i

JOB STRESS, BURNOUT AND COPING MECHANISMS

OF STAFF NURSES IN SURIGAO CITY

A Thesis Proposal Presented to Faculty of

Graduate School of Health Science
Southwestern University
Cebu City

In Partial fulfillment of the Requirements for the

Degree of Master of Arts in Nursing
Major in Nursing Service Administration

Leong, Zarah H.

February 2018
 ii

TABLE OF CONTENTS

TITLE PAGE……………………………………………………………………………………..i
TABLE OF CONTENTS………………………………………………………………..…...ii

CHAPTER I. THE PROBLEM AND ITS SCOPE

Rationale of the Study…………………………………………..…….….……1

Review of Related Literature……………………………...…….……..…..4

The Problem
Statement of the Problem…………………….…………..…..….14
Statement of the Null Hypothesis………….………….…..….16
Significance of the Study………………….…..……..….….…….16

Methodology
Research Design……………………….……….…..……..….………20
Research Environment……………….…………….…..….……….20
Research Respondents…………………….…….…..…….….……21
Research Instrument……………………………………..…..………22
Research Procedure………………….…….…………..…..…………25

Definition of Terms…………………………………………..….….…..………28

Appendices
Appendix A. Letter to the Dean…………………….…..……….33
 iii

Appendix B. Letter to the CRH Chief Nurse…..….……….34

Appendix C. Letter to the MFH Chief Nurse….….….……35
Appendix D. Letter to the Respondents……………..………36
APPENDIX E. Research Instrument
Part I. Demographic Profile……….……………………..37

Part II. Job Stress Questionnaire……………….…….38

Part III.Maslach Burnout Inventory………..…….…42

Part IV.Brief Cope Inventory……….……………………45

Curriculum Vitae………………………………………………………….48
 CHAPTER I
THE PROBLEM AND ITS SCOPE
INTRODUCTION

Rationale of the Study

Nursing is considered as one of the most stressful

professions. In fact, according to the American Holistic Nurses’

Association, nurses are experiencing workplace stress at higher

rates than most other professions. Stress in nursing is rooted

largely to the physical labor, suffering and emotional demands of

patients and families, work hours, shift work, interpersonal

relationships, and other pressures that are central to the work

nurses do. Moreover, factors that have amplified job stress among

nurses since the 1980s include the rising use of sophisticated

healthcare technologies, budget cuts, increasing workload, and

constant organizational changes in some healthcare environments

(Roberts, R. 2012).

One of the major adverse consequences of job stress is

burnout. It has been conceptualized as a severe effect on

prolonged stress at work. It can be seen that many Filipino nurses

experience emotional exhaustion, depersonalization and reduced

personal accomplishment which are known as the syndrome of job

 2

burnout. Other symptoms include tiredness, insomnia, headaches,

increased absenteeism and eating disorders. Studies have shown

that nurses have very high rates of burnout. Aiken and

colleagues (2002) found that more than 40% of hospital staff

nurses scored in the high range for burnout, with 43.2% of nurses

reporting high levels of emotional exhaustion. Indeed, it has taken

a great toll on the nurses who are the front-liners and major health

care providers.

With these being said, it is a challenge to know the different

coping mechanisms that the nurses use for them to be able to face

and solve the pressure they have in their workplace. It is also

important to discuss effective ways of responding to stress not on a

macro scale but rather on the individual level. It is very essential to

know these coping mechanisms for them to be able to continue

giving effective and appropriate nursing care management to their

patients and for them to not experience job burnout.

As a staff nurse in a tertiary hospital, with a nurse to patient

ratio reaching to 3:60, handling many demands and complaints

from patients as well as doctors, working double shifts because of

understaffing and absenteeism, dealing with more complicated

healthcare machineries, and not to mention new organizational

 3

changes such as accreditations and certifications, the researcher

has witnessed firsthand the current situation of the hospitals in the

Philippines. It has motivated her to further explore the

apprehensions and stress of the nurses in dealing with different

difficulties in the hospital setting and be able to identify the

effective coping mechanisms they have applied to become a guide

to future nurses who will face the same circumstances forthcoming.

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LITERATURE BACKGROUND

Job stress in the nursing profession has been an unrelenting

global problem for many years now. It has been linked with a

variety of adverse attitudinal, behavioral, physical and emotional

health consequences. Among attitudinal and behavioral

consequences are diminished job satisfaction, turnover intentions,

and actual turnover or absenteeism. Among adverse physical and

emotional health consequences are hypertension, cardiovascular

disease, immune disorders, obesity, depression, and burnout.

Health care workers are at a higher risk for the development of

stress or strain related illnesses. The Dutch Central Bureau of

Statistics has shown that absence rates among hospital personnel

are among the highest of all sectors and higher than absence rates

in other stressful occupational settings such as catering industry,

transport, or education (Beh, L. 2012).

