Chapter I
Chapter I
Chapter I
CHAPTER I
INTRODUCTION
Rationale
Nurses fill an interesting position in the provision of health care. Often they are
the sole intermediary between the doctor and the patient and also performs a multiple
and different tasks that are not limited to direct contact with the patients. In nursing
profession, nurses require a great deal with people in different profession collaboration
(Belachew et al., 2016). Nurses play a vital role in medical field. The primary role of
nurses is to care for their patients and to help them manage their physical needs,
prevent illness, and treat health conditions. They advocate interests of the patients in
keeping the patients’ dignity right through treatment and care. Nurses are also in
charge of ensuring that patients are able to understand their health, illnesses,
medications and treatment to the best of their ability. And also, nurses are involved in
decision making process for the treatment of the patients (Smith, 2019).
Nurses’ performance plays an important role in our society for they are one of the
medical practitioners who help in saving the lives of the people. The performance of the
nurses greatly affects the patients. As claimed by Tesfaye et. al., (2015), nurses
Less performing nurses reduces hospital productivity, a reason for poor hospitalized
Nurses play a huge role in the care of the patient (Cabriera, 2019). The patient’s
subjected to more stress which arises from their work environment. Stress has been
health care services. There are some factors that causes job stress and might be
According to (Akbarbegloo & Zadeh, 2011), job stress is the result of interaction
between individuals and the working environment and every kind of physical and
psychological event which could lead to negative result in the performance of the
individuals and the organizations. Job stress can have a significant effect on
individuality of nurses and their abilities to accomplish their task and may cause
weakness in decision making, loss of concentration, apathy, and loss of motivation and
As to nurses, there are a lot of major sources of stress. It also occurs when
choices and when the amount of external support are low. The longer the hours nurses
put on work, the higher the level of stress could nurses experienced.
To sum it up, nurses experienced job stress that may affect their performance in
a positive or in a negative way. This study is conducted to determine the level of job
Through this study, the nurses may be helped in learning the easiest and effective
way of creating stress free working environment for themselves. It would be beneficial
for their patients, hospital management and nurse managers who could also adapt
researchers might also suggest and conduct programs if ever the level of stress is
Theoretical Background
this study. This was developed by psychologists Robert M. Yerkes and John Dillinghan
Dodson in 1908. This theory gets its name from the curve created when there is a
correlation between pressure (or “arousal”) and performance. In this theory, the
U. It means that as arousal level increases, performance improves, but only to a point,
arousal is thought to be necessary for efficient performance, but too much arousal may
As to what Yerkes-Dawson explained in their theory, the left hand side of the graph in
Figure 1, shows the situation where people are not being challenged. In this theory,
they
5
Age
Gender
Length in Service
Employment ward
see no reason to work hard on a task, or they might feel in danger of approaching their
work in a slobbish and unmotivated way. The middle part of the graph shows where
people work at peak of their effectiveness. They are seemly motivated to work hard.
They are not so burdened that they are starting to struggle. In this part, people can
experience enjoyable and highly fruitful state in which they can do their best at work.
The right hard hand side of the graph shows where they are starting to fall apart under
pressure. They are oppressed by the volume and scale of demands on their attention,
and felt a lack of control on their situation (Mind Tools Ltd, 2019).
does not manifest improved performance but when an individual experiences too high
level of stress, it may spend more time coping with stress and invest less effort in
defined stress as a bodily or mental tension which is the outgrowth from the factors that
tend to change an existent equilibrium. Also, according to Robbins et. al. (2007), stress
constant, or demand related to what he or she desires and for which the outcomes are
Abualrub et. al (2008) believed that stress is a key factor that creates a
and absenteeism. It can also cause the deterioration of the body which can
7
according to the World Health Organization (WHO) in 2014, stress collignated from
work is the second highest prominent health problem which targets both physical and
mental aspect of the people. Furthermore, Farquharson (2013) believed that job stress
can be damaging to a person’s physical and mental health, while its high levels have
outcome. Job performance is the work related activities expected of an employee and
how well those activities were executed (Business Dictionary, 2019). According to
Homayan et al., (2013), job performance refers to how effective employees are in
accomplishing their tasks and responsibilities related to direct patient care. Improving
the performance of employees has been a topic of great interest to practitioners as well
(Leeuw, 1996).
Tesfaye et al., (2015) claimed that nurses’ job performance level is the
remains long standing in deciding the quality service rendered for patients admitted to
hospitals. Nurses, as the largest human resource element of health care systems, have
a major role in providing ongoing, high- quality care to patients. The nurses are one of
the medical practitioners who are capable in saving lives and their performances have
factors that may varied the efficiency of nurses’ performance. These include admitting
patients, patient care, discharging of patients, patient education and patient referral.
