PSYCHIATRY NURSING JOURNAL

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(Jurnal Keperawatan Jiwa) This is an Open Access article
Vol. 5, No.2, September 2023 distributed
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Laman Jurnal: https://e-journal.unair.ac.id/PNJ Attribution 4.0 International
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http://dx.doi.org/10.20473/pnj.v5.i2.46403

Original Research
EXPERIENCES OF STUTTERER NURSES IN THE PROVISION OF NURSING
CARE IN PAKISTAN

Rizwan Ullah1* and Bakhtyar Ali Shah2

1 Student, Khyber Medical University Peshawar, Pakistan
2 Assistant Professor, Khyber Medical University Peshawar, Pakistan

ARTICLE HISTORY ABSTRACT

Received: June 13, 2023
Introduction: “Stuttering” is a speaking disorder where the flow of speech is blocked by
Revised: August 08, 2023
Accepted: August 09, 2023 an involuntary audible or inaudible pause, repetition and prolongation, causing; anxiety,
Available online: Sept 10, depression, and embarrassment for a person. This study aimed to explore the lived
2023 experiences of a stutterer nurses caring for the patients at clinical site.
Method: Qualitative descriptive phenomenology design was used to recruit Nine Stutter
Nurses (6 males, 3 Female) through Purposive sampling technique. Individual, face to face,
semi structured interviews were conducted and analyzed using thematic analysis.
CORRESPONDING Results: Three major themes and associated sub-theme emerged from the analysis of the
AUTHOR
participants’ narratives. The first theme compromise triggers of stuttering, with stress
Rizwan Ullah
swatrizwan660@gmail.com being the prominent one, the second theme compromises the impact and effect of
Student, Khyber Medical stuttering in nursing, sub-associated with impact on self-esteem which is predominantly
University Peshawar, negative; impact on clinical care, which is of minimal impact; effect on relationships with
Pakistan colleagues that have no affect; and effect on relationships with patients that exert effect.
The third theme compromise of management strategies by stutter nurses, sub-associated
with techniques to overcome stuttering at clinical site.
Conclusions: Stuttering does not necessarily impact a nurse's ability to provide
compassionate and competent care. By using strategies to manage stuttering and seeking
support from colleagues and supervisors, a nurse who stutters can effectively
communicate with patients and excel in their clinical practice.

Keyword: communication; experiences; nurses; nursing care; stutterers

Ullah, R. & Shah, B. A. (2023). Experiences of Stutterer Nurses in the Provision of Nursing
Cite this as:
Care in Pakistan. Psych. Nurs. J., 5(2). 55-65. doi.org/ 10.20473/pnj.v5.i2.46403

1. INTRODUCTION and avoidance of particular circumstances (Kelman &

Nicholas, 2020). Stuttering affects many facets of life;
“Stuttering” is a speaking disorder where the flow of sufferers express negative feelings about their
speech is blocked by an involuntary audible or stuttering and dissatisfaction with their lives. They
inaudible pause, repetition and prolongation, also had communication difficulties in important
causing; anxiety, depression, and embarrassment for contexts with constrained life objectives (Yaruss,
a person (Bajaj, Varghese, Bhat, & Deepthi, 2014). 2010). When someone stutters, their audience is
According to (Shapse, 2008), stuttering as a disorder more likely to pay attention to how they speak than
of persistence repetition and prolongation of sounds the content they are trying to convey, which prevents
or syllables. Dysfluencies of interjection, words them from the joy of speech (Klompas & Ross, 2004).
fragments, audible or inaudible sounds, When speaking to a stranger, someone of the
circumlocutions, pronunciation of words with extra opposing gender, or a person of great position, stress
physical tension and whole word repetition were also makes stuttering worse (Rana, Kausar, & Khan, 2021).
mentioned. The characteristics of stuttering include The majority of people who stammer are victims of
physical tension, struggling behavior, verbal changes, prejudice, which limits their opportunities to get

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R. ULLAH, ET AL.

