Rajiv Gandhi University Of Health Sciences

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALOREPROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION1. NAME AND ADDRESS Ms. PRABHA MATHEW OF THE CANDIDATE IST YEAR M.Sc. NURSING N.D.R.K. COLLEGE OF NURSING B.M ROAD, HASSAN, KARNATAKA2. NAME OF THE N.D.R.K COLLEGE OF NURSING INSTITUTION B.M. ROAD, HASSAN3. COURSE OF STUDY MASTER IN PSYCHIATRIC NURSING AND SUBJECT4. DATE OF ADMISSION 06-05-2007 OF THE COURSE5. TITLE OF THE TOPIC LEVEL OF STRESS AMONG STAFF NURSES ON NIGHT SHIFT5.1 STATEMENT OF THE “A STUDY TO ASSESS THE LEVEL OF PROBLEM STRESS IN RELATED TO PSYCHO PHYSIOLOGICAL FUNCTIONS AMONG STAFF NURSES WORKING ON NIGHT SHIFT AT S.C. HOSPITAL, HASSAN, KARNATAKA” 6. BRIEF RESUME OF THE INTENDED WORK6.1 INTRODUCTION“ Everyday the nurse confronts start suffering, grief and death as few other people do. Many nursing tasks are mundane and unrewarding. Many are by normal standards, distasteful and disgusting others are often degrading, some are simply frightening”1 Hingely, 1984The nurse plays an important role in health team along with other health professionals. She strives for the prevention of disease, promotion of health and prolonging the life of the individual and of the community. Nurse is the co-ordinator for all the services and person concerned with patient care. 2Nursing profession requires lots of skills and competency. These make the professionals to face too many challenges, which are stress producing secondly their constant awareness of vulnerability of various kinds of diseases and disabilities results in worries pertaining to their own health conditions. Similarly nurses work daily in the midst of personal and professional stress. Nurses deal with emotional situations involving stress, anxiety, joy, anticipation, anger, new life and death. Nurses job subject them to environment hazards. Further, the nurses have to interact with different relationships like physicians, patients, families and peers. This also takes them to stress. Apart from this organizational structure also at times never recognizes the potentials of the nurse. Hence it becomes more demanding and develops unrealistic job related expectations, work load, rotating shifts, double shifts etc. These create an unusually stressful climate to the nurses. 2As a starting point to understanding work stress, researches have studied those factors that may be intrinsic to the job itself such as poor working conditions, shift work, long hours travel, risk and danger and work overload. 3 A study analyzed the nurses job performance and their job related stress with relevance to the type of shift they work. Analysis of variance was used to examine the association between the job performance and the type of shift worked. 4Working rotating night shift disrupts circadian rhythms and may have a wide range of physiologic, psychological and social effects on shift workers. In previous studies, shift work has been linked to higher risks of chronic disease, including, including cardiovascular diseases and certain types of cancers. Shift work may further induce physical or mental stresses and hormonal changes. Shift work has been linked to a lower circulating concentration of melatonin. 56.2 NEED FOR STUDYEvery era in history has been characterized by some debilitating disease. For instance plague in the Middle Ages, polio and pneumonia in the early 1990’s followed by tuberculosis and later on HIV AIDS. Our society today also has a disease characteristic of it, but one that is not so easy to prevent or eliminate. It underlies such diverse conditions as psychosomatic diseases, heart diseases and can be a major contributor to disturbances in one’s emotional, social and family life. It inhibits creativity, personal effectiveness and exhibits itself in general dissatisfaction with either the home or working environment. The name of this condition is “stress” and it has been called “the most debilitating medical and social problem of the present country”. 7Over the recent years, there has been growing concern about stress in Nursing. Stress can have an effect on the individual nurse, in terms of both physical and psychological health. Although there is a growing body of research into stress in nursing. 