College Students' Academic Stress Analysis

This assignment involves analyzing a study published in the American Journal of Health Studies (Misra & McKean, 2000) that investigates the relationship between academic stress among college students and factors such as anxiety, time management, and leisure satisfaction. Students should critically evaluate the methodology, findings, and implications of the study, and compare it with other relevant studies on academic stress.

Does multitasking and
increased workloads reduce
nursing standards

Table of Contents
INTRODUCTION...........................................................................................................................1
Purpose of review........................................................................................................................1
Importance of topic......................................................................................................................1
Scope of review...........................................................................................................................2
Search techniques and literature selection...................................................................................2
MAIN BODY..................................................................................................................................3
Theme 1: Impact of multitasking and increased workload of nurses on patients........................3
Theme 2: Impact of multitasking and increased workload on nurses.........................................4
Theme 3: Impact of workload on nursing standards...................................................................5
Theme 4: Steps taken by management to increase quality standards..........................................6
CONCLUSION................................................................................................................................7
Summary of the main arguments.................................................................................................8
Research gaps and areas of further research................................................................................8
Requirements of research to existing knowledge........................................................................8
REFERENCES................................................................................................................................9

Topic: Does multitasking and increased workloads reduce nursing standards?
INTRODUCTION
Purpose of review
There are various goals pursued by hospital at the same time. These are like providing
excellent services to the patients, high quality of care, operational excellence and retaining
employees for a longer period of time. Hence, it is required to create a good balance between
nursing staff and patients so that ultimate deliverables will be effective enough. One of the
common method adopted by the management to ensure proper ratio of nursing staff and patients
is work load management. The most challenging task present in front of management is to ensure
that whether capacity of nurses’ match with patient’s requirement in the hospital ward or not
(Valiee, Peyrovi and Nikbakht Nasrabadi, 2014). It helps in balancing the available resources
and using them optimally wherever required the most. It helps in preventing extra cost related to
over staffing of nurse in a particular ward.
A direct relationship has been found between workload on nurses and patient’s outcomes.
It depends upon the quality of care provided by nurses to ultimate service users. Workload
management helps in keeping employees healthy and preventing them from burn out and
absenteeism. It is difficult to determine the workload simply by observation but requires asking
nurses to fill out a questionnaire which can carry out questions regarding amount of work
available and professional mental load on them (McHugh and Stimpfel, 2012).
Importance of topic
Research has evidenced that ineffective staffing and patient ratio reduces the quality of
care extended to ultimate service users. Increased patient nurse’s ratio reduces the amount of
time that every nurse spends on each patient affecting health outcome of patient as well.
Negligence of nurse due to presence of workload addresses the common issue related to patient’s
safety. It is quite logical that if the number of patients under one nurse increases then eventually,
it will lead the nurse to comprise with requirements of patient’s care and safety. Ineffective nurse
and patient ratio leads to increase in the risk of service user’s safety events, morbidity and
mortality rate in the hospital due to lack of nursing care given to them (Hwang and Park, 2014).
It is important to ascertain impact of workload and multi-tasking on quality of care and nursing
standards provided to nurse. Hence, the main aim of research is:
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“To ascertain the impact of multitasking and increased workload on nursing standards”
Scope of review
In order to develop proper understanding regarding the subject matter, it is important to
review the opinions and researches that have already been conducted by the other researchers.
Hence, a secondary examination, based upon the articles extracted through search strategy and
inclusion as well as exclusion criteria in it will be conducted. Research articles will be chosen to
ascertain the researches that will be able to come up with adequate results having direct
relationship to the aim of present research (Van Bogaert and et.al., 2013). Another important
aspect that will be covered in the present research is related to presentation of summary based
upon arguments collected from secondary research and reaching to a specific collection that will
have direct relation to subject matter.
Search techniques and literature selection
Inclusion and exclusion criteria technique will be used to reach to specific articles that can
have direct relationship to chosen topic of relationship between multitasking and nursing
standards provided to the end users (Steyrer and et.al, 2013). PubMed database was used to
ascertain the results based on keyword, nursing standards, multitasking and workload. In initial
stage, 742 articles were drawn which were related to the subject matter. However, articles
published in between 2013 to 2018 were only used to gather latest data regarding the subject
matter (Tappenden and et.al., 2013). Hence, it helped in reducing the number of articles to 173.
