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:

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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.:

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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.

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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.

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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

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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:

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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

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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.

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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).

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CHAPTER 2:
Literature Review
2.1: Introduction:
According to Taylor et al. (2015), while conducting a primary research, it is extremely
important for the researchers to formulate an idea about the existing scholarly literatures. This
is on account of the reason that researcher derive a preliminary idea about the research
studies already conducted and effectively identify the existing gaps in the literature (Tesch
2013). Further, upon analysing the available literatures, researchers are able to develop an
appropriate research guideline and accordingly plan the research study further. In this section,
the scholarly literatures that were retrieved after conducting a thorough search on the
electronic databases would be discussed so as to evaluate and build on the findings.
2.2: Search Strategy:
According to Silverman (2016), prior to conducting a literature review, it is extremely
important to conduct an effective search to retrieve relevant scholarly literatures. In this case,
an exhaustive search was conducted on the electronic databases that included Google
Scholar, PubMed and PMC. Specific exclusion and inclusion criteria were used to retrieve
relevant literatures. Specific key words were used to effectively retrieve the most relevant
literatures that aligned with research question (Ritchie et al. 2013) . Typically the research
articles that were published in between 2011 to 2018 were considered for the literature
review. 40 research studies were retrieved from the databases after a quality check, out of
which only 20 studies were considered for the basic audit. Further, 10 of the retrieved
literatures were eliminated because of duplication and 10 of the research papers were not
accessible for complete text.

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Exclusion Criteria:
The exclusion criteria forms a set of the characteristics that are used to eliminate
research papers. As stated by Flick (2018), a set of exclusion criteria helps in narrowing
down the research and retrieving relevant research papers. In this case, the set of exclusion
criteria that was included, comprised of the following characteristics:
 Papers published in languages other than English
 Papers that were published prior to 2011
 Papers that were not full-text accessible
Inclusion Criteria:
The inclusion criteria on the other hand forms a set of characteristics that are used to
include research papers in the literature review. According to Marshall and Rossman (2014),
a set of inclusion criteria helps in retrieving the most relevant research papers that are closely
aligned to the research question of the proposed research study. In this case, the set of
inclusion criteria that was included comprised of the following characteristics:
 Papers published in English language
 Papers published in between 2011 to 2018
 Papers that were completely accessible
Key Words:
As stated by Ritchie et al.(2013), key words can be defined as the short phrases or
words that align closely with the concept of the research question. The key words help in
scanning the evidence base to recruit the most appropriate research papers that are relevant to
the devised research question and the research objectives (Corbin et al. 2014). In this case,
the key words that were used included the following:

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Pain, Pain appraisal, nursing learning, emergency ward. Psychological stress, burnout,
nurses, nursing professionals, emotional exhaustion, Saudi Arabia, stress, exhaustion,
healthcare
Boolean Operator aided search:
In order to conduct a relevant search on the electronic databases, the Boolean
operators ‘OR’ as well as ‘AND’ were used. The Boolean operators can be defined as
connectors that help in connecting the key words so as to retrieve a refined and a relevant
search (Tesch 2013). One example of using the Boolean operators to conduct a search can be
explained as the combination of the key words as emotional exhaustion OR Burnout AND
nursing professionals AND emergency department AND Saudi Arabia.
2.3: Overview on stress and related outcome on nursing professionals working within
the ED
Definition and nature of stress
According to Lamdah and Sayed (2014), stress can be defined as an emotional
attribute that affects the physical as well as the mental wellness of an individual. A number of
research studies have reported a strong association between burnout resulting due to stress
and employee turnover (Mosadeghrad 2013). This has emerged as a major concern for the
organizational wellness and productivity. Practically, stress has been reported to trigger
feelings of dissatisfaction and emotional strain on employees working within an organization
(Keriri 2013). Stress has been defined according to multiple perspectives however,
commonly it has been studied as the primary reason that leads to dissatisfaction among
employees as a result of workplace stress. Research studies define stress as a condition
characterized by psychological and mental disturbance that limits the ability of an individual
to cope with regular activities (AbuRuz 2014; Karkar et al. 2015). Research studies further
indicate that stress is primarily caused due to extensive workload, stretched shift hours and
unpleasant work environment (Alsaqri 2014). Therefore, to summarise it can be mentioned