8Many workers today have jobs requiring them to work in shift, some of which go around the clock. Studies have found that shift work is a common occupational stressor that effects blood temperature, Metabolic rate, blood sugar levels, mental efficiency and work motivation, shift work also influences sleep patterns and family and social life. 3Is your night shift disturbs sleep-wake cycle? Is premature graying of hair because of your graveyard shifts? 9Night shift can have a negative impact as it disturbs sleep-wake cycle, changes eating habits and in the long run causes severe gastro intestinal disturbances neuro- psychic problems, chronic fatigue, anxiety, depression and probably hypertension and heart attacks. 9A study was conducted in department of Health and psychosocial Medicine, Alchi medical university, Japan to identify the changes in psycho physiological functions during the night shift were investigated on 12 nurses. The cortisol and Nk cell activity levels were low during the night shift, suggesting that the night shift itself is a high stress level, which is prejudicial to biodefense. The score of sleepiness was significantly lower.10 In the present setting the student investigator observed that the nurses those who are working in night shift or having emotional and physiological problems with their shift rotation and the nurses are having insufficient time for family, rest. So it is felt by the student investigator that there was a need for the study to assess the level of stress among nurses working in night shift. 6.3 STATEMENT OF THE PROBLEM“A study to assess the level of stress in related to psycho physiological functions among staff nurses working on night shift at S.C. Hospital,” Hassan.6.4 OBJECTIVES OF THE STUDY1. To assess the level of perceived stress in nurses working in night shifts 2. To assess the relationship between the stress and night shift. 3. To associate the relationship between night shift and psycho physiological functions. 4. To associate the relationship between the level of stress and select demographic variables. 6.5 HYPOTHESESH1 There will be significant difference in the level of stress among nurses working in night shift.H2. There will be significant relationship between the level of stress and the physiological variablesH3. There will be significant relationship between the level of stress and psychosocial variables.6.6 ASSUMPTIONS1. The level of stress is more in staff nurses working in night shifts than staff nurses working in regular shifts. 2. The level of stress is more in staff nurses working in night shifts as there will be less time for non professional activities family, leisure or rest. 3. There will be significant changes in psycho physiological functions among staff nurses working in night shifts than nurses working on regular shifts. 6.7OPERATIONAL DEFINITIONSLEVEL OF STRESS : Stress means pressure and it represents an Uneasy experience. It is an un pleasant Psychological and physiological state caused due to some internal or external demands that go beyond our capacity. The level of stress is assessed by using occupational stress scale for nurses and stress response scale.6 PSYCHO PHYSIOLOGICAL FUNCTIONS : Certain emotional and Physiological reaction patterns and Mechanisms in related to stress ASSESS : It is an activity to measure the outcome by using the occupational stress scale for nurses and stress response scale.STAFF NURSES : Refers to staff nurses who are professionally Qualified (Diploma / Degree in Nursing) as a Nurse and registered in the Nursing council and practicing as a nurse and on night shifts NIGHT SHIFT : Those who are in night shifts on rotation basis working for one full month6.8 CRITERIA FOR SELECTION OF SAMPLES : 1. INCLUSION CRITERIA - 60 Staff nurses working in night shift in S.C. Hospitals Hassan during the period of study.  Only female nurses are included.  Those who are working in general wards.  Those nurses on night shifts after one week of their night duty.2. EXCLUSION CRITERIA -  Those who are not willing to participate in the study.  Those who are having some health problems during the study.  Those who are not available at the time of the study.  Those who are working on weekly shifts.  Those who are working in ICU and other departments6.9 DE-LIMITATIONS OF THE STUDY The study period will be limited to 4 weeks.  Sample size is limited to 60 Nurses.  The study will be limited only to the nurses working in night shift in S.C. Hospitals of Hassan.6.10 SIGNIFICANCE OF THE STUDYThe study signifies that nurses those who are working in night shift have more digestive problems, more accidents, more clinic risk more sleeping problems and more menstrual disturbances. A higher frequency of problems with their sex lives and less satisfaction in their personal lives than other shift workers. 