39 STRESS & HEALTH - COMP STUDY

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IIMS Journal of Management ScienceVol. 6, No. 3, September-December, 2015, pp- 236-258

IIMS Journal of Management Science 236

DOI: 10.5958/0976-173X.2015.00021.4

IndianJournals.com

Stress and Health: A Comparative Study among Nurses

D. Rajan

ABSTRACT

This survey based descriptive research has been undertaken in Tirunelveli District, Tamil Nadu as a comparativestudy to identify and differentiate sources of stress and its impact on health of nurses working in four coredepartments namely intensive care unit, operation theatre, emergency department and ward. Sources of stresshave been identified under three dimensions namely physical environment and welfare facilities related stressors,discrimination and harassment related stressors and attitude towards work related stressors. The study hassampled 360 nurses qualified with Diploma in General nursing and Midwifery and Bachelor of Science innursing courses from 45 general types of private hospitals using a stratified sampling technique. Weightedaverage method has been applied to analyse sources of stress. Mean, standard deviation and coefficient ofvariation have been used to understand perception of nurses working in four core departments towards sourcesof stress. Kruskal–Wallis test has been administered to examine the relationship between sources of stress anddemographic variables. Multiple regression models have been used to know relationship between sources ofstress and health. The result indicated that all three dimensions of stressors have been perceived at mediumlevel by majority of the nurses. The result also found that among three dimensions of stress or physical environmentand welfare facilities related stressors has occupied the first place followed by attitude towards work relatedstressors and discrimination and sexual harassment related stressors. The study has given suitable suggestions toovercome the stress.

Keywords: Stress, Nurse, Health, Private hospital, Tirunelveli District

JEL Classification: M12, I1

Biographical Note: Dr. D. Rajan has been working as lecturer at Department of Management Studies, DMI-

St. John the Baptist University, Mangochi, Malawi, Central Africa. He can be reached at: [email protected]

INTRODUCTION

Background of the Study

Health industry has been becoming a dominant in

service industry in terms of economy and employment

opportunity of a country. Population growth,

environmental changes (air pollution, water pollution

and noise pollution) and cultural changes (fast foods)

aspects are increasingly causing health related problems.

As a result of higher rate of diseases, the numbers of

hospitals are increasing day by day which in turn reflect

on economy as well as employment opportunities

positively. Both government and deemed universities

started offering various courses related to medical as

well as paramedical discipline that enrich employment

opportunities for middle and lower income group of

peoples to meet over the excessive demand. Nursing,

radiography, medical laboratory technology, dialysis

technology, physiotherapy, bio-chemistry, medical

records technicians and hospital information

technology are important paramedical courses among

them having wide employment opportunities.

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Research has shown that health professionals are a

group at significant risk from the negative effects of

stressful workplaces (Kirkcaldy and Martin, 2000; Tyler

and Cushway, 1998). Among health professionals,

nurses are particularly at risk from stress-related

problems, with high rates of turnover, absenteeism,

and burnout (Clegg, 2001; Kirkcaldy and Martin,

2000). It has also been proved that they work in high-

stress environments, since their main responsibility

focuses upon providing help to patients who are

usually encountering life crisis (Dewe, 1987). Calnan

et al. (2001) found that 27% of all hospital staff was

classified as suffering from stress and mental ill health,

compared to general population between 14% and

18%. Stress is the result of conflicting internal and

external pressures that causes strain and alter the

effectiveness of individuals (Munro, 1998). Lazarus

and Folkman (1980) indicated that stress is an outcome

of a transaction or relationship between the person

and the environment. Stress causes various health

related issues such as headache, diabetes mellitus,

hypertension, palpitation, constipation, respiratory

disorders, etc. Hence, it remains important to identify

the sources and impact of stress among nurses and to

make them aware about those factors.

In light of these aspects, the present study is undertaken

in the study area, Tirunelveli District, with a view of

identifying and differentiating sources of stress in

terms of physical environment and welfare facilities

related stressors, discrimination and harassment related

stressors and attitude towards work related stressors

and examining its impact on health of the nurses. The

study area has attained a marked development in health

care sector. Though the number of hospitals,

laboratories and pharmaceuticals has increased

tremendously in the study area, still inadequate

physical environment, welfare facilities, discrimination

and sexual harassment and negative attitude about the

job, lack of professionalism and professional respect,

inadequate resources (shortage of manpower and

equipments) and unclear organisation structure and

policy, ill defined hierarchy structure, unhealthy shift

work system (two shift work system), unhealthy

interpersonal relationship, long working hours, lack

of career development opportunities, lack of salary,

inadequate supply of protective equipment, negligible

waste disposal methods and high patient loads are

found in many hospitals. These factors not only cause

stress among nurses but also affect their health. Hence,

the study of such as work related stress can help in

improving the health of nurses in study area by

alleviating the factors producing stress.

Statement of the Problem

Health is wealth. Good health is essential for the

happiest life. It makes the employee very active and

fast in their work. Moreover, the healthy employee

will be the productive worker and his or her

contribution towards the work will also be effective.

On the other hand, poor health makes an employee

inactive and slow in his work causing undue delay in

his task. Besides, the contribution of the ill healthy

employee will be poor and ineffective which will

further cause undue dissatisfaction among the patients.

There are number of factors deciding health of the

employees in an organisation. Among them, physical

environment, welfare facilities, attitude of the

employees and the treatment of the employees in

terms of fairness in the work place are some of the

important factors. When these factors are positive they

will definitely be the motivators of the employees.

On the other hand, the negative aspects of these factors

will produce the stress among employees. It has been

proved that stress causes number of health related

problems such as aches, digestive disorder, and cardiac

disorder such as palpitation, restlessness, neurologic

disorders (sleeplessness, hypertension, forgetfulness and

lack of concentration), etc. Nurses, the paramedical



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Vol. 6, No. 3, September-December, 2015238

D. Rajan

employees should have sound health as they are

dealing with patient care activities. When nurses

undergo stress, they may develop forgetfulness, lack

of concentration, sleeplessness and the like, which will

affect the safety of the patients. Hence, it is important

for the hospital management to concentrate on

physical infrastructure, welfare facilities, attitude and

fair treatment of the employees so as to make them

stress free and deliver the quality care for the patients.

In view of this aspect, the present study is undertaken

to enhance the awareness level of nurses towards impact

of stress on health.

Scope of the Study

The study has focused female nurses working in general

type of private hospitals in Tirunelveli District, Tamil

Nadu with the qualification of DGNM (Diploma in

General Nursing and Midwifery) and Bachelor of

Science in Nursing courses. The study has exclusively

focused the nurses working in intensive care unit,

operation theatre, ward and emergency departments.