Stress from admitting patient might affect the efficiency of nurses performance.
According to Shekelle (2013), a reasonable nurse- patient ratio is 2-3 patients to one
nurse on a general care unit and a 1:1 ratio in intensive care units (ICUs); however, a
systematic review of 28 studies on nurse to patient staffing ratios demonstrated that the
average was three patients per nurse in the ICU, 4 per nurse on surgical units, and 4.4
per nurse on medical units (Shekelle, 2013). the increased ratio causes more physical
Also, stress from patient care is one of the factors that may vary the performance
of the nurses. According to Reference Md (2012) patient care is the services that is
given by the members of the health profession for the benefit of a patient. Camington
College (2013) believed that patient care plays an important role for it influenced
positive recovery experience and can improve the physical and mental quality of people
Clarke SP et. al (2008) believed that the quality of care that the nurses gives to
experience as well as human factors such as fatigue. Quality of care is also influenced
by the system where the nurses work in, which involves staffing levels, and then needs
suggests that there are two types of patient care, direct and indirect. Direct patient care
9
refers to activities that “assist the patient in meeting their basic needs”. Indirect patient
are refers to activities that “focus on maintaining the environment in which nursing care
Also, nurses have a responsibility to ensure that patients are discharged from
hospital care in a safe and efficient manner (Hesselink, 2013). According to Waring et
al. (2014) discharge of patients is the point at which patients hospital care end, with
difficult process that is loaded with challenges. It can also result in errors and delays of
To ensure that patients leave the hospital at the right time and care, hospital has
care and processes. It is describe as the critical link between treatment received in
activities and information to patients, careers and family members so they can actively
participate in their health care and any treatment they may be receiving.
nursing care. It empowers people towards health seeking behaviour and self care
leading to a healthy life and smooth recovery. Patient education plays a vital role in all
the aspects of care from prevention to treatment. Nurses educate the patients, so as
10
the family members of the patients by providing information that is understandable and
Moreover, Arkansas (2019) stated that effective patient education starts from the
time patients are admitted to the hospital and continues until they are discharged.
stay to teach the patient about self-care. Without proper education, a patient may go
home and resume unhealthy habits. These actions may lead to a relapse and a return
to the hospitals.
In the same way, patient referral stress may be a factor that affect the efficiency
(2016), that referral is a process in which a health care provider, having an insufficient
resource such as equipment, knowledge and skills to perform a critical condition, seeks
the assistance of a higher level of health care facility that can provide a better health
care to take over the client’s case. It is also the cornerstone of a basic health care for it
is a complete and sustainable system with the direction of the two to connect the
primary health care units and hospitals which leads to continuous improvement
(Lancet, 2011).
health care provider and specialist in the hospitals. It is the responsibility of the primary
health care physician to deliver a clear message for the reason of referring a patient.
On the other hand, the specialist of the hospital is responsible for conveying a clear
nurses who are typically the first health provider to ask about the patient health
condition. Nurse’s role included consultation, follow-up treatment, patient education and
illness prevention (Stromberg et al., 2003; Griffiths et al., 2007). They are the linchpin in
the coordination of patients care and are best equipped to coordinate a successful
transition. Also, nurses create transitional care plans by compiling all the patient’s
This study is also under various legal foundations. The laws being used as
foundation were the Republic Act No. 11058, and Work Health and Safety Act 2011.
According to Republic Act No. 11058 or “An Act Strengthening Compliance with
Occupational Safety and Health Standards” (OSHS), “the state shall ensure a safe and
healthful workplace for all working people by affording them full protection against all
hazards in their work environment”. As the hospital administrators who manages their
employees, they shall give their full cooperation to ensure a safe and healthy working
Moreover, the Work Health and Safety Act of 2011 also help and protecting the
health, welfare and safety of all the other people who might be affected at work. The
WHS Act also gives protection for the general public in order to ensure that their health
and safety is not at risk by work activities. Through this, it is the duty of the
management to give their best at implementing and securing a healthy and safe
There are multitudinous studies regarding job stress and on how it influences the
performance of the nurses. The findings of the following studies may provide basis or
comparison concerning job stress and on how it affects performance of the nurses.
the influence of job stressors to the performance of nurses who work in Pirngadi
analyzed by descriptive and inferential hypothesis. Results showed that work stressors
between Job Stress and Performance among the Hospital Nurses”. The study aimed to
know the relationship between job stress and performance among the hospital nurses.
