INTRODUCTION:

The changes that have occurred during the process of globalization have significantly impacted people's way of life, health, and work structure.¹ The concept of stress was first defined in the 1950s with the introduction of the general adaptation syndrome. It is a state in which several systems of the organism deviate from their normal resting conditions due to a non-specific agent. This agent causes stress through the activation of a chain of reactions, leading to the release of catecholamines and glucocorticoids.²

The overall prevalence rate of stress among ICU staff was determined to be 52.43%. A study conducted by Coomber et al. (2002) in the UK revealed a 29% prevalence of stress among ICU doctors. It was observed that ICU staff who spent less time with family and friends were more likely to experience stress compared to those who allocated more time to social interactions. Moreover, findings indicated a significantly higher level of stress among ICU staff who had experienced stressful events either at their workplace or at home (Earle et al., 2005). These insights held statistical significance across the general ICU staff population. This suggests that recent stressful events, whether in the workplace or at home, may contribute to heightened stress levels, impacting day-to-day functioning.³

When individuals feel obligated to respond to a situation but are unable to cope with the demands, stress arises. Stress is subjective and varies from person to person, influenced by factors such as genetic vulnerability, coping style, personality type, and social support. The impact of stress on an individual depends not only on the nature and severity of the stress but also on the individual's psychological makeup. Researchers have long suspected that individuals with stressed-out personalities have a higher risk of health issues such as high blood pressure, heart problems, asthma, obesity, diabetes, headaches, depression and anxiety, gastrointestinal problems, and Alzheimer’s disease.⁴ Hence, this study was taken to develop insight into type of stressors and their effects on staff – nurses and to prepare guidelines on enhancing ways to address these stressors.

OBJECTIVES:

1. To identify the level of stressors experienced by staff nurses working in the intensive care units.

2. To examine the level of effects of stressors on staff nurses working in the intensive care units.

3. To find the correlation between the stressors and effects of stressors with the selected variables.

4. To develop guidelines for staff nurses on how to deal with these stressors and their effects.

METHODOLOGY:

Research Approach – Quantitative research approach.

Research Design – Non-experimental research design.

Research Setting – Intensive Care Units of Christian Medical College, Ludhiana, Punjab.

Sample and Sampling Technique – Staff nurses (N = 100), Purposive sampling technique.

Research Tool – On the basis of the study objective, the research tool developed had tree parts.

Part – 1: Socio-demographic characteristics: age, gender, marital status, number of children, family members, residential area, academic qualification, total professional experiences, professional experience in ICU.

Part – II: Rating Scale on Stressors:

The area of stressors were divided into 6 categories, i.e. Personal and Family Stressors, Stressors related to Managerial staff, Stressors related to Interpersonal Relationships, Stressors related to workload, Stressors related to ward resources, Stressors related to patient care.

Part – III: Rating Scales on Effect of Stressors:

The rating scale consisted of statements which included the effects of stressors among staff nurses.

Criterion Measure – The criterion measure used in the study is as follows:

Level of Stressor	Scores	Percentage
Severe	More than 79	> 77 %
Moderate	57 - 78	56 – 76 %
Mild	Less than 57	< 56 %

To identify the level of effects of stressors:

Level of effects of stressors	Scores	Percentage
Severe	More than 37	> 76 %
Moderate	26 - 37	54 – 76 %
Mild	Less than 26	< 54 %

Validity:

The content validity of the tool had been determined from the expert’s opinion on the relevance of the tool.

Reliability:

Reliability of the structured rating scale was computed by split – half method using Karl Pearson’s Co-efficient of correlation and Spearman Brown’s prophecy. The reliability of the tool was highly reliable (r = 0.808)

Data Collection Process:

We collected the data in February 2016 after obtaining formal permission from the institutional authorities. The time taken by the respondents to respond to the items in the tool was between 15 and 20 minutes.

Ethical Considerations: In view of ethical considerations, the researcher discussed the type and purpose of the study with experts in the College of Nursing CMC & Hospital, Ludhiana, Punjab. The concerned authorities granted written permission, and the staff nurses provided their written consent to participate in the study. We assured the staff nurses that we would keep their details confidential and use them solely for the research study. Data collection did not interfere with the patient's treatment.

Data Analysis Procedure:

The study's objective guided the analysis. We analyzed the data using both descriptive and inferential statistics. The chosen level of significance was p < 0.05. Tables, bar, and pie diagrams displayed the study's results.

