ACKNOWLEDGEMENT

During my studies at Om Health Campus, and particularly during the course of this research, I have received both great personal assistance and profound technical education from many people.

Firstly I would like to express my gratitude to Purbanchal University, Om Health Campus, Chabahil, Kathmandu for me the opportunity to conduct this study as a partial fulfillment of post basic bachelor of nursing programme.

I wish to express my heartfelt gratitude to my research advisor Associated professor Ms Milan Lopchan, for introducing me to the topic and constructive suggestions throughout the work. I am highly obligated to her kind help, support and supervision during completion of this work.

My deep and cordial gratitude also goes to BN faculties, faculties chief Ms Maiya Ranjitkar for their valuable suggestion.

I am also thankful to Matron Ambika Shrestha , stffs and all patients of medical, surgical and general ward of Om Hospital and Research Centre, Chabahil, Kathmandu for their great co-operation during my data collection period.

I am very much indebted to staffs of Om Health Campus for their inspiration and fruitful suggestions. I offer special thanks to my colleagues for their co-operation, inspiration and regular assistance during my studies and also during the preparation of this research.

Last but certainly not least, I express my gratitude to my Mum Padma Kunwar,my late.Grandfather Bam Bahadur Kunwar,Grandmother Damber kumari Kunwar and My Husband Ram Bahadur Chettri for their internal help, support and inspiration

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in my every step of life. Urmila Kunwar

AbstractThis descriptive study was carry out with the purpose to find out “contributing factors of stress among hospitalized adult patients” at Om Hospital and Rsearch Centre,Chabahil, Kathmandu. Total 50 patients who were admitted at hospital were interviewed with semi structured questionnaires.

A non probability purposive sampling technique was used. The questionnaires wa developed into two parts. First part consists of Socio-demographic data and second part consists of contributing factors of stres

Majority of respondents 16(32%) were of age group 30-39 years and minority of respondents 8(16%) were age group25-29 years.

Majority of respondents 38(76%) were married and minority of respondents 12(24%) were unmarried

Majority of respondents 16(32%) were Brahman whereas,only2(4%) were from Rai/Limbu.

Majority of respondents 37(74%) were Hindu and minority of respondents 2(4%) were from other(kirat).

Majority of respondents 14(28%) were Higher secondary education level and minority of respondents 2(4%) were primary educational level.

Majority of respondents 15/15(30/30%) were farming and business and minority of respondents were 4(8%) from Daily wage earner.

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Majority of respondents 33(66%) were no experience of previous hospitalization and minority of respondents 17(34%) were have experience of previous hospitalization.

Majority of respondents 10(20%) were 2 times experience of hospitalization and minority of respondents 2(4%) were more than 4 times experience of hospitalization.

Table of Contents

Acknowledgement

Abstract

List of tables

List of figures

CHAPTER 1: INTRODUCTION

1.1 Background of the study

1.2 Rational of the study

1.3 Objectives of the study

1.4 Variables of the study

1.5 Operational definition of the relevant terms

1.6 Hypothesis

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1.7 Significance of the study

CHAPTER 2: REVIEW OF RELATED LITERATURE

2.1 Review of literature

2.2 Summary of the literature review

CHAPTER 3: RESEARCH METHODOLOGY

3.1 Research design

3.2 Study area

3.3 Population of the study

3.4 Sample size

3.5 Sample technique

3.6 procedure of data collection

3.7 Instrumentation

3.8 Validity and reliability of the instruments

3.9 Pre-testing

3.10 Ethical consideration

3.11 Process of data generation, processing and analysis

CHAPTER 4: ANALYSIS AND INTERPRETATION OF DATA

4.1 Part 1: Socio-demographic data

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4.2 Part 2: Contributing factors of stress

CHAPTER 5: FINDINGS< CONCLUSION AND RECOMMENDATION

5.1 Findings of the study

5.2 Discussion and conclusion of the study

5.3 Recommendation

5.4 Implication for the nursing practice

5.5 Difficulties faced during study

5.6 Strength of the study

5.7 Limitation of the study

BIBLIOGRAPHY

ANNEXES

Annex 1 Work Plan

Annex 2Questionnaries

Annex 4 Campus Letter

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CHAPTER 1INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Stress is defined both in terms of its physical and psychological dimensions and involves an increasing sense o f the loss of control over the environment, pro-ducing fear and uncertainty. Stress is a problem in the terms of stress in the workplace because work related stress contributes to a variety of problems both for the individual experiencing stress and for the organization for which he or she works. The problems can range from reduced performance to open violence.

