Manifestations of occupational stress among nurses in Phu Yen general Hospital - Viet Nam

Nội dung text: Manifestations of occupational stress among nurses in Phu Yen general Hospital - Viet Nam

1. RESEARCH ARTICLE Strengthen prevention and control of non- Mujib Medical University Journal December, communicable diseases. General report 2016; 9: 193-19. DOI: 10.3329/bsmmuj. on health sector 2014. Hanoi: Medical v9i4.3015. Publishing House. 13. Nguyen Thi Lan et al (2018). 11. Dimyan, M.A. and Cohen, L. G. Improving caregivers’ practice of motor (2011). Neuroplasticity in the context of rehabilitation for stroke patients at Quang motor rehabilitation after stroke. Nature Ninh General Hospital. Journal of Nursing Reviews Neurology. 7(2), pp.76-85. Science; No.2 Vol.1/2018; pp. 23-29. 12. Rahman, S and Mohammad Salek 14. Letrud, K (2012). A rebuttal of NTL A.K (2016). Training of caregiver for home Institute’s learning pyramid. Education care management of stroke survivor at low Vol.133 No.1 January 2012, pp.117-124 resource setting. Bangabandhu Sheikh MANIFESTATIONS OF OCCUPATIONAL STRESS AMONG NURSES IN PHU YEN GENERAL HOSPITAL - VIET NAM Do Minh Sinh1, Tran Thi Phuong Ha1, Vu Thi Thuy Mai 1 1 Nam Dinh University of Nursing 2 Phu Yen Medical College ABSTRACT Objective: To describe the common (53.4%); decrease in concentration (42%); signs and symptoms of occupational insomnia (33.1%) and fastidious, irritable stress in nurses. Method: The descriptive (36.7%). The symptoms were few or never study design was conducted on 281 appear including causing trouble with nurses who were taking care patients at people around, making frequent mistakes, the Phu Yen General Hospital, Phu Yen limiting contact, forming negative habits. province. Data collection instruments were Conclusion: Occupational stress was a developed based on literature reviews. common health problem, and their signs The self-report questionnaire were used or symptoms varied from person to group. to collect data from participants. Results: All nurses had at least one of the signs Current research was performed to assess or symptoms belonging to 4 groups of the signs or symptoms of occupational physical, psychological, emotional and stress in nurses and it would provide very behavioral signs or symptoms. Physical and useful data for healthcare facility sector in psychological signs appeared more than Viet Nam. emotional and behavioral signs. In which, Keywords: Nursing, Occupational the most frequent and continuous signs were stress described including of fatigue, headache 1. INTRODUCTION Occupational stress has been recognized as one of the most common Cor. author: Do Minh Sinh health problems among health care workers Email: dmsinh@ndun.edu.vn [1]. In which, nursing was identified as a Received: Feb 24, 2021 profession with a high level of stress [2], Revised: Mar 01, 2021 [3]. Occupational stress is fundamentally Accepted: Mar 05, 2021 Journal of Nursing Science - Vol. 04 - No. 01 139
2. RESEARCH ARTICLE related to interpersonal relationships and report in Pakistan (2019) described the work environments that are perceived emotional conditions of anger, coldness, to challenge or exceed the resources of hatred, and social alienation of nurses nursing and endanger their health. Many when affected by occupational stress [12]. studies had shown that work stress had As may be seen, research on signs or dangerous effects not only on the health symptoms of occupational stress in nurses of nurses but also affects their ability to had been very interesting topics. The cope with work needs. This had seriously results from these studies may help the weakened the provision of quality care and process of managing the health problem efficiency of health service delivery [4], [5]. better, towards reducing and controlling Nursing occupational stress is defined occupational stress of nurses and improving as the emotional and physical responses coping ability. So far, in Viet Nam, there was resulting from the interaction between a lack of data on the symptoms or signs of the nurse and their work environment, occupational stress in nurses. Therefore, where the demands of the job exceed the aim of this study was to describe the capabilities and resources [6]. Stress common symptoms or signs of occupational responses are physiological responses stress in nurses. (such as tachycardia, increased blood 2. RESEARCH METHOD pressure) and psychological (anger, fear), A cross-sectional descriptive study which occur while facing with stressor was conducted from January to June [7]. Research over the years showed that 2020 at Phu Yen General Hospital. Study signs or symptoms of occupational stress participants were nurses proving care seemed to be on the rise in nurses, which for the patients. The study selected was related to a number of