Stressful factors can influence healthcare workers in many

aspects of personal and organizational life. It’s been found that

different styles of personality, gender differences of an individual,

age of the person, family history and emotional state can all

influence a person’s level of obtaining workplace stress. For

example, in a previous study by Wichert (2002) he found that men

 5

and women who reacted differently to stress over the long term

,that men showed an increased level of physical deterioration as a

response to stressful situations, whereas women showed more

psychological symptoms (Wichert ,2002).

Selye’s (1975, 1980) General Adaptation Syndrome model

can help in understanding stress associated with nursing, for

example in managing difficult situations such as the care of dying

patients, when stress may be related to anticipated loss and

ambiguity about decision making. Emotional demands may exceed

the person’s ability to respond appropriately, and stress-related

behavior may be exhibited. There are three stages of Selye’s

(1975, 1980) general adaptation syndrome model: Alarm reaction

– pituitary adrenocortical response; Resistance – tissue defense;

Exhaustion – destruction of tissue, organ or body.

According to Selye, a full understanding of stress and its

many effects must involve great attention to the three related

stages (Selye, 1956:31). Arousal rises quickly to high levels and

many physiological changes that prepare our bodies for strenuous

activity (either flight or combat) take place. The body prepares to

fight or adjust to the stressor by increasing heart rate, respiration,

muscle tension and blood sugar. This initial reaction is soon

 6

replaced by the second stage known as resistance. Here, if a

stressor is too intense the individual may feel restless to cope with

it. However, after a short period of alarm the individual will gather

all strength and start resisting the negative effects of the stressor.

The body tries to return to a normal state by adapting to the

stressor. If stress persists, the body’s resources may become

depleted and the final stage known as exhaustion occurs. During

the exhaustion stage the body begins to wear down from exposure

to the stressor. At this point, the ability to cope decreases sharply

and severe biological damage may result if stress persists. If a

person experiences the stressor long enough and does not

effectively manage the source of stress then stress-related

illnesses can appear. The damaging effects of stress occur in this

stage for both the individual and organization.

In nursing, exhaustion may be prevalent in situations where

the delivery of optimal care is unrelenting, physically and

emotionally. Daly and Carnwell (2003) reported that such

exhaustion can lead to progressive loss of idealism, energy and

purpose, often expressed as fatigue, depression, conflict, negativity

and cynicism. Mannion et al (2010) stated that these stressors are

exacerbated by the many other organizational demands placed on

 7

the nurse. Central to any psychological stress theory in nursing is

the nurse’s evaluation of the significance of what is happening in

terms of his or her wellbeing (appraisal), and the effort in thought

and action to manage specific demands (coping)(Lazarus 1993).

The term “burnout”, was coined by German born American

clinical psychologist Herbert Freudenberger (1974). Burnout has

been described as a specific kind of occupational stress-reaction

among human service professionals, as a result of the demanding

and emotionally charged relationships between caregivers and their

recipients (Maslach & Schaufeli, 1993). More specifically, burnout is

most commonly defined as a syndrome of feelings of exhaustion,

depersonalization, and reduced personal accomplishment (Maslach

et al, 1996).

Emotional exhaustion refers to energy depletion or the

draining of emotional resources. Depersonalization refers to the

development of negative, cynical attitudes towards the recipients

of one’s service or care. These two burnout dimensions are

generally considered the core symptoms of burnout (Shirom,

1989), and they show the most robust relationships with work-

related stressors (Schaufeli & Enzmann, 1998). The third

dimension, lack of personal accomplishment, is often studied only

 8

as an afterthought. It refers to the tendency to evaluate one’s own

work with recipients negatively, and is accompanied by feelings of

insufficiency (Schaufeli & Buunk, 1996).

Nurses are considered to be particularly susceptible to

burnout. According to two European epidemiological studies,

burnout affects approximately 25% of all nurses (Landau 1992 &

Saint-Arnaud et al. 1992). Their jobs are typically stressful and

emotionally demanding, since nurses are repeatedly confronted

with people’s needs, problems and suffering. Several studies have

shown that burnout is positively correlated with the amount of time

nurses spend with their patients (Lewinson et al. 1981, and with

exposure to patients with a poor prognosis (Hare et al. 1988).

Older nurses may experience less job burnout , as they have

better adaptability skills to their jobs , and implement coping

strategies , then more younger nurses. This was found in one study

conducted by Barron et al (2005) who found that younger nurses

under the age of 30 experienced higher levels of job turnover than

more older nurses. These findings suggest that age is a major

predictor on obtaining job burnout. Accoring to Aiken et al (2001) ,

nurses under the age of 30 years’ experience higher levels of

 9

burnout than more experienced nurse over the age of 30 (Aiken et

al , 2001).