The respondents comprised of 491 nurses and were randomly chosen from the
hospital in Zahedan, Iran. In analyzing the data descriptive and inferential analysis were
used. The findings of the study showed that there was a negative correlation between
among Staff Nurses in Metro Manila”used a total of 277 registered nurses from the
correlational and cross sectional design were used in the study. The result concluded
that age, civil status and length of service had a significant relationship to work-related
stress level. On the other hand, a number of patients handled per shift, educational
13
In addition, there were also related studies that have been made to determine
In accordance to age and gender, a study by Gupta, et. al, (2014) entitled “Effect
finding the effect of age and gender on occupational stress among teachers which
Mathura highway. The data analysis is done through mean, SD and t-ratio. After
analyzing the data, the result revealed that male teachers experience higher
occupational stress than females. The males in the age group 41-50 experience
on the Occupational Stress among University Lectures in Edo State, Nigeria” consisted
of 350 lecturers randomly selected from 7 universities. Two research questions and two
hypotheses where formulated to guide the study. The study indicated that there were
stress. The study also found out that there were significant differences between young
Male and Female Nurses in ICU”. The study aimed to assess the perceived stress in
male and female nurses working in ICU that include 60 staff nurses working in different
14
ICU of hospitals in India. It had been found out that there was no significant change in
Additionally, Lee, et. al, (2016) formulated a study concerning “Gender Differences
in Job Stress and Coping Strategies Among Male and Female Nurses”. The objective
of the study was to identify gender differences in job stress and coping strategies
among male and female nurses. The samples of the study were gathered from three
169 nurses. In analyzing the data it uses statistical analyses. The result of the study
found out that male nurses have experienced more job stress than female nurses.
differentiating job stress among nurses. A study conducted by Olatunji (2013) entitled
“Effect of Tenure of Service on Job Stress and Nurse- Physician Collaboration among
Nurses and Doctors” supported the argument that the longer a worker works the higher
level of stress they have. The study has a total sample size of 191 participants which
included 89 doctors and 102 nurses who were randomly picked from different
department. The study concluded that tenure of service has a significant effect on job
stress among nurses. Workers who work within the span of more than 10 years
reported of having high level of stress compared to those workers who works in a fewer
years of experience.
and Intention to Leave among Nurses in Different Medical Units: Implication for
cross- sectional Spearman correlation, one way ANOVA and multiple regression
analyses it came up with a result and found out that tenure of service was a significant
Yet, the results of the study conducted by Elahi (2012) entitled “A Detailed Study
on Length of Service and Role Stress of Banking Sector in Lucknow Region” that
medium tenure group experienced medium stress and the short tenure group
experienced the maximum stress, pointing out the negative relationship between length
Wards”. The survey utilized 180 nurses who worked in different hospital ward setting
which include the surgical, internal, and psychiatric wards. It used HSE and statistical
analysis using SPSS software/ test and analysis of variance (ANOVA). Upon analyzing
the data gathered, they came up with a result that nurses of surgical and internal ward
showed a significantly higher level of stress compared with the nurses who worked in a
psychiatric ward.
descriptive design, Kashmir (n.d.)found out that nurses who worked in the emergency
ward experienced a severe level of stress whereas the nurses who worked in the
In addition to this, the study of Rama Masa (2016) bearing the title, “Perceived
highest stress followed by the nurses who were assigned in oncology, ICU/CCU and
EU department. Also, medical and surgical nurses were reported to have the lowest
To sum it up, the researchers want to know how job stress influences the job
performance of the nurses. The main theory that served as the foundation of this study
is the Inverted- U Theory that was developed by psychologists Robert M. Yerkes and
John Dilinghan Dodson in 1908. The main assertion of this theory states that as arousal
level increases, performance improves but only to a point beyond which increases in
Several legal foundations are utilized in the study as well including Republic Act No.
11058 and Work Health and Safety Act 2011. With the support of various foundations,
Through the study, it is expected that it will lead to a clear and better understanding
THE PROBLEM
The main objective of this study is to determine the level of job stress among
regular nurses of Garcia Memorial Provincial Hospital (GMPH) and how this influences
their performance.
a. age;
b. gender;
d. employment ward?
a. Admitting patient;
b. patient care;
c. patient education;
a. age;
b. gender;
c. years in service;
18
d. employment ward?
performance?
6. Based on the findings gathered, what actions would be offered to lessen the
Hypotheses
classified according to age, gender, years in service and employment ward; and
and performance.
This research attempts to determine the level of job stress and how it influences
the performance of the nurses in Garcia Memorial Provincial Hospital (GMPH) and Don
Emilio del Valle Memorial Hospital (DEDVMH) as such, following could benefit from the
study in particular.