factors ranging this group because their scope of work from changing disease patterns, restructure encompassed almost all occupational the health system to strengthen the roles, areas of nursing including administrative requirements and responsibilities of nurses work, care practice, relationships with staff [6], [8]. and patients. Therefore, the work pressure A study in Ghana (2017) [9] found would be higher and the symptoms of common occupational stress manifestations work stress would be more pronounced. of nursing including of fatigue, headache, All nurses who were part of the study were high blood pressure, insomnia, anxiety, invited to participate in the study and had overreaction to an certain issues. Peterson access to basic information such as the and Wilson [10] in a study on stress in the design, purpose and significance of the US concluded that one in five nurses tested study, as well as their rights to participate. were at risk of health problems related to The anonymity of the participants was stress; 2 out of 5 nurses were facing work maintained throughout the study. They were fatigue problems as a result of excessive given written consent before enrolling in the work pressure or working with mental study. A total of 281 in 311 nurses agreed to fatigue. Fatigue patterns or manifestations participate in the study, the rest participated had been described by Hiva Azmoon et al., in the instrument testing. Including of physical fatigue, psychological Data collection instrument was fatigue, decreased motivation and developed based on the document decreased activity [11]. Another recent of Psychological Trauma (stress) and 140 Journal of Nursing Science - Vol. 04 - No. 01
3. RESEARCH ARTICLE Preventive Measures by Nguyen Huynh 3. RESULTS Ngoc [13] and refered to the instrument in 3.1. Participants characteristics the study of Pham Thi Hang et al. [14]. The Table 1. Participants characteristics (n=281) instrument described four groups of signs or symptoms of stress, including: physical, Characteristics Number % psychological, emotional and behavioral signs or symptoms. Each sign or symptom < 25 44 15,7 was assessed through four levels of never, Age group 25 - < 35 146 52,0 sometimes (appear monthly), frequently (appear weekly), always (appear daily). 35 - < 45 52 18,5 After development, the instrument was sent to three experts who were knowledgeable ≥ 45 39 13,9 about the research issue to check the Sex Male 28 10,0 validity of the content. The testing results of the content index validity (CIV) reached Female 253 90,0 0.91, showing that the instrument was Post- 0 0,0 relatively valid. The instrument was then graduate sent to 30 nurses doing clinical work at Phu Education Yen General Hospital. Using the results level University 59 21,0 from these 30 forms to check the reliability, College 99 35,2 the analytical results of the Cronback alpha reached 0.79. Intermediate 123 43,8 Data collection process was described Less than 5 132 47,0 as follows. On the day of the survey, the years chief nurse invited all the nurses of the Seniority 5-10 years 52 18,5 department to the administrative office for data collection. The investigator 10-20 years 57 20,3 communicated the research purpose and how to respond to the self-report > 20 years 40 14,2 questionnaire to the nurses under the Overtime Yes 157 55,9 supervision of the investigator. Those who agreed to participate in the study were No 124 44,1 sign the consent form and be given the questionnaire. Some nurses can not go to Concurrently Yes 38 13,5 the administrative office due to health or No 243 86,5 work reasons, researchers provided the forms to nurses directly for data collection. Yes 248 88,3 After collecting sufficient data, the data Enough leave were managed using EpiData software. No 33 11,7 Then, the data were analyzed using SPSS <8 153 54,4 21.0 software. The results of analyzing Number descriptive statistics were tabulated with of shifts / 8-12 128 45,6 frequency distribution and percentage of month variables. >12 0 0,0 Journal of Nursing Science - Vol. 04 - No. 01 141
4. RESEARCH ARTICLE 3.2. Manifestations of occupational stress in nurses Table 2. Physical manifestations of participated nurses (n=281) Appearance level Physical manifestations 1 2 3 4 Number % Number % Number % Number % Dry mouth, loss of appetite, 20 7,1 225 80,1 31 11,0 5 1,8 indigestion Fatigue, headache 4 1,4 155 55,2 114 40,6 8 2,8 Pain in the neck, shoulders, 15 5,3 174 61,9 78 27,8 14 5,0 and waist Rapid pulse, increased 80 28,5 175 62,3 18 6,4 8 2,8 sweating (Appearance level: 1 = Never, 2 = sometimes, 3 = frequently, 4 = always) Table 3. Psychological manifestations of participated nurses (n=281) Appearance level Psychological 1 2 3 4 manifestations Number % Number % Number % Number % Insomnia 18 6,4 170 60,5 86 30,6 7 2,5 