116.11 CONCEPTUAL FRAMEWORK. Will be done based on modified Lazarus model of stress.6.12 REVIEW OF LITERATURE.The review of literature is the standard requisition for scientific research. It contains the information related to the research problem. The review of literature is an important guide to define problem, identify its significance, appropriate study design and sources of date.Department of pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, did a study to find out the relationship of sleep disturbance and functional bowel disorders in rotating shift nurses. The study concluded that functional bowel disorders were more and common and severe between rotating shift nurses. The functional bowel disorders score was positively and independently correlated with the sleep disturbance score, suggesting that poor sleep might be associated with increased functional bowel disorders symptom in rotating shift nurses.14 A qualitative descript was done to assess situations influencing habits in diet and exercise among nurses working night shift, School of Social and Health Sciences, Halmstad University, Halmstad, and Development Unit for Primary Health Care, Sweden. The aim of investigation was to describe situations with a significant influence on health diet and exercises habit among nurses working in night shift. The result showed that nurses diet and exercises and habit were influenced by social interaction with colleagues at work and by the disruption to their circadian rhythm.13 A Pilot study was conducted to assess the shift work on the diet and gastrointestinal complaints among nurses. The aim of the study was to Preliminary assess the quality of meals consumed at night and nutrition habits among nurses as well as to compare the use of stimulants in the groups of shift to and non-shift nurses. The analysis near done in 171 nurses working in shifts and at night and 70 non shift nurses, aged 22-50 yrs. Result showed that nurses consumed a warm meal at night shift. Statistically significant irregularity in defection was observed in nurses working in shift. Study concluded with the suggestion that nurses working at night most often consumed cold meals and drank daily more cups of coffee. Some gastrointestinal complaints were also observed .12 A study elicited to find out the possibility of sleeping on the job during the night shift, Laboratory of Health and environmental Education Department of biology, Oswaldo Cruz Institute, Brazil. The aim of the study was to analyze whether the time devoted to duty activities is related to the number of worked hours and to nap- taking during the night shift. Result showed that there is a reduction in the time dedicated to house work among workers with long working hours. The time of personal needs was significantly lower among those who did not sleep on the job as compared to day workers. Sleeping on the job during the night shift seems to practically compensate for the shorter sleep at home among night workers and may play a beneficial effect in coping with two jobs.15 A study conducted in Department of Health and psychosocial Medicine, Aichi Medical University School of Medicine, Japan to Clarified the effects of changing shift schedules from a full-day to a half-day before a night shift. 12 Single nurses and 18 married nurses with children that engaged in night shifts works. The duration of sleep before a night shift of married nurse was significantly shorter than that of single nurses for both shift schedules.16 A study evaluated by work and cognition laboratory, Tolouse II University, Toulouse, France, for the understanding of sleep strategies of 12 hours shift nurses with emphasis on night sleep episodes. The objective of the study is to find out the episodes of sleep during night shift. The results indicate that half of the nurses chose to the naps in 75% of their night shifts. The study a concluded that nurses use different sleep wake strategies to cope with night work. These different strategies may be due to circadian influence although social factors cannot be totally excluded.17 A cross sectional exploratory study was done to test the hypothesis that the prevalence of diseased, sleep complaints and insufficient time for nonprofessional activities family, leisure and rest are higher among night than day workers at Laboratory of Education on environment