Out of all, 72 potential articles were chosen which were short listed to 8 articles at the end that
were used for the purpose of study and gather adequate amount of results regarding impact of
multitasking and increased workload on nursing standards.
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MAIN BODY
Theme 1: Impact of multitasking and increased workload of nurses on patients
According to Kc, (2013) multitasking is considered to be an important skill in healthcare
while performing clinical functions. Hence, in the contemporary workplace, nurses are generally
expected to perform multitasking activities. However, workload on workplace and multitasking
are the two aspects that make it difficult to move hand in hand. It leads to reduce individual’s
working performance. Since, nurses are in direct link to the patients (Purnell, 2012). Main impact
is generally borne by the end users, that is, patients. Some of the common errors are related to
wrong diagnosis, medication prescribing errors, quality and safety deficiencies, etc. It is a serious
concern as inadequate division of work and excessive workload on individual nurses lead to
increase overall morbidity and mortality rate of the hospital. Research suggests that management
can add certain new dimension to workload management of nurses by adopting certain methods.
However, the method needs to be changed as per characteristics of patients that arrive to the
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hospital. Researcher has selected six surgical wards having six different specialities. There are
various roles that a nurse need to pay in this ward for proper management of patients and giving
the best possible services to them. These are wound care, blood transfusion, dialysis and
chemotherapy (Beerens and et.al., 2014). The adoption of workload management method
requires proper planning based upon the characteristics of patients and intensity of nurse required
to be delivered on each patient. It also takes into consideration the actual time that is required to
give care to patient. Hence, in this manner, better patient care can be extended to them at the
time of workload.
However, in contrast to this, as per the views of van den Oetelaar and et.al. (2016)
constant vigilance of nurse is required to be present at the patient’s bedside for better delivery of
services. It is quite common that if the number of patients increase, the quality of support and
care provided by nurse also decreases to a high extent. Hence, it can be stated that nurse and
patient ratio is one of the important aspects of patient’s safety in the hospital. The research stated
that common responsibility of nurse is to take care of patients and his / her requirements. Any
deviation in delivery of services can affect the health outcomes which can lead patient to death as
well (Letvak, Ruhm and Gupta, 2012).
Inadequate supply of nurses in health care centres reduces the quality of care extended by
them to the ultimate patients. It has been evidenced that high workload has direct correlation to
inflated infection rate, increased incidences of readmission of patients, longer stay of patients in
the hospital, diminished ability of nurses to analyse potentially fatal medical complications, low
amount of patient’s satisfaction and more patient falls (Bogaert and et.al., 2013).
Theme 2: Impact of multitasking and increased workload on nurses
According to Barrios and et.al. (2017) Impact of workload is not only borne in the form of
quality of care to the patient but its stronger impact can also be assessed on quality of life of
nurses as well. Various working life problems can be identified in the case where the nurse need
to redesign the quality standards he /she provides to the patients. It not only affects the well
being of nurse but adequate amount of impact can be borne by the nurses as well. It has
generated the requirements to measure workload on nurses, its causes and effect. The research
suggests that patient and nurse ratio is good representation of overall workload borne by the
nurses. There are various levels at which demand and resources interact ultimately declining the
quality of services so as to fulfil the demand. The workload of nurses can mainly be divided into
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three levels. These are, unit level, job level and task level. Researcher have been able to analyse
that 23% increase in the risk of nurse reported burnout due to additional assignment of patients to
the nurse. It also led to increase in job dissatisfaction by 15% (Williams and et.al., 2014).
Further, the researcher collected data from 36 emergency physician nurses. All the tasks related
to interruptions, tasks and instances of multitasking were recorded for continuous 120 hours.
Nurses working memory capacity was also analysed as a significant aspect of multitasking. The
results of the research indicated that nurses experienced 7.9 interruptions per hour where 239
medication orders containing 208 prescribing errors were found. The results also indicated that
multi taking, poor sleep and interruptions and significantly associated with the increased rates of
prescribing errors. It is also ‘leading to decreased Working Memory capacity of the nurses as
well negatively affecting quality of life.