Worried, depressed, sad 13 0,6 213 75,8 51 18,2 4 1,4 Decreased concentration and 22 7,8 141 50,2 116 41,3 2 0,7 memory (Appearance level: 1 = Never, 2 = sometimes, 3 = frequently, 4 = always) Table 4. Emotional manifestations of participated nurses (n=281) Appearance level Emotional manifestations 1 2 3 4 Number % Number % Number % Number % Fastidious, irritability 33 11,7 145 51,6 102 36,3 1 0,4 Easy to be emotional, panic 56 19,9 191 68,0 33 11,7 1 0,4 Anxious, impatient 47 16,7 195 69,4 38 13,5 1 0,4 (Appearance level: 1 = Never, 2 = sometimes, 3 = frequently, 4 = always) Table 5. Behavioral manifestations of participated nurses (n=281) Appearance level Behavioral manifestations 1 2 3 4 Number % Number % Number % Number % Causing trouble with people 120 42,7 157 55,9 4 1,4 0 0,0 around Frequent mistakes 88 31,3 186 66,2 7 2,5 0 0,0 Overreacting to all problems 122 43,4 147 52,3 12 4,3 0 0,0 Isolated, limited contact 165 58,7 109 38,8 7 2,5 0 0,0 Appear negative habits 203 72,2 67 23,8 10 3,6 1 0,4 (Appearance level: 1 = Never, 2 = sometimes, 3 = frequently, 4 = always) 142 Journal of Nursing Science - Vol. 04 - No. 01
5. RESEARCH ARTICLE 4. DISCUSSION they often felt fatigued. The research had a higher proportion than the study of Pham ss was a stimulus that had a strong Thi Hang and her colleagues at the Nam impact on people, the physiological and Dinh General Hospital. The proportion of the psychological responses of people to frequent feeling in the stress symptoms of that effect [13]. Therefore, when under Pham Thi Hang et al were the tachycardia, stress, people may show some physical increased blood pressure accounted and psychological signs. In this study, for for 1.9%, sweating accounted for 7.1%, the purpose of maximizing information headache, fatigue, insomnia accounted for exploitation, stress signs were classified 7.6%, dry mouth, loss of appetite accounted into four groups of physical, psychological, for 8.9% and joint pain accounted for 8.2% emotional and behavioral signs. However, [14]. Research by Nguyen Thi Kim Anh at each person had a different way of coping the Bac Giang Pediatric Hospital on nurses, with stress, therefore, its symptoms may midwives showed that 28.3% of them change, the symptoms of the problems may felt dry mouth [15]. A qualitative study of be ambiguous, then, the appearance of the stress symptoms among nurses in the first signs was continued dividing into 4 levels Chinese anti-Ebola medical group showed of never, sometimes (appear monthly), similar physical manifestations. Specifically, frequently (appear weekly), always (appear anorexia was a common symptom reported daily). in 7 of 10 participants: “I lost my appetite, The physical signs were clear signs, had bloating and often constipation” [16]. easy to recognize, however, easily confused Fatigue and severe headache were stress symptoms found in a qualitative study with the physical manifestation of many conducted on 20 nurses working in the other conditions. In this study, the physical ICU department of a university hospital in stress signs that the nurse perceived to be Natal [17]. The proportions in the study, at an occasional appearance. Most of the although higher or lower than that of similar nurses felt tired, headache sometimes with studies, did not exclude cases that may be a proportion of 40.6% and always with a confused with the manifestations of other proportion of 2.8%. This was followed by diseases that the nurses suffered from. neck, shoulder, and lumbar pain, 27.8% However, the study results reflected the of the nurses felt it very often and 5% of hard work of nursing, frequently staying up the nurses who felt it very often. Nurses at night, performing activities contrary to often experienced dry mouth, anorexia, physiological hours, resulting in physical and indigestion, accounting for 11% and manifestations as a direct consequence. 1.8% alway level. Signs of rapid pulse, In addition to stress, it directly affected increased sweating while not exercising the nurse’s health and the quality of their appear only frequently accounted for 6.4% medical service delivery. and accounted for 2.8% in nurses. Physical manifestations appeared on a fairly high While under stress, in addition to physical frequency. This may have a negative impact manifestations, the nurses were also on the performance of the nurses. Interviews psychology affected. This easily affected and discussions were conducted among mental health, the ability to focus at work nurses getting quite similar results, as the and easily led to working errors. Research majority of nurses felt that under stress had found that 30.6% of nurses frequently Journal of Nursing Science - Vol. 04 - No. 01 143
