CHAPTER 1

PROBLEM AND IT’S SCOPE

Introduction
Developing future nurse leaders is one of the greatest challenges faced by the nursing
profession (Mahoney, 2001). Powerful leadership skills are needed by all nurses those providing
direct care to those in top management positions. Anyone who is looked to as an authority (e.g.,
a nurse taking care of a patient) or who is responsible for giving assistance to others is considered
a leader(Mahoney, 2001).

A clinical nursing leader is one who is involved in direct patient care and who continuously
improves care by influencing others (Cook, 2001). Leadership is not merely a series of skills or
tasks; rather, it is an attitude that informs behaviour (Cook, 2001). In addition, good leadership
is consistent superior performance with long term benefit to all involved. Leaders are not merely
those who control others, but they act as visionaries who help employees to plan, lead, control,
and organize their activities (Jooste, 2004).

Stress is a well-known and identified problem within the nursing profession. Stress occurs
when one is faced with events or encounters that they perceive as an endangerment to their
physical or psychological well-being. Additionally stress levels will increase when controllability
and predictability in a situation decrease. (McGowan, 2001)

Stress is intrinsic to nursing and a highly demanding job with poor support, rapidly
changing circumstances, shortage of resources and staff, and dealing with death and dying all
contribute (Chang et al., 2005). Nursing is emotionally demanding and this interactive stress
contributes to the daily stress of nurses (Mann and Cowburn, 2005). Environmental factors
compound these intrinsic factors and these include difficult patients and their families,
relationships with physicians and low institutional commitment to nursing (Chang et al., 2005).
 Stress has been identified as a 20th century disease and has been viewed as a complex
and dynamic transaction between individuals and their environments (Kelly & Evans, 2004).
Stressors can be broadly defined as situations or events that have the potential to affect health
outcomes. Stress can be regarded as a psychological threat, in which the individual perceives a
situation as a potential threat (Day & Livingstone 2004).

The cause of stress for nurses has found to be related to the nature of the profession.
Included in these stressors are an intense work environment with extended work hours,
weekends, night and holidays. According to Ruggiero (2003) stress could be related to variables
of shift work, which is both physically and mentally taxing.

As the nursing profession continuously emerges, there is always a question on how a

healthcare provider renders service to humanity. Many things that someone is experiencing can
give rise to what kind of nurse he/she could be. As these nursing supervisors exposed to different
areas in the hospital, they will meet some kinds of stressors that produce discomfort and
irritation conducive to stress that if not given proper attention may affect their professional
practice because stress interferes with learning. It is in this context that the study is focused to
help the supervisors identify some stressors during their duties and to recommend possible
solutions on how to manage this stress most importantly.

We all feel overwhelmed from time to time; that is normal. It is virtually impossible to
eliminate times when events conspire and the body’s stress response is triggered, but there are
ways that we can quickly reverse our body’s reaction to stress, like buffering the damage to our
health and keeping our thinking clear so we can more deal effectively with what’s going on in the
moment.

It may seem that there is nothing we can do about our stress level. However, we have a
lot more control than we might think. In fact, the simple realization that we are in control of our
life is the foundation of stress management.
 Managing stress is all about taking charge of our thoughts, our emotions, our schedule,
our environment, and our problems. The ultimate goal is a balanced life, with time for work,
relationships, relaxation, and fun – plus the resilience to hold on under pressure and to meet
challenges head on.

There are many ways to manage unhealthy stress in our life. The key to stress reduction
is identifying strategies that work for us. As we begin to understand more about how stress
affects us, we will develop our own ideas to help relieve the tension.

Because each person is unique, some of these stress management strategies will be more
helpful for you than others, and some will be new skills that require practice to be effective. Think
about learning to ride a bicycle. There was a time when this was a new skill and felt very unnatural
and awkward. You probably needed help at first but with some coaching, practice, and stress
management, cycling or any other skill, becomes easier and more effective.
 Theoretical Framework
This chapter presents the theoretical orientation and review of related literature and
studies by the researchers that are relevant to the present investigation.

Review of Related Literature

Stress is a feeling that is created when we react to particular events. It is the body's way
of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina,
and heightened alertness.

The events that provoke stress are called stressors, and they cover a whole range of
situations everything from outright physical danger to making a class presentation or taking a
semester's worth of your toughest subject.

The human body responds to stressors by activating the nervous system and specific
hormones. The hypothalamus signals the adrenal glands to produce more of the hormones
adrenaline and cortisol and release them into the bloodstream. These hormones speed up heart
rate, breathing rate, blood pressure, and metabolism. Blood vessels open wider to let more blood
flow to large muscle groups, putting our muscles on alert. Pupils dilate to improve vision. The
liver releases some of its stored glucose to increase the body's energy. Moreover, sweat is
produced to cool the body. All of these physical changes prepare a person to react quickly and
effectively to handle the pressure of the moment.

