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Jabatan Kesihatan Masyarakat 2007: Jilid 13 Bil.

ORIGINAL ARTICLE

WORK-RELATED STRESS AND COPING: A SURVEY ON MEDICAL AND SURGICAL


NURSES IN A MALAYSIAN TEACHING HOSPITAL

ZA Emilia1, I Noor Hassim2


1
Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
43400 Serdang, Selangor Darul Ehsan, Malaysia & 2Department of Community Health, Medical Faculty,
Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak 56000 Cheras, Kuala
Lumpur, Malaysia.

ABSTRACT

Background: A cross-sectional study on work-related stressors among nurses in a public teaching


hospital had also attempted to explore functions of coping strategies in determining stress.
Materials and Methods: A structured bilingual questionnaire (English-Malay) on symptoms and
sources of stress, and coping style measure was disseminated to medical and surgical nurses working in a
teaching hospital in Kuala Lumpur. Socio demographic information and stress management methods were
inquired. Frequency in workplace stressors were assessed using Nursing Stress Scale. Stress symptoms
and home-life stressors were evaluated using Personal Stress Inventory. Measurement of coping strategies
was performed using Coping Orientation for Problems Experienced questionnaire.
Results: A total of 181 questionnaires were disseminated and 151 (83.4%) were satisfactorily
completed by nurses. It was found that the prevalence of work-related stress among medical and surgical
nurses was 49.3% (N=74/150). Analysis of dichotomized outcome (between Stress and No stress group)
illustrated high workload (t-value=4.122; p<0.001), concerns about death and dying (t-value=2.784;
p<0.05) and conflict with physicians (t-value=3.821; p<0.05) as the highest stress contributing factors.
Socio demographic factors such as age, marital status, salary per month and tenure of service were not
significantly (p≥0.05) associated with stress. Sources of stress from the home life were found to be
significantly associated with stress experienced (t-value=3.971; p<0.05). Pearson’s correlation analysis
between coping and stress scores demonstrate significant (p<0.05) positive association of avoidance,
acceptance and venting of emotion with higher stress levels. Multiple linear regression analysis on selected
variables demonstrates that high workload (B=1.052; p<0.05), conflicts with physicians (B=1.398;
p<0.05), lack of support (B=0.346; p<0.05) and coping through venting of emotion (B=2.207; p<0.05)
significantly contributes towards determining nurses stress. This model explains 44.8% (adjusted R
square=0.448) in the variation of stress scores.
Discussion: High workload as a stressor has been repeatedly mentioned in literature on work-
related stress among health professionals, as in this study. Findings suggest that sources of work-related
stress do not differ much from other nurses with different specialty. Other significant stressors were
associated with death and dying concerns and conflicts with doctors. Coping by acceptance, venting of
emotion and avoidance contribute significantly to stress and thus could be categorized as maladaptive
instead of working as a buffering factor to reduce work-related stress.
Conclusion: Findings of this study supports the hypothesis that workload is still the major source
of work-related stress among the study population. Besides the usual recommendation for the management
team to put effort to reduce the workload problem faced by nurses, stress management program if any
should emphasize on educating nurses in selecting the most adaptive coping methods could be used at both
personal as well as organizational levels in order to ameliorate the impact of work-related stress on job-
related strain and health.

Key Words: work related stress, nurses, coping strategies, teaching hospital.