and health, Oswaldo Cruz Institute Brazil. Among night workers, a significant relation was found between years working nights and high cholesterol values. Working nights more than four times per 2-week span was related to complaints about insufficient time for children and rest / leisure time. The results can be related to the “Social value of time, ‘ as evenings and nights are when families usually spend time together.22 A study was conducted in Harvard Medical School and Brigham and Women’s Hospital by Dr. Schernhammer examined the relationship between working rotating night shift and the risk of Cancers among nurses. Compared with women who never worked rotating night shifts, women who worked 1 to 14 night shifts had a higher risk of colorectal cancer. The researcher concluded that working a rotating night shift at least there nights per month for increase the risk of colorectal cancer in women .20 A study was designed to examiner the short term effects of shift work on mood changes by the Department of epidemiology, National Institute for Logevity Sciences. The subjects were 1,608 Japan4ese female nurses, working on rotating 3 shift schedules consisted of day, evening and night shift. Prominent changes of subjective fatigue, activity and confusion were observed especially when shift changes occurred. The mood changes were observed even after adjusting for the effect of sleep hours, indicating that irregular sleep pattern is not only cause that affects mood.18 A study was conducted to determine the influence of night shift work on psychological state and cardiovascular and neuroendocrine responses in healthy nurses, Division of Hypertension and Cardiology, Tohoku University Graduate School of Medicine, Japan. The study examined whether psychological states after night work are related to adaptive alterations of the cardiovascular and neuroendocrine systems. Study conducted in 18 healthy nurses engaged in a shift rotation system. Systolic and diastolic blood pressures during night shift work and the subsequent awake period correlated positively with score for vigor and negatively with scores for confusion. The study concluded that psychological disturbances after night work were associated with altered cardiovascular and endocrine responses in healthy nurses. Some of the psychological complaints may be attributable to lower waking blood pressure.21 A study was done in Department of Public Health, Nihon University School of Medicine to identify the influence of lifestyle and night shift work on sleep problems among female hospital nurses in Japan. The study aimed to clarify the situation regarding sleep disorders in female hospital nurses and their relation with night shift work and life style. The result showed significant correlations were observed between sleep disorders and working night shift, having anxiety in stress, getting less than 6 hours of sleep etc. The results of this study suggest that sleep problems among nurses are associated not only with night shit work but also with life style. They also suggests that nurses who work night shifts, especially in Tokyo, should try to get sufficient hours of sleep to ensure good quality of sleep.197 MATERIALS AND METHODS OF STUDY7.1 SOURCES OF DATAStaff nurses working in night shift in S.C.Hospital.7.2 RESEARCH DESIGNDescriptive study.7.3 METHOD OF COLLECTION OF DATAPART A: Socio demographic profile. PART B: Occupation stress scale for nurses (Standardized tool used by Usha V.K. Revised version for nurses) Stress Response scale(Standardized tool used by Thippe Swamy )POPULATION: i. Target population : Staff nurses working in night shift in S.C. Hospital ii. Accessible population : Staff nurses working in night shift in general wardsSAMPLE:Staff nurses who fulfilled inclusion and exclusion criteria. SAMPLE SIZES: The total numbers of 60 nurses are selected from S.C.Hospital working in night shifts. SAMPLING TECHINIQUE: Non-probability convenient sampling.RESEARCH SETTING: S.C.Hospital, Hassan.PILOT STUDY: Pilot study will be planned for 10% of the sample to find out the convenience and practical difficulties of the study. 