employed or promoted and psychologically ruins method for phenomenological study (Creswell &
their job pleasure (Klein & Hood, 2004). The cause of Poth, 2016). Participant for the study were recruited
stuttering is unclear, although contributing variables through in-depth interview. The eligibility criteria for
include a child's gender, cognitive capacity, and the study include those nurses who are stuttering by
environmental influences (Prasse & Kikano, 2008). birth.
According to (Delgado, 2008), Stuttering is not only a
2.3 Pre-testing the Interview Guide
problem in the mechanism of speaking but it involves
multiple factors in their etiology including physical For the appropriateness of guiding questions for the
actions, intentions, feelings, perceptions, and beliefs. research enquiry, the interview guide was pilot tested
Stuttering usually starts between the ages of two and on two stutterer nurses who met the inclusion criteria
seven, peaking in the fifth year of life. 98% of but didn’t participate in the study. The study guide's
instances start before the 10th year. The majority of probes were improved via the pilot testing, which
the youngsters which is approximately 50% to 80% also helped determine how comfortable the
recovered on their own without any treatment, participants were answering the questions. One more
However 1% of these population persistently do probe was added to question two following the pilot
stuttering throughout their life (Yairi & Ambrose, interview since it was essential for understanding the
2013). Stuttering is more prevalent in males than in nurse's experience in patient care.
girls, with a ratio of 4:1 between the two (Nang,
2.4 Data Analysis
Hersh, Milton, & Lau, 2018). In USA, the stuttering
prevalence rate is 2.25%, whereas it is 1.5% in India For data analysis, thematic analysis was done. The
and 1.13% in Iran (Mohamadi, Nilipour, & Yadegari, taped recorded interviews' were first translated into
2008; Proctor, Yairi, Duff, & Zhang, 2008; Srinath et English. The process of data analysis was guided by
al., 2005). These are almost identical statistics in Asia the phases given by (Braun & Clarke, 2006). Inductive
as compared to studies carried out in the Western coding was used to analyze the data by using latent
Countries. According to (Sheldon, Barrett, & Ellington, approach of thematic analysis; Similar codes with the
2006), a key component of everyday nursing practice same meaning were merged together to form sub-
is effective communication between the nurse and the theme and that were analyzed for construction of core
patient. It enhanced and strengthened nursing care. A theme.
successful nurse must have effective communication The detective went over each transcript many times
skills since ineffective communication can be harmful and underlined any statements that seemed to be
and cause confusion (Sibiya, 2018). The foundation particularly informative. More precisely, while
for delivering trustworthy, high-quality patient care choosing quotes with a lot of detail, broad guidelines
is communication with patients (Bramhall, 2014). were followed. First, those deemed to be directly
The practice of nursing heavily relies on relevant to the subject matters under investigation
interpersonal interactions. It requires the were considered prospective quotations. Repetitive
development of interpersonal, intellectual, technical, statements, purely social remarks, and elements
and clinical competencies and skills in addition to within a narrative piece that did not provide new or
theory and clinical practice (Kourkouta & important information were eliminated.
Papathanasiou, 2014). This indicates that
2.5 Ethical Consideration
interpersonal interactions, practice, and knowledge
are all necessary components of nursing (Kourkouta The study approval was taken from the office of the
& Papathanasiou, 2014). The level of communication Research, Innovation & Commercialization Khyber
between the nurse and the patient is crucial for Medical University Peshawar. Prior to involving the
improving patient outcomes and reducing medical participants in the study, a written informed consent
mistakes (Sibiya, 2018). According to (Craig & Calver, was taken by informing each participant about the
1991), services with more communication make it research. The participation in the study was on a
harder for those who stutter. The study aimed to voluntary basis and participants were assured that
explore, the experiences of a stutterer nurses caring they could withdraw from the study at any time.
for the patients. Findings from this study will be disseminated without
revealing the identity of the study participants.
2. MATERIALS AND METHODS
2.6 Data Collection
2.1 Design
After obtaining ethical approval from Khyber Medical
This research study was guided by a qualitative University Peshawar (92-91-9217268), participants
exploratory descriptive design. who showed interest in participating in the study
2.2 Population and Sampling received an information sheet with a concise
summary and the study's aims. After that a written
A total of nine stutterer nurses (6 Male, 3 Female) consent was singed from the participant and was
were interviewed based on the availability and data recruited for the study via in-depth interviews. All of
saturation. Participants were selected via purposive the interviews, which lasted between 20 and 40
sampling technique, which is a choice of sampling