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Women men are seen as having greater stress than women because men have long experienced stress in the workplace, but as more and more women enter the workplace as well, they are also subject to the same levels of stress.

Certain life experiences are stressful in varying degrees, and incoming college stu-dent’s experiences stress for a variety of reasons, including workload demands, culture shock, added responsibilities, living away from home for the first time, and so on.

Harvard researchers estimated that 60-90% of doctors visited are caused by stress.

Stress in itself can be a good thing when the level of stress is not too high and when the individual is able to control the stress and its effects. Marks greener emphasizes that stress is a response to change in the environment and that any change can lead to stress, even if the change itself is enjoyable stress is not a new problem, though it is better recognized today as a concern for the business world and as a contributing factors in the development of a stress.

It appears from a review of the literature that stress is directly related to physical and mental illness at all ages of development and across all socio-economic strata from infants who have a higher asthma morbidity because of stress related fac-tors to workers who suffer burnout and illness from occupational related stres-sors, increasing numbers of Americans are suffering from the physical and mental effects of stress. This research will focus on the correlation between stress and physiological illness. Stress related physiological illness is increasing in the United States while some people become physically ill from the effects of stress, others see, able to cope with it in amore effective manner?

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Stress is anything that exerts our bodies physically, mentally and /or emotionally. We all have observed people who experience stress and handle it effectively and we have observed other who experience similar stress, but become irritable, tense and /or physically ill? (Berry, 1999,1). Stress from emotional tension appears more likely to be associated with physiological illness than stress from work or exercise further, research has shown that type.

A-personalities are more susceptible to the deleterious health effects of stress (Berry, 1999, 1).

While many people experience stress in the work place. Stress and its negative impact on health appear to affect people at all ages of development.

Lots of essays.com

(Stress and illness)

1.2 RATIONALE OF THE STUDY

Stress is an unpleasant experience and a part of daily life. Everyone faces stress in his or her day to day life in different situation, the stress can be increased sub-stantially when admitted to hospital Further more, stress in contributed by sev-eral factors such as, hospital environment, behavior of staffs, certain procedures equipments and financial arrangements.

It is believed that when that stress becomes more severe, it affects the patient’s condition, prolonging the course of illness. Hence, it is important to fine out the factors that cause stress during hospitalization.

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In Nepal, in most of the health care centers, and hospitals where patients were admitted nurses along with other health care providers are only providing their attention to treat physically and clinically whereas, psychological aspect of a pa-tient seems somehow neglected. Because everyone wants to be recognized as an individual and to feel that he is important to someone else. The need for atten-tion increase in response to illness thus a nurse should respect and accept patient as a person.

So the main purpose of this study was to assess the contributing factors of stress among hospitalized patients.

On the other hand, very few researches have been conducted regarding this topic in Nepal. So researcher interested to conduct this research study.

1.3 OBJECTIVE OF THE STUDY

1.3.1 General objective

To assess the contributing factors of stress among hospitalized patients.

1.3.2 Specific objectives

To find out the socio-demographic characteristics of respondents. To identify contributing factors of stress among hospitalized patients.

1.4 VARIABLES OF THE STUDY

1.4.1 Independent variables

Attitude and behavior of hospital staffs. Lack of orientation on admission. Hospital environment.

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Disease condition and prognosis Nursing procedures and certain equipments. Loss of independence. Financial problem. Home separation. Diet restriction.

1.4.2 Dependent variables

Contributing factors of stress among hospitalized patients.

1.5 OPERATIONAL DEFINITIONS OF THE TERMS

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

1.6 HYPOTHESIS

Rural area’s patients have more stress than urban area’s patients.

Illiterate patients have more stress than literate patients

Hospitalized experienced patients have less stress than patients of inexperienced of hospitalization.

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1.7 SIGNIFICANCE OF THE STUDY

Hospitalized patients will be benefited by this study because if the nurse who is caring them have knowledge to find out contributing factors of stress to reduce then.