Coping is defined as the cognitive and problem solving behaviors

people employ to tolerate, minimize, or eliminate stress (Lazarus

and Folkman, 1984). It is a complex interplay of thoughts and

behaviors. Coping allows individuals to control and reduce the

negative consequences of a stressful situation. Coping resources

can be derived from both the personal and environmental. They

refer to those reserves a person has that they draw upon to

manage stressful encounters. When coping resources, no matter

the type, are adequately matched to the stressor, outcomes are

successfully controlled (Millikan et al., 2007). If, however,

stressors exceed available resources, the aforementioned

manifestations of stress can be observed. Coping strategies, on the

other hand, refer to the behaviors/efforts that are put forth to

combat the stress (Carver et al., 1989; Lazarus and Folkman,

1984). As an example, consider religion/spirituality which is a

common coping resource. The actual coping strategy utilized would

therefore be prayer or meditation or trusting that a higher power is

in control. While research regarding the identification of major

 10

stressors for hospice nurses is plentiful, few studies have examined

the primary ways of coping for this group.

Coping is an essential component in the understanding of

workplace stress (Lazarus, 1999) and the resultant effects it can

have on employees. Utilizing appropriate coping strategies can

influence the outcome of a perceived stressful event. These

findings can have significant implications for the development of

effective organizational interventions designed to combat

workplace stress. The work of Lazarus and Folkman (1984) on the

Transactional Model of Stress and Coping offers a model of the

process as a relational transaction between the person and

environment. It highlights perceptions of the individual but

recognizes the context within which the individual operates (Coyne

and Lazarus, 1980; Lazarus and Folkman, 1984). This underscores

the earlier identification of stress as a result of more than personal

characteristics or behaviors. Instead, the focus is on both the

person and his/her environment. According to the model, the

individual’s appraisal of the event as positive, irrelevant or stressful

is the initial step. This decision is based on the individual’s

evaluation of the severity of the event and her susceptibility to

stress. Second, the perceived amount of control he/she has over

 11

the event itself as well as potential resources to manage the event

is evaluated. It is then up to the individual to decide which of those

resources to draw upon as well as the coping strategy to manage

the stressful event.

Researchers agree that coping mechanisms can be generally

divided into two broad categories; problem-focused coping and

emotional-focused coping (Gold and Thornton, 2001; Payne, 2001;

Yancik, 1984). Problem–focused coping seeks to change the

stressful event, whereas emotional-focused coping is directed at

changing the way one perceives the stressful situation. Another

important distinction prevalent in the coping literature is that of

active versus avoidant coping (Carver et al., 1993). Active coping

involves exerting effort of some kind to eliminate or minimize the

stressful event. In active coping, individuals acknowledge the

stressor and take measurable steps to resolve the issue. In

contrast, avoidant coping relies on disengagement or denial. This

type of coping results in dismissal of or an attempt to suppress the

problem. Research suggests that problem-focused coping and

active coping are most often associated with positive outcomes

(Carver et al., 1989; Cohen, 1984; Holahan and Moos, 1987; Pina

et al., 2008). These general coping styles (problem and emotion-

 12

focused vs. active and avoidant) have specific strategies that

overlap one another. Ultimately, the chosen coping mechanism

depends on the individual, his/her resources and the type of

stressor. It is also not uncommon for a combination of these

mechanisms to be used for any given stressor (Lazarus and

Folkman, 1984).

Furthermore, Registered Nurses are trained to treat others

with compassion, but unless they identify their own emotions, they

can't generate compassion for themselves and begin to heal.

Journaling, meditating and praying are strategies to help one get in

touch with those deep rooted inner feelings. Similarly, interests

such as poetry, gardening, working, animals, and painting are

useful methods to unleash these deep rooted feelings. Consider the

nurse who has just experienced the loss of one of her patients; she

might feel guilty and/or depressed. Unless she has a series of

coping mechanisms in place to deal with the situation, her health

and overall job performance might suffer.

The preceding studies were carefully chosen for us to know

how apparent job stress in nursing is and how important it is to

have coping mechanisms. Selye and the rest of the health care

theorists emphasized the effects of stress, Maslach stressed the

 13

effects of burnout and Lazarus and Folkman emphasized the

importance of coping. This led to the formulation and development

of the study.
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THE PROBLEM

Statement of the Problem

This study aims to determine the level of job stress, job

burnout and coping mechanisms of staff nurses in both a public

and private hospital in Surigao City. The findings of which will be

the basis for a proposed action plan.

Specifically, this seeks to answer the following:

1. What is the profile of the respondents in terms of:

1.1 Age;

1.2 sex;

1.3 civil status;

1.4 highest educational attainment;

1.5 work status;

1.6 area of assignment;

1.7 length of service;

1.8 average patients handled per day;

1.9 average monthly income?