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that stress leads to psychological distress and causes burnout syndrome in professionals
which subsequently leads to employee turnover and at the same time also affects the level of
productivity (Eswi et al. 2013).
Symptoms of stress
Upon defining stress, it is extremely important to develop an understanding about the
symptoms that trigger stress among professionals. Research studies typically characterize
stress symptoms into three basic categories that include physiological, emotional and
behavioural symptoms. According to Al-Qahtani (2015), the underlying physiological
symptoms of stress include symptoms which is marked by the fluctuation in blood pressure,
respiratory rate, heart beat and excessive sweating. Upon overlooking the fluctuations caused
in the vital signs there could be possibility that fatal events such as cardiac arrest, elevated
cholesterol levels or eating and sleeping disorders mightoccur. On the emotional front,
symptoms such as anxiety, tension, depression, mental exhaustion, lower self-esteem and
lower self-confidence could manifest itself. As stated by Cañadas-De la Fuente et al.(2015),
elevated levels of mental stress leads to poor level of job satisfaction and causes the burnout
syndrome. Further, on the behavioural front, symptoms such as decrease in performance
output, abstinence, increase in turnover rate, higher dependence on substance abuse such as
smoking, unexpected mood swings and experiencing difficulty while concentration can be
explained as the most common and prevalent symptoms that are manifested due to excessive
work stress (Eswi et al. 2013).
Sources of stress
Research studies indicate that work stress could manifest itself on account of a
number of reasons. The reasons could either be intrinsic or extrinsic (Abu Ruz 2014).
According to Alsaqri (2014), poor ability to balance and manage professional as well
personal life generates stress in an individual which ultimately hampers the level of
productivity of an employee. In addition to this, it should be noted that research studies have

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revealed that stretched shift hours and excessive workload has also lead to the generation of
work related stress (Al-Hosis et al. 2013). Further, lack of adequate staffing within a hospital
automatically leads to over burden of workload that causes stress among care professionals
working in a health care setting (Attar 2014; Almajwal 2016). In addition to this, factors such
as incivility or bullying by fellow colleagues, supervisors as well as patients and their family
members has also been reported as a source of work pressure for nursing professional (Al
Sareai et al. 2013). In addition to this, other factors such as stagnation of designation or job
role and lack of appropriate opportunities to train or move on to a better or higher designation
also leads to stress among nursing professionals (Alsaqri 2014). A research study conducted
by Al-Makhaita et al. (2014), evaluated that more than 70% of the graduate nurses considered
leaving the profession on account of lack of a clear job role and excessive work load. In
addition to this, factors such as job role ambiguity, conflicts with other employees and work
related pressure were reported to the major reasons that caused stress among 433 care
professionals who were representatives from the seven legislative areas of Kuwait (Almajwal
2016). Another research suggested that the nature of profession and the threats from the
family members of the patient led to the emergence of stress among the employees (Al-
Qahtani 2015). A large number of research studies have revealed that burn out syndrome is
common among care professionals and other multidisciplinary professionals who are
associated with the health care profession (Canadas et al. 2015; Attar 2014; Al-Makhaita et
al. 2014). A research conducted by Eswi et al. (2013), revealed that nursing professionals and
attendants were twice most likely to affected with the burnout syndrome rather than
physicians or specialists. A research conducted by Hamaideh et al. (2017) suggested that
14.4% of the nursing professionals and attendants working within the emergency unit
experienced the burnout syndrome. The study also indicated that the level of burnout varied
between professionals and depended upon the nature of their work and the unit where they

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were placed (Hamaideh et al. 2017). A research study conducted by Keriri (2013) suggested
that care professionals working as medical attendants within the emergency department felt
symptoms of exhaustion and fatigue. According to Al Hosis et al. (2013), it was found that
nursing professionals working within the neonatal and maternal emergency units experienced
psychological and physical stress and considered leaving the profession within 6 months of
placement (Gillespie, Gates and Berry 2013).
Outcome of work-stress
On the basis of the reviewed scholarly literatures it was found that work stress
invariably resulted in causing the burnout syndrome (Hamaideh et al. 2017; Hamaideh
2014) . In addition to this, a number of behavioural issues such as stress related to the nature
of work, conflicts and poor relationship with colleagues and increase in the application of
leaves was detected in patients (Keriri 2013; Karkar et al. 2015). In addition to this a marked
increase in the rate of anxiety and fear related to stress and work performance was also
evaluated (Mosadeghrad 2013). Another research study conducted on the care professionals
placed within the hospital settings of Saudi Arabia indicated that emotionally exhausted
nurses were bound to quit their profession (Adriaenssens et al. 2015). Also, nurses working
within care units that had an organized structure and lesser work flow had professionals who
wanted to sustain in the profession (Kim et al. 2014). It can hence be stated that stress could
trigger physical and mental health wellness issues such as cardiac health issues, substance
abuse dependence and emotional wellbeing (Rushton et al. 2015). Therefore, upon adapting
stringent measures to regulate the sources of work stress, care professionals could be offered
respite from the burnout syndrome and work related exhaustion symptoms.
Socio-demographic variables and work-stress
Research studies have critically suggested that nurses working within the emergency
department of a healthcare setting felt a variance in between the emotions of fear and anxiety
(Rushton et al. 2015). A number of research studies further indicated that stress affected