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minutes, were taped. It was made sure that interviews people who stutter to communicate effectively. This
were placed at convenient times for the participants. can be particularly challenging for nurses, who rely
on effective communication to provide high-quality
3. RESULTS care to their patients. There are several ways in which
A total of nine stutterer nurses (6 Male, 3 Female) stress may contribute to stuttering in nurses. One way
Participated in the study. Participants were selected is through physical tension or arousal. When we are
via purposive sampling technique. Participant for stressed or anxious, our bodies become tense and our
the study were recruited through in-depth muscles may become tight or strained, making it more
interview. Table 1 shows the demographic difficult to produce fluent speech. As a participant
information of the participants. All significant expressed his view of tense situation as:
concepts, words, and phrases that were related to
the phenomena were highlighted and assigned a “It happens when a nurse is less sleeping, tense,
code by following the inductive, in vivo coding anxious, and in a pressured environment” (P3).
process. The development of sub-themes involved
combining similar codes with the same meaning. A Another view was stated as:
description was written in front of each sub-theme “Stammering occurs more if a person is very
in their respective column.
emotional, in an angry mood, in tense or in hurry” (P1).
Based on the sub-themes a core theme was
then identified. Personal names, word or phrase Stress may also affect stuttering through cognitive
repeats, and interjections (such "um" and "uh") factors. When we are stressed, our thoughts and
were left out of the transcription. The analysis of the attention may become more focused on our worries
narratives led to three broad themes and associated and concerns, rather than on the task at hand. This
sub-themes, as shown in (Table 2). can make it more difficult for nurses who stutter to
concentrate on their communication with patients,
3.1 Triggers of Stuttering in Nursing leading to increased stuttering. As one of the
3.1.1 Stress-induced Stuttering in Nursing participant stated as:
Across all the triggers Stress was identified as the
“In a comfortable situation, a proper sleeping or
leading cause of stuttering in nursing, since almost all
friendly environment is the best situation in which
participants experienced it. It is not uncommon for
stammering occurs less or if you are in a friendly group
nurses to experience stress in the workplace. The
discussion. Or your thinking is completely different
demands of the job, including long hours, high levels
from that I have stuttering” (P3).
of responsibility, and the need to make important
decisions under pressure, can all contribute to stress 3.1.2 Stuttering is due to Anxiety and Fear of being
and burnout. For nurses who stutter, stress may be an
Stuck
even more significant factor in their experience of
stuttering. As a participant stated: Anxiety is a common emotion that can affect
individuals who stutter, as well as nurses who stutter.
“When we are in communication with our Anxiety can manifest in several different ways,
seniors, teacher, or consultant who came suddenly on including feelings of nervousness, worry, pressurized
us and make us stressed so in that time stuttering are and fear. For nurses who stutter, anxiety may be
occurring more. So it occurs mostly in a stressful particularly prevalent in situations where effective
situation” (P5). communication is required, such as when speaking
with patients or colleagues. As a participant
Research has shown that stress and anxiety can
communicated;
exacerbate stuttering, making it more difficult for

Table 1. Demographic profile of the participants

Variables N (%)

Gender
Male 06 (67)
Female 03 (33)
Age 18- 30 years 06 (67)
31- 40 years 02 (22)
41 years & above 01 (11)
Marital status Single 03 (33)
Married 06 (67)
Divorce 00 (00)
Clinical experience 0 to > 1 year 00 (00)
1 to > 2 years 00 (00)
2 to >3years 05 (56)
3 years or above 04 (44)