The study also focused the variables namely physical

environment and welfare facilities related stressors,

discrimination and sexual harassment related stressors

and attitude towards work related stressors and health.

Significance of the Study

The study has discussed in detail about the stress arising

as a result of physical environment, welfare facilities,

discrimination, sexual harassment and attitude of the

employees towards work related stressors. The result

of the study will help the hospital management and

other organisations which are offering similar services

to establish and regulate their policy regarding these

factors and thereby to eliminate these stressors to be

improved their health. The present study will serve as

secondary data for future research scholars.

Profile of the Study Area

The study area, Tirunelveli District is located in

southern part of Tamil Nadu. It consists of 11 taluks

and 19 blocks. The total population of the district

census is 3,072,880 of which male population are

1,518,595 and female are 1,554,285 (Source: Census,

2011). There are five colleges offering DGNM course

and eight colleges offering B.Sc. Nursing course. There

are 482 government hospitals including primary health

centres and sub centres and 221 private hospitals

including nursing homes and clinics (source: Office

of Deputy Director of Health, Tirunelveli District,

Biomedical waste management department).

Research Objectives

The following are the objectives of the study

(i) To identify the source of stress among nurses in

terms of physical environment and welfare

facilities, discrimination and sexual harassment

and attitude towards work related stressors;

(ii) To understand extent of perception of nurses

towards sources of stress;

(iii) To compare the perception of nurses working

in various departments towards source of stress;

(iv) To examine impact of stress on health;

(v) To examine the relationship between

demographic variables and sources of stress;

(vi) To provide suitable suggestions to manage and

prevent stress.

Research Hypotheses

The following were the hypotheses of the study:

(i) There is no significant difference in the

perception scores of sources of stress among the

group of respondents based on age.

(ii) There is no significant difference in the

perception scores of sources of stress among the

group of respondents based on marital status.

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(iii) There is no significant difference in theperception scores of sources of stress among thegroup of respondents based on native place.

(iv) There is no significant difference in theperception scores of sources of stress among thegroup of respondents based on places of stay.

(v) There is no significant difference in theperception scores of sources of stress among thegroup of respondents based on educationalqualification.

(vi) There is no significant difference in theperception scores of sources of stress among thegroup of respondents based on salary.

(vii) There is no significant difference in theperception scores of sources of stress among thegroup of respondents based on work experience.

(viii) There is no significant difference in theperception scores of sources of stress among thegroup of respondents based on ward allotment.

(ix) There is no significant difference in theperception scores of sources of stress among thegroup of respondents based on work shift.

(x) There is no significant difference in theperception scores of sources of stress among thegroup of respondents based on job situation.

Conceptual Framework of the Study

The conceptual framework of the study, which explainindependent variables of the study (physicalenvironment and welfare facilities related stressors,discrimination and harassment related stressors andattitude towards work related stressors) and dependentvariables (health) of the study is depicted as follows:

REVIEW OF LITERATURE

Stress

Occupational stress is the harmful physical andemotional responses that occur when the requirementsof the job do not match the capabilities, responses, orneed of the worker. Job stress can lead to poor healthand even injury to the affected person (NationalInstitutes for Occupational Safety and Health, 1998).

Stress is any characteristic of the job environment thatposes a threat to the individual, either excessivedemands or insufficient supplies to meet the need andlead to a rising tension in a person (Hinshaw, 1993;Edwards, 1995).

It is a state of mind of personal dysfunction as a resultof the conditions in the workplace, and one’spsychological and physiological reactions to theseuncomfortable, adverse, or intimidating workplaceconditions (Daniel, 1996).

It is the harmful physical and emotional responses thatoccur when the requirements of the job do not matchthe capabilities, responses, or need of the worker(National Institutes for Occupational Safety and Health,1999).

It is the experience of negative feelings, such asfrustration, worry and anxiety, perceived to arise fromwork related factors (Kyriacou, 2001). Job stressorsare the environmental factors that are involved in thestress process are called job stressors (Schaufeli andPeeters, 2000). They are the situations or events thathave the potential to affect health outcomes (Barling,1990).

Health

According to World Health Organization 1948,‘Health is a state of complete physical, mental andsocial well-being and not merely an absence of diseaseor infirmity’ (Park, 2000).

Disease is a physiological or psychological dysfunction.Mental health has been defined as ‘a state of balance

1. Physical environmentand welfare facilitiesrelated stressors.

2. Discrimination andharassment relatedstressors.

3. Attitude towards workrelated stressors.

Stress Health→→→→→ →→→→→

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D. Rajan

between the individual and the surrounding world a

state of harmony between oneself and others, acoexistence between the realities of the self and thatof other people and that of the environment’ (Park,

2000).

The state of physical health implies the notion of‘perfect functioning’ of the body. The signs of physical

health in an individual are a good complexion, a cleanskin, bright eyes, lustrous hair with a body well-clothed with firm flesh, not too fat, a sweet breath, a

good appetite, sound sleep, regular activity of bowelsand bladder and smooth, easy, and coordinated bodilymovements (Park, 2000).

Studies Related to Stress

Shah et al. (2014) in their study analysed theoccupational stress of lecturer, assistant professor,

associate professor and professor from the sample of220 respondents. The study analysed four variablesnamely peer relationship, working environment,administrative factors and economic factors. The result

revealed that administrative factors were highlycorrelated with peer relationship factors then workingenvironment, while, working environment factors

were highly correlated with economic factors thenadministrative factors and administrative factors hadhigh influences on working environment factors and

economic factors.

Singh and Gogia (2014) analysed the effect of workstress on performance and productivity of hoteliers in

hotels of Delhi and NCT. The result found that roleconflict, role ambiguity, peer pressure, highly conflictenvironment and performance pressure had positive

effect on employee motivation and also they enhancedthe overall performance and productivity. The studysuggested that management should implement

activity-based appreciation, recognition programmes,certification and some monetary benefits if theemployees performed well. Moreover, management

should organise some recreational activities for

employees and help hoteliers to increase theirperformance and productivity.

Khasawneh and Futa (2013) analysed the relationshipbetween job stress and nurses performance in theJordanian Hospitals. The study assessed therelationship between job stresses with nurses’performance. The study found the following werestressors: organizational climate, economic factors, jobdifficulty, competition, and family factors. Creativityand innovation has primarily been affected by stressfollowed by problem solving and decision makingabilities. Hypothesis results indicated that economicfactors had troublesome results on nurses’performance. Physical, emotional and informationalrequirements of nursing job were distress factors fortheir performance. The dysfunctional competition andnature of contact with peers could lead to performanceerosion. Organisational climate was the mostinfluential stressor on creativity and innovation andon the nurses’ ability in problem solving and makingreasonable decision.

Arbalisarjou et al. (2013) analysed the relationshipbetween job stress and performance among thehospital nurses. The sample consists of 491 nursesfrom the hospitals in the year 2012–2013. The resultof the study indicated that the variables role, demand,control, support, relationship and change hadsignificant relationship with job performance. Thestudy also reported that, though employees do theirwork regularly, workload and time constraints reducedtheir performance.

Suresh (2013) studied stress and its impact on womenworking in BPOs from the samples of 132 middlelevel employees. The study analysed 30 factors thatinfluenced the stress of working women. The resultfound that among the 30 factors, over work load,depression due to hurt, to work under tension,encountering criticism from boss for minor mistakes,facing abusive verbal or written comments, lose ofweight, difficulty taking decision and encountering

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offensive or patronising language were the foremostfactors influenced in creating stress among the womenemployees working in BPOs.

Manzoor et al. (2012) investigated the impact of workstress on job performance of textile sectors. The studyhas found that job ambiguity, pressure due to heavywork load, physical dangers and noise at work causeringing in their ears, job insecurity, long work hourswith undesirable timings and not getting much timeto spend with their family were the sources of stress.Majority of the respondents reported that job stresshas not affected their job performance and they havealso said that they were able to work and recordquickly and effectively and they were also willing topay additional efforts to reach their targets; they wereable to be a good team member and they could getalong with their colleagues easily. The correlation tableshowed that no significant relationship existedbetween job stress and employee job performance.

Rajan and Joseph (2012a, 2012b, 2012c) analysedorganisation related stressors and pharmacist’s specificstressors. The study also examined impact of stress onjob satisfaction and coping strategies. Unclear andundirected role, inadequate salary, conflict withmedical staffs and other departmental staffs, lack ofstaff, sufficient space and ventilation, inadequateenvironment facilities to practice professionalpharmacist role, unfair performance evaluation, poorcommunication system, difficulty to contactadministrative personnel during emergency situations,lack of job security, long working hours, difficultywith shift work, being under pressure due to over workload and paper work, difficulty doing multiple workat the same time, frequent interruption over phone,equipment failures, manual work to handle thesituations, doing non-pharmacist’s work, dealing withemotionally and physically threatening patients,doctors prescribing the drugs which are not in stock,difficulty to understand the handwriting of the doctorsare the stressors of the pharmacists. Lack ofrecognition, growth and development opportunities,

lack of health and safety practice, lack of opportunityin decision making and training and developmentfacilities are the dissatisfaction factors among thepharmacists. The study has proved that there is asignificant relationship between stress and jobsatisfaction.

Rajan and Joseph (2012a, 2012b, 2012c) examinedorganisation structure and policy, managers’ specific,professionalism and career development, superior andsubordinates, interpersonal relationship and supportand role and work home conflict related stressors ofhospital managers. The study also analysed impact ofstress on behaviour, physical health and mental health.The result of the study found that complex hierarchiesof authorities, lack of motivation, receiving the ordersnot only from owners but also from their familymembers and other relatives, monotonous and notchallenging type of work which limit the skills withina small circle and affect the development of personalskills and career, irritation and criticism by higherofficers in front of subordinates, patients and theirrelatives, lack of interaction and coordination withother departmental managers, unclear job descriptionabout the expectations of the hospital as a managerare the major stressors causing stress among the middlelevel managers working in non-medical department.Over reaction and irritation to small things, difficultyin getting sleep and depression and negative thinkingare the impact of stress. The study found that sex andmarital status have significant relationship with all kindof stressors.

Rajan and Joseph (2012a, 2012b, 2012c) analysedorganisation related stressors and medical recordtechnicians specific stressors and also examined theimpact of stress on job performance of medical recordtechnicians and their coping style. The findings showedthat long working hours and rigid policy with regardto the working hours, inadequate salary, inadequatestaff, lack of recognition, fear of job insecurity,inadequate welfare facilities, performing multiple tasksat the same time, dealing with death and dying,

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D. Rajan

unavailability of the doctors, dealing with policepersonnel, searching the case sheets of very past year,sitting in the same posture for long time are the majorstressors causing stress among the medical recordtechnicians. Committing mistakes in the record work,slow work speed, difficulty in recalling instruction ofdoctors, inability to finish the work in time, decreasedefficiency and productivity, forgetfulness, extendinglack of cooperation to other departmental staffs arethe major impact of stress. The study found significantrelationship between age and organisation relatedstressors and marital status and medical recordtechnicians’ specific stressors.

Yau et al. (2012) examined job stress level and stressorsamong China nurses. The study found that the moststressful domains were work load and time, workingenvironment and resources, nursing profession andclinical duty, patient care and management andinterpersonal relationship. Participants working inpaediatric unit were found to have the highest stresslevel. Study reported that job would directly affecttheir health and job induced tension was the higheststress among the participants. Among the stressorswork load and time was the most serious source ofstress. Increased work load among the nursing staffhad a negative impact on nurses’ job satisfaction.Women were found to have more psychological strainsand depression and to experience greater sadness andanxiety and also more vulnerable to repeated stressexposure. Not being respected by physicians, patient’sand patients’ relatives, being physically attacked andnot trusted by patients and being yelled at by physicianswere the most common stressors.

From the above literature survey, it could beunderstood that though there were study in the studyarea related to stress of various occupational groups;they were limited to Tirunelveli city only and theydid not cover entire district. Therefore, there was ascope to undertake the research covering entire district.The present research fulfilled that gap by means ofcovering entire Tirunelveli District.

RESEARCH METHODOLOGY

Research Design

This survey research is descriptive in nature. It describesthe nature and characteristics of stress of nurses in theprivate hospitals by using the following methodology.

Sampling Techniques and Sampling Procedure

The general types of private hospitals having morethan 25 beds and having the facilities of wards,operation theatres, intensive care units and casualtydepartments have randomly been selected for studyfrom the list of hospital obtained from office of theDeputy Director of Health, Tirunelveli District. Inorder to sample the respondents target population hasbeen stratified into four categories namely nursesworking in ward, intensive care unit, operation theatreand casualty departments. From each category, twonurses have been sampled using proportionate typeof a stratified random sampling technique. Thus atotal of eight nurses have been sampled from a singlehospital. The same method has been extended to 45hospitals. Thus a total of 360 nurses (samples) havebeen sampled for this research. The total populationof nurses working in these selected hospitals have been1100.

Instrumentation

The self-constructed questionnaire has beenadministered to collect primary data from therespondents. The questionnaire was composed of threesections namely Section ‘A’ that dealt with profile ofthe respondents, Section ‘B’ that dealt with sourcesof Stress and, Section ‘C’ that talked about impact ofstress. The questionnaire had been made based onLikerts five points scale namely ‘Strongly agree’,‘Agree’, ‘No opinion’, ‘Disagree’ and ‘Stronglydisagree’. The points were allotted for them as 5, 4,3, 2 and 1, respectively.

Data Collection

Primary data have been collected directly from the

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nurses using structured questionnaire. Moreover,personal observation discussion with nurses was alsomade to collect primary data. Secondary data for thestudy have been collected from books, theses,dissertations, journals and the internet to provideappropriate significance to the study.

Tools of Analysis

Weighted average method has been used to identifysources of stress and impact of stress. Mean, standarddeviation and coefficient of variation have been appliedto understand extern of perception of sources of stress,to compare the sources of stress among variousdimensions and to compare perception sources ofstress among nurses working in various departments.Kruskal–Wallis test has been administered to find therelationship between demographic variables andsources of stress. Multiple regression analysis has beenused to find the relationship between sources of stressand health.

ANALYSIS AND RESULTS

Demographic Variables

It would be understood from Table 1 that all (100%)respondents were female. Among them, 83.3% weremarried and 1.7% was unmarried. Of them, 1.7%was below 22 year of age, 80% between 22 and 26year, 11.7% between 26 and 30 year and 0.7% wereabove 30 year of age. Besides, 56.7% belonged to ruraland 43.3% belonged to urban. Moreover, 80% hadowned house and 20% had rented house, 56.7% werestaying in house and 43.3% were staying at hostel.Of them, 23.3% were qualified with B.Sc. Nursingand 76.6% were qualified with DGNM courses.

Moreover, 30.0% had below 4 members, 60.0% hadbetween 4 and 6, 8.3% had between 6 and 8 and1.7% had above 8 members in their family. Amongthem, 48% were drawing below 5000, 45% between5000 and 8000, 5% between 8000 and 11,000 and1.7% were drawing above 11,000 salaries. In all, 35%were below 1 year, 41.7% between 1 and 3 year, 8.3%

between 3 and 5 year and 15% had above 5 year ofwork experience.

Overall, 36.7% were full-time permanent, 61.7% full-time temporary and 1.7% was part-time permanentemployees. Among them, 16.7% had rotating eight-hour shift, 76.7% had rotating 12-hour shift and 6.7%had permanent day shift.

Furthermore, 51.7% reported that they had between1 and 2 nurses, 33.3% between 2 and 4 nurses and15% had between 4 and 6 nurses in their ward.Overall, 45% of the respondents used public transport,1.7% hospital bus and 16.7% used two wheelers totravel and 36.7% came by walk to the duty.

From Table 2 it could be revealed that insufficientventilation and lighting in the ward are the majorstressor. It has occupied the highest total score of 1482.The greater importance given to this factor may bedue to congested patient room facilities and absenceof adequate windows and lighting facilities in the ward.From the importance given to this factor it could beunderstood that staff nurses are in need of sufficientventilation and lighting facilities to perform their tasks.Inadequate infrastructure for nursing practice andinadequate space to accommodate all staff, equipmentand medicines in the ward have occupied the next twoplaces in physical environment and welfare facilitiesrelated stressors with the total scores of 1356 and1332, respectively. Lack of privacy in the ward andinadequate welfare facilities such as toilet, rest room,insurance and canteen facilities are next in line withthe total scores of 1188 and 1152, respectively.

From Table 3 it could be noted that inferior opinionand perception by the public on nursing profession isthe major discrimination and sexual harassment relatedstressor. It has occupied the total score of 942. Verbalabuse by the patients and receiving comments andintrusive and unwelcome questions about appearance,body parts, sex life and dirty jokes are the nextforemost discrimination and sexual harassment relatedstressors. They have occupied the total scores of 864

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D. Rajan

Table 1: Profile of the respondents

Measure Item Frequency Percentage

Sex Female 360 100

Marital status Married 60 16.7

Unmarried 300 83.3

Age Below 22 year 6 1.7

Between 22 and 26 year 288 80.0


Above 30 year 24 0.7

Native place Rural 204 56.7

Urban 156 43.3

Residential status Owned house 288 80

Rented house 72 20

Places of stay Home 204 56.7

Hostel 156 43.3

Educational qualification B.Sc nursing 84 23.3

DGNM 276 76.7

Strength of family member Below 4 members 108 30.0

Between 4 and 6 members 216 60.0

Between 6 and 8 members 30 8.3

Above 8 members 6 1.7

Salary Below 5000 174 48.3

Between 5000 and 8000 162 45.0

Between 8000 and 11,000 18 5.0

Above 11,000 6 1.7

Year of working experience Below 1 year 126 35



Above 5 year 54 15

Department Casualty 90 25

Intensive care unit 90 25

Operation theatre 90 25

Ward 90 25

Job situation Full-time permanent 132 36.7

Full-time temporary 222 61.7

Part-time permanent 6 1.7

Work shift Rotating eight hour shift 60 16.7

Rotating twelve hour shift 276 76.7

Permanent day shift 24 6.7

Allotment of nurses in department Between 1 and 2 nurses 186 51.7

Between 2 and 4 nurses 120 33.3

Between 4 and 6 nurses 54 15.0

Mode of travel Public transport 162 45.0

Hospital bus 6 1.7

Two wheeler 60 16.7

Walking 132 36.7

Source: Primary data

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and 816, respectively. Criticism by other professionals(for example, doctors) and receiving career threats suchas loss of job or withheld promotion if not accededto requests for a date or sexual favour are the leastdiscrimination and sexual harassment related stressors.They have occupied the total scores of 810 and 774,respectively.

It could be demonstrated from Table 4 that negativefeedback by the superiors and co-workers about thelevel of sacrifice in the work has been the major stressor.It has occupied the total score of 1344. The greaterimportance given to this factor may be due to poorinterpersonal relationship and inability to tolerate thenegative feedback of colleagues. From the importancegiven to this factor, it could be understood that nursesare in need of stress tolerance training. Trouble insleeping at night when some work is postponed andstarting to think about the problem immediately aftergetting up from the bed have been the next foremost

stressors. They have occupied the total scores of 1236and 1188, respectively. Inability to relax and switchoff from work even after coming home and beingpreoccupied with work thoughts even after going tobed have been the least attitude towards work relatedstressors. They have occupied the total scores of 1158and 1152, respectively.

It could be understood from Table 5 that alldimensions of stressors are perceived at medium levelby majority of the respondents. The same is depictedin Figure 1.