6. RESEARCH ARTICLE experienced insomnia and 2.5% of nurses frequently found themselves difficult and always experienced it. With expression of irritable, 11.7% of nurses found themselves anxiety, depression, sadness, 18.2% of easily emotional, panic, and 13.5% of nurses frequently complained it and 1.4% nurses frequently found impatience, short- always experienced it and especially, up tempered and anxious. In all three emotional to 41.3% nurses frequently felt reduced manifestations, it was noted that 0.4% of concentration, decreased memory. This NUTRERS feel it very often. The similar was an alarming number because nursing emotional manifestations were in the study required a high level of concentration, even at Bac Giang Obstetrics and Gynecology the slightest mistake may lead to serious Hospital such as no interest accounted consequences for the patient’s health. for 28.3%, anxiety accounted for 26.8%, Therefore, nursing managers should take negative emotions accounted for 20.7% countermeasures for the nurses to limit [15]. These manifestations in the study of work stress. The study of Pham Thi Hang Pham Thi Hang et al. were that 4.4% of and colleagues noted that expressions of nurses felt difficult, irritable, 1.9% of nurses anxiety, depression, and sadness were felt easily emotional and panic, and 1.3% reported at a frequent level of 61.4% of nurses felt isolated, limited contact [14]. and always level of 4.4%. With regard to These results demonstrated that the nurses insomnia, 59.5% of nurses sometimes felt in the study had significantly higher stress it and 7.6% of nurses frequently felt it [14]. levels and more severe stress symptoms. Nguyen Thi Kim Anh’s research showed that This was also a situation that should find depressed expression accounted for the the resolutions by the hospital managers highest percentage of the manifestations of because psychological influences may stress. The percentage of nurses recorded affect the care process and communication of stress was 34.8% [15]. China’s first of the nurses with the patients and the anti-Ebola nurses listed insomnia as one patient’s family, causing conflicts and of the most common symptoms of stress. unsatisfaction in the nurses and patients. Specifically, “I usually sleep only after midnight. This happens five or six days When stressed, the nurses tend to per week. (Nurses E) ”. In addition, the release, manifest outwardly by their expression of anxiety, inability to focus on behavior towards themselves and everyone work was also common among nurses “I around them. It is these behaviors that am always anxious, with a lot of anxiety. I make it easier for people to recognize that easily forgot what I did. (Nurses C) ”[16]. a person is under stress and many times these behaviors cause conflicts, negative The physical and psychological effects not only on the nurses itself but also manifestations, although easy to recognize, relationships around them. However, the were easily confused and affected by research results of signs / symptoms of many other conditions. Therefore, in behavioral stress showed that the majority of addition to the physical and psychologial nurses presented it at sometimes and never manifestations, when assessing the stress level. The frequent level was reported with a status, it was necessary to pay attention relatively low in nurses. Specifically, causing to the psychological and emotional trouble with people around accounted for manifestations. The study of emotional 1.4%; making mistakes accounted for 2.5%; stress symptoms found that 36.3% of nurses overreaction to all problems accounted for 144 Journal of Nursing Science - Vol. 04 - No. 01
7. RESEARCH ARTICLE 4.3%; isolate and limit contact with people commonly described signs included around accounted for 2.5%; occurrence fatigue, insomnia, irritability / fastidious and of negative habits such as smoking and decreased concentration. Occupational drinking alcohol accounted for 3.6%. Out stress was a common health problem in of all the behaviors, only one case had a nurses and carried negative health and negative habit accounting for 0.4%, which economic burdens. Current research was always occured. The results was similar performed to assess the signs / symptoms to those obtained from Pham Thi Hang of occupational stress in nurses and it et al., in which 1.9% of nurses frequently provided very useful data from a healthcare caused trouble with people around, 1.3% facility sector in Viet Nam. This research of nurses was isolated, limited contact with may, however, be misleading as it cannot the people around them, 1.9% of nurses be identified with signs / symptoms of other smoked and drank [14]. Research by the health problems. Besides, it was only using Chinese nurses, the behavioral symptoms the self-report method to collect data. In were mainly negative thoughts. The results order to be able to fully and accurately obtained from interviews with 