2. What is the level of job stress among the nurses in terms of:

2.1 Intensity;

2.2 frequency?
 15

3. What is the level of job burnout among the nurses in terms

of:

3.1 emotional exhaustion;

3.2 depersonalization;

3.3 personal accomplishment?

4. What is the level of coping mechanisms among the

respondents in terms of:

4.1 self-distraction;

4.2 active coping;

4.3 denial;

4.4 substance use;

4.5 use of emotional support;

4.6 use of instrumental support;

4.7 behavioural disengagement;

4.8 venting;

4.9 positive reframing;

4.10 planning;

4.11 humour;

4.12 acceptance;

4.13 religion;

4.14 self-blame?
 16

5. Is there a significant relationship between the following:

5.1 Profile of respondents and level of job stress;

5.2 Profile of respondents and level of job burnout;

5.3 Profile of respondents and level of coping mechanisms;

5.4 Level of job stress, job burnout and level of coping

mechanisms?

6. What action plan can be proposed based on the study?

Statement of the Null Hypothesis

1. There is no significant relationship between the following:

1.1 Profile of respondents and level of job stress;

1.2 Profile of respondents and level of job burnout;

1.3 Profile of respondents and level of coping mechanisms;

1.4 Level of job stress, job burnout and level of coping

mechanisms.

Significance of the Study

The study has great implication and importance because

discovering the levels of stress and job burnout of staff nurses and

identifying their different coping mechanisms will give great insight

 17

as to how difficult it is to become a nurse. Moreover, it is

significant to find ways in dealing with the stress to provide

efficient and effective nursing interventions and quality care. The

result of the study will surely benefit the following groups and

entities:

Patient/Clientele. Stress on the part of the nurses greatly

affects their treatment to the patients. Being able to understand

their stress and the possible burnout, and be able to respond to it

with effective coping mechanisms will ensure that the care given to

the clientele will not be compromised.

Staff nurses. Second most important group that will benefit

from this study are the staff nurses. Staff nurses are the ones who

will be giving care to their patients. It is important for them to

know and understand that stress and burnout could hinder in their

functions as nurses. It will benefit them if they will be able to know

the effective coping mechanisms that they could use to minimize

their stress.

Nursing Administrators. Since they are the ones who

would manage the present situation in wards and special areas, it

 18

is important for them to be able to know how their subordinates

are feeling and how they are able to handle stress.

Hospital Administrators. As the main employer of the

health care providers, it is the duty and responsibility of the

administrators to assess the status of their employees. This study

will give them assessment findings of their nurses’ current status

and will help them determine steps necessary to improve the

services of their institution.

Philippine Nurses Association. This will help them

understand the experiences and the current situation of majority of

nurses in the Philippines regarding stress and job burnout. This

study will help them formulate proposals that will benefit all

Philippine nurses.

The Researcher. The researcher will benefit from this study

by helping her gain knowledge that will be useful in her career

plans. As she grows in her career, she will be able to be educated

on the current situation of nurses and will be able to help solve the

cause of problems.
 19

Future Researchers. This will help to identify means to

improve the study and be able to give long lasting if not permanent

solutions on the increasing stress and burnout on nurses.

 20

METHODOLOGY

Research Design

This study will utilize descriptive-correlational design

employing quantitative approaches in determining levels of job

stress, job burnout and as well as the coping mechanisms of

nurses in Caraga Regional Hospital and Miranda Family Hospital.

Research Environment

This research will be conducted at a public tertiary hospital

Caraga Regional Hospital (CRH) and a private hospital Miranda

Family Hospital (MFH). Both hospitals are located in Surigao City,

on the northeastern tip of the Philippine island of Mindanao. The

hospitalsare two of at least four hospitals serving the area.

In 1941 the Philippine Commonwealth government

appropriated money to establish a hospital in Surigao. However, in

1942 Japan seized control of the Philippines from the United

States, disrupting plans to build the hospital. In 1948, after

independence was achieved, construction began on what was to

become Surigao Provincial Hospital. The building was completed at

the end of 1949 and was opened in January 1950 with a capacity

of twenty-five beds.
 21

The hospital was expanded and the number of beds

increased in 1958 to fifty beds. The hospital continued to grow to

seventy-five beds and in 1970 it grew to 100 beds. The current

number of beds, 150, was authorized in 1975. In 1993 the hospital

was devolved by the Philippine government to the province of

Surigao del Norte. On February 11, 1997, the hospital was

renamed Caraga Regional Hospital.

Today CRH provides many in-patient and out-patient services

to the residents of the Surigao area.