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Table 2. Data analysis table

Descriptions Code Associated themes Themes

Open Axial

“So it occurs mostly in a stressful Stress-induced

situation". Stress full Stressful mind & stuttering in nursing
“Stammering is automatically situation, environment

Triggers of stuttering in nursing

linked with the mind and it mostly Mind with exacerbate
occurs in stress” stress stuttering
“In stuttering a person normally Tension, Preconception of Stuttering is due to
takes tension or considers Superior fear, anxiety and fear of
someone superior to him then his status, Anxious feeling being stuck.
stuttering occurs”. Fear,

1st
“There will be fear in your heart Get stuck
that if you get stuck while
answering”.

“Stammering occurs more if a Emotional, feeling of self- Communication

person is very emotional, in an Tense, consciousness pressure
angry mood, in tense or in hurry, Hurry,
or even talks with a person of
higher status”.
“They will laugh at them and will Laugh, Issues of Impact on self-esteem

The impact and effect of stuttering in nursing

make fun of their stuttering. Making fun of, personality
It affects self-esteem and it is a Grooming
defect in a person grooming personality
personality”
“Due to this, some information is Missed Affair in care. Impact on clinical care
often missed. So it might cause a information,
little delay but normally it doesn’t Little delay,
happen”.
“I tell you, I even don’t realize the Easily Communication Effect on patient

2nd
patient of my problem. We can communicate, with patient relationships
easily communicate with the My problem
patient”.

“In my opinion, it does not affect. Known Interactivity with Effect on Relationships
Because they are the people of behavior, colleagues with co-workers
their ward, they already know his Senior doctor,
behavior. But when you talk to a fear
senior doctor, there is a lot of fear
in the heart of a person”.
Speak slowly, Specific exercises Techniques to
clinical site by stutter nurses.

“I speak slowly and first inhale Deeply inhale and techniques overcome stuttering at
Management of stuttering at

deeply and then exhale slowly and Deeply exhale, clinical site
speak the word while exhaling so
stammering did not occur much
with such techniques”.
3rd

