Archives of Psychiatric Nursing 29 (2015) 208–212

Contents lists available at ScienceDirect

Archives of Psychiatric Nursing

journal homepage: www.elsevier.com/locate/apnu

Occupational Stress and Coping Strategies Among Emergency

Department Nurses of China
Dong-Mei Lu a, Ning Sun a, Su Hong b, Yu-ying Fan b, Fan-ying Kong b, Qiu-jie Li b,⁎
a
Department of Nursing, The second affiliated hospital of Harbin Medical University, School of Nursing, Harbin Medical University, Harbin, P. R. China
b
School of Nursing, Harbin Medical University, Harbin, P. R. China

a b s t r a c t

Emergency department(ED) nurses work in a rapidly changing environment with patients that have wide variety of
conditions. Occupational stress in emergency department nurses is a common problem. The purpose of this study was
to describe the relationship between coping strategies and occupational stress among ED nurses in China. A
correlational, cross-sectional design was adopted. Two questionnaires were given to a random sample of 127
ED nurses registered at the Heilongjiang Nurses' Association. Data were collected from the nurses that worked
in the ED of five general hospitals in Harbin China. Occupational stress and coping strategies were measured by
two questionnaires. A multiple regression model was applied to analyze the relationship between stress and
coping strategies. The stressors of ED nurses mainly come from the ED specialty of nursing (2.97 ± 0.55), work-
load and time distribution (2.97 ± 0.58). The mean score of positive coping strategies was 2.19 ± 0.35, higher
than the norm (1.78 ± 0.52). The mean score of negative coping strategies was 1.20 ± 0.61, lower than the
norm (1.59 ± 0.66), both had significant statistical difference (P b 0.001). Too much documents work, criticism,
instrument equipment shortage, night shift, rank of professional were the influence factors about occupational
stress to positive coping styles. Too much documents work, and medical insurance for ED nurses were the
influential factors on occupational stress to negative coping styles. This study identified several factors associated
with occupational stress in ED nurses. These results could be used to guide nurse managers of ED nurses to
reduce work stress. The managers could pay more attention to the ED nurse's coping strategies which can further
influence their health state and quality of nursing care. Reducing occupational stress and enhancing coping
strategies are vital not only for encouraging nurses but also for the future of nursing development.
© 2015 Published by Elsevier Inc.

The emergency department (ED) of a general hospital, is an ever- of stress correspond to cognition activity and behavior activity which
changing, highly regulated, critical environment. ED nurses initiate the stress adopts (Jiang, 1999). Coping strategies of individuals to
treatment for a broad spectrum of illnesses, some of which may be stress situations, which is a maintenance psychology balance method
life-threatening and require immediate attention (Zhang, 2000). (Zohar, 1999), which will react with important control on the stresses
Because of this dynamic environment, ED nurses have high levels of (Jiang, 1999).
occupational stress. Stress is the individual response after cognition Coping strategies of individuals to the stressors are dependent on
appraisal of ones internal or external stimuli, causing a series of physio- experiences of the individual in terms of frequency, intensity and charac-
logic and psychological responses (Li, 2001). Nursing occupational teristic of the stressor (Dai, 1998). The risk of mental health problems
stress refers to an unbalanced condition of the mind and body that increases among individuals under high stress conditions if they lack
creates demands on the nurse's physiologic and psychological state. use of coping mechanisms (Zhao, Gao, Geng, et al., 2002). Positive coping
Experts of nursing and psychology have affirmed stresses to individual strategies could be the advantageous to an individual's psychological
influence, and varied in the stress level, wherein some people have adaptation, and negative coping strategies could aggravate the body
had serious health problems, whereas some people only had light and mind to exhaustion (Liu, 2004). As a result of researches, it is clear
adaptation difficulty. Coping strategies of the individual to each kind that occupational stresses widely existed in clinical, especially in the ED
nurses, and the different coping strategies would adjust the stress in
some way. However, there is little researches showing the relationship
between occupational stress and coping strategies of ED nurses.
Financial disclosure: None reported. The purposes of this study were to explore the occupational
Conflict of interest: No conflict of interest has been declared by the authors.
⁎ Corresponding Author: Qiu-jie Li, MSc, RN, School of Nursing, Harbin Medical University,
stress, coping strategies and their relationship, and to examine factors
Harbin, P. R. China, 150040. that contribute to occupational stress among Chinese ED nurses in
E-mail addresses: [email protected] (D.-M. Lu), [email protected] (Q. Li). general hospitals.

http://dx.doi.org/10.1016/j.apnu.2014.11.006
0883-9417/© 2015 Published by Elsevier Inc.
 D.-M. Lu et al. / Archives of Psychiatric Nursing 29 (2015) 208–212 209

