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A Thesis Proposal Presented to the Faculty in Partial Fulfillment of the

Requirements for the Degree in Masters of Arts in Nursing



Niña Fatima Y. Berecio, RN

March 2019


Background of the Study

Nursing is generally perceived as challenging profession. Along with

the increased demand and progress in the nursing profession, stress among the

nurses has also increased. When the person is subjected to a stressor, a

characteristic syndrome of physical reactions will occur. The stress response

can be physical, psychological, emotional or spiritual in nature and is usually

a combination of these dimensions. Stress, similarly, can arise from one or

more dimensions and can be either internal or external. A moderate level of

stress or “Eustress” is an important motivating factor and is considered normal

and necessary. If stress is intense, continuous, and repeated, it becomes a

negative phenomenon or “Distress,” which can lead to physical illness and

psychological disorders. It is usually observed that nursing profession

undergoes tremendous stress which affect on work performances of nurses

and ultimately affects the patient care delivered. Chronic stress takes a toll

when there are additional stress factors like home stress, conflict at work,

inadequate staffing, poor teamwork, inadequate training, and poor

supervision. ¹
Workplace stress is not limited to a particular profession or country.

Health care professionals are highly vulnerable to burnout as they experience

high levels of emotional strain, given the stressful working environments

exacerbated by the need to manage and care for sick and dying patients. ₂

Nurses are exposed to a range of psychosocial stressors such as a lack of

control, long work hours, shift work, interpersonal conflicts, insufficient

resources and poor reward systems ₃, in addition to inadequate systems for

communication flow and workplace aggression ⁴. Their psychosocial working

conditions have effects on their health in general ⁵. Additionally, the emotional

demands of nurses’ jobs and their work with patients who are in constant need

of attention contribute to creating stressful environments ⁶.

Nursing studies have determined that excessive exposure to

psychosocial stressors produces considerable job stress, resulting in various

problematic short- and long term outcomes. In the past decade, nurses have

consistently reported the highest levels of job stress of all healthcare

professionals ⁷. Nurses have been found to experience higher levels of stress-

related burnout than other health care professionals ⁸.

Nurse in Schistosomiasis Hospital, a total of 8 hours per shift, fixed 8

days off in a month and P700 a day. These figures sum up the reality and in

addition, most of the nurses are in job order positions. Like most nurses, they

do not have the privilege of a fixed schedule. The shifts are assigned each

month and vary every week – often at random. While the law sets the

minimum pay for entry-level nurses at government hospitals at P15,000 a

month (Salary Grade 11), this also means that it does not get benefits that

regular employees enjoy.

Nursing became extremely popular in the Philippines over a decade

ago, as many countries abroad started hiring Filipino nurses. Schools offering

nursing programs also increased rapidly.

On 2011, the Philippines was producing more qualified nurses than the

domestic and global economies could absorb, leading to massive

unemployment in the sector. This forced many nursing graduates to work in

hospitals for free – with some even having to pay their way in.

In this study, they would to know more about factors affecting

workplace stress among nurses in Schistosomiasis Hospital and how nurses

respond to the different stressors they encounter.

Statement of the Problem

The study aims to determine the prevalence of occupational stress in a

population of nurse and explore factors that may cause or be associated with

workplace stress. Specifically, it seeks to answer the following questions:

1. What are the profile of the nurses in terms of:

1.1 age

1.2 gender

1.3 marital status

1.4 job occupancy

2. What are the different stressors encountered by the nurses?

3. What are the perceived extent of workplace stress affecting the nurses?

4. What coping mechanisms are utilized by the nurses in dealing with their

perceived level of stress?

5. What stress management training modules are developed based on the

findings of the study?

Null Hypothesis

The study will lead this null hypothesis.

There are no significant findings between the perceived extent of workplace

stress and perceived extent of effectiveness of coping mechanism utilized by

the study.