The Miranda Family Hospital (MFH) is a privately-owned 35-

bed capacity Level 1 Hospital located in Surigao City, province of

Surigao del Norte, Philippines. It was founded in 1980 as the

Miranda Family Clinic by Dr. Josefino P. Miranda and was

renamed Miranda Family Hospital in 1989 as it raised its service

capability. It was registered with the Securities and Exchange

Commission in 1996 as a stock corporation with the family

members as Incorporators and Directors.

Research Respondents

The researchers will select 130 out of 218 nurses in CRH and

12 out of 19 nurses in MFH using 95% level of confidence with a

 22

margin error +/-5%. The researchers will be using quota sampling

in choosing respondents assigned in different areas in CRH and

MFH. They must be employed in not less than 6 months.

Research Instrument

This study will be using 1 instrument (questionnaire) with

four parts.

The first part of the instrument is a researcher-made tool to

determine the demographic profile of the respondents in terms of

age, sex, civil status, highest educational attainment, work status,

area of assignment, average census/day, length of service and

average monthly income.

The second part of the instrument is a 5-point likert

questionnaire developed by Leatt et al (1980) called the Job Stress

Questionnaire.

Job stressors or inputs were measured by the Job Stress

Questionnaire (JSQ). The JSQ was initially developed by Leatt and

Schneck (1980) to assess head nurses' perceptions of stressors. By

rewording slightly, Lobb and Reid (1987) adapted the JSQ to

assess perceptions of stressors in a group of staff nurses and head

nurses. This instrument consists of 21 items representing job

 23

stressors such as "inability to satisfy conflicting demands," and

asks respondents to rate each according to the frequency with

which it occurs ("never, rarely, sometimes, often, always") and the

intensity of the stress it induces ("very little, a little, some, quite a

bit, very much"). Leatt and Schneck (1985) used the stress

questionnaire to investigate differences between nursing subunits

in hospitals. Within subunits they multiplied the mean of individual

intensity scores by the mean of individual frequency scores to

derive a composite stress score for each situation.

The third part of the instrument is a validated 7-point likert

questionnaire by Christina Maslach and colleagues called the

Maslach Burnout Inventory.

The Maslach Burnout Inventory (MBI) is an introspective

psychological inventory consisting of 22 items pertaining to

occupational burnout. The original form of the MBI was constructed

by Christina Maslach and Susan E. Jackson with the goal to assess

an individual's experience of burnout. The MBI measures three

dimensions of burnout: emotional exhaustion, depersonalization,

and personal accomplishment. Each respondent indicates their

answer on a seven point likert scale ranging from 0=Never , 1=A

 24

few times a year or less , 2=Once a month or less , 3= A few times

a month , 4=Once a week , 5= A few times a week , 6= Every day.

The fourth part of the instrument is a self-report

questionnaire, developed by Carver (1997) to assess a number of

different coping behaviors and thoughts a person may have in

response to a specific situation. It was revised into a shorter

version by the Department of Psychology, University of

Miami (both because of the length and redundancy of the full

instrument and because of the overall time burden of the

assessment protocol). This is called the Brief Cope Inventory.

The questionnaire consists of 28 coping behaviours and

thoughts (2 items for each subscale) with fourteen theoretical

coping responses: self-distraction, active coping, denial, substance

use, use of emotional support, use of instrumental support,

behavioural disengagement, venting, positive reframing, planning,

humour, acceptance, religion and self-blame. These are measured

across a five- point likert scale 1=never , 2=rarely , 3=sometimes

4=often and 5=always.

Scales are computed as follows (with no reversals of coding):

 25

Self-distraction, items 1 and 19

Active coping, items 2 and 7

Denial, items 3 and 8

Substance use, items 4 and 11

Use of emotional support, items 5 and 15

Use of instrumental support, items 10 and 23

Behavioral disengagement, items 6 and 16

Venting, items 9 and 21

Positive reframing, items 12 and 17

Planning, items 14 and 25

Humor, items 18 and 28

Acceptance, items 20 and 24

Religion, items 22 and 27

Self-blame, items 13 and 26

Research Procedures

Gathering of Data.

The researcher will write a letter addressed to the dean of

the graduate school requesting for an approval to conduct the

study.
 26

After obtaining an approval from the dean, a letter will be

written addressed to the hospital in-charge of Caraga Regional

Hospital and Miranda Family Hospital requesting for the approval to

conduct the study on “Job Stress, Burnout and Coping Mechanisms

of Staff Nurses in Surigao City”.

A pilot testing of the research instrument will be done to 10

staff nurses. During the actual collection of data, the researcher

will send the research instrument to the respondents for them to

fill and later be collected.

Treatment of Data. The following are the statistical treatment to

be used for the study:

Simple Percentage will be used to determine the

demographic profile of the respondents in terms of age, sex, civil

status, highest educational attainment, work status, area of

assignment, average census/day, length of service and average

monthly income.