This study will be helpful for matron and supervisors of OM Hospital and Research center, chabahil, Kathmandu because after identifying the contri-buting factors of stress to reducing stress in hospitalized patients

Moreover this study will be more significant to nurse because she can be-came aware of circumstances that are likely to produce stress and can help patient in adjustment to the hospital by fulfilling various needs by achieving knowledge regarding stress reduction.

Furthermore, nursing tutors will be benefited form this study, it will help them to each and help the student to find out the factors that contributes to stress and reducing mechanism in hospitalized adult patients.

Last but certainly not the least this study will help researcher to improve knowledge and skill regarding appraisal and management to stress in hospitalized patients after identifying the contributing factors.

1.8 DELIMITATION OF THE STUDY

The study was limited up to OM Hospital and Research center, chabahil, Kathmandu.

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Only 50 samples were taken for the study.

Total time for study was 4 weeks.

Researchers herself funded budget for research.

CHAPTER IILITERATURE REVIEW

Nancy. K and RNP.A (2004) concluded in the study of “patient’s satisfaction with nurse practitioner service” that there was high level of patient’s satisfaction with those nurse practitioner who were aged and married, as they provided services to meet patient’s expectation including respect and politeness with patient.

Burggraf (2006) explained that patient’s may want to have pictures of their loved ones near them and to use their own pillows from home. They may wish to pray with one another using a special tea, herbal remedy, vitamin, lotion, perfumes or cologne may help better normalize the experience of hospitalization and it is found that patients are more comfortable to share their feelings with married nurses rather than unmarried because they believe that married nurses are likely to understand their feelings

Jenkins’s (2006) concluded in the study “sources of stress and psychological well being of patients well being through dealing with patients and relatives. Reactions to stress elicited a range of adaptive and maladaptive

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coping styles. This study recommends sending nurses on management and administration courses and stress-management programs.

Coy (2002) mentioned that stress plays a role in vulnerability to disease. A patient when comes to hospital expects respective behavior and positive attitude from nurses. Nurses who have high professional education are likely to have to have more knowledge regarding stress and coping and work to minimize stress of a patient.

Emory. S (1953) Stated that nurses however, expert on physical procedures are not sufficiently knowledgeable on reducing patient’s suffering than nurses who are expert in psychological aspect

Healthcare Research and Quality (2004) issued a synthesis of nursing research studies that details the impact that staffing levels, have on patient outcomes. The report cites studies showing that hospitals with lower nurse staffing levels and fewer registered nurses compared with licensed practical nurse or nurses aides tend to have higher rates of poor patient outcomes.

Mohoughton.N (1969) stated that the more commitment of a nurse towards fulfilling patients needs the more knowledge she possess. If the patient will often confide his fears, worries, or some information bearing on his illness.

Pun.k (1995) mentioned in the study “opinions of patients about nursing care gi ven in different ward in S.S.G hospital, Boroda, Gujrat” tht various need of patients were poorly met by less experienced nurses than nurse who have more working experience.

Potter.P.A (2004) stated that throughout the life all individuals including patients/nurse may have experience with illness or hospitalization, personal

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memories, of changes in normal activities, affected usual roles can help can one to become empathetic with clients who are experiencing can provide useful insight in how to work effectively with a current client.

Summary of literature Reviewed

The researcher in developing concept and nature of the current stud used all there studies and literatures.

CHAPTER IIIRESEARCH METHODOLOGY

3.1 RESEARCH DESIGN

A descriptive research design method was used to find out the contributing factors of stress.

3.2 STUDY AREA

The study was carried out in different departments of OM Hospital and Research Centre Chabahil Kathmandu.

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3.3 POPULATION OF THE STUDY

Patients hospitalized at OM Hospital and Research Center Chabahil Kathmandu were the population of the study.

3.4 SAMPLE SIZE

50 patients hospitalized at OM Hospital and Research Centre Chabahil Kathmandu.

3.5 SAMPLING TECHNIQUE

Non probability purposive sampling was used for data collection

3.6 PROCEDURE OF DATA COLLECTION

Formal approval from the research in hospital authority was obtained. Data was obtained after verbal permission from each respondent before data collection. Interview techniques were applied and close end with face to face interview technique.