Theoretical Framework

The General Adaptation Syndrome

Hans Selye in 1956 described the stress response theory as an entire

stress process, which occurred at the system level, and focused on the threat

as well as the individual’s reaction to this stress encompassing the external

demands or forces placed upon the person by their environment, and was

called the General Adaptation Syndrome (GAS), (Selye, 1956). Stress was

simply viewed as the physiological reaction of the body to any demand;

regardless of the nature of the stressor, and it was therefore interpreted as a

natural response or defense mechanism and a consequence of normal living

providing a protective response by individuals (Cox, 1978; Murray, 10

Zentner, & Yakimo, 2009). A criticism of this model or syndrome is that it

predominantly focuses on the physiological aspects of stress rather than taking

into account the psychological processes such as emotions or feelings (Cox,


Person-Environment Fit Theory

This theoretical model has been in existence since 1935 (Dewe,

O'Driscoll, & Cooper, 2012; Lewin, 1935). In terms of this theory, stress is

not defined by the person or the environment rather it assumes that stress will

occur when there is a mismatch between them both. According to this theory,

when there is a mismatch between what the person wants and what they

receive, in conjunction with a mismatch with their actual abilities, then stress

occurs. A criticism of this model is that it does not take into consideration the

subjective views held by the individual, such as their perception of their

environment, their wants, emotions, and personal abilities. Furthermore, it is

a very static model failing to take into account any ongoing contributing issues

between the person and their environment (Dewe et al., 2012), and as such is

not relevant to this study. In contrast the Job Demands-Control Model is one

of the leading job stress models and focuses on the work environment and the

impact this has on the individual’s level of stress and overall health (3).
Job Demands-Control Model

The Job Demands-Control Model was first developed by Karasek in

1979 (Karasek, 1979), and later expanded on by Karasek and Theorell in 1990

(Karasek & Theorell, 1990). The model focuses on the workplace and looks

at how demanding a person’s job can be, and how much control they have

over these demands. Jobs that are high on demands and low on control have

the highest risk of illness and reduced wellness, in comparison with jobs,

which have a low demand and a high level of control (Ha ü sser, Mojzisch,

Niesel, & Schulz-Hardt, 2010). A criticism of this model is its uncertainty

over any emerging effects from these demands, or if they are singular rather

than merging together or if they impact on each other. Furthermore, the model

does not take into account any impact peer support may have, acting as a

buffer to the stressor (Dewe et al., 2012). Although Cox and Mackay (1976)

Transactional Model of Stress does not specifically mention peer support,

rather the model places emphasis on the individual’s perceptions of their work

environment which includes support from others, their perception of control

and personal ability to cope with the demands, otherwise known as stressors

that are placed upon them.

Conceptual Framework
Significance of the Study

This study will benefit the following:

1.Nurses. They will able to express their feelings and concerns regarding

work-related stress.

2.Patients. Will benefit in terms of quality care.

3.Organization. This study may serve as an eye opener to the entire


Scope and Delimitation of the Study

This study focuses only to the workplace stressors and coping

mechanism utilized by the public hospital in Leyte.

Definitions of Terms



This chapter includes the ideas, finished thesis, generalization or

conclusions and others. Those that were included in this chapter helps in

familiarizing information that are relevant and similar in the present study.

Related Literature
Related Studies

Occupational stress among staff nurses: Controlling the risk to health (1).

Conclusion: The main nurses’ occupational stressors were poor doctor's

attitude, posting in busy departments (emergency/ICU), inadequate pay, too

much work, and so on. Thus, hospital managers should initiate strategies to

reduce the amount of occupational stress and should provide more support to

the nurses to deal with the stress.

Occupational Stress and its Management among Nurses at St. Dominic

Hospital, Akwatia, Ghana(2)

Results: The study found out that the major causes of stress identified by the

nurses were inadequate motivation (98.6%), inadequate staffing levels

(91.8%), handling a large number of patients alone (83.6%), lack of break

during shift (82.2%) and nursing difficult patients (71.3%). The major

occupational stress management strategies used sometimes were going on

break (60%), meditation (51.6%), exercises (64.1%) and relaxation (74.3%).