Table 2: Physical environment and welfare facilities related stressors

Physical environment Strongly Agree No Disagree Strongly Totalagree opinion disagree score

Inadequate space to accommodate all staff, 90 168 24 60 18 1332equipment and medicines in the ward

Insufficient ventilation and lighting in the ward 144 156 24 30 6 1482

Inadequate infrastructure for nursing practice 102 144 42 72 0 1356

Lack of privacy in the ward 84 108 24 120 24 1188

Inadequate welfare facilities (toilet, rest room, 78 120 24 72 66 1152insurance and canteen)


Table 3: Discrimination and sexual harassment related stressors

Discrimination and harassment Strongly Agree No Disagree Strongly Totalagree opinion disagree score

Criticism by other professionals 6 78 66 60 150 810

Verbal abuse by the patients 12 84 60 84 120 864

Inferior opinion and perception by the public 6 54 156 84 60 942on nursing profession

Receiving career threats 12 6 120 108 114 774

Receiving comments and intrusive and 18 24 102 108 108 816unwelcome questions


Figure 1: Extent of perception towards sources of stress

Physical environment and welfare Discrimination and sexual Attitude towards workfacilities related stressors harassment related stressors related stressors

1 8 . 3 3

0 .00

2 0 . 0 01 1 . 6 7

0 .00

2 0 . 0 0 1 5 . 0 0

7 0 . 0 0

1 5 . 0 0

Low Medium High

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Table 4: Attitude towards work-related stressors

Attitude towards work Strongly Agree No Disagree Strongly Totalagree opinion disagree score

Starting to think about the problem immediately 84 108 24 120 24 1188after getting up from the bed

Inability to relax and switch off from work even 48 138 42 108 24 1158after coming home

Negative feedback by the superior and co worker 54 210 48 42 6 1344about the level of sacrifice in the work

Being preoccupied with work thoughts even after 36 150 42 114 18 1152going to bed

Trouble in sleeping at night when some work is 72 144 36 84 24 1236postponed


Table 5: Extent of perception towards sources of stress

Sources of stress Low Medium High

No. of Percentage of No. of Percentage of No. of Percentage ofrespondents respondents respondents respondents respondents respondents

Physical environment and welfare 66 18.33 222 61. 67 72 20facilities related stressors

Discrimination and sexual harassment 42 11.67 246 68. 33 72 20related stressors

Attitude towards work related stressors 54 15 252 70 54 15


Table 6: Comparative analysis of sources of stress

Dimensions of stressors Mean Standard Coefficient ofdeviation variation (%)

Physical environment and welfare facilities related stressors 72.33 15.11 20.90

Discrimination and sexual harassment related stressors 46.73 16.49 35.29

Attitude towards work related stressors 67.53 13.31 19.71

Source: Computed from primary data

It would be known from Table 6 that among threedimensions of stressors, physical environment andwelfare facilities related stressors occupied first rankwith the mean score of 72.33. Attitude towards workrelated stressors and discrimination and sexualharassment related stressors are next in line with themean scores of 67.53 and 46.73, respectively.Comparative analysis of different dimensions ofstressors among themselves is given in Figure 2.

It could be known from Table 7 that physical Figure 2: Comparative analysis of sources of stress

environment related stressors have been mostly shownby casualty nurses. Their mean score has been 77.07.

Physical environment and welfare Discrimination and sexual Attitude towards workfacilities related stressors harassment related stressors related stressors

7 2 . 3 3

1 5 . 1 12 0 . 9 0

4 6 . 7 3

1 6 . 4 9

3 5 . 2 9

6 7 . 5 3

1 9 . 7 1

Mean Standard deviation Coefficient of variation

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Operation theatre, ward and intensive care unit arenext in line with the mean scores of 74.40, 72.00 and65.87, respectively.

Discrimination and sexual related stressors have beenexpressed mostly by ward nurses with the mean scoreof 52.80. Casualty, ICU and operation theatre nursesare next in line with the mean scores of 47.73, 44.27and 42.63, respectively.

Attitude towards the work related stressors have beenmostly found by ward nurses with the highest meanscore of 72.80. ICU, casualty and operation theatreare next in line with the mean scores of 70.67, 65.87and 60.80, respectively.

Impact of Stress

From Table 8 it could be noted that restlessness andtired, fatigue and low energy and headache are theforemost impacts of stress on general health of nurses.

Table 7: Comparison of sources of stress among departments

Sources of stress Ward Operation theatre Intensive care unit Casualty

Mean SD CV Mean SD CV Mean SD CV Mean SD CV

Physical environment 72.00 14.83 20.61 74.40 10.57 14.21 65.87 19.75 29.99 77.07 11.42 14.82

Discrimination and sexual 52.80 13.72 25.98 42.13 14.97 35.53 44.27 17.16 38.76 47.73 18.02 37.75harassment

Attitude towards the work 72.80 10.20 14.01 60.80 12.91 21.23 70.67 10.25 14.50 65.87 15.88 24.11

Source: Computed from primary data

Figure 3: Comparison of sources of stress among departments

Table 8: Impact of stress on general health

Health Strongly Agree No Disagree Strongly Totalagree opinion disagree score

Nervousness, anger, aggression, fear and anxiety 36 156 60 90 18 1182

Poor sleeping and difficulty in falling asleep 102 114 30 72 42 1242

Headache 108 126 36 54 36 1296

Restlessness and tiredness 150 156 6 24 24 1464

Fatigue and low energy 90 168 48 48 6 1368

Worry and depression 90 150 18 84 18 1290

Dry mouth 42 168 30 84 36 1176

Feeling worse in morning 66 138 18 102 36 1176

Isolation 42 114 30 138 36 1068

Muscles are tight and tensed 42 102 36 120 60 1026


They have occupied the highest total scores of 1464,1368 and 1296, respectively. Worry and depression,poor sleeping and difficulty in falling asleep,nervousness, anger, aggression, fear and anxiety anddry mouth are the next foremost results of stress onhealth of nurses. They have occupied the total scoresof 1290, 1242, 1182 and 1176, respectively. Feelingworse in morning, isolation and muscles are tight andtensed are the least experienced as stress on generalhealth of nurses in line. They have occupied the totalscores of 1176, 1068 and 1026, respectively.