Composite Scoring will be used to measure the level of job

stress in terms of intensity and frequency.

Weighted mean will be used to determine the level of

burnout and coping mechanisms.

 27

Chi-square will be used to determine the relationship

between the profile and level of job stress, the relationship

between the profile and level of job burnout and the relationship

between the profile and coping mechanisms.

Pearson r will be used to determine the relationship

between the level of job stress and job burnout, the relationship

between the level of job stress and coping mechanisms, and the

relationship of job burnout and coping mechanisms.

 28

DEFINITION OF TERMS

To enhance understanding of the study, the following terms

are operationally defined:

Coping Mechanisms/ Strategies- refer to the strategies that the

staff nurses do to handle internal and external stress.

Job Burnout- refers to the degree of exhaustion of staff nurses

measured in three scales: emotional exhaustion, depersonalization

and personal accomplishment.

Emotional exhaustion- measures feelings of being

emotionally overextended and exhausted by one's work.

Depersonalization-measures an unfeeling and impersonal

response toward recipients of one's service, care treatment,

or instruction.

Personal Accomplishment- measures feelings of

competence and successful achievement in one's work.

Job Stress- refers to the degree of stress experienced by the staff

nurses in CRH in dealing with problems and adversities in the

hospital.
 29

Proposed Action Plan-refers to the planned actions that mitigate

the effect of similar scenarios and shall be created based on the

conclusion of the study

Staff Nurse- refers to nurses working in both Caraga Regional

Hospital and Miranda Family Hospital

 30

BIBLIOGRAPHY

Aiken, L. et al (2002). Nurse Burnout and Patient Satisfaction.

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC2904602/

Ameritech College of Healthcare. (2014). 5 Myths about Registered

Nurses Retrieved from http://explorehealthcareers.org/
en/Field/6/Nursing

Beh, L. (2012). Job Stress and Coping Mechanisms among Nursing

Staff in Public Health Services. Retrieved from
www.hrmars.com/admin/pics/912.pdf

Bratianu, P. (2015). Why Workplace Stress Impacts Nurses.

Retrieved from https://www.ausmed.com/articles/stress-in-
nursing/

Buchanan, J. (2002): "Global nursing shortages". Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122695/

Carver, C. et al (1989). Assessing Coping Strategies: A

Theoretically Based Approach. Retrieved from
https://pdfs.semanticscholar.org/5a8c/2bceefede7391164c9d
45ff01f1d4619ba46.pdf

Demerouti, E. et al (2000). A Model of Burnout and Life

Satisfaction Amongst Nurses. Retrieved from
http://www.wilmarschaufeli.nl/publications/Schaufeli/139.pdf

Freudenberger, H.J(1974) Staff burnout .Journal of Social Issues ,

Vol 50 , 159-165.

Guvan, E. (2016): Stress, burn-out and coping mechanisms

amongst Irish healthcare nurses. A questionnaire survey.
Retrieved from http://trap.ncirl.ie/2211/1/emmaguven.pdf

Hale, E. (1993). An Investigation of Stress and Burnout in Hospital

Registered Nurses. Retrieved fromhttp://scholarworks.
gvsu.edu/cgi/viewcontent.cgi?article=1160&context=theses
 31

Indian J. (2014 ): Occupational stress among staff nurses:

Controlling the risk to health. Retrieved from
https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC4280777/

LaToya J. M. Harris, DrPH (2013): Journal of Hospice and Palliative

Nursing Exploring How Nurses Manage Workplace Stress.
Retrieved from http://www.medscape.com/viewarticle/814499_6

McIntosh, B. et al (2012): Effects of Stress in Nursing integrity.

Retrieved from http://journals.rcni.com/doi/pdfplus/10.7748/
ns2013.02.27.25.35.e7199

Roberts, R, et al. ( 2012)."Alleviating Job Stress in Nurses”.

Retrieved from http://www.medscae.com/viewarticle/765974

University of Miami, Department of Psychology (2007).Brief COPE.

Retrieved from http://www.psy.miami.edu/faculty/ccarver/
sclCOPEF.html

Ward, J. (2012): Stress Management for Nurses. Retrieved from

http://www.nursetogether.com/stress-management-nurses

Wichert, I (2002) Job insecurity and work intensification. The

effects on health and well-being. In B Burchell, D Ladipa , E
& F Wilkenson (Eds). Job Insecurity and work intensification,
New York: Routledge, 92-111.
 32

APPENDICES
 33

Appendix A. Letter to the Dean

February 17, 2018

Michelle B. Yu, RN, DMc

Dean, College of Nursing
Southwestern University, Cebu City

Dear Dean Yu,

I am going to conduct my Master’s Degree Thesis at Southwestern

University entitled “Job Stress, Burnout and Coping Mechanisms of
Hospitals in Surigao City.”