This natural reaction is known as the stress response. Working properly, the body's stress
response enhances a person's ability to perform well under pressure. However, the stress
response can also cause problems when it overreacts or fails to turn off and reset
itselfproperly.(Wikipedia,2008."Stress(biological)"http://en.wikipedia.org/wiki/Stress_(medicin
e)
 Rebecca J. Frey(2009) said that stress in humans results from interactions between
persons and their environment that are perceived as straining or exceeding their adaptive
capacities and threatening their well-being. The element of perception indicates that human
stress responses reflect differences in personality, as well as differences in physical strength or
general health.

Risk factors for stress-related illnesses are a mix of personal, interpersonal, and social
variables. These factors include lack or loss of control over one's physical environment, and lack
or loss of social support networks. People who are dependent on others (e.g., children or the
elderly) or who are socially disadvantaged (because of race, gender, educational level, or similar
factors) are at greater risk of developing stress-related illnesses. Other risk factors include
feelings of helplessness, hopelessness, extreme fear or anger, and cynicism or distrust of others.

Selye explained that stress is non-specific response of the body to pay demand made
upon it under ordinary circumstances, the body’s reaction to specific stimulus anticipates
because of its repetitive pattern. Therefore, a person experiences pain. When the body is warm,
it perspires and when it is used the body shivers. All human exhibits uniform response to stimulus
because of homeostasis. When response is erotic and does not uniform to the usual reaction
expected from the application of the stimulus, the body is said to be in stress.(“The Nature of
Stress” http://www.icnr.com/articles/thenatureofstress.html)

Walter Cannon (2009) in the meantime said that the human body reacts either positively
or negatively to a stress factor producing two kinds of possible reaction. When the human body
tries to flee from stress situation, negative reaction is exhibited. Positive reaction comes about
when the body makes the principle of homeostasis apply the body to overcome stressful situation
which is known as adaptation or coping. He advocated that while the concepts of stress are an
absolute fact, its presence and intensity reception are all relative in accordance with the physical
and psychological make-up of the individual. All people therefore, experience stress but the way
stress is present and is handled by each individual is unique for each other. A little difficulty is
hardly felt by another.

By understanding, we can more easily identify stress factors and their effects on who need
or seek healthcare. Each individual is experiencing stress, in her own particular manner. How the
individual adopt or fails to adopt depend on several factors: personality and conditional make
past experiences dealing with stress.

It is important to remember that stress syndrome can be both positive and negative. Any
change or alteration in the balance of life can create stress. We are all unique individual, we
respond differently to various stressors. Thus, it neither does not matter. Whether, it is positive
or negative light or severe. What matter is how we developed adoptive mechanism to cope with
these stressors and can be translated as the ability to withstand stress and create a life
experiences that do not work against you. The implication of stress theory is by being able to
withstand stress and by coping with it. Diluting it when occurs and eliminating it, you can actually
affect your life. You are not programmed for premature aging. The fact is you control your own
health. The quote of the journal of American Medical Association says, “Nature did not intend to
grow old and ill, we were designed to die young in old age but free of disease”.

Schafer (2000) defined stress as the “arousal of mind and body in response on the demand
made upon them”. The concept of stress is important because it provides a way of understanding
the person as a human being who responds in totality (mind, body and spirit) to a variety of
changes that takes place in daily life.
Review of Related Studies

According to Richard Lazarus and Susan Folkman(1984) stress could be thought of as

resulting from an “imbalance between demands and resources” or as occurring when “pressure
exceeds one's perceived ability to cope”. Stress management was developed and premised on
the idea that stress is not a direct response to a stressor but rather one's resources and ability to
cope mediate the stress response and are amenable to change, thus allowing stress to be
controllable.

In order to develop an effective stress management program it is first necessary to

identify the factors that are central to a person controlling his/her stress, and to identify the
intervention methods which effectively target these factors. Lazarus and Folkman's
interpretation of stress focuses on the transaction between people and their external
environment (known as the Transactional Model). The model conceptualizes stress as a result of
how a stressor is appraised stressor-stress link by proposing that if stressors are perceived as
positive or challenging rather than a threat, and if the stressed person is confident that he/she
possesses adequate rather than deficient coping strategies, stress may not necessarily follow the
presence of a potential stressor. The model proposes that stress can be reduced by helping
stressed people change their perceptions of stressors, providing them with strategies to help
them cope and improving their confidence. Stress is a condition in which the person responds in
the normal balanced state. Most of the concerns and worries are commonly repetitive, ongoing,
extreme and in most cases, out of proportion to the actual situation. Some of these things are
relationships, work, health or family’s health and finances. Because of these worries, the person
experiences very high level of stress on regular basis.
 Conceptual Framework
Research paradigm is shown on Figure 1. This included the input, the process, and the
output. The input contains the profile of the Nursing Supervisors of Negros Oriental Provincial
Hospital, the different stressors they encountered, and the different stress management they
performed to alleviate their stress. In the process, questionnaires were distributed and
observations were conducted to gather pertinent information from the respondents. It also
included the analysis and evaluation of the gathered data and information from the respondents
using statistical treatment such as frequency count, percentage, average mean, weighted means,
and analysis.

