Introduction

1. بسم الله الرحمن الرحيمAn-Najah National Universityfaculty of Nursing“Predisposing Factors For Stress Among Nurses Working In Critical Care Units In Nablus Public Hospitals”prepared by:Abdulaziz Masre Ahmed Adnan Isra' Al-sheikhAyat Samarasupervised by :Dr. Adnan Sarhanmiss. Mariam Altellmiss. Fatima Herzalla1st semester 2008-2009

2. Introduction • Stress is a well-known and identified problem within the nursing profession. It is important to understand that the very nature of nursing is stressful, increasing the vulnerability of all nurses to the hazards of occupational stress (Smith et al., 2001). • Identification of job related stressors and strategies that can be employed to manageoccupational stress for the nursing profession have been receiving increased consideration by researchers, nursing organizations, and employers over the last two decades (Cox & Griffiths, 1996).

3. The environment of critical care units has been recognized as stressful since their inception in the 1960’s . • Critical care nurses confront death and dying, end of life decisions, and ethical dilemmas regularly. In addition to providing vigilant care to their patients, critical care unit nurses interact frequently with distraught families. • Conflicting values between nurses, physicians, and coworkers create additional tensions in the units. However, the acute shortages of nurses especially in critical care units has prompted considerable research related to the identification of stressors for this group of nurses.

4. Research has indicated that increased stress can lead to job dissatisfaction, burnout, and precipitate attrition from critical care units, thereby increasing employment costs. Prolonged exposure to stress may lead to a variety of physical and psychological disorders (Smith et al., 2001).. • The aim of study , is to identify the predisposing factors for stress (stressors) among nurses working in critical care units in Nablus public hospitals, and to explore the relationship between predisposing factors of stress (stressors) and presented variables ( age, gender, work experience, and work place).

5. methodology • Aim of the study: 1)- To identify the major predisposing factors for stress ( stressors) among nurses working in critical care units in Nablus public hospitals. 2)- To explore the relationship between predisposing factors of stress (stressors) and presented variables ( age, gender, work experience, and work place).

6. Study design: A descriptive, non experimental study. • Study question: 1)-what is the major predisposing factors for stress (stressors) among nurses working in critical care units in Nablus public hospitals ? 2)-what is the relationship between predisposing factors of stress (stressors) and presented variables ( age, gender, work experience, and work place) ?

7. Problem statement : Is there a relationship between working in critical care units and developing stress among nurses working in this area? • Hypothesis: 1)- There is no significant statistical differences at α=0.05 between predisposing factors of stress among critical care nurses in Nablus public hospitals and age variable. 2)- There is no significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and gender variable.

8. 3)- There is no significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and work experience variable. 4)- There is no significant statistical differences at α =0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and work place variable {ICU, ER, hemodialysis).

9. Setting: public hospitals in Nablus city. • Population: Population of this study involves both male and female nurses who are working in the critical care units in Nablus public hospitals. • Sample: A convenience sample of 50 nurses who are working in critical care units in Nablus public hospitals.

10. Inclusion criteria: • Nurse's age >= 21 years old . • Nurses with at least 1 year of critical care experience . • Tool of data collection : An adopted questionnaire (Hussein, H. (2003). Jordan magazine for applied sciences) was distributed for nurses who are working in critical care units in Nablus public hospitals, to identify the major sources of stress among them.

11. Questionnaire consist of two parts : • Part one: Demographic variables ( age, gender, marital status, scientific qualification ,work experience, work place {ICU, ER, hemodialysis} ). • Part two: consist of 6 criteria that represent the major sources of stress among critical care nurses, include the following : 1)- Workload.( points 1-12). . 2)- Unfair policy of the hospital. (points 13-17) 3)- Conflict with physicians, nurses and supervisors.( points 18-23).

12. 4)- Inadequate preparation to deal with the emotional needs of patients and their families. (points 24-32) . 5)- Dealing with death and dying, and appropriate decision making. (points 33-37) . 6)- Lack of staff support.( points 38-40) . The answers depend on Likert Scale which consist of 4 scales : (strongly disagree (1), disagree (2), agree (3), strongly agree (4) ) . • Limitations: 1)- small sample which consists of 50 critical care nurses only. 2)- and the setting is two public hospitals in Nablus city only .

13. The results and Conclusions: After data statistical analysis using SPSS program the study has the following results : • First: results related to the questionnaire questions :

14. The previous table shows the following conclusion: The major predisposing factor for stress (stressor) among critical care nurses in Nablus public hospitals is Dealing with death and dyingwith percentage(66.96%), followed by workload with percentage (63.20%), followed by unfair policy of hospital with percentage (62.88 %), followed by the emotional needs of the patients and their families with percentage (61.82 %), followed by Conflict with physicians, nurses and supervisors with percentage (54.60 %), and finally lack of staff support with percentage (54.40 %) .

15. This conclusion is supported by: Research by Foxall and associates indicated that critical care unit nurses experienced significantly more stress related to death and dying (Foxall et.al.1990).

16. Second:the results related to hypothesis: • First hypothesis: “There is no significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and age variable”. Result: The Sig. level is 2.400 which is greater than level assumed in hypothesis (0.05). So we accept the hypothesis and say that “there is no significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and age variable”.

17. Second hypothesis: “There is no significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and gender variable”. Result: The Sig. level is 0.061 which is greater than assumed grade in hypothesis (0.05). So we accept the hypothesis and say “there is no significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and gender variable”.

18. Third hypothesis: “There is no significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and work experience variable”. Result: The Sig. level is 1.100 which is greater than level assumed in hypothesis (0.05). So we accept the hypothesis and say that “there is no significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and work experience variable”.

19. Fourth hypothesis : “There is no significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and work place variable”. Result: The Sig. level is .007 which is less than level assumed in hypothesis (0.05). So we reject the hypothesis and say that “there is significant statistical differences at α=0.05 between the predisposing factors of stress among critical care nurses in Nablus public hospitals and work place variable”.

20. Recommendations 1)- Nurses need to feel that they are involved in decision making especially related to patient care issues. Therefore a more decentralized, democratic management approach would be beneficial . 2)- Break down barriers of communication between physicians and nurses, and promote collaboration between nursing and medical services. This can be accomplished by creating open forums, group discussions, and collaborative workshops. Organizations must develop and strictly enforce policies for disruptive behavior in the workplace.

21. 3)- Provide access to educational programs, not only in clinical areas, but in teamwork, communication, family interactions, and stress management . 4)- The development of an ethics forum would give nurses a place to express their concerns. about end-of communication, family -life issues and other ethical concerns. 5)- Stress management programs, Increasing flexibility of scheduling and shifts will enhance the workplace, and Skills and knowledge can be shared, enhancing team-building.