In view of this, may I request your kind permission to allow me to

obtain necessary data from the staff nurses from Caraga Regional
Hospital and Miranda Family Hospital both situated in SurigaoCity.

Favorable response would be highly appreciated. Thank you!

Respectfully yours,

Zarah H. Leong
 34

Appendix B. Letter to the CRH Chief Nurse

February 17, 2018

Mercy A. Yandra, RN, MAN

Chief Nurse
Caraga Regional Hospital

Madam,

I am going to conduct my Master’s Degree Thesis at Southwestern

University entitled “Job Stress, Burnout and Coping Mechanisms of
Hospitals in Surigao City.”

In view of this, may I request your kind permission to allow me to

gather necessary data through questionnaire checklist from the
staff nurses from your respected institution.

Favorable response would be highly appreciated. Thank you!

Respectfully yours,

Zarah H. Leong

Michelle B. Yu, RN, DMc

Adviser
 35

Appendix C. Letter to the MFH Chief Nurse

February 17, 2018

Jane T. Miranda, RN, MAN

Chief Nurse
Miranda Family Hospital

Madam,

I am going to conduct my Master’s Degree Thesis at Southwestern

University entitled “Job Stress, Burnout and Coping Mechanisms of
Hospitals in Surigao City.”

In view of this, may I request your kind permission to allow me to

gather necessary data through questionnaire checklist from the
staff nurses from your respected institution.

Favorable response would be highly appreciated. Thank you!

Respectfully yours,

Zarah H. Leong

Michelle B. Yu, RN, DMc

Adviser
 36

Appendix D. Letter to the Respondents

February 17, 2018

Sir/Ma’am,

Greeting of peace!

I am I am going to conduct my Master’s Degree Thesis at

Southwestern University entitled “Job Stress, Burnout and Coping
Mechanisms of Hospitals in Surigao City.” The aim of this study is
to identify the level of stress and job burnout of staff nurses as well
as determine the coping mechanisms that are commonly used.

In connection to this, may I request you to answer the following

questionnaire honestly and sincerely. Rest assured that all data
gathered will be treated with utmost confidentiality.

Thank you and God bless!

Respectfully yours,

Zarah H. Leong

Michelle B. Yu, RN, DMc

Adviser
 37

APPENDIX E. RESEARCH INSTRUMENT

Part I.

Demographic Profile

1. Age:

2. Sex: ( ) male ( ) female

3. Civil status: ( ) single ( ) married

4. Highest Educational Attainment:

( ) BSN ( ) with Masters unit ( ) with Masters degree

( ) with Doctorate unit ( ) with Doctorate degree

5. Work status: ( )regular ( )casual ( )job order

6. Area of assignment: ( ) ward ( ) special area

7. Length of service: _______

8. Average patients handled per day: ______

9. Average monthly income: ______

 38

Part II.

Job Stress Questionnaire

The first part of each question is concerned with the intensity of a

stressor(s). The second part is concerned with the frequency of the
stressor(s). Please circle the answer that most closely
approximates your perception regarding your typical work
experience.

1. How stressful is it if nursing staff have insufficient resources to

do all the things that should be done?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

2. How stressful is it if nursing staff are unable to satisfy the

conflicting demands of various people (e.g. patients, physicians,
other paramedical staff, etc.)?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

3. How stressful is it if the scope or responsibilities of a job are

unclear?

very little / a little / some / quite a bit / very much

How often does this situation occur'.’
never / rarely / sometimes / often / always

4. How stressful is it if there are personality conflicts among

nursing staff members?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always
 39

5. How stressful is it if nursing staff are insecure in their nursing

knowledge or skills?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

6. How stressful is it if physicians appear impatient or hypercritical

of nursing staff?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

7. How stressful is it if physicians are not available when they are

wanted?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

8. How stressful is it if physicians do not communicate well with

nursing staff?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

9. How stressful is it if a patient's behavior or personality is

troublesome?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

10. How stressful is it if a patient is very ill and his/her prognosis is

poor?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always
 40

11. How stressful is it if nursing staff are caring for mostly elderly
patients?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

12. How stressful is it if nursing staff must perform painful but life-
preserving treatments for patients?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

13. How stressful is it if a patient's family is not informed of the

condition of one of their members?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

14. How stressful is it if a patient's family is upset or anxious about

one of their members?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

15. How stressful is it if scheduling and staffing are unpredictable

or there are irregularities in the way time-off is scheduled?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

16. How stressful is it if the workload is so consistently heavy that

the nursing staff lack energy for leisure activities?

very little / a little / some / quite a bit / very much

 41

How often does this situation occur?

never / rarely / sometimes / often / always

17. How stressful is it if the nursing staff are exposed repetitively

to suffering, death, and dying?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

18. How stressful is it if the previous shift often leaves unfinished

work that should have been handled during their shift?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

19. How stressful is it if the nursing staff are frequently faced with
crisis situations which are not considered normal work?

very little / a little / some / quite a bit / very much

How often does this situation occur?
never / rarely / sometimes / often / always

20. How stressful is it if nursing staff are asked to relieve on other

units of the same specialty?

very little / a little / some / quite a bit / very much

How often does this situation occur ?
never / rarely / sometimes / often / always
 42

Part III.