3.7 INSTRUMENTATION

Data collected by using close ended questionnaire on the objectives with simple and understandable language to assess knowledge on reducing stress among the nurses of Om Hospital and Research Center, Chabahil, Kathmandu through interview.

3.8 VALIDITY AND RELIABILITY OF THE INSTRUMENTS

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The validity of the instrument was done by consulting the Advisor and Expert Teachers. Reliability was maintained by pre-testing the instruments. Some questionnaires were modified according to need and suggestions received from advisor and experts.

3.9 ETHICAL CONSIDERATIONS

The permission was obtained from the related authority in Om Hospital and Research Center, Chabahil, Kathmandu.

The patients were explained verbally about the research study by using informed consent.

Nobody was forced for participation and confidentiality and anonymity was maintained.

3.10 PLAN/PROCEDURE FOR DATA GENERATION, PROCESSING AND ANALYSIS

After completion of data collection, checked for its completeness and accuracy and categorized according to research objectives and analyzed through descriptive statistical method. Percentage frequency and findings presented in figures and tables. The inferential

Statistical test was used to test stated hypothesis i.e. X2 test.

CHAPTER 4

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Analysis and interpretation of dataAfter data collection, the data are analyzed on the basis of objectives and arranged on relevant tables, graphs and pie charts. The major findings are presented into four parts.

Part 1: Socio demographic data

Part 2: Contributing factors of stress.

Part 1: Socio demographic data

Table 1: Distributon of respondents according to sociodemographic characteristics

Variables Frequency

n=50

Percentage(100%)

Age

20-24years 11 22%

25-29years 8 16%

30-39years 16 32%

40years and above 15 30%

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Marital status

Unmarried 12 24%

Married 38 76%

Ethnic group

Brahman 16 32%

chettri 11 22%

Newar 6 12%

Tamang/gurung/magar 12 24%

Rai/limbu 2 4%

Others(chaudhary,B.k.,etc..) 3 6%

Religion

Hiund 37 74%

Buddhist 8 16%

Christian 3 6%

Muslim 0 0%

Others(kirat) 2 4%

Education

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Illiterate 7 14%

Can read and write 7 14%

Primary 2 4%

Secondary 7 14%

SLC 5 10%

Higher secondary 14 28%

Bachelor and above 8 16%

Occupation

Farming 15 30%

Service 6 12%

Daily wage earner 4 8%

Bussiness 15 30%

Others(students) 10 20%

Previous hospitalization experience

Yes 17 34%

NO 33 66%

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If, Yes

2 times 10 20%

3 times 5 10%

4th times 0 0%

>4 times 2 4%

Majority of respondents 16(32%) were of age group 30-39 years and minority of respondents 8(16%) were age group25-29 years.

Majority of respondents 38(76%) were married and minority of respondents 12(24%) were unmarried

Majority of respondents 16(32%) were Brahman whereas,only2(4%) were from Rai/Limbu.

Majority of respondents 37(74%) were Hindu and minority of respondents 2(4%) were from other(kirat).

Majority of respondents 14(28%) were Higher secondary education level and minority of respondents 2(4%) were primary educational level.

Majority of respondents 15/15(30/30%) were farming and business and minority of respondents were 4(8%) from Daily wage earner.

Majority of respondents 33(66%) were no experience of previous hospitalization and minority of respondents 17(34%) were have experience of previous hospitalization.

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Majority of respondents 10(20%) were 2 times experience of hospitalization and minority of respondents 2(4%) were more than 4 times experience of hospitalization.

TABLE 2: Distribution of respondents according to contributing factors of stress that lead to stress in hospitalized adult patients.

S.N. Variables YES

NO

Frequency

n =50

Percentage

1. Hospitalization is a stressful situation

Yes

No

46

4

92%

8%

2. Attitude and behavior of hospital staffs.

Yes

No

14

36

28%

72%

3. Hospital environment Yes

No

24

26

48%

52%

4. Anxiety and fear with equipments used in nursing procedure

Yes

No

25

25

50%

50%

5. Financial problems Yes

NO

37

13

74%

26%

6. Separation from home Yes 43 86%

21

No 7 14%

7. Restricted diet Yes

No

21

29

42%

58%

8. Hospital rules and regulation Yes

No

11

39

22%

78%

9. Spreading cross infection Yes

No

29

21

58%

42%

10. Feeling of comfortable to take meal inside hospital

Yes

No

21

29

42%

58%

11. Sleeping in the hospital bed Yes

No

25

25

50%

50%

12. Feeling comfortable to explain your quarries to the Doctor and nurse

Yes

No

42

8

84%

16%

13. Feeling comfortable when your relatives visit in the hospital

Yes

No

45

5

90%

10%

14. Feel loneliness in the hospital even though there are many people around you

Yes

No

17

33

34%

66%

15. Uncomfortable changing your Yes 33 66%

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routine work No 17 34%

16. Feel bad when your knowledge doesn’t match with doctor and nurses

Yes

No

26

24

52%

48%

17. Feel good when doctor explain about disease condition

Yes

No

50

0

100%

0%

18. Feeling stress due to sharing room with strange neighbours

Yes

No

24

26

48%

52%

23

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Figure 1: Distribution of respondents according to hospitalization is a stressful situation.

Figure 2: Distribution of respondents according to attitude and behavior of hospital staff

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Figure3: distribution of respondents according to hospital environment

Figure4:

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Figure :5

Figure:

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No- 14%

Yes – 86%

figure :7

Figure : 8

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No- 58 %Yes- 42%

Figure :9

Fig:10

29

Fig :11

fig 12

30

Fig:13

Fig: 14

Fig: 15

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Fig: 16

Fig:17

Fig: 18

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Chapter 5Findings, conclusion and recommendations

The study was conducted to identify the contributing factors of stress among hospitalized patients.

5.1 Findings of the study

The collected data were thoroughly analyzed and interpreted in terms of findgs and stated objectives.The major findings of the study are as follows.

5.1.1 Demographic findings

Majority of respondents 16(32%) were age group of 30-39years and minority of respondents 8(16%) were age group of 25-29years.

Majority of respondents 38(76%) were married and minority of respondents 12(24%) were unmarried.

Majority of respondents 16(32%) were Brahman whereas, only 2(4%) were from Rai/Limbu.

Majority of respondents 37(74%) were Hindu and minority of respondents 2(4%) were from other(kirat).

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Majority of respondents 14(28%) were Higher secondary education level and minority of respondents 2(4%) were primary educational level.

Majority of respondents 15/15(30/30%) were farming and business and minority of respondents were 4(8%) from Daily wage earner.

Majority of respondents 33(66%) were no experience of previous hospitalization and minority of respondents 17(34%) were have experience of previous hospitalization.

Majority of respondents 10(20%) were 2 times experience of hospitalization and minority of respondents 2(4%) were more than 4 times experience of hospitalization.

5.1.2 Contributing factors of stress

Majority of respondents 46(92%) agreed that hospitalization is a stressful situation for patients and 4(8%) do not agreed. Total 50(100%) patients know about the factors that leads to stress in hospitalized patients. Among them, majority of respondents 43(86%) were due to separation from home, 37(74%)were due to financial problems 25(50%) were due to anxiety and fear due with equipments used in nursing procedures, 21(42%) were due to restricted diet, 11(22%) were due to hospital rules and regulation, 29(58%) due to spreading of cross infection,29(58%) due to feeling uncomfortable to take meal, 33(66%) due to changing routine work, 26(52%) due to disease doesn’t match with doctor and 24(48%) were stressed due to sharing room with strange neighbor.

5.2 Discussion and conclusion of the study

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5.3Recommendation

For hospital

It seems important that specific orientation and holistic nursing care to patients should be provided .

Result of the study can be helpful to improve the standard of nursing in the hospital.

For the study

A similar type of study can be replicated in other hospitals.

Similar type of study can be done extensively in a large scale.

Study can be done in different people such as out patients, visitors to know

the contributing factors of stress.

5.4 Implication for nursing practice

The study will provide background to study related to hospital stress in future.

This study will help the nursing personnel to plan care focused education to strengthen the nursing services.

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5.5 Difficulties faced during the study

Journals, research reports and were not available for review literature.

BIBLIOGRAPHY

www.who.int/hinary

www.scholar.google.com.pub.med

www.med.IND.NIC.IN

www.njog.org.np

www.docstoc.com/docs/20166585

www.Lots of essay.com(stress and illness)

ANNEX IWORK PLAN FOR RESEARCH WORK

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