RESULTS:

Table – I: Frequency and Percentage Distribution of Staff Nurses According to Subject’s Characteristics (N = 100)

S. No

Subject’s Characteristics

Frequency

Percentage

Age (Years)

a. 21 – 25

b. 26 – 30

c. 31 – 35

d. 36 – 40

e. > 40

32.00

49.00

8.00

7.00

4.00

Gender

a. Male

b. Female

Marital Status

a. Single

b. Married

c. Widow

d. Divorced

57.00

43.00

0.00

No. of Children

a. None

b. 1

c. 2

d. > 2

72.00

18.00

10.00

0.00

Family Members

a. < 4 members

b. 5 – 9 members

c. > 10 members

58.00

40.00

2.00

Residential area

a. Urban

b. Rural

26.00

74.00

Academic Qualifications

a. Senior secondary

b. Graduate

c. Post-Graduate

31.00

64.00

5.00

Professional Qualification

a. GNM

b. B. Sc / PB. B. Sc

66.00

34.00

Total Years of Professional Experience

a. 6 months – 1 year

b. 1 year – 5 years

c. 5.1 – 10 Years

d. > 10 years

5.00

61.00

23.00

11.00

10.

Professional Experience in ICU (Years)

a. 6 months – 1 year

b. 1 year – 5 years

c. 5.1 – 10 Years

d. > 10 years

20.00

61.00

16.00

3.00

Table I revealed that 49 individuals (49.00%) fell within the age range of 26 to 30. In terms of the sample's gender distribution, 76(76.00%) of the participants were single women. Of the samples, 72(72.00%) were childless. In terms of family members, the bulk of the samples had more than four. The vast majority of the 74(74.0%) samples came from rural areas. Regarding the sample's educational background, 64(64.00%) of the participants had obtained their graduate degree. The sample's professional qualifications show that the majority of the 66 samples (66.00%) have successfully finished a GNM course. The majority of those with 61(61.00%) years of total professional experience had fewer than one year of experience. 61(61.00%) of the participants had between one and five years of professional experience in the ICU.

Table – II: Frequency and Percentage Distribution of Samples According to Level of Stress (N = 100)

S. No	Level of Stress	Frequency	Percentage
1.	Severe	5	5.00
2.	Moderate	93	93.00
3.	Mild	2	2.00

Table II displays the number of samples and their percentage spread based on the stress level. Among the samples, most of them (93.3%) had moderate amounts of stress. Five samples, or five percent of the whole, had a high stress level.

Table – III: Frequency and Percentage Distribution of Samples According to Level of Stressors (N = 100)

S. No	Level of Stressors	Frequency	Percentage
1.	Severe	1	1.00
2.	Moderate	25	25.00
3.	Mild	74	74.00

The frequency and percentage distribution of samples is shown in Table III, which is organised according to the level of stressors. The bulk of the samples, representing 74 (74.00%), were determined to have a moderate level of stressors. The number of individuals who were experiencing a moderate degree of stresses was 25 (25.00%).

Table – IV: Mean, Mean Percentage, and Rank Order of Stressors According to Area of Stressors (N = 100)

Area of Stressors	Maximum Scores	Stressor Score		Rank Order
Area of Stressors	Maximum Scores	Mean Score	Mean %	Rank Order
Personal Stressors	157	0.62	50.83	6
Stressor’s r/t managerial staffs	24	15.87	66.14	3
Stressor’s r/t workload	12	9.625	80.20	1
Interpersonal stressors	24	14.625	60.93	4
Stressor’s r/t ward resources	12	8	66.66	2
Stressor’s r/t patient care	12	9	60	5

Table IV shows the mean, mean percentage, and rank order of stressors according to their area. The maximum score for personal stressors was 157, with the mean score as 0.62 and the mean percentage as 50.83. The maximum score for stressors related to managerial staff was 24, the mean score for stressors related to interpersonal relationships was 15.87, and the mean percentage was 66.14. Stressors related to workload ranked number 1 among all stressor areas, while stressors related to ward resources ranked second.

Table – V: Mean, Mean Percentage, and Rank Order of Staff Nurses Effects of Stressors Score According to area of effects of Stressors (N = 100)

Effects of Stressors	Maximum Scores	Mean	Mean %	Rank Order
Physical Effects	30	13.25	44.16	2
Psychological Effects	18	9.62	53.4	1

Table V displays the mean, percentage, and rank order of stressor score impacts on staff nurses. The effects of stressors were classified by area. Stressors had an average impact on staff nurses' physical health of 13.25. The psychological impacts had a mean value of 9.62. As a result, stressor-induced psychological impacts were ranked first, followed by physical effects.