Corresponding author: ZA Emilia, Faculty of Medicine


and Health Sciences, Universiti Putra Malaysia, 43400
Serdang, Selangor Darul Ehsan, Malaysia
Tel: 03-89472358
(e-mail: emilia@medic.upm.edu.my)

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physical health to prevent distress, burnout and


psychological maladjustment10. Lazarus and
INTRODUCTION Folkmanhave also identified two distinct coping
strategies; emotion-focused coping which could
Nursing is, by its nature a stressful alleviate emotional distress and problem-focused
profession1. Nurses work in high-stress coping which attempts to manage or alter the
environments since their main responsibility problem causing distress10.
focuses upon providing help to patients who are There have been a few studies that
usually encountering life crisis. Many researches suggest the use of problem-focused coping
have focused on the causes and effects of work- strategies may prevent stress whereas avoidance
related stress among the nursing profession2-6. In or emotion-focused strategies could contribute to
Malaysia, a study done by Rokiah in 1994, stress15, 17, 18. Emotion-focused strategies may be
showed that more than 49.5% of nurses in a maladaptive because they focus on the source of
public hospital in Kuala Lumpur experienced distress and thus exacerbate it, or because they
stress due to workplace factors whereas a study put off dealing with the problem17. However,
among community nurses in Kelantan have many of the stressors involved in nursing are not
depicted the prevalence of work-related stress to amenable to change, thus emotion-focused
be at 38.5% 7, 8. strategies may form an important part of
Stress is the result of conflicting coping19. Hence, the moderating influence of
internal and external pressures that causes strain coping is likely to depend on the amount of
and alter the effectiveness of individuals9. coping, source of stress, individual’s appraisal
According to the Lazarus & Folkman model, and situation in the workplace.
stress is an outcome of a transaction or This current study attempted to explore
relationship between the person and the work-related stress, risk factors involved and the
environment10. This model demonstrates that a mediating effect of coping mechanism on stress
person will experience stress when the of medical and surgical nurses in a teaching
environmental stressors are perceived to be hospital in Malaysia. This study employed a
demanding and have exceeded the personal transactional model of stress and coping in
resources present in order to cope with them. exploring work related stress, factors involved
From a systems perspective, the sources and coping of medical and surgical nurses in
of occupational stress for nurses radiate in which research have been limited. Therefore, it is
concentric circles from the individual to the hoped that this study will not only be able to
extra-organizational, including those at the illuminate the present work-related stress
immediate, work environmental and experienced by the nurses, but could also
organizational levels11. A review of studies contribute towards the design of a suitable
across cultures and nursing specialties indicates intervention program which is tailor made to fit
that common occupational stressors for nurses the nurses population.
include workload, role ambiguity, interpersonal
relationships, and death and dying concerns12-14. MATERIALS AND METHODS
In addition, Hipwell et al. also points out that
most nurses rated high workload and dealing Study design
with death and dying as their major stressful
event15. Review on work-related stress among In December 2005 to February 2006,
nurses will conclude that workload could be the we conducted a cross sectional survey in which
principal predictor of health and well-being data were collected through self-administered
among all the potential sources of stressors structured questionnaires. Subjects were all
related to nursing9. medical and surgical U29 nurses working in a
Sources of stress that have a direct teaching hospital in Kuala Lumpur.
impact on the mental health of an individual will
also elicit coping responses. The differences in Sample size determination
coping methods use could greatly affect the
response to stressors. In times of stress, an Sample size for the prevalence of work-
individual normally engages in certain coping related stress was estimated using guidelines by
strategies to handle stressful situations and their Lwanga and Tye for a 95% confidence interval
associated emotions15. Coping is a process of (CI) and prevalence of 49.5% and 38.5% for
moderating the effects of stress on mental and work-related stress by Rokiah and Majdah

