HLN405 Research Proposal: Female Nurses' Stress Management Practices

This research proposal investigates the stress management practices of female nurses, comparing experiences in Saudi Arabia and Australia. The study aims to identify high-risk stress factors, explore coping strategies, and provide an overview of healthcare sectors in both countries. Employing q...Read More

Running Head: NURSES OCCUPATIONAL STRESS MANAGEMENT 1
Proposal Title; Female Nurses’ Stress Management Practices: A cross-cultural comparison
between Saudi Arabia and Australia.
Student Name;
Student Admission:
University Supervisor;

NURSES OCCUPATIONAL STRESS MANAGEMENT 2
Table of Contents
Female Nurses Stress Management Practices; Cross-cultural Comparison.................................................3
Research Statement.....................................................................................................................................3
Objectives....................................................................................................................................................3
Literature Review........................................................................................................................................3
Methodology...............................................................................................................................................4
Study Plan...................................................................................................................................................4
Expected Results.........................................................................................................................................4
Conclusion...................................................................................................................................................5
Introduction.................................................................................................................................................5
Methodology...............................................................................................................................................6
Qualitative questionnaire.............................................................................................................................7
UtterHealth Questionnaires.........................................................................................................................7
Stress Management Strategies.....................................................................................................................9
Findings.....................................................................................................................................................10
Overworking as a factor related to stress in nursing professionals.........................................................10
Handling of Patients Demands and Needs.........................................................................................10
Loopholes in this research method............................................................................................................12
Observation as a research tool...................................................................................................................13
Study of Saudi Arabian Medical Nursing Records....................................................................................13

NURSES OCCUPATIONAL STRESS MANAGEMENT 3
Theoretical Framework..............................................................................................................................15
The relevance of the Research...................................................................................................................16
Conclusion.................................................................................................................................................16
References.................................................................................................................................................17

NURSES OCCUPATIONAL STRESS MANAGEMENT 4
Female Nurses Stress Management Practices; Cross-cultural
Comparison
Research Statement
Did you know, occupational stress levels in the nursing workforce is estimated to range from
9.2% to 68% globally ( Shahroud University of Medical Sciences, 2018)? There has been a
reported number of increases in stress levels among nurses, especially those working on night
shifts globally. Some factors contributing to stress levels among nurses include overworking and
nurse shortages across health institutions. This research will apply qualitative research
methodologies in assessing the stress management strategies among nurses working night shifts
across two different countries and cultures; Australia and Saudi Arabia.
Objectives
 Identify high-risk factors causing stress among nurses
 Identify key strategies on how nurses manage stress levels
 Get an overview of health sectors in both Australia and Saudi Arabia
Literature Review
With the robust growth and improvements in the health sector globally, professional health labor
requires has been noted to unequal in relation to nurse per patient ratio (American Nurses
Association, 2019). This has led to a noted increase in stress levels in medical nurses worldwide
(Timothy R. Jordan, 2016). This research employs qualitative methods of research, that is;
observation, qualitative questionnaires, and exploration of medical records to aid in

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understanding the causes of stress in nurses across Saudi Arabia and Australia and how nurses
cope and manage stress in their professions.
A thorough study of Saudi Arabian health sector will be conducted, accompanied by interviews
and observations from the teaching hospitals I do my clinical trials. The data will be analyzed
through pie charts and an explanation and conclusion of the results deducted will be done.
Methodology
The research methodologies play a key role in gaining an in-depth view of the environment,
challenges, motivations and coping strategies that nurses apply in their field of work (Nursing
Dept., University of Huelva, 2019). Qualitative research methodologies such as observation, the
study of existing Saudi Arabian historic medical documents and interviews will be used in the
research to gain an in-depth understanding of nurses’ cultures.
Study Plan
The research and study strategy applied in this research will employ two strategies; first, a
thorough study of existing medical records from the internet from Australian and Saudi Arabian
hospitals will be done and observation of nurses in the hospital where I do my clinical trials. I
will administer qualitative questionnaires to six female nurses of whom I am close with to gain
detailed information.
Expected Results
Expected results may include understanding the nursing field a bit from a view of across two
cultures, that is Saudi Arabia and Australia. The practices nurses use to cope with stress in their
profession will also be given a thorough review in this study to help identify the most relevant