Physical environment Discrimination and sexual Attitude towards work

7 2 74.4 7 7 . 0 7

Ward Operation theatre Intensive care unit

Mea

n

Coefficient of variation

6 5 . 8 7

52.84 2 . 1 3

4 7 . 7 34 4 . 2 7

72 .860 .8 6 5 . 8 77 0 . 6 7

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Table 9: Relationship between age and perception scores of sources of stress

Sources of stress Critical value Level of significance Result

Physical environment and welfare facilities related stressors 0.850 0.838 Not significant

Discrimination and sexual harassment related stressors 17.532 0.001 Significant

Attitudes towards work related stressors 21.537 0.000 Significant

Total score 26.406 0.000 Significant

Degree of freedom: 3, at 5% level

Relationship between Demographic Variablesand Sources of Stress

It would be known from Table 9 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors and attitude towardswork related stressors is 0.838, 0.001 and 0.000,respectively. It could be observed from the value oflevel of significance that there is no significantrelationship between age and perception scores ofphysical environment and welfare facilities relatedstressors. It could also be known that there is asignificant relationship between age and perceptionscore of discrimination and sexual harassment relatedstressors and attitude towards work related stressors.With regard to the total score, the value of level ofsignificance (0.000) is less than 0.05 (5% level), andhence the null hypothesis is rejected stating that thereis a significant difference in the perception scores ofsources of stress among the group of respondents basedon age.

It would be known from Table 10 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors and attitude towards

work related stressors is 0.000, 0.641 and 0.337,respectively. It could be observed from the value oflevel of significance that there is no significantrelationship between marital status and perceptionscores of discrimination and sexual harassment relatedstressors and attitude towards work related stressors.It could also be known that there is a significantrelationship between marital status and perceptionscore of physical environment and welfare facilitiesrelated stressors. With regard to the total score, thevalue of level of significance is more than 0.05 (5%level) and hence the null hypothesis is accepted statingthat there is no significant difference in the perceptionscores of sources of stress among the group ofrespondents based on marital status.

It would be known from Table 11 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors and attitude towardswork related stressors is 0.022, 0.753 and 0.912,respectively. It could be observed from the value oflevel of significance that there is no significantrelationship between native place and perception scoresof discrimination and sexual harassment relatedstressors and attitude towards work related stressors.It could also be known that there is a significant

Table 10: Relationship between marital status and perception scores of sources of stress


Physical environment and welfare facilities related stressors 14.481 0.000 Significant

Discrimination and sexual harassment related stressors 0.218 0.641 Not significant

Attitude towards work related stressors 0.920 0.337 Not significant

Total score 0.239 0.625 Not significant

Degree of freedom: 1, at 5% level.

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Table 11: Relationship between native place and perception scores of sources of stress







relationship between native place and perception scoreof physical environment and welfare facilities relatedstressors. With regard to the total score, the value oflevel of significance is more than 0.05 (5% level) andhence, the null hypothesis is accepted stating that thereis no significant difference in the perception scores ofsources of stress among the group of respondents basedon native place.

It would be known from Table 12 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors and attitude towardswork related stressors is 0.002, 0.196 and 0.000,respectively. It could be observed from the value oflevel of significance that there is no significantrelationship between places of stay and perceptionscores of discrimination and sexual harassment relatedstressors. It could also be known that there is asignificant relationship between places of stay andperception score of physical environment and welfarefacilities related stressors and attitude towards workrelated stressors. With regard to the total score, thevalue of level of significance is less than 0.05 (5%level); hence the null hypothesis is rejected stating thatthere is a significant difference in the perception scores

of sources of stress among the group of respondentsbased on places of stay.

It would be known from Table 13 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors and attitude towardswork related stressors is 0.000, 0.027 and 0.558,respectively. It could be observed from the value oflevel of significance that there is no significantrelationship between educational qualification andperception scores of attitude towards work relatedstressors. It could also be known that there is asignificant relationship between educationalqualification and perception score of physicalenvironment and welfare facilities related stressors anddiscrimination and sexual harassment related stressors.With regard to the total score, the value of level ofsignificance is less than 0.05 (5% level); hence the nullhypothesis is rejected stating that there is a significantdifference in the perception scores of sources of stressamong the group of respondents based on educationalqualification.

It would be known from Table 14 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination and

Table 12: Relationship between places of stay and perception scores of sources of stress




Attitude towards work related stressors 18.103 0.000 Significant



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Table 13: Relationship between educational qualification and perception scores of sources of stress







Table 14: Relationship between salary and perception scores of sources of stress







sexual harassment related stressors and attitude towardswork related stressors is 0.004, 0.000 and 0.000,respectively. It could be observed from the value oflevel of significance that there is a significantrelationship between salary and perception scores ofall dimensions of stressors. With regard to the totalscore, the value of level of significance is less than 0.05(5%) and hence the null hypothesis is rejected statingthat there is a significant difference in the perceptionscores of sources of stress among the group ofrespondents based on salary.

It would be known from Table 15 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors and attitude towardswork related stressors is 0.004, 0.000 and 0.037,respectively. It could be observed from the value oflevel of significance that there is a significantrelationship between work experience and perceptionscores of all dimensions of stressors. With regard tothe total score, the value of level of significance is morethan 0.05 (5% level) and hence the null hypothesis isrejected stating that there is a significant difference inthe perception scores of sources of stress among thegroup of respondents based on work experience.

It would be known from Table 16 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors and attitude towardswork related stressors is 0.000, 0.000 and 0.000,respectively. It could be observed from the value oflevel of significance that there is a significantrelationship between ward allotment and perceptionscores of all dimensions of stressors. With regard tothe total score, the value of level of significance is morethan 0.05 (5% level) and hence the null hypothesis isrejected stating that there is a significant difference inthe perception scores of sources of stress among thegroup of respondents based on work experience. Withregard to the total score, the value of level ofsignificance is less than 0.05 (5% level) and hence thenull hypothesis is rejected stating that there is asignificant difference in the perception scores ofsources of stress among the group of respondents basedon ward allotment.

It would be known from Table 17 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors and attitude towardswork related stressors is 0.000, 0.000 and 0.137,

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Table 15: Relationship between work experience and perception scores of sources of stress







Table 16: Relationship between ward allotment and perception scores of sources of stress







Table 17: Relationship between work shift and perception scores of sources of stress







respectively. It could be observed from the value oflevel of significance that there is no significantrelationship between work shift and perception scoresof attitude towards work related stressors. It couldalso be known that there is a significant relationshipbetween work shift and perception score of physicalenvironment and welfare facilities related stressors anddiscrimination and sexual harassment related stressor.With regard to the total score, the value of level ofsignificance is less than 0.05 (5% level) and hence thenull hypothesis is rejected stating that there is asignificant difference in the perception scores ofsources of stress among the group of respondents basedon work shift.

It would be known from Table 18 that the value oflevel of significance of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors and attitude

towards work related stressors is 0.091, 0.561 and0.000, respectively. It could be observed from the valueof level of significance that there is a significantrelationship between job situation and perceptionscores of physical environment and welfare facilitiesrelated stressors and attitude towards work relatedstressors. It could also be known that there is nosignificant relationship between job situation andperception score of discrimination and sexualharassment related stressors. With regard to the totalscore, the value of level of significance is more than0.05 (5% level) and hence the null hypothesis isaccepted stating that there is no significant differencein the perception scores of sources of stress amongthe group of respondents based on job situation.