8 VARIABLES Independent Variable : Staff nurses working in night shift Dependant Variable : Level of stress9 PLAN FOR DATA ANALYSISIt includes descriptive and inferential statisticsDESCRIPTIVE STATISTICS :Number, frequency, percentage, Mean and Standard Deviation.INFERNTIAL STATISTICS :Pearson Chi-square test, Yates corrected Chi-square test, One Way ANOVA ‘ F- tests, student independent t- test, Pearson correlation co-efficient,Biserial correlation co-efficient 10ETHICAL CONSIDERATIONS10.1 Has the ethical clearance being obtained from the institution ? Yes 10.2 Has the ethical consent taken from the samples ? Yes11. LIST OF REFERENCES1. Sailaxami Gandhi,” Effectiveness of a stress management program on selected variables in nurses working in a psychiatric hospital;” unpublished Dissertations for Ph.D submitted to National Institute of mental health and Neuro Science. (Deemed University 2005.)2. Usha V.K.” A study on occupational stress and job satisfaction among nurses.” Unpublished Dissertation for M.Sc. submitted to National Institute of Mental Health and Neuroscience. (1992) 3. Susan Cartwright, Cary L. Cooper. “ Managing work place stress,” sage publications, 14 – 16, 1-3.4. Coffey L.C, Skipper J.K., Jung F.D.., “ Nurses and shift work effects on job performance and job related stress,” Journal of Advanced Nursing, Vol : 13, 245 – 254, 1988.5. Honglein Chem, Eva Scherdhammer, Michael A. Schawarzschild, Alberto Ascherio.” A Prospective study of Night Shift work, sleep Duration and Risk of Parkinson’s Disease,” American journal of epidemiology volume 163, Number 8, 726 – 730.6. Sreevani.R” A Guide to Mental Health And Psychiatric Nursing,” Jaypee Publications second eddition page. No.2087. Nuernberger P.,” Freedom from stress.” Pennsylvania : Himalayan International Institute of Yoga Science and Philosophy, 1990.8. Chiriboga D.A, Jenkins, G. Bailey J.” Stress and coping among Hospice nurses,” Test of an analytic model, Nursing Research, 294 – 299, 1999.9. Pooja Virendra Kumar. Have Grey hair ? Blame night shifts, Times City, Times of India, October 9, 2007.10. Kobuyashi F, Furui H, Akamatsu Y, Watanabe T, Horbie H.” Changes in Psychophysioloical functions during night shift in nurses.” International Arch Occupational environmental health, 1997, 83-90.11. Sharol F. Jacobson, H Marie Mc Grath.” Nurses under stress,” A Wiley Meidcal Publication 56-58, 7 – 9.12. Bilski B.” Influence of shift work on the diet and gastrointestinal complaints among nurses,” Article in polish, Med Pr. 2006; 57: 15-19. 13. Person M, Mayrtensson J,” Situations influencing habits in diet and exercise among nurses working night shift.” Journal of Nursing Management 2006 July : 414 – 423.14. Zhen Lu W, Ann Gwee K. Yu Ho K.” Functional bowel disorders in rotating shift nurses may be related to sleep disturbances. “ European Journal of Gastroenterology Hepatology. 2006 June; 623 – 627.15. Ribiro – Silva F, Rotenberg L, Soares RE, Pessanha J, Ferreira FL, Oliveria P, Silva-Costa A, Benedicto – Silva AA. “Sleep on the job partially compensates for sleep loss in night shift nurses.” Chronobiology Int., 2006; 23 : 1389 – 1399.16. Watanabe M, Akamatsu Y, Furui H, Tomita T, Watanabe T, Kobayashi F. “Effects of changing shift Schedules from a full-day to a half-day shift before a night shift on physical activities and sleep patterns of single nurses and married nursed with children,” Ind Health, 2004 January : 42 : 34-40.17. Daurat A, Foret J. “Sleep strategies of 12 hour shift nurses with emphasis on night sleep episodes. “Journal of work environmental Health, 2004 Aug : 299 305.18. Fukkawa Y, Nakashima C, Tsuboi S, Saito I, Kosugies, Shimokata H.” Effects of shift work schedule on mood changes among female nurses. “ 2003 Oct, 354 – 61.19. Ohida T, Takemura S, Nozaki N, Kawahara K, Sugie T, Uehata T.” The influence of lifestyle and night shift work on sleep problems among female hospital nurses in Japan,” Department of Public Health, 2001 Aug : 595 – 603.20. Sandy Smith.” Night shift work and risk of colorectal cancer among nurses, occupational hazards, “2003 June.21. Munakata M, Ichis, Nunokula T, Saito Y, Ito N, Fukudo S, Yoshinaga K. “Influence of night shift work on psychological state and cardiovascular and neuroendocrine responses in healthy nurses.” Hypertens Res. 2001 Jan; 24 : 25 – 31 (Pub Med – Indexed for Medline). 22. Portela LF, Rotenberg L, Waissmann W. “ Self reported health and sleep complaints among nursing personnel working under 12 hour night.” Chronobiol int. 2004; 21 : 859 – 70 (Pubmed – Indexed for Medline).12 SIGNATURE OF THE CANDIDATE 13 REMARKS OF THE GUIDE14 NAME AND DESIGNATION14.1 GUIDE 14.2 SIGNATURE14.3 HEAD OF THE DEPARTMENT14.4 SIGNATURE15 REMARKS OF THE PRINCIPAL15.1 SIGNATURE

Rajiv Gandhi University Of Health Sciences

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