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respectively7, 8, 20. With the absolute precision of English version was translated into Malay using
11% and assuming a 10% non-response rate, the the back-to-back translation method7,21.
sample size was calculated to be 174 subjects
from a minimum of 154 subjects. Socio Demographic Factors
Demographic information obtained
Methods included age, education level, marital status,
salary per month and number of years in nursing
Permission to carry out the study was experience.
obtained from the Medical and Ethics Research
Committee of Universiti Kebangsaan Malaysia. Personal Stress Inventory
Questionnaires were sent out by hand to 181 U29
nurses according to their respective medical and There are two separate parts to Personal
surgical wards in the participating hospital. A Stress Inventory or PSI where the first part of the
consent form was included in the questionnaire inventory was used to measure psychological
booklet and it was stressed that participation was and physiological symptoms of stress, and the
on voluntary basis and confidentiality of second part inquired about personal and family
information was assured. To maximize the factors that could affect stress22.
response rate, a reminder notice was sent to non- The first part of PSI consisted of 11
respondents three weeks after the initial handing psychological and physiological subscales which
out of questionnaires and if not successful, then add up to 52 items (musculoskeletal system- four
direct personal contacts were made. items, gastrointestinal system- six items, other
physical system- six items, depression- six items,
Subjects anxiety- ten items, energy level- three items,
diet- five items, activities- three items,
Subjects were identified from the relationship- three items and sleep- three items).
nurses’ registry obtained from the Nurses Measurement for symptoms occurrence during
Management Department. From the registry, a the previous 1 month was based on a four-point
total of 181 names were selected after excluding Likert scale (with ‘3’ and ‘0’ bringing the
those who were on maternity leave, those who highest and lowest weightage respectively) and
were unavailable due to attendance at courses, raw scores were calculated by summing the item
and those who were on no pay leave or have scores which comprise each subscale. The scores
transferred during the study period. obtained were later dichotomized to Stress (score
Subjects eligible for the study were of 36 ≥) and No stress (score of < 36) group7.
further selected using the inclusion and exclusion Receiver operator characteristic (ROC) curve
criteria. Those who were working as U29 nurses analysis was used to determine the cutoff point
regardless of being local or otherwise, with a that, as Rokiah correctly point out, minimizes the
tenure of 3 months or more were chosen as the total number of false-positives and false-
inclusion criteria, whereas nurses with chronic negatives. This study estimated the reliability of
medical condition which were known to affect PSI by the alpha Cronbach value of 0.937.
the emotional state of an individual and their The second part of PSI consisted of 12
stress level such as cardiovascular disease, items and method of scoring was similar to the
diabetes mellitus, hypertension and first part of PSI (i.e. 4-point Likert scale). A
hyperthyroidism were not included in the study. study done earlier on a nursing population in a
different state21 demonstrated the mean
Research instrument reliability denoted by alpha Cronbach was 0.96.

The self-administered questionnaire have been Nursing Stress Scale


contrived to consist questions on socio
demographic backgrounds, measurement of The Nursing Stress Scale (NSS) was used to
stress levels, instrument to determine both work- measure frequency of work-related stressors22.
related (i.e. Nursing Stress Scale) and personal The scale consisted of 34 items comprising
stressors (i.e. Personal Stress Inventory) and to seven subscales: Death and dying (seven items),
assess coping style (i.e. Coping Orientation for conflict with physicians (five items), inadequate
Problems Experienced). In order to reduce preparation to deal with the emotional needs of
misinterpretations, the questionnaire was made patients and their families (three items), lack of
bilingual, using Malay and English. The original support (three items), conflict with other nurses

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and supervisors (five items), workload (six 87 (58.0%) respondents who were married and
items) and uncertainty concerning treatment (five 63 (42.0%) were single.
items). The NSS is scored on a 4-point scale The majority of the respondents (n=90;
from never (0) to very frequently (3) and yields 60.0%) have an income of RM1000 to RM1500
seven subscale scores. Raw scores were and 83.3 % had been working as a nurse for less
calculated by summing the item scores which than 5 years (n=125). Occupancy in a unit of less
comprise each subscale and relative scores were than 2 years (n=93; 62.0%) scored the highest
calculated by dividing each raw subscale score mean in all the 13 wards. Socio demographic
by the number of items comprising that characteristic among nurses in medical and
particular subscale. A high score would be surgical wards were shown on Table 1.
anticipated in an individual who finds a stressor
frequently problematic. Mean reliability across
the subscales, estimated by alpha Cronbach was
0.89.