increased stuttering and a sense of self-consciousness

“If there are such high-status patients then the
or discomfort. As a participant stated;
individual took pressure and stuttering can occur. So, if
the individual will talk slowly to communicate then “It is a psychological issue; in stuttering a person
stuttering will not occur that much” (P6). normally takes tension or considers someone superior
to him, then his stuttering occurs” (P1).
Anxiety can make it more difficult for nurses who
stutter to communicate effectively, leading to
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It is not uncommon for individuals who stutter to in hurry the words will not come to their tongue. So the
experience anxiety and fear related to their message is not transferred properly” (P8).
stuttering. This can be especially true for nurses who
stutter, as their job requires frequent communication 3.2 The Impact and Effect of Stuttering in Nursing
with patients, colleagues, and supervisors. One 3.2.1 Impact on Self-esteem
common fear that individuals who stutter may It is common for people who stutter to feel self-
experience is the fear of being "stuck" or unable to conscious, anxious, or embarrassed about their
produce fluent speech. As a participant verbalized; speech. This can lead to feelings of low self-esteem,
“You will have more knowledge of one thing; a social isolation, and difficulty expressing them-selves.
teacher will ask you about it but there will be fear in As the response of a participant was;
your heart that if you get stuck while answering people “if anyone has more stuttering issues, he has
will laugh at me” (P9). more problems. As I said, there will be a most talented
This fear can be particularly challenging for nurses, person, but he will not be able to show his expressions.
who rely on effective communication to provide high- So it affects self-esteem and it is a defect in a person
quality care to their patients. Several factors can grooming personality” (P2).
contribute to this fear in nurses who stutter. One
factor is negative experiences in the past, such as Stuttering is a normal and natural human variation
teasing or bullying related to stuttering. These that can affect an individual's ability to communicate
experiences can lead to feelings of self-consciousness effectively. For many individuals who stutter,
or embarrassment and may make it more difficult for stuttering can shape their self-esteem in several ways.
nurses who stutter to feel confident and comfortable One way that stuttering may shape self-esteem is
communicating with others. As a participant on through to the stigma and misunderstandings
teasing and bullying stated; surrounding stuttering. As a participant
communicated;
“There is a fear in the heart of a person that if he
is in communication with someone and he is stuck in “It greatly affects the self-esteem of an
between them then the people will laugh at them and individual. Especially if a weak student needs to present
they will make fun” (P7). properly in the classroom. He thinks that other people
communicate well and I can’t, so they suffer from an
inferiority complex” (P2).
3.1.3 Communication Pressure
Communication pressure referred to the feeling of Stutter person can avoid speaking or social
self-consciousness that individuals who stutter may interactions as a result, can lead to feelings of
experience during speaking situations. Most of the isolation and a sense of difference from others. As a
participants in this study highlighted that; participant stated;
communication pressure can trigger stuttering in
nursing. One of the primary sources of “Stammering is a speaking disorder, where an
communication pressure is the fear of negative individual flow of speech is blocked involuntarily. They
reactions from others, as a participant verbalized it repeat their own words over and over again, and feel
as: shy to talk in front of people. The majority of the time,
an individual is silent and isolate” (P4).
“When you are in communication with someone
and you stuck repeatedly, and do stuttering, so people
3.2.2 Impact on Clinical Care
laugh at you, they look at you strangely” (P7).
Quality nursing care involves providing safe,
When individuals feel pressured to speak quickly or compassionate, and evidence-based care to patients.
to meet certain expectations in their speech, such as Providing nursing care requires clear and effective
maintaining fluent and uninterrupted speech, it can communication with patients, which can be difficult
trigger stuttering. A participant in the study for those who stutter. However, it is important to
verbalized as: remember that individuals who stutter are just as
capable of providing high-quality nursing care as
“Stammering occurs more if a person is very those who do not stutter. Nurses who stutter can be
emotional, in an angry mood, in tense or in hurry, or successful in their roles. As a participant state that;
even talks with a person of higher status than his e.g of
high scale, high educational status, or his officer” (P1). “It does not affect or delay in care of the patient.
Or even I can say that they do better care then others
Time constraints, interruptions, or critical listeners as they normally prefer to work in a silent mood” (P3).
can contribute to this pressure. As a participant stated
as: Another person expressed himself as; “The Patient is
dependable on us and patient listens to us whether we
“If an individual is stuck in an emergency stutter or speak correctly. So in my opinion it did not
situation; it doesn’t convey his message. Or if they were

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R. ULLAH, ET AL.