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nurses belonging to diverse economic backgrounds differentially (Adriaenssens et al. 2015;
Khamisa et al. 2013). A research study conducted by Khamisa et al. (2013), mentioned that
nurses belonging to a stable economic background sustained better within the profession and
was not affected by feelings of anxiety and sadness. Another research study reported that
female nursing staff professionals were better focused than male nursing professionals
(Hayes et al. 2015; Myhren et al. 2013). Also, research studies have reported that nursing
professionals belonging to both native and non-native origin felt equally stressed due to work
pressure (Hunsaker et al. 2015). As mentioned by Laschinger and Fida (2014), nurses of non-
native origin felt increased levels of work stress and work burden and considered leaving the
profession on account of experiencing burnout.
Summary:
Therefore, on the basis of the exhaustive literature review conducted, it can be
mentioned that stress is caused among nursing professionals on account of physiological,
mental as well as emotional factors (Oyeleye et al. 2013). It was typically observed from the
research findings that lower level of job satisfaction, conflicts with colleagues, harassment
and bullying, stretched shift hours, excessive work load and threatening comments and
queries from the family members of the patient led to the emergence of stress among the
nursing professionals (Neville and Cole 2013; Myhren et al. 2013). In addition to this, it was
also evaluated that the emergence of stress caused burnout syndrome and led to high rates of
turnover, dissatisfaction and hampered the mental and emotional wellness of the nurses
(Ozden et al. 2013; Neville and Cole 2013). Also, stress hampered the quality of production
and negatively affected the performance output of the care professionals. It was also found
that the level of stress varied in between nurses working across different care units (Hayes et
al. 2015; Hinderer et al. 2014). Also, stress affected the performance level of the male
nursing professionals more when compared to the female nursing professionals (Myhren et

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al. 2013). In addition to this, stress affected nurses working within the emergency department
more in comparison to other departments and it also affected nurses belonging to poor socio-
economical background (Laschinger and Fida 2014; Hunsaker et al. 2015).
Literature Gap:
Therefore on the basis of the review of literatures, a substantial gap was identified in
terms of identifying available support strategies that could help nursing professionals deal
with the level of work stress. In addition to this, a substantial literature gap was also
identified in the number of research papers that revealed the impact of stress on foreign
nurses in comparison to native nurses (Ozden et al. 2013; Ko and Lee 2013). Also, none of
the research papers considered in the research review highlighted that whether or not
psychological stress and burnout was influenced by other parameters such as age, pay scale
or social status. Although, the reviewed literatures indicated that the level of psychological
stress was maximum in nurses working within the emergency care unit, however, the claim
was not backed by a number of research studies (Neville and Cole 2013; Oyeleye et al. 2013).
This suggests that a research is required to assess the relationship between stress and the level
of performance of nurses within the emergency unit. Also, there is a need to evaluate the
existing relationship between the social determinants and the impact of stress among the
nurses working within the emergency department of a healthcare setting.

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CHAPTER 3:
Methodology
3.1: Introduction:
According to Tesch (2013), methodology forms an integral aspect while designing
and conducting a research. As stated by Taylor et al. (2015), the procedure that is used to
collect cues and informative data that helps in shaping the structure of the research can be
defined as methodology. It is extremely important to choose an appropriate methodological
procedure that closely aligns with the defined research question and the research objectives.
The methodology procedure could typically comprise of interviews, surveys or other relevant
research questions that can ideally help in interpreting the collected research data so as
retrieve relevant findings of the research (Ritchie et al. 2013). In this section of the
dissertation, appropriate research study design, setting, data collection as well as data
findings would be discussed.
3.2: Research Design:
The research study comprised of conducting a qualitative questionnaire survey where
in relevant data was collected from the participants (Flick 2018). A random data sampling
was carried out in order to facilitate the assessors to critically evaluate the data and
analytically record the data so as to critically evaluate the outcome of stress on nursing
professionals working within the emergency department of different healthcare organizations.
3.3: Research Setting:
The research study setting comprised of a number of hospitals that were located in the
cities that were looked after by the Saudi Ministry of Health. However, care was taken to
select hospitals that contained emergency wards. The targeted research participants
comprised of doctors, nurses and the allied health care professionals along with the
professionals that worked at the administration department under the Ministry of Health and

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Welfare, Saudi Arabia. It should be noted here that the hospitals that were selected were
recruited on the basis of random stratification.
3.4: Population:
The research participants that were considered for the research study included the
target audience of health care professionals and comprised of the nurses, doctors and
multidisciplinary team of care professionals. The healthcare professionals that were
considered for the research study worked under the Ministry of Health and Welfare, Saudi
Arabia.
3.5: Sampling Criteria:
The sampling criteria was chosen in a manner that it helped in recruiting participants
from the population who could provide response that critically reflected the underlying
interest of the participants. The recruited sample size was rationalized by consulting with the
Ministry of the Health Personnel. It should be noted in this context that the participants were
recruited on the basis of a set of inclusion criteria that comprised of including nursing
professionals who were registered and worked as local nursing professionals.
3.6: Sample Size:
A total of 100 registered nurses (RNs) were considered as the total sample size.
Specific measures were adapted in order to ensure that out of the 100 recruited participants,
50 nurses were local nurses who were native in origin. On the other hand, the remaining 50
nursing professionals were also registered locally but were non-native in origin and belonged
to foreign countries. In order to fulfil the requirement of stratification of the sample size, the
sample size was stratified according to the consideration of nursing per cadre clinic. Also,
50% of the population were subjected to questionnaires from among the total participants.
This made it possible to compare and contrast the results across the specified stratum so as to
acquire result based on the similarity present within the sample population.