However, as per the views of Akhu‐Zaheya, Al‐Maaitah and Bany Hani, (2018) the main
reasons of high workload on nurses is due to increased demand, inadequate supply, reduced
staffing and increase in patient’s length of stay without compromising with the new admissions
made in each department. When shortage of nurses occurs, workload is faced by them who are
on duty. In such cases, nurses tend to take care of the nurses who are sicker than the other
patients so that mortality rate can be reduced. Heavy workload in different departments lead to
increased burnout and enhanced level of dissatisfaction as well. It deteriorates their motivation
level as they have to give extra number of hours in the hospital It leads to low morale, high
dissatisfaction rate, nurse turnover, poor performance on job, threatened quality of care to the
patients, and organizational effectiveness. Heavy working load leads to various job stressors,
such as, emotional exhaustion, anger and cynicism, etc (Kitson and et.al., 2013). It beholds them
from ineffective and inefficient working performance at the health care department. The research
indicated that adoption of human factors reengineering approach can help in redesigning and
reducing the workload to a level that can positively affect the nursing practices even at the time
of workload.
Theme 3: Impact of workload on nursing standards
The objective of research presented by Ohnstad and Solberg, (2017) is to investigate on the
relationship between seven workload factors and patient and nurse outcome. The researcher has
conducted a cross sectional correlational study with 472 acute care nurses from British
Columbia, Canada (Cherry and Jacob, 2016). Various workload factors were considered nurse
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reports of unit level and acuity of patient and their dependency, perception of nurses based upon
heavy workloads, level of compromised standards, interruption they feel in the work
environment to due acute level of work load in the health care set up (Tilden and et.al., 2012).
The study stated that the interruption and workload lead to patients fall, medication error,
emotional exhaustion, urinary tract infection and lower job satisfaction, etc. the results of the
research stated that job level perceptions and task level interruptions have direct relationship to
patients and nurse outcome (Burgess, Irvine and Wallymahmed, 2010). It leads to make adequate
amount of compromises made based upon heavy workload present in the health care set up. The
research has been concluded on the basis that, it is important for the management to identify
better work environmental strategies for ailing situation of workload.
In the opinion of Johnson and et.al., (2017) research conducted by them suggested that
degrading situation of nurses is due to increased presentation of complex patients in the
emergency department and medical advancement in the field (Chernomas and Shapiro, 2013). A
cross sectional survey was conducted by the researcher where sample was gathered from
emergency department nurses of Edmonton zone in the form of questionnaire considering
nursing beliefs (Morgan and Yoder, 2012). Options were indicated in 7 point Likert scale. The
results stated that majority of the nurses agreed on the statement that it is due to unavailability of
qualified nurses due to which they are not able to give adequate amount of nursing care to the
patients arriving in the hospital. Hence, it was concluded that, despite of having heavy workload,
nurses strongly agreed upon importance on medication and nursing facilities to the patients in
need (Griffiths, P. and et.al., 2014).
Theme 4: Steps taken by management to increase quality standards
There are different types of steps that are required to be considered management of
hospitals so that they are able to raise the quality of standards. Main for this respect is provided
towards nurses. When they type of roles and responsibilities played by them are effective, then it
has high positive impact over understanding needs of patients (Sharma and Rush, 2014). A per
person is satisfied when they get all their needs and requirements fulfilled.
According to the research conducted by Aggarwal and et.al. (2010) medication education
enables to enhance knowledge, attitudes and skills for the professionals towards delivering safety
to patients. it requires to have skilled like leadership, communication and team working as in
nursing with effective coordination it improves the relationship with patients and co-workers.
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When nurses are provided with training and development, then it enables to clarify all the doubts
that they have in relation with their roles and responsibilities (Galbraith and Brown, 2011).
However, management need to monitor their performance level so that all the areas in which
improvement is required can be identified and steps are taken to provide them with training. In
conditions when training is provided without any monitoring at before it, then it would not get
benefited ( Aggarwal and et.al. 2010). There are high costs involved in providing training and
when nurses do not get benefited, then these are type of losses. Apart from this, each of the
nurses need to be effective communication skills so that all health related issues can be solved
and high quality care can be delivered. There are situations in which proper coordination is
required among nurses so that proper medication can be provided.