BACKGROUND METHODS AND PARTICIPANTS

Occupational Stress Design

Occupational stress is stress defined in terms of its physical and A correlational, cross-sectional design was adopted. Questionnaires
physiological effects on a person, and can be a mental, physical or emo- were used for data collection.
tional strain involving work. It can also be tension or a situation or factor
that can cause stress (Butts, DeJoy, Schaffer, Wilson, & Vandenberg, Sample
2009). Occupational stress occurs when there is a discrepancy between
the demands of the workplace and an individual's ability to carry out This study was performed as a cross-sectional design in 5 general
and complete these demands (Cooper, Dewe, & Michael, 2001). A hospitals located in Harbin China. All ED nurses working in these 5
stressor can make the body to have a physiological reaction which can hospitals were invited to participate in the study. Participation was
strain the person physically as well as mentally. The work overload is voluntary, random and anonymous. All study participants have been
one of the main causes of occupational stress. working full-time-work for more than 1 year. Samples with primary
Occupational stress may cause physical symptoms including disease were excluded.
fatigue, stomach problems, headache, chronic mild illness, muscular
aches and pains, sleep disturbances, and eating disorders. Psycho- Study Measure
logical and behavioral problems that may develop include irritability,
anxiety, alcohol and drug abuse, feeling powerless and low morale Occupational Stress Source Questionnaire
(Zohar, 1999). Chronic health problems can occur including stroke Occupational Stress Source questionnaire was developed by Li and
if stressors in the workplace are prolonged. There was a study Liu (2000), which have 35 items, with 5 subscales: (1) nurses work
among Japanese, specifically showing a more than 2-fold increase and specialization; (2) work load and time assignment problem;
in the risk of total stroke among men with job strain (Kossek & (3) working conditions and equipment issues; (4) patient care; (5) man-
Ozeki, 1998). Stroke can cause blood pressure and immune system agement and interpersonal relations. Each question uses a scale of
dysfunction. Prolonged occupational stress also can lead to occupa- 4-point Likert scale ranging from 1 to 4, from strongly agree (4), agree
tional burnout. (3), disagree (2), and strongly disagree (1). The questionnaire
Different factors are associated with occupational stress among Cronbach's α is: total 0.98; in which nurses work and specialization is
nurses. Studies in different parts of the world indicated that stressors 0.95; work load and time assignment problems 0.83; working conditions
specific to nursing include emotional burden of dealing with death, and equipment issues 0.92; patient care 0.94; management and interper-
conflicts with physicians, lack of support, inadequate professional sonal relations 0.90 (Tao, Zhang, Zhong, et al., 2005).
knowledge, and heavy workload. Lack of self-confidence and career
prospects, low wages are important factors that influence stress Coping Strategies Questionnaire
(Wheeler & Riding, 1994). Coping strategies questionnaire was developed by Xie (1998)that is
to determine the coping mechanisms employed by the individuals then
adapt to stressful conditions. The questionnaire has 20 items on a
Coping Strategies 4-point Likert scale range of 0-3, from never (0) to always (3). Two sub-
scales were used to measure positive and negative coping strategies.
Coping has been defined in psychological terms by Lazarus and Each subscale is scored separately. Higher scores indicate that coping
Folkman (1984) as “constantly changing cognitive and behavioral strategies are used more often (Xie, 1998). In this study, the Cronach's
efforts to manage specific external and/or internal demands that α was 0.90, and the Cronach's α for the positive coping strategies sub-
are appraised as taxing”. Coping is expending conscious effort to scale was 0.89 and 0.78 for the negative coping strategies.
solve personal and interpersonal problems, and seeking to master
and minimize stress (Weiten & Lloyd, 2008). Psychological coping Ethical Considerations
mechanisms are usually termed coping strategies or coping skills.
Unconscious strategies are commonly excluded. The term coping The study was approved by the appropriate committees and officials
generally refers to adaptive or constructive coping strategies. How- of each hospital. All the completed questionnaires were examined only
ever, some coping strategies can also be considered maladaptive. by the investigators and placed in a locked cabinet for security. To assure
Maladaptive coping can be described as non-coping. Furthermore, the anonymity, code numbers were placed on the questionnaires after
term coping commonly refers to reactive coping. This contrasts with returning to the investigators.
proactive coping, in which a coping response aims to head off a future
stressor. Coping responses are partly controlled by personality, but Data Analyses
also by the social context, particularly the stressful environment
(Carver & Connor-Smith, 2010). SPSS 15.0 software (SPSS Inc.,Chicago, IL) was used to analyze the
The comprehensive conceptual framework of coping, which include data. Multiple regression analysis was performed to test the association
the environmental system, personal system, life crisis and personal of ED nurses' the working pressure source, type, and the degree. Put
change, personal cognitive evaluation and response, health, emphasized them to the multiple regression models to explain the relationships
the interactive role of individual with the changing pressure factors. between stress type and coping strategies.
Researchers from different perspectives and findings reported coping
with positive or negative aspects, which features are easier to be recog- RESULTS
nized and understood.
The results of Chinese researches reported the relationship between General Information of ED Nurse
stress and coping strategies, indicating that working pressure level will
be low when the nurses take positive coping strategies facing occupa- Valid answers of the questionnaire were 113 among 127 ED nurses.
tional stress. On the contrary, work stress level will be high when they The effective response rate was 93%. Of the participants, 51% with less
take negative coping strategies, such as avoidance, denial of the problem than 4 years of work experience; 29% with 5–9 years of work experience;
and self blame. 15% with 10–14 years work experience; 5% with 15 years work
http://daneshyari.com/article/314932