Table – VI: Mean, Standard Deviation & Correlation between Stressor Score and Effects of Stressors Score Among Staff Nurses

(N = 100)

Relationship Between	Maximum Scores	Mean	Standard Deviation	r value
Stressors	102	64.75	6.46	0.808
Effects of Stressors	48	24	4.43	0.808

Table VI displays the mean, standard deviation, and correlation between the stressor score and the effects of stressors score among staff nurses.

Stressors had a mean and standard deviation score of 64.75±6.46, while their effect had a mean and standard deviation of 24±4.43. The 'r' value was 0.808, which indicated a strong positive correlation.

Table – VII: Mean, SD, & Z test scores of stressors among staff nurses according to Marital Status, Residential Area, and Professional Qualifications (N = 100)

Sample Characteristics

Mean Score

Result

Marital Status

a. Single

b. Married

67.59

68.04

4.71

5.06

0.40

Significant

Residential Area

a. Rural

b. Urban

68.5

67.5

6.17

5.43

0.70

Significant

Professional Qualifications

a. GNM

b. B. Sc /

PB B.Sc

68.3

66.7

5.63

5.54

1.28

Significant

Table VII presents the average, standard deviation, and Z test results of stressors among staff nurses categorised by Marital Status, Residential Area, and Professional Qualifications. Each of these three sample parameters exhibits statistical significance in relation to the stressors.

Table – VIII: Mean, SD, & Z test scores of Effects of Stressors stressors among staff nurses according to Marital Status, Residential Area and Professional Qualifications

(N = 100)

Sample Characteristics

Mean Score

Result

Marital Status

a. Single

b. Married

23.82

22.55

4.24

4.66

1.39

Significant

Gender

a. Male

b. Female

23.70

23.27

5.02

4.45

0.37

Significant

Residential Area

a. Urban

b. Rural

23.93

23.05

4.59

4.40

0.83

Significant

Table VIII presents the average, standard deviation, and Z test results of Effect of stressors among staff nurses categorised by Marital Status, Gender, and Residential Area Each of these three sample parameters exhibit statistical significance in relation to the effect of stressors.

DISCUSSION:

We compared the current study's findings to the supplementary research. Staff nurses at Christian Medical College Hospital in Ludhiana, Punjab, reported moderate stress levels more often than other stress levels. Overall, the samples had a moderate impact on stress levels. Staff nurses reported a strong positive association between stressor levels and their effects. There was a statistically significant relationship between the stress levels of staff nurses and demographic variables including marital status, home area, and professional qualifications. This study found a connection between the impact of stressors on staff nurses and their marital status, gender, and geographic region.

A study conducted by Saravanabavan L et al. (2019) aimed to assess the frequency of stress and burnout syndrome among doctors and other healthcare staff in the Intensive Care Unit (ICU). A comprehensive survey was conducted among healthcare professionals, including doctors, nurses, clinical pharmacists, respiratory therapists, and physiotherapists, working in the intensive care units (ICUs) of multispecialty hospitals in southern India. The study revealed a high burnout rate of 80%, with 6% (n = 12) of doctors and 69% (n = 140) of nurses affected. The study findings indicated a statistically significant association between the degree of job satisfaction and the degree of burnout. A strong association was observed between the degree of stress and the dimensions of emotional exhaustion and depersonalisation as measured by the Maslach burnout questionnaire.

Two comprehensive investigations conducted in France revealed that 50% of intensivists and 60% of ICU nurses experiencing severe burnout expressed a desire to resign from their positions. Among the participants in our study, 11, 1638% (n = 78) expressed their intention to depart from the ICU within the next year, regardless of their level of burnout. Our survey revealed that the prevailing health problems experienced by individuals in the workplace were back discomfort, headaches, insomnia, and depression. The French study conducted by Puneet and his colleagues revealed a higher prevalence of sleep disorders and insomnia, but a lower prevalence of sorrow. The prevalence of depression among ICU physicians was examined by Embriaco and his colleagues in a comprehensive one-day national survey conducted in 189 French intensive care units (ICUs). The study revealed that 25% of the intensivists exhibited symptoms of sorrow.