As per Spilsbury, Hewitt and Bowman, (2011 ) it is required to have strong relationship
with among nurses so that cases of patients are taken proper care. Within health care nurses pay
vital role in delivering care for dependant older people. There are different aspects that can be
considered with the help of which quality of care can be provided. The research conveys that
strong relationship needs to be maintained from the side of nurses so that quality of services can
be raised. There are in total 13411 references that are identified and these were helpful enough to
provide in depth knowledge and learning (Edwards and Burnard, 2003). All the articles that are
selected provide information in relation with strategies applied by management to raise quality of
services. Further, implementation of new or updated technology is made so that problems faced
by patients can be identified and steps are taken to overcome them. Apart from this, it also
requires to have team working as it enables to complete the work within speculated timer period.
The condition of multitasking arises when there are many tasks that are required to be performed
within speculated time period (Spilsbury, Hewitt and Bowman, 2011 ). When a task is performed
by single person, then total time that is taken to complete it will be more when same task is
performed by a group. The type of food that is consumed in this modern world has raised many
health related issues. This way, the researcher has identified an increase in number of patients on
daily basis. This can be considered to be one of the reason due to which increase in work load
and this becomes difficult to complete the task in effective manner (Misra and McKean, 2000).
CONCLUSION
From the assignment, it can be concluded that patients, nurses and management faces
issues when nurses are provided by many tasks that they are required to complete within
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speculated time period. The rate of turnover increases when nurses are not able to handle work
pressure. It is important to have motivation so that all the tasks to be performed can be done with
willingness.
Summary of the main arguments
One the arguments that were discussed, it can be stated that patients fail to satisfy their
requirements as nurses do not get time. They are generally occupied in other activities due to
which need of patients are not considered sometimes by nurses. Further, there is different type of
medications provided and it is one of the responsibility of nurses to provide them. When they are
not able to perform their roles due to work lead, then it affects the satisfaction level of patients.
Due to workload the level of stress increases . The perceptions that are carried by each of
the individuals are different, there will be few of them who are able to handle work but there will
be few of them who fail to do so. This way the performance level of nurses gets affected. In
addition to this, it also makes nurses depressed and thus quality of services negatively affected.
It is required for the nurses to consider the situations faced in which they provide patients
with high quality services. All these are only possible when they are able to have strong
interaction with co-workers and patients. This also helps in understanding the requirement of
patients and in making them raise their satisfaction level.
Research gaps and areas of further research
There are various other areas in which research can be carried out. With this respect, it
includes positive impact of training and development, strategies that can be applied to improve
the communication among nurses and patients. Further, the type of services that are delivered by
individuals at different countries differs. The similar type of research can be carried out at
various part of the world and the perception carried out each one of the nurses can be identified
and steps can be taken to overcome them.
Requirements of research to existing knowledge
There are two methods with the help of which information can be gathered. With this
respect, it includes primary and secondary methods. Both these methods have their own set of
benefits and advantages. In order to conduct the research, statistical tool can be used in data
analyses part. This is helpful enough to provide in depth analyses and effective interpretation.
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REFERENCES
Books and Journals
Aggarwal, R., and et.al. (2010). Training and simulation for patient safety. BMJ Quality &
Safety, 19(Suppl 2), pp.i34-i43.
Akhu‐Zaheya, L., Al‐Maaitah, R., & Bany Hani, S. (2018). Quality of nursing documentation:
Paper‐based health records versus electronic‐based health records. Journal of clinical
nursing. 27(3-4).
Barrios, S. & et.al. (2017). Nurses’ workload in hemodialysis units. Revista médica de
Chile. 145(7). 888-895.
Beerens, H. C. & et.al., (2014). Quality of life & quality of care for people with dementia
receiving long term institutional care or professional home care: the European
RightTimePlaceCare study. Journal of the American Medical Directors
Association. 15(1). pp.54-61.
Bogaert, P. & et.al., (2013). Nurse practice environment, workload, burnout, job outcomes, &
quality of care in psychiatric hospitals: a structural equation model approach. Journal of
advanced nursing. 69(7). pp.1515-1524.
Burgess, L., Irvine, F., & Wallymahmed, A. (2010). Personality, stress and coping in intensive
care nurses: a descriptive exploratory study. Nursing in critical care, 15(3), 129-140.
Chernomas, W. M., & Shapiro, C. (2013). Stress, depression, and anxiety among undergraduate
nursing students. International Journal of Nursing Education Scholarship, 10(1), 255-
266.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management.
