Assessment of Job Stress for Nurses in Psychiatric Hospitals at Baghdad City

Objectives : The aim of study is to assess job stress for nurses who are working in psychiatric hospitals in Baghdad city and its relation to socio-demographic characteristics of the nurses


INTRODUCTION:
Job stress describes as the stress associated with professional or work environment, a tension that created when the demands of the job exceed the capacity of the person to respond effectively (Mcvicar 2003).The issue of job stress among nurses is one of the main concerns in psychiatric nursing, according to the national institute for occupational safety health;nursing was found to be one of jobs that had high than expected incidence of stress, it was found that stress brought about hazards impacts on both nurses health and their ability to cope with job demands (Adriaenssens, 2013).Working with suffering patients and those who call for abundant attention, compassion, and sympathy is also found to be directly correlated to the consensus that nursing is indeed one of the very stressful professions (Miller, 2010).Whenever nurses face situations like these, they may eventually become irritable, depressed, and disappointed (Gallagher and Gormley, 2009).Bhattacharya et al., 2004 considers the workload, role ambiguity, interpersonal relationships, and death and dying concerns as the frequent job stress among nurses.It emphasized that this may result in emotional distress, fatigue and psychological morbidity.Nurses working in settings without support from their superiors and engaged in inter professional conflicts, especially between nurses and physicians; face a great problem (Milutinovi et al., 2009).Mental health nurses are working on locked units provide care for clients who require increased observation and complex treatment modalities which may exposes them to a variety of difficult work-related stressors (Currid, 2009).Konstantinos and Christina (2008)identified the numbers of job stress for mental health nurses working in hospitals included the poor professional relationships as the lack of collaboration between doctors and mental health nurses, conflicts between nurses and physicians, and lack of doctors' respect for nurses' opinions and their participation in decision making about patients' care.Also mentioned that mental health nurses are become stressed by difficulties in relationships and conflicts with other staff nurses they work with them.From this point of view it was found that assessing job stress for psychiatric nurses considered serious issue that may results in decreasing nurse's emotional distress and psychological morbidity.

OBJECTIVES OF STUDY
To assess job stress for nurses who are working in psychiatric hospitals in Baghdad city.To identify relation between job stress and socio-demographic characteristics of the nurses.

METHODOLOGY:
A descriptive analytical design study order to achieve the objectives of study for assessment of job stress for nurses in psychiatric mental health hospitals in Baghdad city, the period of study starting from 4th November 2013 to 25th of Feb. 2014.Participants were conducted from three hospitals, first from Baghdad Teaching Hospital (Psychiatric ward) at the 10th Floor, Second from Ibn-Rushd Psychiatric teaching Hospital, Third from Al-Rashad Psychiatric Teaching Hospital.100 nurses were chosen randomly from the three hospitals accepted to participate in the study.The sample was distributed in three hospitals who were 6 from Baghdad Teaching hospital at psychiatric ward of total 10, 30 from Ibn-Rushd psychiatric Teaching hospital of total 62, and 64 from AL-Rashad psychiatric Teaching hospital of total 300.The study was conducted using a questionnaire divided into two sections, the 1 st section included general information (demographical characteristic) of nurses that include: gender, age, marital status, level of education, Years of experience in psychiatric mental health nurse, Training courses related to psychiatric mental health care inside or outside Iraq.The 2nd section was based on job stress scale consist of five domains which are: Dealing with patients and their families, Workload, problems with doctors, Problems with supervisors and Conflict relating peers.The questionnaire constructed by researcher for the present study was based on Expanded nursing stress scale (ENSS) developed by French and her colleagues (French et al., 2000).The content validity of the instrument was established through penal of (11) experts in order to examine the validity of the questionnaires, and given for their opinions and suggestions to investigate the clarity, relevancy and adequacy of items.It was presented to experts in different fields: (5) experts from College of Nursing, University of Baghdad, (1) experts from College of Nursing, University of Babylon, (1) expert from College of Ibn Rushd, University of Baghdad,(1) expert of statistics from College of Health and Medicine Technology.(3)experts from College of Medicine, University of Baghdad.And reliability was done by using the most common internal consistency measure which is Cronbach's alpha and the result was 93%.Acceptance to participate in the study was taken before questioner administrating.The questionnaire was completed by researcher through the distribution of self reported questionnaire to nurses in nurse's staff rooms.The researcher used the appropriate statistical methods in analyzing data which include the following: 1-Descriptive data analysis: this approach was performed through the determination of: Frequencies (F), and Percentage (%), Mean (M), Standard Deviation (S.D).