Nurses. The result of the study will provide useful information regarding how job
stress influences their performance those who are working in Garcia Memorial
Provincial Hospital (GMPH) and Don Emilio del Valle Memorial Hospital (DEDVMH).
Also, this study will help the nurses to come up with new strategies which can be
Patients. The result of the study will give patients care and service that they
deserve and are expected to deliver since nurses may be given a background about
Future Researchers. This study will help the future researchers to know more
about the job stress and how it influences the performance of nurses.
This study focused on the job stress of the nurses and how it influences their
performance. The study was conducted at the Garcia Memorial Provincial Hospital
(GMPH) and Don Emilio del Valle Memorial Hospital (DEDVMH) and only included the
regular nursing staff in the distribution of the questionnaires. This study did not cover
any problem that is not related to the study. This study was done through the utilization
The nurses’ performance is also checked based on their profile in terms of: (a) age; (b)
gender; (c) length in service; and (d) employment ward. It also includes the level of
nurse job stress in terms of:(a) admitting patient; (b) patient care; (c) health education;
(d) discharging patient; and (e) referral of patients to higher center. By these, the
researchers will be able to know the relationship of job stress to their performances.
20
Other non-medical and medical staffs such as administrators and doctors are not
RESEARCH METHODOLOGY
Research Design
This study utilized the survey approach of conducting research, especially the
descriptive-correlational design since the main goal of the study was to determine the
According to Burns and Grove (2005), descriptive studies are used when little is
identified variables, determine the frequency and magnitude in which it occurs and
categorizes the information. This is utilized in the study to describe and determine the
level of the respondents job stress and efficiency in their performance, as well as their
profile.
design that attempts to determine the scope of the relationship between two or more
variable using statistical data. This design is used to review if changes in one or more
variable are related to the changes in another variable measurement if job stress and
performance were made before correlation approach was applied to determine any
determines the connection that happens naturally between the variables. In addition,
Lappe (n.d.) stated that the design is used for depicting how one phenomenon is
related to another. This is utilized to know the relationship between job stress on the
performance of nurses.
Research Environment
This research was conducted in the only hospital in the Municipality of Talibon,
Bohol and one of the hospital in the Municipality of Ubay, Bohol, specifically the Garcia
Memorial Provincial Hospital and Don Emilio del Valle Memorial Hospital.
This institution was selected as the research environment since it is the largest
and closest health-care institution in Talibon. Moreover, the researchers of this study
were Senior High School students who are living in Talibon which means that they
Research Respondents
Twelve (12) regular nurses from Garcia Provincial Memorial Hospital (GMPH) in
Talibon and thirteen (13) regular nurses from Don Emilio Del Valle Memorial Hospital in
regular nurses for they are more exposed and have longer experience than contractual
nurses and those who are convenient to answer the questionnaire. In selecting the
22
respondents, researchers went to the health care institution to ask permission for the
Research Instrument
This study utilized a survey questionnaire which consisted of two parts. The first
part was all about the respondent’s demographic profile and the name and address of
The second part was the self-made survey questionnaire that was based on the
Individual Performance Commitment and Review (IPCR) of the nurses that was given
by the head nurse of Garcia Memorial Provincial Hospital (GMPH). It covers the five
sub- variables of this study namely; (1) admitting patient, (2) provision of care which
was changed into patient care, (3) discharging patients, (4) health teaching which was
also changed into patient education, and (5) referral of patients to higher center.
The core function of the IPCR were used as a phrase of the survey questionnaire
for the nurses so that the researchers will be able to measure the stress of the nurses
in each function and the performance of the nurses will be determined through
documentary analysis.
The survey questionnaire utilized in this study contains 14 items which measures
the stress of the nurses on their job. The two sub- variables “ admitting patients” and
“patient care”are appropriated with 6 items and 5 items respectively. The other three
23
Table 1 presents the 5 sub-variables of stress along with the item numbers that
Health education 12
Discharge patient 13
The survey questionnaire uses 5-point Likert Scale with the range of responses
including; (1) never stressful; (2) seldom stressful; (3) sometimes stressful; (4) most of
rating the performance of the nurses. The IPCR is used to ensure that the nurses
achieves the objectives set by the hospital management . The IPCR includes includes
Research Procedure
The step for the accomplishment of the research study includes the drafting of a
letter that is to be sent to the hospital head to ask for permission to conduct the study
and attach a consent and letter that states that the nurses are to answer voluntarily the
given questionnaires. The study has a two- part questionnaire with the inclusion of
IPCR (Individual Performance Commitment and Review) requested from the hospital
and will serve as a basis to measure the performance of nurses. Through purposive
sampling and convenience sampling, the nurses from GMPH and DEDVMH who
After obtaining due approval from the hospital head of GMPH and DEDVMH to
collect data, the researchers will proceed towards administering the questionnaire to
The collected data are tallied, tabulated, and then subjected to statistical analysis.