The output was consists of the findings about the stress management performed by the
respondents.

Research Paradigm
Input Process Output

 Supervisor’s Profile  Distribution of “STRESS MANAGEMENT

Questionnaire PERFORMED BY THE NURSING
 The different  Observation
stressors encountered SUPERVISORS OF NEGROS
 Analysis and evaluation
by the different ORIENTAL PROVINCIAL
using statistical
nursing supervisors
treatment HOSPITAL: JUSTIFICATION
in NOPH with regards
1. Frequency Count
to their clinical FOR AN EFFECTIVE QUALITY
2. Percentages
duties. NURSING CARE”
3. Average Mean

 The different stress 4. Weighted Mean

management performed Figure 1
by the respondents to
alleviate their
stress

Research paradigm used in this study is illustrated in Figure 1. It shows the steps adopted by the
researchers in order to come up with the output of the study. It best describes the idea of the
procedural design used by the researchers.
 THE PROBLEM
Statement of the Problem
This study was conducted to analyse the “Stress management performed by the Nursing

Supervisors of Negros Oriental Provincial Hospital: Justification for an Effective Quality Nursing

Care”.

Specifically, this study aims to answer the following questions:

1. How may the profile of the Nursing Supervisors of Negros Oriental Provincial Hospital be

described in terms of the following:

1.1 age

1.2 gender

2. What are the distinct stressors encountered by the Nursing Supervisors of Negros Oriental

Provincial Hospital?

3. What are the different stress management performed by the respondents with regards to their

duties?

4. What are the implications of this study to nursing practice in rendering effective quality nursing

care?

Hypotheses

H0: Some nursing supervisors are using effective stress management activities to manage their
stress levels.
Ha: None of the nursing supervisors are using effective stress management activities to manage
their stress levels.
Significance of the Study
The researchers believe in the merits of the study especially to the following:
the researchers, conducting this kind of study brought a learning experience for them. It handed
them the idea when it comes to stress management they performed with regards to their clinical
duties, which was hardly known without survey.

The Nursing Supervisors, who may acquire greater insights of the stressors, problems and
challenges they may encounter all throughout their clinical performances which is part of their
chosen career. This knowledge will give them better and wider perspective about their profession
and aid them in enhancing their coping abilities and self-confidence.

The Head Nurses, the findings may provide them understanding why their supervisors behave
like they do. This study will also provide them hints of what remedial measures they need to
institute to lessen the learning difficulties of their supervisors. Further, it will eventually help
them to build a better relationship with the nurses, promote educational growth, and improve
human and public relations with the identified clinical area of operation.

The hospital administrator, who may help to work out solutions and course of action that will
improve the nurse’s performance. It also gives them the chance to improve the quality of nursing
education for the benefit of the nurses and the institution as well.

The patients, who are the recipients of the healthcare service given by the nurses.

The future researchers, this study can serve as reference material to those students who will
conduct exactly the same or related studies.
Scope and Limitation of the Study
This study was entitled “Stress management performed by the Nursing Supervisors of Negros
Oriental Provincial Hospital: Justification for an Effective Quality Nursing Care”.

The primary focus of this study was directed toward the different stress management that
the nursing supervisors usually utilized and performed to alleviate their stress and to render
effective quality nursing care to their patients.

The data however were limited from those gathered from the nurses from Negros
Oriental Provincial Hospital as respondents of the study with Two years of experience and above.
 RESEARCH METHODOLOGY
Research Design

The researchers took into consideration the present factors and current conditions of a
group of persons, events or a class in finding facts and data to be interpreted. This summary
includes in the descriptive method, which was used to accomplish this study. Descriptive research
is a study in which bodies of data are collected, recorded and analysed. It is used to answer
questions, satisfy curiosity established a cause and effect relationship.

Moreover, descriptive researching is the most popular approach in research. It

systematically, factually and accurately describes an area of interest or situation. Description,
analysis and interpretation of conditions that exist are involved. Researchers may also deal with
comparison and contrast or the discovery of existing relationship between events or groups.

In addition, as this method of research was used in the study it describes systematically
the workflow and management in the wards and stress management performed by the Nursing
Supervisors of Negros Oriental Provincial Hospital with Regards to their Clinical Duties:
Justification for an Effective Quality Nursing Care. The study describes also its symptoms,
management or treatment and situations in which stress may arise in order to obtain a factual
and accurate result of the research in which nurses could avail.