affect the care of the patient. Even we can do it in a “To maintain good relations with a patient, we need to
better way” (P2). get close to the patient who needs effective
communication with the patient. But a stutter nurse
About all of the study's participants regret the has an issue of shyness, and fear, which acts as a barrier
assumption that stuttering may affect clinical care. between the nurse and the patient” (P4).
However, several of them suggested that it may have
an effect in situations where stress is common. As Another participant on fear and pressure
participant presented as; reported as; “The individual feels pressure from the
patient and colleague during communication that they
“Normally not, but it delays in a way if an will laugh at them and will make fun of their stuttering”
individual is stuck in an emergency situation; it doesn’t (P1).
convey his message. Or if they were in hurry the words
will not come to their tongue. So the message is not In addition, effective communication and
transferred properly” (P6). collaboration among the healthcare team are
important for providing high-quality patient care.
3.2.3 Effect on Relationship with Colleagues When communication is hindered by stuttering or
Providing patients with high-quality care requires other factors, it can affect the accuracy and timeliness
effective teamwork and communication among the of information exchange, which can impact the
employees. A tense situation might cause stuttering patient's treatment and outcomes. In the study
more frequently. Stress is absent or minimal in a express the above notion as;
friendly setting. Almost all participants highlighted “it delays the patient care initially because if we
that stuttering in such a profession has a negative tell details of care to our colleagues, it may take a while
effect on relationship with coworkers. Participants more as compared to fluent speakers which may
verbalized as; slightly delay the care but usually it didn’t affect it
much” (P5).
“Stuttering direct relation is with stress. While
stress does not occur in a friendly environment, it has
more impact in an unknown environment. Therefore, Moreover, participant also stated that their stuttering
while talking with your friend and colleague, the stress didn’t affect their relationship with patients, as
on you is not so much and you can talk easily” (P4). patient are sub-ordinate to us and communication
with them is less stressful, as stuttering become
However, they also noted that because of their
worsen when speaking to those who are perceived as
seniority affects, which further increase stress and
superiors. The participant verbalized as;
tension, it may have an impact on the relationship
with seniors. As a participant put it; “It means we can easily communicate with the
patient because they are subordinate to us, and we are
“In my opinion, it does not affect. Because they
not pressurized to communication with them” (P2).
are the people of their ward, they already know his
behavior. But when you talk to a senior doctor, there is 3.3 Management of Stuttering at Clinical Site
a lot of fear in the heart of a person. And when there is
fear and people take stress, stuttering will occur more 3.2.1 Techniques to Overcome Stuttering at Clinical
and will affect communication. If we don’t think about Site
a person’s reputation, then communication will be easy In this study, self-management is considered as a
for an individual” (P5). combination of internal coping methods and external
help from professionals such as speech therapist,
3.2.4 Effect on Relationship with Patient doctors, or other individuals. The desire to take
Nursing is a demanding and rewarding profession control of the stutter frequently included the action of
that involves providing care and support to patients going out and getting expert assistance. As a
of all ages, in a variety of settings. Nurses who stutter participant stated;
may face some unique challenges in the provision of
nursing care, particularly when it comes to “I want to add a few things more if stammering
communication with patients. People who are able to patient speaks fast, then he will face stammering issues
express their feelings and opinions to others more. Actually our tone is a little bit fast then others. It
successfully build relationships. Stutterers may is better to do it slowly. And a speech therapy, when
struggle with social situations and may find it difficult they guide you some tips and then you follow it. So it
to establish connections since stuttering may have a will be helpful to manage stuttering” (P9). Another
significant influence on communication. Stutter may participant stated as;
experience shyness, fear or discomfort when
speaking, which can affect their ability to effectively “I have done speech therapy, I do some special
communicate with others. As a participant in the exercises, and then I do not face stammering. It is when
study stated; a person is comfortable and feels relaxed” (P6).

