Dissertation on Stress Factors and Coping Strategies of ER Nurses KSA

This dissertation investigates the factors contributing to stress among emergency room nurses in Saudi Arabia and examines the coping strategies they employ. The study utilizes a questionnaire distributed to both native and foreign nurses working in Saudi Arabian hospitals, with data analyzed using SPSS software and ANOVA tests. The findings indicate that nurses in the emergency department experience high levels of stress, influenced by experience and job role rather than gender, leading to issues like agitation, depression, and mental exhaustion. The dissertation concludes with a recommendation for implementing mental wellness programs to improve job satisfaction and reduce attrition rates among nurses in this high-stress environment. Desklib provides access to this dissertation and other solved assignments for students.

Running head: DISSERTATION
FACTORS AND COPING STRATEGY OF STRESS AMONG THE EMERGENCY
ROOM NURSES IN SAUDI ARABIA
Name of the Student:
Name of the University:
Author Note:

1DISSERTATION
Declaration:
I the undersigned solemnly declare that the project report is based on my own work carried
out during the course of our study under the supervision of ……………. I assert the
statements made and conclusions drawn are an outcome of my research work. I further certify
that:
I. The work contained in the report is original and has been done by me under the
general supervision of my supervisor.
II. The work has not been submitted to any other Institution for any other
degree/diploma/certificate in this university or any other University of abroad.
III. We have followed the guidelines provided by the university in writing the report.
IV. Whenever we have used materials (data, theoretical analysis, and text) from other
sources, we have given due credit to them in the text of the report and giving their
details in the references.
Name:
Enrolment No.:

2DISSERTATION
Acknowledgement:
Thank you to all of those who have helped listened and encouraged me throughout this study.
I am indebted to my supervisor ......................... whose guidance, advice and patience have
been immeasurable. My sincere thanks to all members of the............... [Mention your
university/college name], both staff and students, whose continuous support have made this
thesis possible.
I would like to thank all of the participants in the study: students, teachers and Local
Education Authorities, for the time and help given throughout. Without their participation,
this research would not have been possible. In this context, I am also thankful to them, whose
research work helped me to execute this paper well.
Finally, I thank my family, without whom this thesis would not have been started or
completed! Your encouragement and support have never faltered; thank you.

3DISSERTATION
Abstract:
Introduction: Stress generates a cumulative physical, mental as well as emotional response
on an individual which limits the ability to participate in an activity with enthusiasm. Stress
normally emerges from a level of dissatisfaction that arises due to poor interaction level or
unfavourable and non-cooperative environment setting. Stress could be a result of multiple
factors, some of which include, inability to cope with an academic environment, inability to
achieve personal goals and stress generated on account of the nature of a profession.
Background: Research studies have suggested that the nursing professionals majorly
experience the burnout and fresh graduate nurses upon placement within the Emergency unit
plan to quit the profession. Therefore on the basis of the background information as well as
the problem statement, the research objectives of the study intends to evaluate the key
sources of stress within the emergency wards of the hospitals in Saudi Arabia, to determine
the impact of stress on the working conditions of the nursing professionals and to evaluate the
available strategies in order to help professionals cope with the stress.
Methodology: In order to evaluate the factors that lead to stress among nursing professionals
working within the emergency unit of a healthcare setting, a questionnaire was distributed to
the nursing professionals working within the emergency unit of reputed hospitals in Saudi
Arabia. The questionnaires were distributed to 50 native nurses and 50 foreign nurses
working within Saudi Arabia. The questionnaire responses acquired were then evaluated by
using the SPSS software and ANOVA test.
Findings: The findings revealed that nurses working within the ED experienced higher level
of stress and the level of stress did not depend on gender but dependent on the basis of
experience level and job role.

4DISSERTATION
Conclusion: Higher stress led to problems such as agitation, increased stress levels,
depression as well as mental exhaustion. Therefore, over all it was found that the level of
stress and associated poor outcome was the highest among the nursing professionals who
worked at the emergency ward.
Recommendation: Hence, there is an increased need to include programs which could help
in promoting mental wellness among the nurses so as to improve their level of job
satisfaction and at the same time improve the rates of attrition.