Relationship between sources of stress and health

In order to analyse impact of stress on health of nurses,

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Table 18: Relationships between job situation and perception scores of sources of stress







the multiple regression model has been applied. Theresult of the test is presented as follows:

Table 19: Multiple regression model summary of impact ofstress on general health

Model R R Adjusted Standard errorSquare R square of the estimate

1 0.741 0.549 0.529 6.352

Source: Computed from primary dataPredictors: (Constant), PES, DSS, ATS

From Table 19 it could be observed that the adjustedR square value of 0.529 indicates that around 52% ofthe independent variables (sources of stress) haveimpact on general health.

Table 20: Multiple regression ANOVA of impact of stress ongeneral health

Model Sum of df Mean F Sig.squares square

Regression 16905.142 15 1127.009 27.931 0.000

Residual 13880.458 344 40.350

Total 30785.600 359

Dependent variable: General health

Predictors: (Constant), PES, DSS, ATS

From Table 20 it could be observed that the table

value 0.05 is greater than the calculated value 0.000.

It indicates that there is a significant relationship

between independent variables and dependent

variables. Therefore it could be known that stress has

an impact on general health.

It could be observed from Table 21 that physical

environment and welfare facilities related stressors,

discrimination and sexual harassment related stressors,

attitude towards work related stressors, have significant

impact on general health of nurses.

From the above findings the following regression

model can be developed:

SIOGH = (-12.209) + 0.303X1 + (-0.479X2) + 0.311X3

t Value = (-2.738) (2.550) (-4.328) (2.113)

Level of significance = (0.007) (0.011) (0.000) (0.035)

R Square (Adj) = 0.529 F = 27.931

Where

SIOGH= Stress impact on health

Table 21: Multiple regression coefficients of impact of stress on general health

Model Unstandardised Standardised t Sig.coefficient coefficient

B Std. error Beta

Constant -12.209 4.459 – -2.738 0.007

Physical environment and welfare 0.303 0.119 0.123 2.550 0.011facilities related stressors

Discrimination and sexual harassment -0.479 0.113 -0.213 -4.238 0.000related stressors

Attitude towards work related stressors 0.311 0.147 0.112 2.113 0.035

Dependent variable: General health.

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X1 = Physical environment and welfare facilities relatedstressors;

X2 = Discrimination and sexual harassment relatedstressors;

X3 = Attitude towards work related stressors.

Where

X1 (physical environment and welfare facilities relatedstressors) = 0.123 i.e., 100% change in physicalenvironment and welfare facilities related stressors has12.3% impact on general health.

X2 (discrimination and sexual harassment relatedstressors) = “0.213 i.e., 100% change in discriminationand sexual harassment related stressors has 21.3%impact on general health.

X3 (attitude towards work related stressors) = 0.112i.e., 100% change attitudes towards work relatedstressors has 11.2 % impact on general health.

DISCUSSION

The findings of the present study such as depression,angry and sleeplessness and so on go along with theresult of NIOSH (1998) which explained that presenceof headache, sleep disturbances, difficulty inconcentration, short temper, upset stomach, jobdissatisfaction and low morale tightness in the chest,arguing with others, aggressive or hostile behaviour,blaming others or administration for tension,absenteeism and high staff on job turnover have beenobserved in hospital nursing staff, which may havenegative effects on their health, personal and workbehaviours. The present study has found thatinadequate space and insufficient ventilation andlighting facilities and inadequate infrastructure fornursing practice are the sources of stress. These findingsprovide support for the evidence of the study of Fako(2010) who revealed that occupational stress wasassociated with several aspects of the work environmentincluding work overload, clarity of responsibilities,tidiness of the physical work environment, the layout

of buildings and the landscape, equity in thedistribution of the workload, adequacy of the workload and freedom to make decisions at work.

The present study has found that stress causes poorsleeping. This result is consistent with the study ofHolt (1993) who indicated that stress can lead to avariety of physical complaints, including sleep andgastro-intestinal problems and can also interfere withthe family life. The result of the present study hasidentified that depression, ache, anxiety, nervousness,anger, fear, restlessness and tiredness are the impact ofstress on health of the nurses. These finding also goesalong with the study of Jackson and Schuler (1985)who investigated that stress affects confidence and itproduces anxiety and depression. The result of thepresent study has indicated that headache, sleepdisturbances, depression, and anxiety are the impactsof stress on health of stress. These results go alongwith the evidence of the study of Critchley et al.(2004); Mansor et al. (2003) who have found thatphysiological stress is associated with headache,migraine, abdominal pain, lethargic, backache, chestpain, fatigue, heart palpitation, sleep disturbance andmuscleache, as well as changes in eating, drinking,sleeping and smoking habits. The same result also gowith the study of Maslach (1986) who reported thatstress has been associated with decreased psychologicalwell-being and can manifest as depression, anxiety, lowself-esteem or dissatisfaction. The same result alsoprovide support for the study of Lu (2008) andAntoniou et al. (2003) who reported that stressproduces sleep disturbance, leg cramp, back pain, stiffneck and headache. They have also reported thatpsychological stress is associated with anxiety anddepression burnout, job alienation, hostility,depression, tension, anger, anxiety, nervousness,irritability and frustration.

The result of the present study revealed that unhealthyphysical environment is one of the major stressors.This is corroborated with the evidence of the studyof Estryn-Behar (1990) and Shah (1990) who found

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that lack of physical infrastructure was a stressfulcondition that produces physiological andpsychological consequences leading to fatigue and sleepimpairment. The present study has identified thatunhealthy work environment and inadequate welfarefacilities are the stressors of nurses. The results areconsistent with the study of Malhotra and Chada(2012) who found that work load, workenvironment, co-worker’s support, poor salary and latenight shifts are the reason for stress of BPO employeesand also provide support for the study of Alexandros-Stamatios et al. (2003) who found out that inadequatefacilities provided for the workers or workers tightschedules are potent threat to work stress.

The present study has demonstrated thatdiscrimination is the stressor of nurses. This findingis corroborated with the study of French et al. (2000)who highlighted that nurses can be exposed on a dailybasis to a large number of potent stressors, includingconflict with physicians, discrimination, highworkload, and dealing with death, patients and theirfamilies. The results of the present study such asheadache and depression go in par with study ofAshcraft (1992); Guthrie, (2006); Kyriacou, (2001);Kyriacou; Suttcliffe (1977) who indicated that stresshas also been strongly associated with temporary andchronic illnesses, such as headache, hypertension,reduced immune response, stomach complaints,ulcers, depression and stroke.