There was significant association between department of work and types of

stress experienced (pvalue< 0.05). There was significant relationship between

age and the type of stress experienced (p-value<0.05) for the physical and

emotional type of stressors. This study also revealed that there were
significant association (pvalue< 0.05) between years of experience, salary and

physical and emotional stressors respectively.

Conclusion: Occupational stress (physical, emotional and psychological) was

statistically significantly associated with the department a nurse is. Nurses’

executives and hospital management should help create an adequate stress-

free work environment for nurses. Nurses should be provided opportunities

for learning a multitude of stress management strategies to improve their


Job related stress among nurses working in Jimma Zone public hospitals,

South West Ethiopia: a cross sectional study(3)

Results: A total of 341 nurses working in Jimma Zone public hospitals were

given the questionnaire, and the response rate was 92.3 % (315). This study

indicated an average overall job related stress level of 58.46 ± 12.62. The

highest level of job related stress was on the sub scale of dealing with death

& dying mean score of 62.94 % followed by uncertainty regarding patient

treatment 57.72 % and workload 57.6 %. While job related stress from sexual

harassment had the lowest mean score of 46.19 %.

Conclusion: Overall job related stress varies across working unit. Working in

a chronic illness follow up clinic, the mutual understanding at work between

nurse & physician and job satisfaction were negatively associated predictors

of job related stress.

Job Stress, Job Performance, and Social Support Among Hospital Nurses(4)

Findings: Perceived social support from coworkers enhanced the level of

reported job performance and decreased the level of reported job stress. The

analysis also indicated a curvilinear (U‐shaped) relationship between job

stress and job performance; nurses who reported moderate levels of job stress

believed that they performed their jobs less well than did those who reported

low or high levels of job stress.

Conclusions: Results indicted the importance of social support from

coworkers, as well as the need for further research to test the U‐shaped

relationship between job stress and job performance.

Leadership, organizational stress, and emotional exhaustion among hospital

nursing staff (5)

Results. In regression analyses, work stressors as a whole were found to

explain 22% of the variance in emotional exhaustion whereas leadership

dimensions explained 9% of the variance in that outcome measure. Stress

emanating from the physical and social environment, role ambiguity, and

active management‐by‐exception leadership were significantly associated

with increased levels of emotional exhaustion. Transformational and

contingent reward leadership did not influence emotional exhaustion.



Research design

As part of the process of planning successful research, the researcher

selected a research design that provides a framework within which to conduct

research which will produce answers to his chosen research questions. The

aim of this study was to determine the prevalence of stress among nurses in

Schistosomiasis Hospital and explore occupational stressors.

In the study, the quantitative survey data was generated to provide an

objective description of stress to which nurses are exposed to. The quantitative

approach provided an insight of the extent of how many nurses were being

exposed to distress, despair and being not contented.

Locale of the study

This study will be conducted at Schistosomiasis Hospital located at

Brgy. Salvacion, Palo, Leyte. This hospital is one of the retained DOH

hospital in Region 8. It is in a level 1 category or a Primary Hospital with 25

bed capacity.

The population in this study are 30 Regular nurses and 64 Job Orders

nurses in different areas worked at Schistosomiasis Hospital excluded to the

number of years they are in the service.

Research instrument

In this study, the sample comprised the whole study population. All

regular and job orders nurses will be the participants. The research instrument

will a form of questionnaire. They were asked to give details of their


Validation of research instrument

Data gathering procedure

This study utilized the cross-sectional survey method to collect

information concerning exposure to stress in hospital setting. In order to

estimate prevalence rates and collect detailed information about sources of

stress, the best study design was a survey. Using a survey is the quickest,

cheapest, and relatively confidential method of collecting big amounts of data

in health and social studies. This design is commonly used to identify

prevalence of occupational stress among nurses and other health care

professionals. The technique that was employed in this study was the self-

administered questionnaire.

Statistical treatment

ANOVA and t-tests were employed to explore the mean differences in

mental distress symptoms and job satisfaction between groups (i.e. females-

males). The clinical significance of the differences between groups and the

total range of score distributions will be calculated.