These collected data were illustrated and interpreted and will become a bases for some
recommendations to be proposed.
The researchers believe that the collected data from the responses of the nurses
of the research study are reliable and valid to complete and satisfy the research posted
by this study.
DEFINITION OF TERMS
25
The terms defined in this section already appeared in the other parts of this
chapter, but it is still important to put these significant terms for the readers’ better
Admitting Patient
In this study, it means giving access to or allowing entrance of a patient who can be
admitted to the emergency room or to the hospital. When the patient is admitted to the
Discharging Patient
This is the point at which patients’ hospital care end, with on going care transfer to
Patient Education
educational activities and information to patients, carers and family members so they
can actively participate in their health care and any treatment they may be receiving
Job Performance
26
accomplishing their tasks and responsibilities of their work. As used in this study, it
pertains to how nurses perform their functions on their job based on their ratings in their
Job Stress
In this study, it refers on the stress that nurses get when they feel pressured and
out of control over their work due to some factors. Moreover, job stress refers to a
burdensome and overwhelming to the point that it imposes unhealthy effects on the
Patient Care
of the health workers for the benefit of the patients (Dorland, 2012).
Referral
It is defined as a process in which a health care provider at one level of the health
care system having insufficient resources such as equipment, skills and knowledge to
manage a critical condition, t seeks the assistance of a better resource health care
facility or health care provider at the higher level of health care system to take over the
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28
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31
Appendices
34
APPENDIX A
CORRESPONDENCES
October 4, 2019
Dr. Jayoma:
Greetings of peace!
The undersigned is a Senior High School student of San Jose National High School,
Talibon, Bohol. I am presently taking up Practical Research 2 - Quantitative Research
subject. I am the group leader of our research study entitled “Job Stress on the
Performance of Nurses in Garcia Memorial Provincial Hospital (GMPH)”
In line with the subject requirement, I would like to request your good office to allow me
and my members in conducting a data collection through survey and documents from
the current medical health workers of Garcia Memorial Provincial Hospital. These data
are required for the accomplishment of the study which aims to determine the level of
stress that might affect to their performance.
Respectfully yours,
Noted:
Approved:
MIGUELITO S. JAYOMA, MD, FPSGS, FPSC, MHM
Chief of Hospital II, GMPH
36
Head of GMPH
Dr. Jayoma:
Good Day!
We humbly request your good office for the list of all regular nurses who are working in your
hospital. These data are required for the accomplishment of our study which aims to determine
the level of stress that might affect to their performance.
We understand that the institution promulgates privacy of information regarding its staffs.
Hence, we would be using the list with utmost confidentiality.
Respectfully Yours,
Group Leader
Noted by:
GISELO B. CAJES
Approved by:
Head of GMPH
37
APPENDIX B
SURVEY QUESTIONNAIRE
(GMPH)
PART I
Personal Information
1. Age: _______
2. Gender:
______ Male
______ Female
3. Years in Service:
Length of service in the institution: ______ years, if less than one year ______
months.
4. Specialized area:
38
______ Ward/ ER
______ OPD
PART II
Instructions: Please put a check in the box for each questions that comes closest to
reflecting your opinion about it.
5. I get stressed in
administering drugs
9. I get stressed in
documenting
39
APPENDIX C
PROVINCE OF BOHOL
City of Tagbilaran
Talibon, Bohol
I, FELIZE MARIE G. MAQUILING, NURSE I of Garcia Memorial Provincial Hospital of the Provincial Government of Bohol,
commit to deliver and agree to be rated of the attainment of the following targets in accordance with the indicated measures for the
period of July 01, 2017 to December 31, 2017.
Ratee
taking
Carry
doctors
order
Prepare
and
administ
er drugs
Attend
OPD
patients
outside
office
hour
procedures
CORE 100% of
FUNCTION 3: comprehensive
Health health teachings
teachings provided to patients
and their Significant
others within days
of confinement
CORE 100% of patient
FUNCTION 4: discharged
Discharge (advised, per
patients request and against
advise) within 5
minutes
CORE 100% of patient
FUNCTION 5: referrals facilitated
Referrals of and conducted
patients to immediately within
Higher center 5 minutes upon
instruction
FINAL
AVERAGE
RATING
44
MFOs- Support
Functions
45
Prepared by: Date: Assessed by: Date: Final Rating by: Date: Date: