, and the system fighting the stressor becomes exhausted.

It is important to keep in mind that the activation of the GAS places extraordinary demands on the body. Clearly, the more frequently the GAS is activated and longer it remains in operation, the more wear and tear there is on the psycho physiological mechanisms. The body and mind have limits. The more frequently a person is alarmed, resist and becomes exhausted by work, non-work or the interaction of these activities, the more susceptible he or she becomes to fatigue, disease, aging and other negative consequences. (Ivancevich, 2001) [xxii] 

Stage 1

Normal level of resistance

Stage 3

ALARM REACTION

The body shows the changes characteristic of the first expose to the stressor. At the same time, its resistance is diminished.

Workplace example:

A request by a manager to submit a budget in 3 days

RESISTANCE

The second stage ensures if continued exposure to the stressor is not compatible with adaptation. Resistance increase above normal.

Workplace example:

Flying off the handle at a meeting because the budget was still unfinished & time is passing with no budget work occurring.

EXHAUSTION

The third stage follows long continued exposure to the same stressor, to which the body has become adjusted. Eventually adaptation energy is exhausted.

Workplace example:

No sleeps, insomnia, worry about the budget. Totally and physically exhausted.

Stage 2

Exhibit no.1

1.7) THE CAUSES OF STRESS

The causes of stress, which may rightly be called stressors, include any environmental condition that place a physical or emotional demand on a person. There are numerous stressors in organizational settings and other life activities.

Exhibit no.2 lists the four main types of work-related stressor:

Physical environment stressors,

Role-related stressors,

Interpersonal stressors and

Organizational stressors.

1.7.1) STRESSORS INHERENT IN PHYSICAL ENVIRONMENT (PHYSICAL ENVIRONMENT STRESSORS)

The physical environment of organization contains some physical environmental stressors; safety hazards, poor lighting, and excessive noise etc. For example, a study of textile workers in a noisy plant found that there level of stress decreased measurably when they were supplied with ear protectors. Another study reported that clerical employees experience significantly higher stress level in noisy, open office than in quiet areas. Physical stressors also include poorly designed office space, lack of privacy, ineffective lighting and poor air quality.

1.7.2) ROLE-RELATED STRESSOR

In this concept of role related stressors, employees have difficulty in assimilating and reconciling or performing the multitude roles that they play in their life.

Main role-related stressors are;

Role conflict,

Role ambiguity,

Workload

Task control:

Role conflict

Accordingly, when masses confront competing demands role conflict occurs. An employee may have two roles that are in conflict with each other (called interrole conflict) or may receive contradictory messages from different people about how to perform a task (called intraoral conflict). Role conflict also occurs when organizational values and work obligations are incompatible with personal values (called person-role conflict). For example, a recent study described how Australian managers experience the stress of people-role conflict when they observe unethical practices involving partners located in other countries.

Work related stressors

Physical environment stressors

Role-related stressors

Interpersonal stressors

Organizational stressors

Non-work

stressors

Individual

Differences

stress

Consequences of distress

Physiological

Heart disease

Ulcers

High BP

Headaches

Sleep disturbance

More illness

Psychological

Job dissatisfaction

Depression

Exhaustion

Moodiness

Burnout

Behavioral

Lower job performance

More accidents

Faulty decisions

Higher absenteeism

Workplace aggression

Exhibit no.2

1.7.2.2 Role ambiguity When workers are unsure of meeting job responsibilities, performance, expected level of authority and job conditions, role ambiguity is said to exist. This tends to occur when people enter new situations, such as joining the organization or taking an overseas assignment, because they are uncertain about task and social expectations.

1.7.2.3Work load-work under load - providing small amount of work or assignment to workers that do not match their talent is a stressor. However, work overload is the most common stressor these days in our dynamic organization. Employees are required to perform too much work in too short time. Long hour work leads to unhealthy lifestyles, which in turn, cause heart disease and stokes. This is a concern in Singapore and Hong Kong where cultural values encourage long work hours. Work hours in Australia are also creeping up, with almost one-third of the workforce clocking in 49 hours or more per week. Work overload is such a problem in Japan that death from overwork has its own name - karoshi.

1.7.2.4) Task control - employees feel more stress when they have no control over their assignment, performance and pace of their activities. Work is potentially more stressful when it is paced by a machine, involves monitoring equipment or the work schedule is controlled by someone else. This is the reason why techno stress-stress caused by information technology-has become one of the leading health hazards in the workplace. Australian now identifies e-mail as their biggest source of stress. One-quarter of British managers also say that email is creating stress. Over two-thirds of employees in large American companies feel overwhelmed by the incessant demands of electronic communication.