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3.7: Variables:
The principle factors that formed the basis of the investigation process included the
three distinct considerations. The considerations comprised of the factors of work-stress,
sources of work-push and outcomes of stretched shifts (Ko and Lee 2013). Typically work
stress was found to allude to a specific circumstance where the existing skills and capacity
inherent within a nursing professional does not compare with the requests, perquisites
required to perform a certain activity. In other words, the employee needs are not aligned to
the nature of the activity. The sources of work push can be defined as the attributes defined
within a workplace which include elements of workplace stress, job struggle vagueness in
terms of job role and authoritarian principles that might lead to extensive work load (Bragard
et al. 2015). The outcomes of stretches shifts and workload lead to negative implications such
as medical health issues and mental health issues including organizational impacts such as
turnover, abstinence and experiencing the burnout syndrome (Ozden et al. 2013).
Independent Variables:
According to Marshall and Rossman (2014), an independent variable can be defined
as the factors that can exist independently and is not affected by other variables. For instance,
the age or gender of a person could be considered as an independent variable which is not
influenced by other variables or does not change with changes in other variables (Flick 2018).
The independent variables in this research includes the consideration of the demographic
profile of the patients that comprise of elements such as age, job, designation, gender,
education level, work experience and training in stress management.
Dependent Variables:
As stated by Taylor et al. (2013), dependent variables can be defined as the variables
that are dependent upon other variables or changes with a change in other variables. It should
be noted in this context that dependent variables differ or keep changing as they are directly

23DISSERTATION
influenced by other variables (Ricthie et al. 2013). For instance, a test score could be
considered as a dependable variable as it could potentially vary on the basis of factors such as
how well an individual prepares for the exam or how familiar is an individual with the
content of the subject. In this case, the dependent variables comprise of practices that are
related to the ability of the nurses to manage stress and the level of knowledge that could
assist care professionals to effectively manage stress levels.
3.8: Instrument:
The instrument that would be used to conduct the research study would comprise of a
questionnaire. The questionnaire would typically comprise of two sections. The first part of
the questionnaire would comprise of important information which would include the
information regarding the parameters of age, gender, job role and the level of professional
experience, educational level, nationality, language used to communicate and marital status.
On the other hand, the second part of the questionnaire would comprise of questions which
would help in evaluating the level of stress that the participants are subjected to in their
professional role. The questionnaire would be evaluated on the basis of a five point scale
which would be graded as: Strongly disagree= 1, disagree=1, do not know=3, agree=4 and
strongly agree= 5. In order to develop an understanding about the validity of the content, the
steps would be followed in an orderly manner and the items incorporated within the
questionnaire was developed only after the retrieved literatures were thoroughly reviewed.
While conducting the literature review, important notes were taken down in order to
conveniently analyse the data findings.
3.9: Validity and Reliability:
The validity of the research study typically confirms the discoveries and inventions
and supports the claims made by the proposal. Typically, a bridge exists between the

24DISSERTATION
specialists understanding and real evidence that supports a claim. In order to validate the
literature review, a literature review trail was left behind (Taylor et al. 2015). Also, a record
of exercises is generally trailed by another analyst. In other words, this helped in recognizing
a picture of what has already been done and also helped in estimating what is left unfinished
(Ritchie et al 2015).
The reliability helps in securing a set of information over a predefined time and a set
of considerations. It enables researchers to rely upon the exploration of discoveries and helps
in establishing truth in the measured outcomes (Flick 2018). It should be mentioned in this
context that reliability review was guaranteed through the inclusion of the special
considerations enlisted by the Ethics and Research committee under the Ministry of Health in
Saudi Arabia.
However, this does not rule out the possibility of the existence of a factor of
transferability which suggests that quantitative as well as subjective discoveries could be
exchanged to different settings as a part of dependability on the part of the researcher
(Silverman 2016). The setting of examination undermine the evaluation of the critical system
that determine the level of transferability present within a specific set of data (Marshall and
Rossman 2014). In this research, the research outcome could be exchanged to the medical
professionals who were responsible for managing the administration and administrative
process in respective offices.
3.10: Pilot Study:
After obtaining the approval from the Ethics and Research Committee, a pilot study
was conducted at the medical centre. A few questionnaires were distributed to 10 nursing
professionals who were working at the Emergency Unit of the medical centre (ENTER THE
NAME OF THE HOSPITAL). The purpose of the pilot test was to assess the validity and the
reliability of the research tool that was being used to conduct the research study. The