Coping Orientation for Problems Experienced


(COPE)

The subscales in COPE were used to measure


general coping strategies used by in order to
handle stress17. We have translated the scale into
Malay using a back-to-back translation method.
The instrument has 60 items designed to measure
15 dimensions of coping strategies: positive
appraisal, mental disengagements, venting of
emotion, instrumental support, active, denial,
religion, humor, behavioral disengagement, self
restrain, emotional support, substance abuse,
acceptance, suppression of other activities and
planning. The nurse then indicates on a Likert
scale how often a specific coping strategy was
used generally in a stressed situation, from
"Never" (scored as 0) to "Almost every time"
(scored as 4). In this study, reliability was
estimated at 0.91 (Cronbach alpha).

RESULTS
Descriptive statistics, Pearson
correlations and multiple linear regression
analyses were carried out using the Statistical
Package for the Social Sciences (SPSS) version
12.02.
This study was conducted among nurses
in 13 medical and surgical wards in a teaching
hospital in Kuala Lumpur. Out of the181 nurses
who were eligible for the study, 151 were
involved in the study, giving a response rate of
83.4%. Most of the respondents were of Malay
ethnicity (n=140; 93.4%) and 3.3% (n=5) of the
respondents have other nationality besides
Malaysian (i.e. Myanmar).
All of the 13 medical and surgical
wards have a majority of nurses between the age
of 26 to 30 years old (n=81; 55.4%). There were

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Table 1: Socio demographic characteristics of medical and surgical nurses

Frequency (%)
Variables
Medical and
Medical Surgical
Surgical
(N=67) (N=83)
(N=150)
Age (years)
≤ 26 26 (48.1) 28 (51.9) 54 (36.0)
26 – 30 36 (44.4) 45 (55.6) 81 (54.0)
31 ≥ 5 (33.3) 10 (66.7) 15 (10.0)

Ethnic
Malay 64 (45.7) 76 (54.3) 140 (93.4)
Indian 2 (40.0) 3 (60.0) 5 (3.3)
Others 1 (25.0) 4 (75.0) 5 (3.3)

Marital status
Single 31 (49.2) 32 (50.8) 63 (42.0)
Married 36 (41.4) 51 (58.6) 87 (58.0)

Salary (RM)
≤ 1000 3 (75.0) 1 (25.0) 4 (2.7)
1001 – 1500 43 (60.0) 47 (40.0) 90 (60.0)
1501 – 2000 13 (40.1) 19 (59.9) 32 (21.3)
≥ 2001 3 (42.9) 4 (57.1) 7 (4.7)

Tenure (years)
≤5 53 (42.4) 72 (57.6) 125 (83.3)
6 – 10 9 (60.0) 6 (40.0) 15 (10.0)
11 ≥ 4 (44.4) 5 (65.6) 9 (6.0)

Tenure in unit (years)


≤2 44 (47.3) 49 (52.7) 93 (62.0)
3-4 10 (40.0) 15 (60.0) 25 (16.7)
5-6 10 (41.7) 14 (58.3) 24 (16.0)
7≥ 2 (40.0) 3 (60.0) 5 (3.3)

The overall prevalence of stress was 49.3% between both category of nurses was also proven
(n=74), with higher stress prevalence occurring to be significant as shown from the Pearson’s
among medical ward nurses compared to the chi-square analysis (χ2=5.20; p<0.05) (Table 2).
surgical ward nurses. The differing prevalence

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Table 2: Distribution of stress prevalence among nurses

Frequency (%) Statistical Difference


Ward Total test value
Stress No stress p valuea

Medical 40 (59.7) 27 (40.3) 67 5.20* <0.05

Surgical 34 (40.9) 49 (59.1) 83

Total 74 (49.3) 76 (50.7) 150

a
Pearson’s χ2 statistical test
* Significant when p<0.05; NS: Not Significant, p≥0.0