The incidence of elevated burnout in our study was 80%, comprising 6% (n = 12) of physicians and 69% (n = 140) of nurses. The majority of the study participants exhibited a high level of burnout in all three areas of the Maslach burnout scale. Comparative research conducted in other countries revealed that the prevalence of burnout among intensive care unit (ICU) healthcare professionals was 31% in Portugal, reaching 46.5% in France, and 62% in Australia and New Zealand combined.

Based on our study findings, we're setting up a team at our workplace to support our nurses in dealing with stress and its effects on their physical and mental health. We'll also be providing relaxation sessions to prevent burnout. Additionally, we're planning to focus on improving our employees' communication skills, reducing their working hours, ensuring they get enough rest after night shifts, and reviewing their salaries. Once we've put these plans into action, we'll conduct another survey to see how these changes have affected the stress and burnout levels. Our study clearly shows how stress impacts the health of our nurses.

CONCLUSION:

The study found a direct association between stressors and their effects, with increasing stressors leading to increasing effects. These findings support the research assumptions that stressors have significant effects on staff nurses, resulting in stress manifestations.

CONFLICT OF INTEREST:

Nil.

ACKNOWLEDGEMENT:

To all Staff Nurses and Hospital Authorities.

REFERENCES:

1. Muhamad Robat R, Mohd Fauzi MF, Mat Saruan NA, Mohd Yusoff H, Harith AA. Why so stressed? A comparative study on stressors and stress between hospital and non-hospital nurses. BMC Nurs. 2021 Jan 4; 20(1): 2. doi: 10.1186/s12912-020-00511-0. PMID: 33390159; PMCID: PMC7780689.

2. Mat Saruan NA, Mohd Yusoff H, Mohd Fauzi MF, Wan Puteh SE, Muhamad Robat R. Unplanned Absenteeism: The Role of Workplace and Non-Workplace Stressors. Int J Environ Res Public Health. 2020 Aug 24; 17(17):6132. doi: 10.3390/ijerph17176132. PMID: 32846878; PMCID: PMC7504706.

3. Kaushik A, Ravikiran SR, Suprasanna K, Nayak MG, Baliga K, Acharya SD. Depression, Anxiety, Stress and Workplace Stressors among Nurses in Tertiary Health Care Settings. Indian J Occup Environ Med. 2021 Jan-Mar; 25(1): 27-32. doi: 10.4103/ijoem.IJOEM_123_20. Epub 2021 Apr 26. PMID: 34295059; PMCID: PMC8259589.

4. Sebastian M, De Maria M, Caruso R, Rocco G, Di Pasquale C, Magon A, Conte G, Stievano A. Exploring Burnout among Nursing Students in Bangalore: A t-Distributed Stochastic Neighbor Embedding Analysis and Hierarchical Clustering in Cross-Sectional Data. Nurs Rep. 2024 Jul 16;14(3):1693-1705. doi: 10.3390/nursrep14030126. PMID: 39051362; PMCID: PMC11270275.

5. O'Marr JM, Chan SM, Crawford L, Wong AH, Samuels E, Boatright D. Perceptions on Burnout and the Medical School Learning Environment of Medical Students Who Are Underrepresented in Medicine. JAMA Netw Open. 2022 Feb 1; 5(2): e220115. doi: 10.1001/jamanetworkopen.2022.0115. PMID: 35195698; PMCID: PMC8867243.

6. Liu Y, Frazier PA. The Role of the COVID-19 Pandemic and Marginalized Identities in US Medical Students' Burnout, Career Regret, and Medical School Experiences. J Clin Psychol Med Settings. 2024 Sep 6. doi: 10.1007/s10880-024-10045-1. Epub ahead of print. PMID: 39242464.

7. Dunham L, Dekhtyar M, Gruener G, et al. medical student perceptions of the learning environment in medical school change as students transition to clinical training in undergraduate medical school. Teach Learn Med. 2017; 29(4): 383-391. doi:10.1080/10401334.2017.1297712 - DOI - PubMed

8. Dyrbye LN, Thomas MR, Harper W, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009; 43(3): 274-282. doi:10.1111/j.1365-2923.2008. 03282.x - DOI – PubMed

Received on 18.09.2024 Revised on 11.11.2024

Accepted on 28.12.2024 Published on 18.02.2025

Available online from March 10, 2025

Int. J. of Advances in Nursing Management. 2025;13(1):15-19.

DOI: 10.52711/2454-2652.2025.00004

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