Maslach Burnout Inventory

How often: 0 1 2 3 4 5 6

Never A few times Once a month A few times Once a A few times Every

a year or less or less a month week a week day

0 1 2 3 4 5 6

1. I feel emotionally drained from

my work.

2. I feel used up at the end of

the workday.

3. I feel fatigued when I get up in

the morning and have to face
another day on the job.

4. I can easily understand how my

recipient feel about things.

5. I feel I treat some recipients

as if they were impersonal

objects.

6. Working with people all day is

a strain for me.

 43

7. I deal very effectively with the

problems of my recipients.

8. I feel burned out from my work.

9. I feel I am positively influencing

other people’s lives through my
work.

10. I have become more callous

towards people since I took this
job.

11. I worry that this job is

toughening me emotionally.

12. I feel very energetic.

13. I feel frustrated by my job.

14. I feel I am working too hard

on my job.

15. I do not care what happens

to some recipients.

16. Working with people directly

puts too much stress on me.

17. I can easily create a relaxed

atmosphere with my recipients.

18. I feel exhausted after

working closely with my
 44

recipients.

19. I have accomplished many

worthwhile things in this job.

20. I feel like I am at the end of

my rope.

21. In my work, I deal with

emotional problems very
calmly.

22. I feel recipients blame me for

some of their problems
 45

Part IV.

Brief Cope Inventory.

These items deal with ways you have been COPING with the
stress in your life. These items will ask you what you have been
doing to cope with stressful situations. Think about what you do
when you are under a lot of stress. Each item explains a different
way of coping.

1 2 3 4 5
never rarely sometimes often always

1 2 3 4 5

1. I have been turning to work or other activities to

take my mind off things.

2. I have been concentrating my efforts on doing

something about my situation I’m in.

3. I have been saying to myself“this isn’t real”.

4. I have been using alcohol or other drugs to make

myself feel better.

5. I have been getting emotional support from

others.

6. I have been giving up trying to deal with it.

 46

7. I have been taking action to try to make the

situation better.
8. I have been refusing to believe that anything has
happened.

9. I have been saying things to let my unpleasant

feelings escape.

10. I have been getting help and advice from

other people.

11. I have been using alcohol or other drugs to

help me get through it.

12. I have been trying to see things in a different

way, to make things seem more positive.

13. I have been criticizing myself.

14. I have been trying to come up with a strategy

about what to do.

15. I have been getting comfort and understand

from someone.

16. I have been giving up the attempt to cope.

17. I have been looking for something good in

what is happening.

18. I have been making jokes about it

19. I have been doing something to think about it

less. such as going to the movies, watching TV ,
reading , daydreaming , sleeping or shopping.

20. I have been accepting the reality of the fact

that it has happened.
 47

21. I have been expressing my negative feelings.

22. I have been trying to find comfort in my

religion or spiritual beliefs.

23. I have been trying to get advice or help from

other people about what to do.

24. I have been learning to live with it.

25. I have been thinking hard about what steps to

take.

26. I have been blaming myself for things that

happened.

27. I have been praying or meditating.

28. I have been making fun of the situation.

 48

CURRICULUM VITAE

PERSONAL PROFILE

NAME : Zarah H. Leong

AGE : 27 years old

SEX : Male

CIVIL STATUS : Single

DATE OF BIRTH : January 1, 1991

PLACE OF BIRTH : Surigao City, Surigao del Norte

PRESENT ADDRESS : Surigao City, Surigao del Norte

OFFICE ADDRESS : Rizal ST. Surigao City

EDUCATIONAL ATTAINMENT

GRADUATE Master of Arts in Nursing- Candidate

Major in Nursing Service Administration

School of Health and Allied Health Science

Southwestern University

Urgello St. Cebu City

2016-2018

COLLEGE Cum Laude

Bachelor of Science in Nursing

Mindanao State University

Marawi City

2007-2011
 49

HIGH SCHOOL First Honorable Mention

Caraga Regional Science High School

Surigao City

2003-2007

ELEMENTARY Valedictorian

Surigao West Central Elementary School

Surigao City

1997-2003