25DISSERTATION
rationale for the choice of the medical centre could be explained as a considerable number of
professionals working in the emergency unit of the hospital where a large number of patients
were admitted who were suffering from critical health conditions and the nurses involved in
the care process self-reported to be stressed (Bragard, Dupuis and Fleet 2015).
3.11: Data Collection Procedure:
The data collection would be conducted by retrieving responses of the questionnaires
as statistical analysis of questionnaire responses can be conducted conveniently (Corbin,
Strauss and Strauss 2014; Silverman 2016). The questionnaires would be reviewed and
aligned to the test results of the pilot study. The questionnaires would be given separately to
the individuals working at the emergency wards of the hospitals where the study would be
conducted. After distributing the questionnaire, ample amount of time would be given to the
participants and along with the questionnaire an introductory letter would be given to the
participants which would highlight the objectives of the study (Marshall and Rossman 2014).
Finally, the responses of the participants would be retrieved.
3.12: Data Analysis:
After collection of the obtained data the SPSS software would be used to analyse the
collected data. The SPSS software is also known as the statistical packages for Social
Sciences and it would be used to analyse and retrieve the consistency present in the
completed questionnaires (Ritchie et al. 2013; Corbin, Strauss and Strauss 2014). Descriptive
statistics would also be implemented along with the continuous variables as well as the
categorical variables so as to evaluate the variable percentage and the frequency distributions
(Flick 2018). ANOVA test was used in order to assess the knowledge along with the level of
educational qualification of the nurses who participated in the questionnaire.
3.13: Ethical Consideration:
As stated by Tesch (2013), complying with ethical considerations form an integral
aspect of a research study. In order to obtain an approval for the research, an approval was

26DISSERTATION
sought from the institution where the research was conducted (Taylor et al. 2015). In addition
to this, an approval was also obtained from the ministry of health, Saudi Arabia. Also, the
requirement of informed consent was sought from the respondents of the research study. The
informed consent was obtained after getting a hardcopy of signed consent form from the
participants. The consent form was mailed to the participants along with a debriefing form
that clearly highlighted the purpose and the rationale for conducting the research. Prior to
obtaining the signed copies of the consent form it was ensured that the participants has a clear
idea about the research study and were equally interested to participate in the research study
(Taylor et al. 2015). At each stage, the doubts of the participants were clarified so as to avoid
the presence of potential ambiguity.

27DISSERTATION
Chapter 4:
Data Analysis and Discussion:
Variable declaration and measures:
Options and (measures)
Demographics
Age 20 to 30
(1)
31 to 40
(2)
41 to 50
(3)
50 to 60
(4)
60+
(5)
gender Male (1) Female
(2)
National origin Saudi
Arabia
Other
middle
eastern
country
Europe American
continent
Asia
Job role General
Caregiver/
support
(1)
Registered
nurse (2)
Supervisor
(3)
Experience Internship <1 year 1 to 5 year 5 to 10
year
>10 years
Emergency word Yes (1) No (2)
Stress level Very Low
(1)
(2) (3) (4) Very High
(5)
Influencing Factors
Long time work Highly
disagree
(1)
Disagree
(2)
Neutral (3) Agree (4) Highly
agree (5)
Workload Very Low
(1)
(2) (3) (4) Very High
(5)
Effectiveness of Management Very Low
(1)
(2) (3) (4) Very High
(5)
Professional Training Very Low
(1)
(2) (3) (4) Very High
(5)
Physical working environment Very Low
(1)
(2) (3) (4) Very High
(5)
Workplace culture Extremely
Poor (1)
(2) (3) (4) Very
motivating
(5)
Outcomes
Job Satisfaction Very Low
(1)
(2) (3) (4) Very High
(2)
Anger or agitation Never (1) Rarely (2) Sometimes
(3)
Often (4) Always
(5)
Health issues Never (1) Rarely (2) Sometimes
(3)
Often (4) Always
(5)
Depressive mood Never (1) Rarely (2) Sometimes
(3)
Often (4) Always
(5)

28DISSERTATION
Cope-up strategies
Involving in recreational
activity
Never (1) Rarely (2) Sometimes
(3)
Often (4) Always
(5)
Increasing verbal
communication with peers
Never (1) Rarely (2) Sometimes
(3)
Often (4) Always
(5)
Consulting psychologists or
counsellors
Never (1) Rarely (2) Sometimes
(3)
Often (4) Always
(5)
Practicing deep breathing and
other relaxing exercise
Never (1) Rarely (2) Sometimes
(3)
Often (4) Always
(5)
Focusing on professional aims Never (1) Rarely (2) Sometimes
(3)
Often (4) Always
(5)
Cronbatch’s alpha reliability test:
Pilot survey was conducted on 10 participants. The reliability test has been done by taking
random 9 ordinal variables from the survey results
Case Processing Summary
N %
Cases Valid 10 100.0
Excludeda 0 .0
Total 10 100.0
a. Listwise deletion based on all variables in
the procedure.
Reliability Statistics
Cronbach's
Alpha
N of Items
.874 9
The apha value 0.874 indicates that the 87% results of the conducted survey is completely
reliable. Hence the survey method was accepted for final survey execution on 100
respondents.
Correlations
Age Gender Job_rol
e
Experienc
e
Stress_level
Age Pearson Correlation 1 .034 .634** .904** -.312**
Sig. (2-tailed) .739 .000 .000 .002

29DISSERTATION
N 100 100 100 100 100
Gender Pearson Correlation .034 1 -.010 -.005 -.169
Sig. (2-tailed) .739 .922 .960 .093
N 100 100 100 100 100
Job_role Pearson Correlation .634** -.010 1 .708** -.362**
Sig. (2-tailed) .000 .922 .000 .000
N 100 100 100 100 100
Experience Pearson Correlation .904** -.005 .708** 1 -.347**
Sig. (2-tailed) .000 .960 .000 .000
N 100 100 100 100 100
Stress_lev
el
Pearson
Correlation
-.312** -.169 -.362** -.347** 1
Sig. (2-tailed) .002 .093 .000 .000
N 100 100 100 100 100
**. Correlation is significant at the 0.01 level (2-tailed).
According to the significant value 0.09 (>0.05) gender is not correlated with the stress level.
Other demographic variables such as Age, job role, Experience are highly correlated with the
stress. Considering the negative correlation values it can be said that all the correlated
variables are inversely proportional with stress level. That signifies that lower aged people
have higher stress level, people with lower job role (support caregivers) has higher stress
level and people with lower experience have higher stress level.
T-test to examine whether people in emergency word have higher stress
Group Statistics
Emergency_word N Mean Std.
Deviation
Std. Error
Mean
Stress_level 1 66 3.74 .966 .119
2 34 2.53 .706 .121
Independent Samples Test
Levene's
Test for
Equality of
Variances
t-test for Equality of Means
F Sig
.
t df Sig.
(2-
tailed
Mean
Differen
ce
Std.
Error
Differen
95%
Confidence
Interval of the

30DISSERTATION
) ce Difference
Low
er
Uppe
r
Stre
ss_l
evel
Equal
variances
assumed
4.57
2
.03
5
6.4
79
98 .000 1.213 .187 .841 1.585
Equal
variances not
assumed
7.1
46
86.4
44
.000 1.213 .170 .876 1.550
From 2 groups independent sample T-test it has been found the significant value 0.00 is lower
that 0.05 (P value). Hence, there is a statistically significant difference between the
emergency word nurses and other nurses in terms of stress level. With this validation it can
be clearly seen that the nurses who works in emergency has higher mean value of stress level
(approximately 1.5 higher).
Individual regression analysis of independent variables (Working hour, workload,
workplace culture, physical environment, professional training and effectiveness of
management) with Stress level
Model Summary
Mode
l
R R
Square
Adjusted R
Square
Std. Error of
the Estimate
1 .960a .923 .922 .295
a. Predictors: (Constant), Working_hours
The outcome is (0.92x100)=92% correct and reliable
ANOVAa
Model Sum of
Squares
df Mean
Square
F Sig.
1 Regression 101.583 1 101.583 1167.46
5
.000b
Residual 8.527 98 .087
Total 110.110 99
a. Dependent Variable: Stress_level
b. Predictors: (Constant), Working_hours

31DISSERTATION
Coefficientsa
Model Unstandardized Coefficients Standardized
Coefficients
t Sig.
B Std. Error Beta
1 (Constant) .220 .096 2.299 .024
Working_hours .937 .027 .960 34.168 .000
a. Dependent Variable: Stress_level
The significance value is 0.02, which is lower than the probability value 0.05. Hence, Stress
level is highly dependent on long working hours. The positive t value (32.1), indicates that
the relation is direct. Hence, Higher working hours is causing higher stress level.
Model Summary
Mode
l
R R
Square
Adjusted R
Square
Std. Error of
the Estimate
1 .991a .983 .983 .139
a. Predictors: (Constant), Workload
The outcome is (0.98x100)=98% correct and reliable
ANOVAa
Model Sum of
Squares
df Mean
Square
F Sig.
1 Regression 108.211 1 108.211 5582.96
6
.000b
Residual 1.899 98 .019
Total 110.110 99
a. Dependent Variable: Stress_level
b. Predictors: (Constant), Workload
Coefficientsa
Model Unstandardized Coefficients Standardized
Coefficients
t Sig.
B Std. Error Beta
1 (Constant) .096 .045 2.122 .036
Workload .977 .013 .991 74.719 .000
a. Dependent Variable: Stress_level

32DISSERTATION
The significance value is 0.00, which is lower than the probability value 0.05. Hence, Stress
level is highly dependent on workload during working hours. The positive t value (74.7),
indicates that the relation is direct. Hence, Higher workload during working hours is causing
higher stress level.
Model Summary
Mode
l
R R
Square
Adjusted R
Square
Std. Error of
the Estimate
1 .028a .001 -.009 1.060
a. Predictors: (Constant), Effectiveness_management
The outcome is only (0.09x100)= 9% correct which indicates that the result is not reliable.
Hence the test results for effectiveness of management have been excluded.
Model Summary
Mode
l
R R
Square
Adjusted R
Square
Std. Error of
the Estimate
1 .859a .738 .736 .542
a. Predictors: (Constant), Professional_Training
The outcome is (0.73x100)=73% correct and reliable
ANOVAa
Model Sum of
Squares
df Mean
Square
F Sig.
1 Regression 81.296 1 81.296 276.500 .000b
Residual 28.814 98 .294
Total 110.110 99
a. Dependent Variable: Stress_level
b. Predictors: (Constant), Professional_Training
Coefficientsa
Model Unstandardized Coefficients Standardized
Coefficients
t Sig.
B Std. Error Beta
1 (Constant) 5.766 .156 36.910 .000
Professional_Training -.899 .054 -.859 -16.628 .000
a. Dependent Variable: Stress_level

33DISSERTATION
The significance value is 0.00, which is lower than the probability value 0.05. Hence, Stress
level is highly dependent on personal. The negative t value (-16.6), indicates that the relation
is inverse. Hence, lack of professional training is causing higher stress level among nurses.
Model Summary
Mode
l
R R
Square
Adjusted R
Square
Std. Error of
the Estimate
1 .920a .847 .845 .415
a. Predictors: (Constant), Physical_environement
The outcome is (0.84x100)=84% correct and reliable
ANOVAa
Model Sum of
Squares
df Mean
Square
F Sig.
1 Regression 93.209 1 93.209 540.466 .000b
Residual 16.901 98 .172
Total 110.110 99
a. Dependent Variable: Stress_level
b. Predictors: (Constant), Physical_environement
Coefficient
Model Unstandardized Coefficients Standardized
Coefficients
t Sig.
B Std. Error Beta
1 (Constant) 5.944 .120 49.586 .000
Physical_environement -.990 .043 -.920 -23.248 .000
a. Dependent Variable: Stress_level
The significance value is 0.00, which is lower than the probability value 0.05. Hence, Stress
level is highly dependent on Physical environment. The negative t value (-23.2), indicates
that the relation is inverse. Hence, lower physical work environment is causing higher stress
level.
Model Summary
Mode
l
R R
Square
Adjusted R
Square
Std. Error of
the Estimate
1 .916a .840 .838 .424
a. Predictors: (Constant), Workplace_culture
ANOVAa

34DISSERTATION
Model Sum of
Squares
df Mean
Square
F Sig.
1 Regression 92.456 1 92.456 513.230 .000b
Residual 17.654 98 .180
Total 110.110 99
a. Dependent Variable: Stress_level
b. Predictors: (Constant), Workplace_culture
Coefficientsa
Model Unstandardized Coefficients Standardized
Coefficients
t Sig.
B Std. Error Beta
1 (Constant) 5.846 .119 49.169 .000
Workplace_culture -.942 .042 -.916 -22.655 .000
a. Dependent Variable: Stress_level
The significance value is 0.00, which is lower than the probability value 0.05. Hence, Stress
level is highly dependent on Workplace culture. The negative t value (-23.2), indicates that
the relation is inverse. Hence, poor workplace culture is causing higher stress level among
nurses.
Correlation between the estimated results of the work life stress among nurses
Correlations
Stre
ss_l
evel
Job_satisfac
tion
Anger_agi
tation
Healt
h_iss
ues
Depressio
n
Stress_level Pearson
Correlation
1 -.915** .987** .973** .983**
Sig. (2-tailed) .000 .000 .000 .000
N 100 100 100 100 100
Job_satisfacti
on
Pearson
Correlation
-.91
5**
1 -.904** -.899*
*
-.897**
Sig. (2-tailed) .000 .000 .000 .000
N 100 100 100 100 100
Anger_agitati
on
Pearson
Correlation
.987
**
-.904** 1 .978** .996**
Sig. (2-tailed) .000 .000 .000 .000
N 100 100 100 100 100
Health_issue Pearson .973 -.899** .978** 1 .982**

35DISSERTATION
s Correlation **
Sig. (2-tailed) .000 .000 .000 .000
N 100 100 100 100 100
Depression Pearson
Correlation
.983
**
-.897** .996** .982** 1
Sig. (2-tailed) .000 .000 .000 .000
N 100 100 100 100 100
**. Correlation is significant at the 0.01 level (2-tailed).
Estimated effective variables such as job satisfaction, anger issues, health issues and
depression level are highly correlated with the stress level. Considering the negative
correlation value of job satisfaction it can be said that job satisfaction are inversely
proportional with stress level. That signifies that higher stress level is causing lower job
satisfaction. Similarly, the positive correlation values of other variables signify that higher
stress level is causing higher anger and agitation problem, higher stress level is causing
frequent health problems, higher stress level is causing higher depressive mood among the
nurses.
Coping up practices among nurses
Mean SD Interpretation
Involving in recreational
activity
2.86 0.65 Sometimes
Increasing verbal
communication with
peers
4.25 0.95 Always
Consulting psychologists
or counsellors
2.67 0.89 Sometimes
Practicing deep breathing
and other relaxing
exercise
3.68 0.78 Often
Focusing on professional
aims
1.95 0.28 Rarely

36DISSERTATION
Chapter 5:
Conclusion
On the basis of the literature review it was found that stress led to emergence of burn
out syndrome among nursing professionals. It was further found that the level of stress poorly
affected the performance level of the nursing professionals. In addition to this, on account of
stretched shift hours and excessive workload and stagnation of job role, majority of the
nursing professionals considered leaving the profession. A number of research studies also
indicated that the level of emotional stress was more among the nurses working within the
emergency unit of the hospital. It was also found that the level of stress affected foreign
nursing professionals more in comparison to native nursing professionals working within a
health care organization. It was also found that stress affected male care professionals more
in comparison to female care professionals.
Further the pilot study was conducted on 10 nursing professionals and the reliability
was tested by considering 9 variables. According to the pilot study it was found that the
survey was completely reliable. From the correlation test it was found that lower aged people
experienced higher stress level. In addition to this it was also found that nurses with lower job
roles experienced more stress compared to nursing professionals who were placed ahead in
the hierarchal structure of the organization. It was further found that gender was not
correlated with the stress level. Also, demographic variables such as age, job role and
experience highly correlated with stress. Interestingly, the results revealed that lower aged
people experienced higher stress levels in comparison to nurses who were older. Also, it was
found that professionals who were employed at a lower job role experienced higher level of
stress compared to professionals who were employed at a higher designation. Further, on the
basis of the T-test result it was found nursing professionals working in the emergency units

37DISSERTATION
experienced higher level of stress levels. This could be validated by the detection of higher
mean value of stress among the nursing professionals working within the emergency ward.
Further, the individual regression analysis of the independent variable suggested that stress
was directly depended on the duration of work hours. Longer working hours and stretched
shift hours caused stress among the nurses. It was also evaluated that lack of professional
training led to higher level of stress among the nursing professionals. Also, work
environment directly affected the level of stress and exhaustion experienced by the care
professionals. In addition to this, stress level was equally found to be dependent on the
workplace culture. Variables such as job satisfaction, frustration, health issues as well as
depression was found to be directly related with the stress levels. However, the level of job
satisfaction and stress level shared an inversely proportionally relationship. It was typically
observed that professionals that experienced higher level of stress were poorly satisfied with
their job role. In simple words, higher stress level led to poor job satisfaction. Higher stress
on the other hand 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.
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. Overall, this research study helped in developing an
idea about the factors that triggered stress among the emergency nurses and also helped in
evaluating the impact of stress among the nursing professionals working within the different
care units in a healthcare organization. However, future research studies could focus on
evaluating the experiences of the nursing professionals with respect to stress and could
present. This could be done by adapting a qualitative approach and using a semi-structured

38DISSERTATION
interview research design. This would help in analysing the experiences of the care
professionals on a broader note and would equip policy makers of the healthcare
organizations to plan support strategies that could be used for reinforcing a positive work
environment. Also, the organization could implement counselling session and professional
training cells which could help professionals in dealing with job related stress and at the same
time promote scope of professional enhancement.

39DISSERTATION
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44DISSERTATION
Appendix 1:
Gantt Chart:

45DISSERTATION
Appendix 2:
Questionnaire:
Questions Select any one from these options
Q1 What is your Age 20 to 30 31 to 40 41 to 50 50 to 60 60+
Q2 What is your
gender
Male Female
Q3 National origin Saudi
Arabia
Other middle
eastern country
Europe American
continent
Asia
Q4 Job role General
Caregiver/
support
Registered
nurse
Supervisor
Q5 Experience Internship <1 year 1 to 5 year 5 to 10
year
>10 years
Q6 Do you work in
emergency word
Yes No
Rate the following
factors:
Q7 Stress level due to
professional life
Very Low Low Moderate High Very High
Q8 Long time or
overtime work
hours
Highly
disagree
Disagree Neutral Agree Highly
agree
Q9 Workload during
work hours
Very Low Low Moderate High Very High
Q10 Effectiveness of
Management
Very Low Low Moderate High Very High
Q11 Professional
Training
Very Low Low Moderate High Very High
Q12 Quality of physical
working
environment
Very Low Low Moderate High Very High
Q13 Work culture Extremely
Poor
Poor Moderate Good Very good
Q14 Job Satisfaction
level
Very Low Low Moderate High Very High
Q15 Experiencing
temperament loss
or agitation
Never Rarely Sometimes Often Always
Q16 Experiencing
health issues
Never Rarely Sometimes Often Always
Q17 Experiencing
depressive mood
(sadness)
Never Rarely Sometimes Often Always

46DISSERTATION
Rate as per what do you usually do to cope up with work pressure:
Q18 Involving in
recreational activity
Never Rarely Sometimes Often Always
Q19 Increasing verbal
communication
with peers
Never Rarely Sometimes Often Always
Q20 Consulting
psychologists or
counsellors
Never Rarely Sometimes Often Always
Q21 Practicing deep
breathing and other
relaxing exercise
Never Rarely Sometimes Often Always
Q22 Focusing on
professional aims
Never Rarely Sometimes Often Always