Elsevier Health Sciences.
Edwards, D., & Burnard, P. (2003). A systematic review of stress and stress management
interventions for mental health nurses. Journal of advanced nursing, 42(2), 169-200.
Galbraith, N. D., & Brown, K. E. (2011). Assessing intervention effectiveness for reducing stress
in student nurses: quantitative systematic review. Journal of advanced nursing, 67(4),
709-721.
Griffiths, P. & et.al., (2014). Nurses’ shift length & overtime working in 12 European countries:
the association with perceived quality of care & patient safety. Medical care. 52(11).
p.975.
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Hwang, J. I., & Park, H. A. (2014). Nurses’ perception of ethical climate, medical error
experience and intent-to-leave. Nursing ethics. 21(1). 28-42.
Johnson, M. & et.al. (2017). The impact of interruptions on medication errors in hospitals: an
observational study of nurses. Journal of nursing management. 25(7). 498-507.
Kc, D. S. (2013). Does multitasking improve performance? Evidence from the emergency
department. Manufacturing & Service Operations Management. 16(2). 168-183.
Kitson, A. & et.al., (2013). What are the core elements of patient‐centred care? A narrative
review & synthesis of the literature from health policy, medicine & nursing. Journal of
advanced nursing. 69(1). pp.4-15.
Letvak, S. A., Ruhm, C. J. & Gupta, S. N., (2012). Nurses' presenteeism & its effects on self-
reported quality of care & costs. AJN The American Journal of Nursing. 112(2). pp.30-
38.
McHugh, M. D. & Stimpfel, A. W., (2012). Nurse reported quality of care: a measure of hospital
quality. Research in nursing & health. 35(6). pp.566-575.
Misra, R., & McKean, M. (2000). College students' academic stress and its relation to their
anxiety, time management, and leisure satisfaction. American Journal of Health Studies,
16(1), 41.
Morgan, S. & Yoder, L .H., (2012). A concept analysis of person-centered care. Journal of
Holistic Nursing, 30(1). pp.6-15.
Ohnstad, M. O., & Solberg, M. T. (2017). Patient acuity and nurse staffing challenges in
Norwegian neonatal intensive care units. Journal of nursing management. 25(7). 569-
576.
Purnell, L. D., (2012). Transcultural health care: A culturally competent approach. FA Davis.
Sharma, M., & Rush, S. E. (2014). Mindfulness-based stress reduction as a stress management
intervention for healthy individuals: a systematic review. Journal of evidence-based
complementary & alternative medicine, 19(4), 271-286.
Spilsbury, K., Hewitt, C., and Bowman, C. (2011). The relationship between nurse staffing and
quality of care in nursing homes: a systematic review. International journal of nursing
studies, 48(6), pp.732-750.
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Steyrer, J. & et.al (2013). Attitude is everything?: The impact of workload, safety climate, and
safety tools on medical errors: A study of intensive care units. Health care management
review. 38(4). 306-316.
Tappenden, K. A. & et.al., (2013). Critical role of nutrition in improving quality of care: an
interdisciplinary call to action to address adult hospital malnutrition. Journal of the
Academy of Nutrition & Dietetics. 113(9). pp.1219-1237.
Tilden, V. P. & et.al., (2012). End-of-life care in nursing homes: the high cost of staff
turnover. Nursing Economics. 30(3). p.163.
Valiee, S., Peyrovi, H., & Nikbakht Nasrabadi, A. (2014). Critical care nurses’ perception of
nursing error and its causes: A qualitative study. Contemporary nurse. 46(2). 206-213.
Van Bogaert, P. & et.al., (2013). The relationship between nurse practice environment, nurse
work characteristics, burnout & job outcome & quality of nursing care: a cross-sectional
survey. International journal of nursing studies. 50(12). pp.1667-1677.
van den Oetelaar, W. F. J. M. & et.al. (2016). Balancing nurses' workload in hospital wards:
study protocol of developing a method to manage workload. BMJ open. 6(11). e012148.
Williams, S. D. and et.al., (2014). Using social determinants of health to link health workforce
diversity, care quality & access, & health disparities to achieve health equity in
nursing. Public Health Reports. 129(1_suppl2). pp.32-36.
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