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and used stress coping mechanisms, such as talking to friends, avoidance and spiritual coping, by
female registered nurses.
Conclusion
Nurses face a variety of hurdles in their daily occupational activities, from dealing with hostile
patients to strained relationships with fellow medics and experiencing traumatizing events that
can be too much to bear for a less- equipped person. Thus, we need to understand the challenges
our medical nurses face in their day to day professional work and the triggers of stress among
nurses. This study could prove helpful in developing key methods to create a work friendlier
environment for nurses, which would only benefit everyone involved and improve the quality of
nurses’ lives and healthcare quality globally.
Introduction
Nurses, professionals play such a critical role in the society since time immemorial, face
challenges in their day to day work that none of us could imagine. From being overworked, the
inadequacy of experienced nurses in the sector, to a lack of adequate skills to deal with the
emotional needs of a patient, nurses experience factors that can lead to psychological torment.
Nurses also encounter a lack of adequate medical equipment to aid terminally ill patients.
Fortunately, the health sector is growing globally, with many numbers of hospitals both private
and public, scientific research institutions and public health institutions being developed. The
current global nurse workforce is estimated to be below average in the estimate of nurse per
patient care and this negatively impacts the standards of health care (Haddad1 & Toney-Butler.,
2019). This research project will apply qualitative research methodologies in understanding the

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basic stress-causing factors among nurses in Australia and Saudi Arabia and mainly focus on
how the female nurses on night shift manage their stress levels.
Methodology
Qualitative Research is a methodology that seeks explanation of people's behavioral patterns in
their natural setting (Barney G Glaser, 2017). It is exploratory research. Qualitative research
seeks motivation and opinions. This type of research develops informative results and data on a
smaller number of people and is a very efficient form of research. Qualitative research
methodologies will be applied in this research project, such as observation, qualitative
questionnaire, and research on medical records. Qualitative research mainly expounds on why
other than the what of social behavior. Some forms of qualitative research methods include;
Phenomenological study – This is a form of qualitative research deals with the explanation of
activity and phenomenon using a combination of research methods. It involves conducting of
around five to twenty-five interviews.
Ethnography - This refers to the process a researcher immerses him/herself in the day to day
environment of the respondents to have a clear understanding of their motivations and
challenges.
Case Study - Case studies deal with the explanation of an event or a business entity through the
use of multiple data research sources.
Narrative Study – This involves an understanding of certain events by analyzing the views of one
or two people to form a story.
Biographies – Biographical Research is a type of qualitative research involved with the
reconstruction of the life events of a certain person through the study of existing documents.

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Grounded Theory – This research theory deals with the explanation of the causations behind the
scenes. It is conducted through the study of existing documents and interviewing of respondents.
Qualitative questionnaire
I submitted six questionnaires to only female friend nurses of mine at a hospital here in
Australia, The Royal Melbourne Hospital. The questionnaire was submitted to registered nurses
with over twenty years’ experience in the Australian Health Sector. This is to gain a deeper
insight into the sector through the vast experience of the registered nurses. A sample of the
questionnaire is provided below;
UtterHealth Questionnaires
PLEASE ANSWER THE QUESTIONS BELOW AS GUIDED WITH A RELEVANT * OR X
MARK AS GUIDED.
Causes of Stress in nurses
1. Overworking
Do you consider yourself overloaded in your profession as a nurse?
 Yes ( )
 No ( )
How much overtime would you estimate you overwork on a weekly basis? (Inclusive of night
shifts too)
 0-10 hrs

