Stress–An Inseparable Entity in Nursing Practice 

Introduction

Nursing practice always deals with life threatening medical conditions that calls for maximum individual attention. Nursing practice is hence, stressful. Recently the term burnout has found a common place in nursing practice (Ricou et.al, 2012). Burnout is a condition, where, a nurse experiences chronic fatigue, exhaustion, tiredness, anger and irritability on account of work stress (Fiabane et.al, 2013). Stress in nursing profession is an often ignored entity and hence, demands serious attention.

Signs and Symptoms of Stress

Stress is most often or always indicated by various signs and symptoms. These signs and symptoms are definitive and indicative. The two distinct terms – ‘signs and symptoms’ are essential to define the gravity of the stress. Stress signs should be treated as presumptive indicators of stress that demand attention. On the other hand, stress symptoms should be treated as definite indicators that demand not only attention but also prompt remedial action. The stress symptoms in nurses can be classified as somatic symptoms and emotional symptoms. The somatic symptoms include disturbance in sleep, frequent muscle cramps, muscle pain, pain in the joints, headaches, fatigue, high blood pressure and gastric disturbances. The emotional symptoms include lack of enthusiasm, irritability, uncontrollable anger, intolerance, tremors or shaking of limbs, abnormal sweating, abnormal emotional outbursts like inconsolable weeping, anxiety, depression, avoiding socializing, lack of sexual drive and tendency to over indulge. A nurse in stress most often has memory problems, is not able to concentrate, make judgments and looks either agitated or depressed. Most of the stress symptoms are due to an increase in activity of the sympathetic nervous system, excessive secretions of stress-related hormones like adrenaline and cortisol and impairment of the immune system that forms the basis of disease resistance. Recent reports point to high levels of occupational stress in nurses. Stress in nurses has been shown to be the major cause of reduced physical and psychological health, reduced job satisfaction, increased sickness absence and reduced job performance (Farquharson et.al, 2013).

Stressors in Nursing Practice

Stressors are factors that trigger a stress. Stressors in nursing practice can be broadly classified as physical stressors, psychological stressors and sociological stressors.

Physical Stressors

Physical stressors are those stressors that cause a stress due to abnormal physical strain. This includes situations that demand severe and abnormal physical exertion. Handling of patients in direct life threatening situations in an emergency department, assisting complicated surgical procedures, monitoring patients in ICU and shifting patients cause substantial physical exertion. The exertion is often complicated by under staffing, poor staff scheduling, consecutive duty hours and poor coordination between various departments leading to stress (McIntosh et.al, 2013). A correlation has been elucidated between workplace strain and multi-site musculoskeletal pain among healthcare workers (Sembajwe et.al, 2013).

Psychological Stressors

Psychological stressors can have severe negative impact on a nurse’s professional life. Psychological stress at work has been found to be high in nurses caring for seriously ill and terminally ill patients (Udo et.al, 2013). Palliative care nurses have been shown to be at a higher risk of psychological stress because of exposure to frequent deaths and family grieving (Peters et.al, 2012). A recent study has reported that about thirty eight percent of the nurse population in South Korea experience depressive symptoms (Yoon et.al, 2013) due to job related stress. The psychological work stress in nurses is often compounded by nurse’s personal psychological problems like deprived emotional care, poverty, quarrelsome spouse, failed love, and failed marriage, grief due to unforeseen diseases or accidents and loneliness.

Sociological Stressors

The average health care worker of the present day no longer has the same lifetime job security that he had twenty years ago and the present-day nurses have to move between jobs, and have to be involved in more tasks and commitments over the course of their careers than caregivers of the past. Sociological stressors start right from getting into a job and clinching a job that pays well (Yoon et.al, 2013). Fulfilling the job mandate, satisfying the superiors, sticking to the job on a long term basis, going quick over the ladder of promotion, attainment of position, family, status and assets are the major sociological stressors (Seleghim et.al, 2012).

Stress Assessment

A nurse can assess by self-assessment or by clinical assessment if she/ he has stress signs and symptoms. Various methods like Holmes and Rahe Stress Scale, Maslach Burnout Inventory (Maslach et.al, 2001); observations on changes in blood pressure and galvanic skin response are useful tools in this process of stress assessment. There are also scales like Kessler Psychological Distress Scale and Depression Anxiety Stress Scale that are useful in stress assessment. Stress assessment is often based on the negative emotions and frustrations that arise from a nurse in a work setting. These include lack of job clarity; difference of opinion with the superiors; departments and tasks being unrelated; lack of trust on the management; frequent break up of tasks to a start a new one killing the work rhythm; inter departmental conflict; negative feedback and tasks that affect the self esteem (Peters et.al, 2012).

Stress considerably alters the normal blood pressure and changes in blood pressure can be utilized to assess stress. Galvanic skin response is a stress assessment technique based on the principle of electrical conductance of the human skin. The electrical conductance is always proportional to skin moisture levels controlled by sweat glands. Since the sweat glands are controlled in turn by the nervous system, the variation in skin conduction as influenced by the sweat is used to study the emotional or neuro-psychological variations caused by stress (Oshumi et.al, 2010). Salivary enzymes like alpha amylase (Urs et.al, 2005) and cortisol (Nicolson and Nancy, 2008) have been identified as potential stress indicators. Analysis of these enzymes has been employed extensively in the clinical assessment of acute stress sometimes clinically referred to as Acute Stress Syndrome (Mealer et.al, 2012). Medical assessment of muscular tension, body temperature, heart beat and breathing patterns are also employed to assess stress.

Conclusion

Stress in nursing profession is an often ignored entity and hence, demands serious attention. Nurse’s professional burnout has serious consequences on account of the errors that can occur in a medical emergency. The fatigue a nurse goes through during a shift trying to finish a multitude of tasks is a reality and demands serious attention. In spite of the fact that there are federal regulations and institutional recommendations in place on nurse employment and staffing, ‘nurse’s job stress’ is still a poorly addressed problem. Although studies have shown that it is possible to reduce nurses' work-related stress through educational interventions and stress management strategies (Udo et.al, 2013), it is imperative to honestly assess and address the key factors that cause distress to caregivers in healthcare settings.

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