1.7.3) STRESSOR - INTERPERSONAL

These include ineffective supervision, office politics and other conflicts with masses. High turnover of front-line staff at Australia's Commonwealth Bank is apparently partly cause by stress from increasingly angry customers. One survey indicate that 88 per cent of call center employees in Australia say that they have high or extreme level of stress, mainly due to angry customers and unsupportive management. 'It's one thing dealing with one angry costumer on the odd occasion, but when you are dealing with people like that all day, it is tough', says JAG Marketing executive Jonathon Gross, who has worked in a call center.

Teamwork is a potential interpersonal stressor. A study of West rail, the government-owned rail transportation company in Western Australia, revealed that employees experienced higher stress when they were formed into work teams. Sexual harassment is another powerful interpersonal stressor. Victims of sexual harassment experience trauma (especially from rape or related exploitation) or must endure tense colleague relations in a hostile work environment. Moreover, they are expected to endure more stress while these incidents are investigated.

1.7.3.1) Workplace violence

Another serious interpersonal stressor is the rising wave of physical violence in the workplace. In the United States, one thousand workers assassinated on job each year and two million other experiences lesser forms of violence. But the international labor organization reports that the highest incidence of workplace assaults and sexual harassment isn't in the United States; it occurs in France, Argentina, Romania, Canada and England. Workplace violence is less common (or less reported) in Pacific Rim countries, but it is significant stressor in some industries. New Zealand's department of work and income has banned 170 people from entering its offices because of their violent or intimidating behavior. All 260 nurses who responded to a survey in New South Wales had experienced some form of violence at least weekly; many cited incidents involving lethal weapons.

Employees have usually symptoms of severe stress, when experiencing violence, or after traumatic events. It is not uncommon for these primary victims to take long-term leave. Some never return to work. Workplace violence is also a stressor to those who observe the violence. After a serious workplace incident, counselors work with many employees, not just the direct victims. Even employees who have not directly experienced or observed violence may show signs of stress if they work in high-risk jobs. For example, one study reported that the greater cause of work-related stress among British bus driver is their perceived risk of physical assault.

1.7.3.2) Workplace bullying

Although less dramatic than workplace violence, workplace bullying is becoming so common that it is considered as more serious interpersonal stressor. It has become enough of a concern that some Scandinavian countries have passed laws against it. Humiliating behavior, intimidating or offensive attitude that insults and ridicules or degrade another workers at organization is better refer to work place bulling. People with higher authority are more likely to engage in bullying or incivility towards employees in lower positions. What studies here in Australia and around the world are showing is that significant source of workplace stress is bullying-intimidating behavior from employers and bossy attitude.

Workplace bullying produces stress and its physiological, psychological and behavioral consequences. Australian studies estimates that almost three-quarters of victims experience or seek counseling for depression, fatigue, sleep disorders and higher blood pressure following incidents of bullying. Workplace bullying also imposes enormous costs on organizations. Australian research has found that victims take an average of 50 days off work and almost 25 % resign or retire following bullying incidents. Back on the job, victims of workplace bullying have impaired decision making, lower work performance and more work errors. Workplace bullying also has hidden costs in the form of investigation costs, loyalty and costumer service.

1.7.4) ORGANIZATIONAL STRESSORS

The seal or merger of a company is one of many organizational stressors that employees face. Downsizing is a stressor for those who lose there jobs. Survivors of lay-offs also experience stress from higher workloads, increased job insecurity and the loss of friends at work. For example, the company nurse at a high-tech company discovered that the percentage of employees surfing from high blood pressure doubled after the company lay off 10% of its workforce. A study in Finland reported that, after a period of major downsizing, the amount of long term sick leave taken by surviving government employees doubled.

1.7.4.1) NON-WORK STRESSORS

Work is usually the most stressful part of our lives, but it's not the only part. We also experience numerous stressors outside organizational settings. Employees do not park these stressors at the door when they enter the workplace. They carry over and ultimately affect work behavior.

There are three main work-non-work stressors;

.Time-based,

.Strain-based

.Role behavior conflict

1.7.4.2) Time-based conflict

Many employees have to contend with the conflict of time-balancing the time demanded by work with other non-work activities and responsibilities of families. This stressor is particularly noticeable in employees who hold strong family values. Time-based conflict largely explains why stress increases with the number of hours of paid employment and the amount of business travel or commuting time. Inflexible work schedules and rotating shift schedules also take a heavy toll because they prevent employees from effectively juggling work and non-work. Time-based conflict is more acute for women then for men because house work and child care represent a 'second shift 'for many women in dual-career families. Until men increase their contribution to home making and business learns to accommodate the new social order, many of these super mums will continue to experience super stress.