The Pearson’s chi-square analysis between difference for age, salary per month and tenure in
categorical socio demographic variables (i.e. service between dichotomized Stress and No
marital status) and stress did not show any stress group. The details could be observed in
significant association (p≥0.05). Independent t- Table 3a and Table 3b.
tests were used to compare the mean numerical

Table 3a: Relationship between socio demographic factors and


work-related stress

Mean±SD
Socio demographic Statistical Difference
factors Stress No Stress test value
(N=76) (N=74) p valuea
Age 26.6±4.1 28.0±6.1 1.662 NS

Salary (RM) 1442.0±287.0 1543.0±390.0 1.715 NS

Tenure (years) 3.9±4.0 5.2±6.4 1.484 NS

Tenure in unit (years) 2.6±1.7 2.8±1.8 0.747 NS

a
Student’s statistical t-test
* Significant when p<0.05; NS: Not Significant, p≥0.05
SD: standard deviation

Table 3b: Relationship between marital status and work-related stress

Frequency (%) Difference


Variable Stress No Stress Statistical p valuea
(N=76) (N=74) test value

Marital status 0.404 NS


Single 33 (52.4) 30 (47.6)
Married 41 (47.2) 46 (52.8)

a
Pearson’s χ2 statistical test
* Significant when p<0.05; NS: Not Significant, p≥0.05

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Work-related factors, especially high work load, physicians. The distribution in mean scores for
were the most frequent stressor experienced by other factors which was not mentioned is
nurses in the Stress category, as shown by the included in Table 4. Differences in mean scores
average score obtained (mean±standard between both the Stress and No stress group
deviation). Concerns about death and dying were warrants a t-test analysis and it was shown that
the second most frequent stressor faced by the all of the seven work-related factors were
nurses and this was followed by conflicts with associated with stress (p<0.05).

Table 4: Work-related stressors and its relationship to stress

Mean±SD
Difference
Variables Statistical test
Stress No Stress value p value

Work load 9.51±3.08 7.64±2.42 4.122* <0.05


(S=74; NS=75)

Death and dying concerns 7.58±3.12 6.00±3.72 2.784* <0.05


(S=73; NS =75)

Inadequate preparation 3.03±1.56 2.42±1.80 2.196* <0.05


(S=74; NS =76)

Lack of support 3.22±1.97 2.04±1.80 3.797* <0.05


(S=74; NS =75)

Unsure of treatment 5.68±2.10 4.81±2.33 2.383* <0.05


(S=73; NS =74)

Conflicts with physicians 5.82±2.82 4.18±2.40 3.821* <0.05


(S=74; NS =74)

Conflicts with friends 4.29±3.01 3.28±2.55 2.199* <0.05


(S=73; NS =75)
.

a
Student’s statistical t-test
* Significant when p<0.05; SD: standard deviation
(S=Number of stress respondents; NS=Number of no stress respondents)

Analysis on the frequency of personal and family have the highest correlation with stress score
factors contributing to stress, it was found that (r=0.498; p<0.05). This was followed with
the mean score for nurses in the stress group mental disengagement (r=0.351; p<0.05) and
(9.36±5.85) was significantly (t-value=3.971; denial (r=0.252; p<0.05). The coping strategies
p<0.05) higher when compared to nurses who of positive reappraisal and religion showed a
were not stressed (5.96±4.54). negative correlation (r=-0.029; p≥0.05 and r=-
Table 5 presents the correlations 0.127; p≥0.05 respectively) however, correlation
between coping and stress scores of the sample was not statistically significant.
population. Venting of emotion was found to

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Table 5: Coping strategies and its relationship to stress

Pearson’s
Coping strategies p value
Correlation, r a

Problem solving
Active 0.033 NS
Planning 0.039 NS
Suppression of other activities 0.209* NS

Support seeking
Instrumental support 0.173 NS
Emotional support 0.203 NS
Venting of emotion 0.498* NS

Avoidance
Denial 0.252* <0.05
Mental disengagement 0.351* <0.05
Behavioral disengagement 0.196* <0.05