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 11-20hrs
 21-30 hrs
 31-40 hrs
 41 or more
2. Patients Demands and Emotional Needs.
Would you consider nurses well equipped to handle the patients’ general emotional needs and
wants?
Strongly Agree ( )
Agree ( )
Neutral ( )
Disagree ( )
Strongly Disagree ( )
Do you consider some patients' demands and needs a stressful encounter in your daily
profession?
Yes ( )
No ( )
On a stress level of 1- 10 how would you rate patient demands and needs as a stress-causing
factor to you as a nursing professional?
1-3 ( )
4-7 ( )
8-10 ( )
3. Ethical and Legal regulations

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Do you consider modern strict ethical and legal health guidelines a major stress-related factor in
your field of work?
Strongly Agree ( )
Agree ( )
Neutral ( )
Disagree ( )
Strongly Disagree ( )
Have you ever been implicated as a defendant in a lawsuit by a patient?
Yes ( )
No ( )
Any Further Comment Relevant to the Study can be Indicated Below.
Stress Management Strategies
Which of the following methods do you use to relieve professional related stress? (Multiple
choices are allowed)
Social Support ( )
Sufficient Rest ( )
Avoidance ( )
Spiritual Coping ( )
Exercise ( )
Hobbies ( )
Sleeping ( )
Eating ( )

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Monitoring of Situation ( )
Findings
Overworking as a factor related to stress in nursing professionals
Out of the six I questioned on overworking, five agreed strongly that being overworked was an
issue in causing stress among nurses. On their estimates of hours overworked, a pie chart
representation is given below. Three argued on being overworked an average of twenty-one to
thirty hours weekly, two answered they were overworked an average of eleven to twenty hours
and the other an average of thirty one to forty hours weekly. Some commented that is the reason
they are always tired, which decreases their occupational output.
Votes
0-10 hrs
11-20 hrs
21-30 hrs
31-40 hrs
Handling of Patients Demands and Needs
On the factor regarding hostility and uncooperative patients, four of the six strongly agreed that
nurses were poorly equipped in dealing with the client's demands and two were neutral on the
matter. This clearly indicates that endless patient demands play a role in heightening stress levels
in nurses in Australia (José Carlos Santos, 2018). A pie chart representation of the nurses’ ratings

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on their view on if hostile patients heightened their stress levels is indicated below. This
indicates hostile patients increase stress levels in nurses.
Rati ngs of Stress Increase in relati on to
Pati ent Hosti lity
0 to 3 4 to 7 8 to 10
Ethical and Legal Regulations
Of the six interviewed, three said they had been taken to court by patients at one point in their
careers. The rest of the three had never been handed a lawsuit in their nursing careers. But all
strongly agreed that strict medical policies against medical practitioners have increased stress
levels among nurses and that has impacted the quality of healthcare delivered negatively.
50%50%
Implication in medical related lawsuits
Yes
No

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Loopholes in this research method
Some loopholes in this qualitative questionnaire research method include the fact that all my
respondents were from a specific hospital, and that may lead to bias as all work under the same
conditions and this may impact their answers. The possibility of untruthful answers is also a
factor that I had to take into consideration while administering these questionnaires.
Stress Coping Mechanisms
Stress Management Strategy Number of nurses voted
Social support 5
Regular exercise 2
Eating 3
Avoidance 4
Monitoring of situation 5
Hobbies 3
Spiritual Coping 1
Sufficient Rest 3
On the stress management strategies employed, the most employed were; social support, either
from fellow nurses or close family members. Monitoring of the stressful event was also a tactic
that was applied by most respondents. Avoidance of the situation and stress eating by nurses was
also a methodology applied in stress control by nurses. Regular exercise mostly after work hours
was also significantly emphasized by the nurses as a key tool in work and also life-related stress
management (National Academies of Sciences, 2017). Three voted for both sufficient rest and
doing what one is passionate about as a coping mechanism. The rest argued that tiredness from