S.D= standard deviation= t-statistics
Table 4 showed that there is a significant difference between job stress with regard to training or conference outside country at p≤0.05, which shows that nurses who did not participate are more susceptible to job stress, while there is no significant difference between job stresses with regard to other variables in this table.

DISCUSSION
The result of study showed that male nurses were more than female nurses; this is considered normal because of the difficulty of work.The study of Hajjaj( 2007) reported that 70% of sample was male.Hamaideh (2008) state that majority of sample was male.Furthermore it was found that most of the studied sample was from middle age group (25-34), this may be related to new policy of ministry of health in employing graduated nurses in psychiatric hospitals as well as the general hospitals which is different from the past years.Hamaideh (2008) indicated also that majority of studied sample have age between 25 to 34 years old.The majority of studied nurses were married, have good income, and they were settled.According to our culture, most of young people prepare to married after graduation and employing.Hajjaj (2007) found 90% of sample was married.Also shows most of the studied sample was from technical institute and they have diploma in nursing, this result related to increased number of technical institute of nursing in Iraq which supply hospitals with a lot of staff.The studies of Al-Hawajreh (2011) and Hajjaj (2007) reported that majority of nurses in their studies have diploma in nursing education too.66% from the studied sample participated in training courses inside country which organized by ministry of health in order to raise nurses competency in psychiatric nursing.Our result revealed that nurses who were not participated in these courses had experience higher level of stress than the other nurses but it was not significant.Also ministry of health organized training courses outside the country for general nursing, but our result reveals that there is a lot of shortage in psychiatric training outside the country.
Only 13% from all psychiatric nurses' number were participated in courses outside the country and it was found also that nurses who were not participated were more susceptible to stress in their work and it was significant.Training courses and conference outside the country were contribute to the convergence of scientific ideals with others and influence nurses ability and skills to deal with psychiatric patients especially in emergency cases.The results shown all job stress domains were moderate level of stress, also the total mean score of job stress was moderate level among nurses in psychiatric hospitals.This study is agreed with the study of (Algamal et al., 2011) they found that the level of stress among mental health nurses was moderate too.The results reveals that there is no significant differences between job stress and other demographic data such as gender, age, maternal status, level of education.This result agree with Al-gamal et al., Hamaideh (2008);Hawajreh (2011) who reported that there is no significant difference in job stress with regard to these variables.

CONCLUSION:
1.The majority of staff are male nurses, the age group from 25 to 35 years old, have diploma, married, short period of experience in psychiatric mental hospitals, and most of nurses' staff participated in training or conference inside country, but the majority of them not participated in training or conference outside country.2. Job stress and all domains of it were found moderate level of stress among nurses in psychiatric mental hospitals.3.There is a no significant difference in job stress with regard to variables except participation in training courses concerning psychiatric-mental health care outside country.

RECOMMENDATION:
1. Improving of employees in the nursing profession by develop of incentive system, upgrade commensurate with assigned to the nursing job.2. Establishment of courses and training (especially in psychiatry-mental health nursing) inside and outside of country in order to develop of nurses' skills according to scientific programs through development of nurses abilities and performance.Also created of special programs on how to deal with stress that impedes them at work.

Table ( 1): Distribution of the Study Samples According to Demographic Data
Table1revealed that the higher percentage of the studied sample was male (79%), between (25-34) years of age (42%) married (79%) most of them from medical institute (44%) almost half of them had five years or less of working experience in psychiatric hospitals.66% from nurses participated in training courses inside country while only 13% from them participated in training courses outside the country.The study showed that there was significant relationship between training courses and job stress especially courses outside the country.

Table 3
showed that there is no significant difference in job stress with regard to the variables in this table at p≤0.05.