Acceptance
Acceptance 0.251* <0.05
Positive reappraisal -0.029 NS
Self-restrain 0.186 NS

Substance abuse 0.097 NS

Religion -0.127 NS

Humor 0.196 NS

a
Correlation between stress and coping scores
* Significant when p<0.05; NS: Not Significant, p≥0.05

With all the significant (p<0.05) and important square value of 0.448. The model obtained was
work factors, non-work factors and coping significant (F=11.223, p<0.05) with R value of
strategies that were potential predictors to work- 0.701. Work load (B=1.052; p<0.05), lack of
related stress included, the preliminary main support from nurses and supervisors (B=0.346,
effect model was obtained. All the independent p<0.05) conflicts with physicians (B=1.398,
variables were fitted into multiple linear p<0.05) and venting of emotion (B=2.207,
regressions and the final main effect model was p<0.05) as a coping strategy was found to
obtained using the backward method. This model contribute to stress scores significantly. Table 6
explained 44.8% of the variance of work-related shows the details of the variables tested in the
stress among medical and surgical nurses in a multiple linear regression.
teaching hospital as shown by the adjusted R

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Table 6: Predictor of work-related stress among medical and surgical nurses

Standard
Independent variables Ba p value
errors

Venting of emotion 2.207* 0.843 <0.05


Conflicts with physicians 1.398* 0.542 <0.05
Work load 1.052* 0.527 <0.05
Lack of support 0.346* 0.771 <0.05
Mental disengagement 0.900 0.717 NS
Denial 1.285 0.706 NS
Behavioral disengagement 1.338 0.894 NS
Suppression of activities -1.000 0.702 NS
Acceptance 0.896 0.710 NS
Non-work related stressor 1.863 0.258 NS

Constant -8.768

a
Multiple Linear Regression Analysis
* Significant when p<0.05; NS: Not Significant, p≥0.05
Adjusted R2 = 44.8%

DISCUSSION In this study, workload was found to be


the principal contributor to work-related stress.
Work-related stress is one of the most Review of studies across cultures and nursing
common problems among workforce but specialties regardless whether the study was
unfortunately its presence has always been done locally or otherwise, indicates that the most
disregarded. This study focused on nurses’ stress commonly cited work-related stressors for nurses
and coping strategies as a moderating effect of was workload1, 7-8, 23, 25, 27-29. Workload was also
stress. Objective of the study was to determine associated with inadequacy in the number of
the prevalence of stress among medical and staffs, increase of paper work, inadequate time to
surgical ward nurses in a teaching hospital in complete nursing work, inadequate time to
Kuala Lumpur and other factors involved. provide emotional support to a patient and also
Results showed that the overall prevalence of unpredictable staffing and scheduling23. Nurses
stress among medical and surgical nurses was that have to produce a greater amount of written
49.3% with 59.7% among the medical ward reports on their activities for the purpose of
nurses and 40.9% among the surgical ward ensuring the quality of services often find
nurses. Previous stress study among nurses themselves torn between spending time on direct
showed a prevalence of 49.5% in Rokiah and patient care and increased administrative duties23,
38.5% in Majdah7, 8. Another study that focused 30
. Narayan et al. and Escot et al. stressed that
on nurses in Hospital Tengku Ampuan Afzan even though work overload, interpersonal
found the stress prevalence to be at 42.5%24. conflict and lack of support are major stressors,
As far as socio demographic they might be compounded by inadequate
characteristics were concerned, factors such as training, lack of time to deal with psychological
age, salary per month, marital status and tenure components of care giving in terminal care, and
in service among the respondents in this study relationship difficulties with other medical
did not suggest any relationship with stress. This staff31, 32.
could be explained by the fact that the population Other nursing stressors such as death
of nurses has a homogenous socio demographic and dying concerns, conflicts with physicians
characteristic and the effects of socio and uncertainty regarding treatment in this study
demographic characteristics were neutralized. was also found to be significantly associated