SUGGESTION AND CONCLUSION

The researcher presents the following suggestions basedon findings of this study:

Infrastructure and Facilities

Adequate space in the ward should be provided inorder to accommodate all nurses, FNAs, equipments,medicines, files and racks. The lighting and ventilationfacilities in the ward should be ensured adequately.Sufficient facilities such as alarm and stretcher shouldbe created in order to access doctors immediately

during emergency conditions (for example, if cardiacarrest occurs at ward, these facilities are required tomove the patient to the ICU immediately).

Required number of equipments and medicationsshould be made available in the ward in order to makeemployees feel safe and secure to perform their workeffectively. The medical equipments in the wardshould be protected adequately to avoid the potentialdanger of equipments and they should be serviced atfrequent intervals so as to ensure their proper workingconditions.

Welfare Facilities

Adequate welfare facilities such as rest room, healthinsurance, water facilities, library, canteen facilities andconcession rate in canteen, crutches, and funeralexpenses should be provided. HRD interventions suchas individual stress alleviation program and justifieduse of grievance handling procedures should be madeto win trust and confidence of employees and toreduce their anxiety and tension related to job relatedproblems.

Regular health check-up should be undertaken atfrequent intervals and those found suffering from veryhigh stress should be subjected to stress managementprocess. Immunisation and other protective devicessuch as hand glows, face mask, head mask and shoeshould be provided incorporated with health educationabout the importance and the methods of usage ofprotective devices in order to safeguard them fromthe infections. Counselling centre should beestablished along with counselling staff. Counsellingon work related and personal problems should beprovided. It should also be extended to the familymembers including dependents and relatives.

Library facilities with recent journals and magazinesshould be made available. The gym with few exerciseinstruments and a table tennis court may be providedfor the nurses to work out and play games forrelaxation. Recreation activities such as tour, family

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lunch, sending SMS (short message service) onbirthdays and giving simple gifts should also be madeto motivate the staffs.

Attitude

Criticism tolerance and communication strengtheningexercises should be provided in order to handle theemotionally unstable, blaming and criticism natureof the patients and their relatives with confidence.Nurses should be educated and trained to tolerate thecriticism and negative feedback of the patientspositively. They should be educated to develop positiveattitude to face difficulties and to sustain happiness inthe work place. Assertive training such as turning downrequests, expressing personal limitations, initiatingsocial contacts, expressing feelings, differing withothers, providing constructive criticism should betaught so as to lessen the anxiety, improve self-esteemand decrease stress.

Discrimination and Harassment

The management should not show any disparityamong the staffs in terms of race, caste, religion,community, language and economic status. Moreover,the male staffs should continuously be monitored toprevent sexual harassment. The hospital managementshould establish a healthy interpersonal relationshipamong male and female staffs by means of creatingappropriate policy, rules and regulations.

Limitations of the Study

The study has been limited to Tirunelveli District only.The study has covered only female nurses working inwards, intensive care units, operation theatres andcasualty departments of general type of private hospitalhaving these four departments. It has not coveredother nurses such as nurses working in governmenthospitals, single speciality hospitals, dialysis units, cathlabs and any other units.

The present study has also been limited to nursesqualified with DGNM ) and B.Sc (Bachelor of Sciencein Nursing) and it has not included any other category

of nurses such as FNA (Female Nursing Assistants),DNA (Diploma in Nursing Assistants), PCBSc (PostCertificate B.Sc Nursing), M.Sc (Master of Nursing),and nursing supervisors and head nurses.

As the respondents are literate they could respond toall questions intelligently. Many of the respondentswere afraid of the management to provide data andsome of them were busy in their work, and hence,the researcher had to spend more time to elicit theresponses. In the study the researcher observed thatsome of the nursing in charges and senior nurses werereluctant to speak about the nurses in their department.

Directions for Future Research

This study is relevant in second tier cities all over thecountry wherever there are hospitals that are being runwith similar facilities, rules and procedures. Thoughthere have been studies on similar parameters of stress,the focus on nurses, the arteries of any hospital, havebeen insignificant. The present study has covered only360 nurses working in four areas of private hospitalnamely wards, intensive care units, operation theatresand casualty departments. The future research can beundertaken with more number of samples coveringother departments with an increased number ofvariables. The future study can also be conducted inthe following ways:

(i) The comparative study of stress between nursesand other paramedical staffs.

(ii) The comparative study of stress between medicaland paramedical staffs.

(iii) The comparative study of stress between nursesand non medical staffs.

(iv) The comparative study of stress between nursesworking in private hospitals and nurses workingin government hospital.

CONCLUSION

The objectives of this descriptive research undertakenin Tirunelveli District, Tamil Nadu as comparative

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study were to identify and differentiate sources of stressunder the dimensions of physical environment andwelfare facilities related stressors, discrimination andsexual harassment related stressors attitude towardswork related stressors and its impact on health ofnurses working in four core departments namelyintensive care unit, operation theatre, emergencydepartment and ward. In order to achieve theseobjectives the study sampled 360 nurses qualified withDiploma in General Nursing and Midwifery andBachelor of Science in Nursing courses from 45 generaltypes of private hospitals using the stratified samplingtechnique. The study has applied the weighted averagemethod applied to analyse sources of stress. Mean,standard deviation and coefficient of variation havebeen used to understand perception of nurses workingin those four departments towards sources of stress.Kruskal–Wallis test has been administered to examinethe relationship between sources of stress anddemographic variables. Multiple regression tests havebeen used to find the relationship between sources ofstress and health. The results identified from thesethree dimensions of stressors indicated that insufficient

ventilation and lighting in the ward, inadequateinfrastructure for nursing practice, inferior opinion andperception by the public on nursing profession, verbalabuse by the patients, negative feedback by the superiorand co-worker about the level of sacrifice in the workand being preoccupied with work thoughts even aftergoing to bed have been the foremost stressors ofnurses. The results also indicated that among threedimensions of stressors, physical environment andwelfare facilities related stressors has occupied the firstplace followed by attitude towards work relatedstressors and discrimination and sexual harassmentrelated stressors. The result also found that, all threedimensions of stressors had significant impact onhealth of the nurses.

Good physical environment, adequate welfare facilities,fair treatment irrespective of caste, religion and race,positive attitude are essential factors to make nursesstress free and to improve their health. It is the essentialduty of the hospital management to concentrate onthese factors and to take necessary steps to establishand strengthen those factors so as to prevent stressand thereby enhance their health.

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39 STRESS & HEALTH - COMP STUDY