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being overworked derailed them from exploring their hobbies and getting adequate rest,
especially those in night shift sessions. One advocated for spiritual guidance in solving work-
related stress issues and they commented that the mechanism worked for them despite popular
belief.
Observation as a research tool
Myself as a nursing student I have observed a lot during my practical and internships in medical
institutions in relation to the matter. High employer demands is a major stress-causing factor
among nurses in their profession. Too much pressure and high employer standards discourage
nurses ( WHO, World Bank Group, 2018). The unequal patient to nurse ratios in the health
sector thus creating overworking of nurses. Exposure to infectious and sometimes lethal diseases
is also a major factor leading to stress increase among nursing professionals (University of Novo
Mesto, 2018). I have seen some nurses hesitate on giving care to patients ailing from fatal
illnesses such as Tuberculosis, Hepatitis B and HIV/ Aids Some nurses are able to manage their
careers properly and prosper but others tend to fall prey to diseases and torment that eventually
disrupts their careers.
I have observed some of the following stress management mechanisms from fellow registered
nurses in the management of stress within the work environment; some nurses prefer to spend
some time finding and doing what they love to relax their mind from professional stress. Some,
myself included preferring to exercise to wind up after work. Nurses, especially those on night
shifts, set strict sleeping timetables that enable them to ensure adequate rest (Nery, 2015).

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Study of Saudi Arabian Medical Nursing Records
Did you know, as per the World Health Organization, there are 40 registered nurses per 10,000
people in Saudi Arabia (Alsaqri, 2017)? This is despite the Saudi Arabian government's promise
to provide free and affordable healthcare to all Saudi Arabian citizens. The female registered
nurse faces multiple challenges in Saudi Arabia; such as, societal perception of nursing as a low-
status occupation, to the fear of mixing with male patients which are considered a cultural and
communal taboo. Occupational women are discriminated against in Saudi Arabia. The fear of not
being considered a marriageable spouse plays a critical role in why females opt for other careers
rather than nursing in Saudi Arabia (Beckerle, 2016). The increased migration of female nurses
is of increasing worry in the Saudi Arabian state. Other challenges faced by the female RN in
this state include; poor childcare facilities for working nurses who are mothers is also of note.
Long working hours and shifts of rotation have played a key part in discouraging females in
pursuing nursing as a career in Saudi Arabia (Alshehry, 2016).
Despite all the turmoil and challenges, some females make a career in nursing in Saudi Arabia by
employing coping mechanisms. Some coping mechanisms applied include; problem-solving,
which is applying one's intellect and life lessons to manage and cope with stress in nursing.
Female nurses are also noted to prefer spiritual coping mechanisms to reduce work-related stress
in Saudi Arabia (Med, 2019). Another stress management strategy noted in Saudi Arabian
female nurses is the avoidance of stress-related situations. This is believed to reduces stress
levels and promote better patient care by nurses.
This research has shown the responses received from nurses in the two countries but these results
cannot completely be accurate. It can be said that this research fails to acknowledge these factors
and consider them in their findings. This research has assumed that the minimum conditions in

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health facilities between the two countries are the same. This includes the number of patients
received, their conditions to be similar and the working conditions to also be similar in the two
countries.
Theoretical Framework
The theoretical framework above explains sand expounds on various factors that contribute to
the development of stress in nurses as per the research paper done. The diagram shows the
different causes of stress and the strategies used by nurses to cope with stress. The framework
expounds that stressors in nurses' occupation include factors such as; personal factors (this refers
activities going on in the lives of nurses leading to stress), hospital organization factors refers to
the stressor that are beyond the nurse’s control, such as, overworking, unequal nurse-patient ratio
and the level of management’s support. The framework also explains the strategies used by