Research Environment

The research study was conducted at the Negros Oriental Provincial Hospital, a Level 1
Government Hospital located at Dumaguete City 6200, Negros Oriental, Philippines. At present
it has an authorized bed capacity of 250 beds, 77% of which are services beds and 23% pay beds
and medicare. It is the referral hospital of patients coming from all the 22 municipalities of the
province with a total population of over 1.3 million. Patients from the province of Siquijor, the
Southern part of Cebu and Northern Mindanao also and it more convenient to come for
appropriate care.
The hospital has 3 major components namely, Medical, Nursing and Administrative
Services. The Medical Service is departmentalized into four major clinical services namely:
Medicine, Surgery, Pediatrics and Obstetrics-Gynecology while the Department of
Anesthesiology is complete in itself. Subspecialty services are the EENT-Ophthalmology,
Neurosurgery (Head Trauma), Orthopedics, Pulmonary Medicine and Nephrology are also
available thru our Medical Pool and visiting consultants.

Research Respondents

The research respondents are the Nurse Supervisors of the Negros Oriental Provincial
Hospital. They are composed of personnel ranked Nurse III to VI and have at least more than 20
years of experience and are well versed in the daily management of the different patient care
areas of the Negros Oriental Provincial Hospital. They have extensive experience handling
difficult situations that arise daily and are considered the managers of the different healthcare
areas. The respondents are composed of all female senior personnel and are all aged more than
50 years old.

Research Instruments

The researchers used the questionnaire as the primary tool in gathering data. This was
made from created materials and statements that could generate the desired result when the
correspondents followed correctly the direction given by the researchers for answering.

The construction of the questionnaire was preceded by intensive perusal and review of
related literature, which provided the researchers insights in forming the questionnaire. The
researchers formulated questions based on their readings from various books, manuals, journal
and experiences as nursing students.
 The questionnaire was first drafted and other members of the post-graduate program
who are knowledgeable on the topic. This is composed of 4 problems. Problem no. 1 involves the
profile of the Nursing Supervisors of Negros Oriental Provincial Hospital. Problem no. 2 involves
the different stressors encountered by the Nursing Supervisors of Negros Oriental Provincial
Hospital. Problem no. 3 is the different stress management performed by the respondents.
While, Problem no. 4 is the implication of the study to nursing practice in rendering effective
quality nursing care. Then the final draft was reproduced for distribution to the respondents.

Statistical Treatment of Data

After the distribution, collection and completion of distributed questionnaires, the

researchers tallied the gathered data and used frequency, percentage, average mean, weighted
mean, and interpretation and ranking
The following statistical computations were accomplished using the following formula:

For the Percentage

Computation of the percentage was made using the expression:
Percentage (%) = F x 100

N
Where:
%- Percentage
F- Frequency or number of response to every item or question
N- Total number of respondents

For the Average Mean

Computation of the average mean was made using the expression:
AM= F x E (DoR)

Where:
AM- Average mean
F- Frequency used
E- Numerical equivalent/ degree of response

For the Weighted Mean

Computation of the weighted mean was made using the expression:
WM=AM

Where:
WM- Weighted mean
AM- Summation of the degree of response multiply frequency (F x E (DoR))
N- Total number of respondents

The researcher used ranking to determine the position of each variable.

NUMBER VALUE E (DoR) INTERPRETATION

4.20-5.00 5 Always

3.40-4.19 4 Often

2.60-3.39 3 Sometimes

1.80-2.59 2 Seldom

1.0-1.79 1 Never

Finally, the findings were summarized and compared with each work; conclusions were drawn,
and recommendations were formulated.

Research Procedure

OPERATIONAL DEFINITION OF TERMS

To convey clearly the meaning of the words used in this study, the researchers defined the terms
used operationally, as follows:

Clinical Wards. A division within a hospital for the care of numerous patients having the different
conditions.

Nursing Administration. encompasses nursing professionals who are knowledgeable of

leadership practices as they relate to the nursing profession.
Coping. This refers to the adaptation to stress events.

Management. This refers to the act or art of managing the whole system of care and treatment
of a sick individual.

Nursing Supervisors. Responsible for managing staff, overseeing patient care and ensuring
adherence to established policies and procedures.

Negros Oriental Provincial Hospital. It is a government hospital that is centrally located in the
province, in the capital city of Dumaguete.

Quality Nursing Care. Degree to which health services for individuals and populations increase
the likelihood of desired health outcomes and are consistent with current professional
knowledge.

Stressors. This pertains to the factors affecting the performances of the nursing supervisors.

Stress Management. A method of limiting stress and its effects by learning ways of behaving and
thinking that reduce it.