1.7.4.3) Strain-based conflict

This type of stress is also known as spills over effect of stress, it occurs when stress from one domain spills over to the other. Relationship problems, financial difficulties and loss of a loved one usually top the list of non-work stressors. New responsibilities, such as marriage, the birth of a child and a mortgage are also stressful to most of us. Stress at work also spills over to an employee's personal life and also becomes the foundation of stressful relation with family and friends. In support of this, one study found that fathers who experience stress at work engage in dysfunctional parenting behaviors, which, in turn, explain their children's behavior in school.

1.7.4.3) ROLE BEHAVIOR CONFLICT

A third work-non-work stressor, called role behavior conflict, refers to, when people are expected to play different work and non-work roles. People who act logically and impersonally at work have difficulty switching to more compassionate roles in their personal lives. For example, one study found that police officers were unable to shake off their professional role when they left job. This was confirmed by their spouses, who reported that the officers would handle their children in the same manner as they would people in their job.(steven, et al, 2004) [xxiii] 

BACKGROUND OF THE STUDY:

Previous research supports that employee with high job demands perceive higher job-related stress. Employees are now being required to act on multiple task, learn new skills, and self manage to meet competitive demands. Some common job stressor includes; Job responsibilities, deadlines, assignments, conflict, working hours, discipline and reprimand from supervisor/boss. Job stress is acknowledged as one big problem from the perspective of employees as well as employer, around the world and is a common concern in both the developing and developed nations. However, understanding job stress and digging out the negative effect of job stress on nurses would be a great help towards this neglected but significant class of our society. Many research studies have been conducted on other employees but very little or no work on the job stress of nurses in our country has been conducted. Nurses face a lot of challenges in the hospital set up. Some of these challenges could lead to frustration, anger, tension and job stress. Job Stress is experienced by nurses constantly because they deal with crying and dying peoples on daily basis.

1.9) STATEMENT OF THE PROBLEM:

Stress can have detrimental effects on the nurse's job in hospital and elsewhere. Stress in the work place plays a significant role in the decline of a productive work environment. Job stress can influence nurses both personally and professionally. A stressful work place can have many effects on health, well being, performance and job satisfaction of the employee. Job stress can lead to physical, emotional, psychological and social consequences. A stressful working environment is unproductive, uncomfortable and ineffective for the employees and organization as a whole .Job stress also negatively affect the quality of work as well.

If we potentially endeavor to work out the main causes of stress in the workplace of female nurses and study its impact on job performance and job satisfaction, it will help a lot in improving the work environment and well being of this totally neglected but significant class of our society.

Job-related stress has negative repercussions on the personal life and professional career of nurses. Job stress can derail the health, welbeing, and performance level and job satisfaction of the nurses in a phenomenal fashion. Its over all impact will emerge in the shape of eradication of multiple social problems

1.10) Objectives of the study:

The main focus of the study will remain directed on the accomplishment of following objectives.

To find out the main causes of stress at the working atmosphere of public sector hospitals and the impact of these stress factors on the performance and job satisfaction of female nurses.

To find out the spill over impact of stress factors on the domestic/social life of female nurses.

To find out the bifurcation in the stress level of nurses belonging to different age groups/ service cadres.

To dig out the stress parameters associated with family background of nurses with respect to education / rural and urban location.

The fundamental objective of the study, in view of the researcher is to develop a model, in light of causes and effects of stress associated with female nursing staff in public sector hospitals of Peshawar, which will prove a landmark in the identification and subsequent elimination of job stress. Thus, the mitigation of this problem can lead to colossal positive impact on the physical, emotional and psychological health of nurses coming from all walks of life to the public sector hospitals of Peshawar in particular and those serving in other hospitals in the country in general.

Job stress is a potent source of decline in the productivity of employees.

1.11) RATIONALE:

The ability to better understand the relationship between job stress and performance and between job stress and job satisfaction and the job stress experienced by the nursing staff serving in hospital and elsewhere can provide insight into the degree of relationship between job stress and performance and job satisfaction. This specific segment of the employees that is nurses is constantly under going new challenges and problems in the work place. The constant interaction with challenges and problems can increase job stress experienced by this segment of employees; it is interesting to dig out a relationship between job stress and job performance and job satisfaction amongst nurses of public sector hospital of Peshawar, metropolitan of Khyber-pakhtunkhwa.

More specifically, it is interesting to gain further insight regarding the degree of relationship that may or may not exist between job stress and job performance and job satisfaction.

This research study can be beneficial to other human service, agencies, human service organization that is concerned with job stress. Job stress can have severe effect on physical, emotional and psychological well being of nurses. Knowledge regarding the relationship between job stress and performance and job satisfaction should be shared with organization in human service field in order to make better over all quality of work and service being provided to our communities. Stress reduction can lead to a more productive working environment for the nurses. A more productive environment is beneficial to the organization as a whole.

1.12) SIGNIFICANCE OF THE STUDY.

No doubt the study in question carries great significance as it aims to focus on the resolution of a social problem. The following points will highlight the significance of the subject.

The nursing class contributes to the welfare of the troubled and downtrodden people, coming from all walks of society, at the cost of their own peace of life. Identification and Elimination of their stress on job through suitable measures will tantamount to the reciprocation of their devotion to their job. Giving due recognition to their valuable services rendered to the society will go a long way in curtailing their frustration level, being necessary ramification of work related stress, and as a consequence , their job performance and job satisfaction will be remarkably enhanced.

A tension free nurse means a blessing for the amelioration of the suffering class of the society, the natural corollary of which is bound to rebound in the shape of comparatively healthier and prosperous society.

3) The study will help in finding the root causes of stress of the female nursing staff in public sector hospitals in Peshawar. However, the recommendation of the study will have a wider scope and their implementation can be extended to other public hospitals in the country, by conveying the findings and proposals to the ministry of health Islamabad.

1.13) HYPOTHESIS

The following hypothesis are presented here.

1) Nursing profession is full of stress.

2) Job Stress leads to decline in performance.

3) Job Stress negatively affects job satisfaction.

4) Various age group and job stress are co-related.

5) Job Stress and experience (service length) has co-relation.

6) Job Stress and service cadres have co-relation.

7) Background (rural, urban) and family status (educated, uneducated) are co-related with job stress.

1.14) Assumptions

It is assumed that the female nursing staff of hospitals displayed honesty when answering all the sections of the questionnaire.

It is assumed that nursing staff of hospitals were honest in determining causes of job stress.

It is assumed that nursing staff of hospitals were honest in determining job stress & its effects on performance & job satisfaction.

1.15) SCOPE AND LIMITATIONS OF THE STUDY.

The subject carries wide scope. However, the researcher intends to limit the study to the public sector hospitals in Peshawar i.e. Lady Reading Hospital, Khyber teaching hospital and Hayatabad medical complex due to time and cost constraints. The patients abundantly over crowd these hospitals and as such there is an influx of patients, patient's attendants and visitors in these hospitals. All these factors add fuel to the fire by contributing significantly to the already stressful job of the female nurses that needs special attention.

A limitation of the study involves recruiting a large sample size. The larger the sample size the greater the validity of the quantitative study. Surveys are commonly known as an easy way to reach the largest number of people, However surveys usually generate a lower return rate. One limitation is that not all nurses were contacted, of those present, not all were willing to complete or return the surveys. Another limitation includes the variety of Confounding variables among the participants being recruited. Some of the confounding variables include factors such as age, service cadres, professional experience/length of employment, permanent background, marital status &status of education.. These variables could have a different impact on stress level and its effects on performance & job satisfaction, experienced by female nurses working in public sector hospitals. The use of self-report measures could affect the nature of the results. As with most self-report measures, accuracy is difficult to guarantee due to the potential susceptibility of containing socially desirable responses. Accuracy could be compromised if the participants were not honest with regard to answering the surveys (questionnaire) administered. Finally, this study was only able to determine correlation, among variables examined. This study only specifies if a significant relationship exists among the variables in question.

1.16) Nature of the Study

This research study is a correlation research design. The study explored if a

Significant relationship exists between job stress and job performance, job stress and job satisfaction among female nurses working in the public sector hospitals of Peshawar. "Stress is a personal reaction/response and is the negative outcome of an imbalance between pressure and the person's ability to cope with that pressure" . This research study explored the relationship between job stress and job performance, job stress and job satisfaction.

1.17) Organization of the remainder of the study/research outlines.

This research study is organized into five chapters. Chapter one focused on the Introduction, background of the study, purpose, and significance, rationale, assumptions, and limitations of the study. Chapter two presents a review of the relevant literature specific to job stress and job performance and job satisfaction. Chapter three outlines the methodology used in this study, including selection of participants, the hypotheses tested, and the procedures used to collect the data. Chapter four presents the data analysis and its description from the Questionnaires that were returned. It gives a complete description of how the data were analyzed and the hypotheses were tested, as well as the findings & results of those analyses. Chapter five discusses the results and provides conclusion of the study. Chapter five also provides recommendations for future studies.

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