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with stress. It was found that among oncology organisational strategies because work-related
nurses in the pediatric department, death and stress experiences cannot always be coped with
dying concerns were the most common stressor in an efficient way if only the individual coping
faced by the nurses33. In the present study, level is taken into account37. Another explanation
conflicts with friends, lack of support and for the correlation between coping mechanism
inadequate preparation are among factors that and stress was that increased use of coping
have a significant relationship with stress even mechanisms was thought to be brought on when
though the mean scores obtained were individuals become aware of its presently
comparatively smaller than other factors. stressed situation.
Reviews from other nursing studies found that Limitations encountered in this study
occupational stressors are idiosyncratic to includes the design of the study itself, where it is
different nursing specialties and further a cross-sectional study, hence the ability to
investigation is required in order to fully determine the adaptive or maladaptive effect of
understand these differences. coping on stress could not be done. So it is
Factors external to the work imperative that a longitudinal study design is
environment, such as personal and family life pursued. Nevertheless, this study did give a
was found to influence stress. For nurses, the picture of work-related stressors faced and the
interaction between demands of work and those coping strategies used among nurses medical and
of family life often exacerbate work-related surgical nurses in a teaching hospital in Kuala
levels of stress. In this study, we found that there Lumpur. This information could be used to assist
were significant relationship between family in stress interventions and management process.
factors and stress. This correlates with a study Improved coping is important for
across six different occupations including prevention and cure at multiple levels. At the
nursing, where it was found that the most personal level, individual therapy that may
significant sources of work-related stress that include identification of stressors and coping
contribute to overall work stress were conflicting skills can reduce work stress, as suggested by
demands between work and family, and Weinberg and Creed6. Facilitating the use of
performance pressures34. Dual responsibilities problem-solving skills and support networks via
are likely to add a significant load on nurses’ nurse support groups could be implemented. At
physical and mental health, and the load itself the organizational level, it is recommended that
might be an additional source of work-related attention be paid to a better nurse–patient ratio to
stress35, 36. Although stressors in the domain of reduce workload and the promotion of team
work and home life are often studied in isolation, working38.
it is important to acknowledge that the
relationship between the demands of work and CONCLUSION
home is an important source of occupational
stress. Findings showed work-related stressors
Across other studies, coping strategies such as workload, concerns about death and
commonly used by nurses are problem solving, dying and conflict with physicians appears to
avoidance and social support18, 36. It was found create a substantial amount of stress. Sources of
that in this study, avoidance, acceptance, stress from the home life were found to be
suppression of other activities, venting of contributed by financial problems, inadequate
emotion, denial, mental and behavioral time for family, conflict with husband and
disengagement as coping methods were conflict with friends. Socio demographic factors
associated with stress. Surprisingly, venting of were not associated with stress. Coping
emotion which was identified to be in the origin mechanisms which have significant association
of social support scale, did not concur the buffer with stress includes venting of emotion,
theory of positive coping. In fact, findings did avoidance, acceptance, denial, mental
not demonstrate the moderating effects of coping disengagement, behavioral disengagement and
on stress score but shows that coping strategies suppression of other activities. Work load,
could be maladaptive. According to Parikh et al, conflicts with physicians, lack of support and
the moderating influence of coping is likely to coping through venting of emotion explains
depend on the type of mechanism that is used.18. 44.8% of variation in stress score distribution.
Hence, it seems that in the occupational domain, Findings of this study supports the hypothesis
individual coping responses may not be highly that work factors contributes significantly to
useful when compared to group and stress. Little evidence for buffering effects of

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coping mechanism was found but the use of sample. J Health Soc Behav 1980;
negative coping such as avoidance, acceptance 21(3): 219-239.
and emotion venting will contribute to stress. 11. Baguma, P. Stress and coping among
Significant correlation between positive coping Ugandan nurses. J Psychol Afr 2001;
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