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registered nurses in coping with stress, such as; social support, monitoring of the situation,
regular exercise and avoidance of the stressor. Some factors connected with a nurse's ability to
cope with occupational stress include; Age, marital status, gender, and work experience.
The relevance of the Research
The research project conducted has enabled us to gain an in a deeper understanding of the main
stressors and the stress coping strategies of female nurses in Australia and Saudi Arabia. It has
provided a mix of two diverse cultures in the nursing profession, and this can be applied
generally in the nursing professional field. The challenges encountered by nurses are also
reviewed in the paper and the best methodologies to adapt to occupational related stress are also
explained. The findings of this study can be employed by resident nursing students and nursing
staff in occupational-related stress control. The results can also aid in the implementation of laws
to create a conducive health care environment for nurses to ensure they provide quality
healthcare globally.
Conclusion
The rising cases of stress levels in nurses globally are a threat not to be taken lightly.
Occupational stress is directly linked to chronic illnesses such as; hypertension, mental health
deterioration and cardiovascular disorders (Annette Prüss-Üstün, 2016). Distressed nurses
provide poor healthcare and this greatly affects the society in terms of loss of key players in the
economy and loved one. It is predicted that the elimination of chronic illnesses could improve
Australia's labor productivity by up to ten percent. Thus, it is up to us to ensure quality

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healthcare globally by promoting the implementation of new laws in the health sector or
employing stress reduction strategies like the ones listed above.
References
Shahroud University of Medical Sciences. (2018). Evaluating the relationship between job stress
and job satisfaction among female hospital nurses in Babol: An application of structural
equation modeling. Health Promot Perspectives, 1.
WHO, World Bank Group. (2018). Delivering Quality Health Services; A Global Imperative.
World Health Organization.
Alsaqri, S. H. (2017). Stressors and Coping Strategies of the Saudi Nursing Students in the
Clinical Training: A Cross-Sectional Study. Education Research International.
Alshehry, A. (2016). Motivations and Barriers for Saudi Nurses to. UMass Amherst Scholar
Works.
American Nurses Association. (2019). Emerging Global Health Issues: A Nurse’s Role.
American Nurses Association.
Annette Prüss-Üstün, J. W. (2016). Preventing Disease Through Early Environment; A Global
Assessment of the Burden of Disease from Environmental Risks. World Health
Organization.
Barney G Glaser, A. L. (2017). Discovery of Grounded Theory: Strategies for Qualitative
Research. Taylor & Francis.

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Beckerle, K. (2016). Boxed In: Women and Saudi Arabia Male Guardianship System. Human
Rights Watch.
Haddad1, L. M., & Toney-Butler., T. J. (2019). Nursing Shortage. Rockville: National Center for
Biotechnology Information.
José Carlos Santos, J. R. (2018). European Psychiatric/Mental Health Nursing in the 21st
Century;A Person-Centred Evidence-Based Approach. Springer.
Laal, M. (2014). Job Stress Management in Nurses. SciVerse ScienceDirect, 6.
Med, A. S. (2019). Perceived stress and coping strategies among ICU nurses in government
tertiary hospitals in Saudi Arabia: a cross-sectional study. Annals Of Saudi Medicine, 4.
National Academies of Sciences. (2017). Communities in Action; Pathways to Health Equity.
National Academies Press.
Nery, E. d. (2015). Napping during the night shift and recovery after work among hospital
nurses. Rev Lat Am Enfermagem, 3.
Nursing Dept., University of Huelva. (2019). Engagement, Passion and Meaning of Work as
Modulating Variables in Nursing: A Theoretical Analysis. Environmental Research and
Public Health, 5.
Timothy R. Jordan, 1. J. (2016). The Impact of Perceived Stress and Coping Adequacy on the
Health of Nurses: A Pilot Investigation. Nursing Research and Practice, 5.
University of Novo Mesto. (2018). Stress Factors among Nurses at the Primary and Secondary
Level of Public Sector Health Care. Jasmina Starc.

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