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Table of Contents
Chapter 1:...................................................................................................................................4
Introduction................................................................................................................................4
1.1 Background:.....................................................................................................................4
1.2 Problem Statement:..........................................................................................................5
1.3 Research Objectives:........................................................................................................5
1.4 Research Question:...........................................................................................................5
1.5: Significance of the study:................................................................................................6
1.6: Limitations of the study:.................................................................................................6
1.7: Operational Definitions...................................................................................................7
CHAPTER 2:.............................................................................................................................9
Literature Review.......................................................................................................................9
2.1: Introduction:....................................................................................................................9
2.2: Search Strategy:..............................................................................................................9
Exclusion Criteria:.................................................................................................................9
Inclusion Criteria:.................................................................................................................10
Key Words:..........................................................................................................................10
Boolean Operator aided search:...........................................................................................11
2.3: Overview on stress and related outcome on nursing professionals working within the
ED........................................................................................................................................11
Definition and nature of stress.............................................................................................11
Symptoms of stress..............................................................................................................12
Sources of stress...................................................................................................................12
Outcome of work-stress.......................................................................................................14
Socio-demographic variables and work-stress.....................................................................14
Summary:.............................................................................................................................15
Literature Gap:.....................................................................................................................16
CHAPTER 3:...........................................................................................................................17
Methodology............................................................................................................................17
3.1: Introduction:..................................................................................................................17
3.2: Research Design:...........................................................................................................17
3.3: Research Setting:...........................................................................................................17
3.4: Population:....................................................................................................................18
3.5: Sampling Criteria:.........................................................................................................18
3.6: Sample Size:..................................................................................................................18

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3.7: Variables:......................................................................................................................19
Independent Variables:.........................................................................................................19
Dependent Variables:...........................................................................................................19
3.8: Instrument:....................................................................................................................20
3.9: Validity and Reliability:................................................................................................20
3.10: Pilot Study:..................................................................................................................21
3.11: Data Collection Procedure:.........................................................................................22
3.12: Data Analysis:.............................................................................................................22
3.13: Ethical Consideration:.................................................................................................22
Chapter 4:.................................................................................................................................24
Data Analysis and Discussion:.................................................................................................24
Variable declaration and measures:.....................................................................................24
Cronbatch’s alpha reliability test:........................................................................................25
T-test to examine whether people in emergency word have higher stress...........................26
Correlation between the estimated results of the work life stress among nurses.................31
References:...............................................................................................................................36
Appendix 1:..............................................................................................................................41
Gantt Chart:..........................................................................................................................41
Appendix 2:..............................................................................................................................42
Questionnaire:......................................................................................................................42

7DISSERTATION
Chapter 1:
Introduction
1.1 Background:
According to Abu Ruz (2014), care professionals are often stressed and emotionally
exhausted on account of the nature of their profession. As suggested by Al Hosis et al. (2013)
stress generates a cumulative physical, mental as well as emotional response on an individual
which limits the ability to participate in an activity with enthusiasm. In the words of Al Sareai
et al. (2013), stress normally emerges from a level of dissatisfaction that arises due to poor
interaction level or unfavourable and non-cooperative environment setting. Stress could be a
result of multiple factors, some of which include, inability to cope with an academic
environment, inability to achieve personal goals and stress generated on account of the nature
of a profession. A number of research studies have reported a high number of turnover in the
nursing profession pertaining to burnout and stress related to the nature of the profession.
Research studies in this context, critically suggest that nursing professionals working within
an emergency environment experience stress and emotional breakdown on account of closely
witnessing deaths and grief (Alsaqri 2014). In addition to this, working in the emergency
department is often accompanied with experiences such as life threats and harassment from
family members of dying patient who are unable to accept the unprecedented or
circumstantial death of the patients. Further, the profession includes job roles such as caring
for dying patients and managing conflicts between multidisciplinary health care
professionals.