10 nurses. examine the signs of occupational stress, The nurses reported “I feel that during that a further study should be conducted to time period, I was a mess with endless talk observe the daily performance of nurses and and slow behavior”, or “I don’t know why use specialized psychological instrument - I cried so much during that time. I cried of course this may require more resources because I saw someone else or after I called and efforts from researcher. my family. I also cried if I couldn’t sleep or had misunderstandings with my colleagues. REFERENCES I didn’t behave like that before.” Interviews 1. R. Burbeck, S. Coomber, S. M. with nurses at the ICU department of the Robinson et. al (2002), “Occupational stress university hospital in Natal showed that hot- in consultants in accident and emergency tempered and rude behavior toward others medicine: a national survey of levels of were common behavioral symptoms in stress at work”, Emergency Medicine stressed nurses [16], [17]. Thus, it can be Journal. 19(3), p. 234. seen that nurses, despite being stressed and having quite frequent physical and 2. Y. Xianyu and V. A. Lambert (2006), psychological manifestations, know how to “Investigation of the relationships among refrain from emitting negative behaviors. workplace stressors, ways of coping, and Although this is adaptation, trying to the mental health of Chinese head nurses”, reconcile with the nurses’ stress, restraining Nurs Health Sci. 8(3), p. 147-55. long-term behavior may lead to outbreaks in 3. Deborah C. Chamberlain (1981), situations where the stress factor is strongly “White collar and professional stress, C. influenced. Therefore, hospital managers L. Cooper and J. Marshall (Eds), Wiley, should prepare the solutions to deal with Chichester and New York, 1980”, Journal of and limit stress-causing situations. Organizational Behavior. 2(3), p. 231-233. 5. CONCLUSION 4. Joseph Lee (2003), “Job stress, Research results indicated that 100% of coping and health perceptions of Hong nurses had at least one signs of symptoms Kong primary care nurses”, International of occupational stress. Among the most journal of nursing practice. 9, p. 86-91. Journal of Nursing Science - Vol. 04 - No. 01 145
8. RESEARCH ARTICLE 5. A. Farrington (1995), “Stress and Pham Van Tung et al. (2019), “Preventive nursing”, Br J Nurs. 4(10), p. 574-8. and coping measures with stress of nurses at Nam Dinh General Hospital”, Thai 6. Huey-Ming Tzeng (2002), “The Nguyeen University Journal of Science influence of nurses’ working motivation and Technology 197 (04), p. 113-118. [In and job satisfaction on intention to quit: VietNamese] an empirical investigation in Taiwan”, International Journal of Nursing Studies. 15. Nguyen Thi Kim Anh (2017), Survey 39(8), p. 867-878. of stress situation and related factors of nurses and midwives at Bac Giang 7. S. K. Judkins (2004), “Stress among Obstetrics and Gynecology Hospital, Master nurse managers: can anything help?”, Thesis of Nursing, Nam Dinh University of Nurse Res. 12(2), p. 58-70. Nursing. [In VietNamese] 8. Nicole Nedd (2005), “Perceptions of 16. Chunzi Liu, Huaming Wang, Lin Empowerment and Intent to Stay”, Nursing Zhou, et al. (2019), “Sources and symptoms economic$. 24, p. 13-8, 3. of stress among nurses in the first Chinese 9. Adzakpah Godwin, Alexander Laar anti-Ebola medical team during the Sierra và Fiadjoe Selorm (2017), “Occupational Leone aid mission: A qualitative study”, J Stress and its Management among Nurses International journal of nursing sciences. at St. Dominic Hospital, Akwatia, Ghana”, 6(2), p. 187-191. Health Science Journal. 10. 17. Cláudia Cristiane Filgueira Martins 10. Michael Peterson and John F. Rodrigues và Viviane Euzébia Pereira %J Wilson (2004), “Work Stress in America”, Santos (2016), “O corpo fala: aspectos International Journal of Stress Management. físicos e psicológicos do estresse em 11(2), p. 91-113. profissionais de enfermagem/The body speaks: physical and psychological aspects 11. Hiva Azmoon, Hamid Salmani of stress in nursing professionals/El cuerpo Nodooshan, Hamed Jalilian, et al. (2018), habla: aspectos físicos y psicológicos “The Relationship Between Fatigue and Job del estrés en los profesionales de Burnout Dimensions in Hospital Nurses”, enfermeira”, Revista de Pesquisa, Cuidado Health Scope. In Press. é Fundamental Online. 8(1), p. 3587. 12. Suriya Khatoon, Syed Shah, Ajmal Khan, et al. (2019), “Anger Expression Style among Nurses Working in General Hospitals of Karachi, Sindh, Pakistan”, Open Journal of Nursing. 09, p. 370-382. 13. Nguyen Huynh Ngoc (2015), Trauma (stress) and preventive measures, Psychology of Medicine - Medicine Ethics, Ministry of Health, Education Publisher, Hanoi. [In VietNamese] 14. Pham Thi Hang, Vu Thi Hai Oanh, 146 Journal of Nursing Science - Vol. 04 - No. 01