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1.2 Problem Statement:
Research studies have suggested that the nursing professionals majorly experience the
burnout and fresh graduate nurses upon placement within the Emergency unit plan to quit the
profession (Alsaqri 2014). In addition to this, research studies have further revealed that the
nursing profession has the largest rate of employee turnover globally (Al Sareai et al. 2013).
A significant number of studies have also shown that the level of dissatisfaction related to the
profession is highest among the nurses of Saudi Arabia. This is majorly on account of stress,
burnout and dissatisfaction in context of pay scale and the key responsibility areas of the
profession (Al Hosis et al. 2013). Further, studies also indicate that within Saudi Arabia, the
nursing profession has not evolved and the professional development of the care
professionals has been ignored to a considerable extent. This has significantly resulted in an
acute shortage of care professionals across the health care organizations and at the same time
has also deteriorated the overall quality of physical as well as mental health of the nursing
professionals.
1.3 Research Objectives:
Therefore on the basis of the background information as well as the problem statement,
the research objectives that can be articulated would comprise of the following:
 To evaluate the key sources of stress within the emergency wards of the hospitals
in Saudi Arabia
 To determine the impact of stress on the working conditions of the nursing
professionals
 To evaluate the available strategies in order to help professionals cope with the
stress
1.4 Research Question:
Therefore, the research questions can be articulated as follows:

9DISSERTATION
RQ1: What are the significant factors or rather the sources of stress that is prevalent in the
emergency wards of the hospitals present in Saudi Arabia?
RQ2:To what level or what extent does the level of work-stress influence the nurses? Is it the
socio-demographic variable and job variables or any other factor?
RQ3: What strategies should be undertaken in order to cope up with the work stress that the
nurses are facing on a daily basis? Additionally what is the relationship between the stress
and the outcomes that is anticipated?
1.5: Significance of the study:
The research study can be deemed extremely significant. This is on account of the
reason that none of the research studies have focused on the quality of psychological stress
that nursing professionals within the emergency department go through. It can be stated in
this context that the proposed research study would help in determining the level of stress that
nurses within the emergency department go through. Also, it would help in formulating an
idea about the factors that lead to stress and lead to the burnout syndrome among the nursing
professionals. In addition to this, it should be noted that the research study would help in
comparing between the Saudi Arabian and the Expatriate nurses and estimate the varying
level of stress on account of work pressure. It should be crucially noted in this context that
the amount of stress elicited on the nurses differs from one department to another. However,
the research would revolve around the estimation of psychological stress that nursing
professionals working within the emergency ward go through.
1.6: Limitations of the study:
As has already been discussed in the previous sections, the research study is
extremely significant on account of novelty. However, the research study has a number of
limitations which includes the biases included in the sampling size. While the sample size
was being considered, the recruited sample size comprised of nursing professionals belonged

10DISSERTATION
to a few countries only. This could be explained as the major reason why ample variation was
not identified within the sample size. The recruited sample size directly affected the research
outcome as it did not allow the researchers to generalize the findings based on the sources of
stress that affected the nurses and compare it with the estimated outcomes. Another limitation
could be identified as the choice of data collection and data analysis procedure. The choice of
statistical evaluation and ANOVA test helped in understanding the existing relationship
between the level of work stress and performance outcome as well as the level of job
satisfaction. However, upon conducting a semi-structured interview, it would have been
easier to formulate an in-depth understanding about the factors that caused stress among
nurses working within the emergency department of hospitals.
1.7: Operational Definitions
BS: Burnout Syndrome: Burnout syndrome can be defined as a state of mental, emotional
and physical exhaustion that is caused in employees on account of excessive and prolonged
stress (Ozden et al. 2013).
ED: Emergency Department:Emergency department can be defined as the department within
a hospital that is exclusively responsible for the provision of medical as well as surgical care
to patients who report to the hospital on account of an accident or emergency (Ko and Lee
2013).
ERC: Ethics and Research Committee:The Ethics and Research committee can be defined
as the organizational body which is responsible for ensuring that a research is conducted in an
ethical manner according to national and international law (Silverman 2016).
SPSS: Statistical Package for the Social Sciences:The SPSS software is also known as the
IBM SPSS Statistics and is used for the analysis of statistical data (Corbin et al. 2014). The
software finds application in a number of filed with health care industry being a primary one.

11DISSERTATION
ANOVA: Analysis of variance:ANOVA test can be explained as analysis of variance which
is another statistical method used to analyse variance present within a set of observations
where the observations are subdivided into a number of distinct components (Marshall and
Rossman 2014).