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Participants also talked on the significance of medical and stress as compared to those with mild to
care for management of stuttering. As stated by a moderate stuttering(Sikandar, Naeem, Iqbal, Nawaz,
participant; “Another way is the use of medicine for Nawaz, et al., 2020).
some time that is according to doctor prescription. In contrast to the current findings, a study compared
Such as SSRI, Acetaloprame” (P8). ten stutter people with ten matched non-stutter
people. The study took placed at University of
Moreover, the participants also emphasized that one Toronto in 2014, It was not discovered that cognitive
method for controlling stuttering is anger stress has any distinct effects on stuttering people
management. In anger, one's stammer gets worse. compared to controls or that it has an influence on
The participants stated as follows; motor execution processes (van Lieshout, Ben-David,
Lipski, & Namasivayam, 2014). While this study’s
“In Anger, during an unusual situation or when participants did mentioned a strong linked of stress
an individual gets angry or is in a quarrel situation. with stuttering. It is because the above study
When there is pressure or anxiety on the individual. participants were in a restricted severity range
they stutter more” (P3). environment.
4. DISCUSSION 4.2 Stuttering is triggered by anxiety and a fear of
becoming stuck
The intent of the study is to explore the lived
experiences of stutter nurses in the provision of The current study present evidence that
nursing care. In addition, this study investigates the stuttering is associated with anxiety and fear of being
triggers in nursing that favor stuttering, the impact of stuck similar to what other researchers before has
stuttering on self-esteem and clinical care of nursing, shown.
and the strategies that nurse uses to manage In previous stuttering literature, Anxiety has been
stuttering. A number of themes identified in this study acknowledge as an associated factor with stuttering.
are similar to those previously discovered for people In a research conducted by (Davis, Shisca, & Howell,
who stammer and their families. However, several 2007), at University College London, comparing the
themes were unique in this study. degrees of anxiety in normal speakers, speakers who
stutter persistently, and speakers who recover from
4.1 Stuttering Caused by "Stress" in Nursing stuttering, those who stammer persistently showed
The findings of the present study revealed that across greater levels of state anxiety. According to a
all the triggers Stress was identified as the leading descriptive cross-sectional research, as compared to
cause of stuttering in nursing, since almost all non-stutterers, those with stuttering score higher on
participants experienced it. traits such as fear of social rejection and anxiety
The finding corresponds with the finding of a study (Bricker-Katz, Lincoln, & McCabe, 2009). Similarly,
conducted in Brazil by (Oliveira & Nogueira, 2014) , stuttering persons who are linked to other stutter
some important elements identified in the study such people for their communication have gained an
as stuttering like Dysfluencies and emotional stress increase in their confidence. Social anxiety can have a
factors, as well as family attitudes that are connected negative effect on a stammer's entire self-concept
to familial persistent developmental stuttering in (Fuse & Lanham, 2016).
males. This implies that the presence of these Moreover, a comparative study conducted by (Blood
variables raises the chance of stuttering. & Blood, 2016), comparing stutters with non-stutters
Considering that stress may cause stuttering on four psychosocial scales. According to study’s
the present study confirms the findings of a study findings, those who stutter score higher on scales
conducted in Brazil by (de Oliveira, Cunha, & dos measuring social anxiety and fear of criticism than
Santos, 2013), In terms of the causes of mental stress, non-stutterers. Additionally, an investigation into the
the study discovered a strong link between emotional connection between teenage stuttering symptoms
stressors and boys' chronic developmental stuttering. and anxiety was done in 2008. The results show that
The current findings was also supported by a study the stuttering group's mean score on the fear of
findings that revealed themes of elevated emotions of negative assessment scale is much higher than that of
fear, anxiety, frustration, stress, and/or inner the non-stuttering participants (Mulcahy, Hennessey,
strength as a result of recurrent stuttering over time Beilby, & Byrnes, 2008).
(Dits, 2014). Moreover, According to (Finn, Howard, 4.3 Communication Pressure
& Kubala, 2005), in his research, a sample of 15 adult
stutterers showed that stress, tiredness, and other The current study findings suggest that
environmental factors aggravated their stuttering communication pressure can have a significant
patterns. Additionally, this study supports a previous impact on nurses who stutter. The study revealed that
Pakistani study of (Sikandar, Naeem, Iqbal, Nawaz, one of the main consequences of communication
Ifthikar, et al., 2020), that explores the effect of daily pressure is increase anxiety and self-consciousness.
anxiety and stress on stuttering. They grouped the The findings correspond with the finding of a
participants on the basis of stuttering severity. Group previous stuttering literature conducted in 2007 at
with moderate to severe stuttering had more anxiety University College London, comparing the degrees of
anxiety in normal speakers, speakers who stutter

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R. ULLAH, ET AL.

persistently, and speakers who recover from 4.5 Impact of Stuttering on Clinical Care
stuttering, those who stammer persistently showed
The current study findings suggest that
greater levels of state anxiety(Davis et al., 2007). The
stuttering have no impact on clinical care. However, it
study also correspond the finding of a cross sectional
may have impact if the working environment is
descriptive study conducted for the purpose of
stressful. Even so, researcher did not found any
investigating emotional reaction to stuttering. 12
literature on the effects of stuttering at clinical sites.
stuttering participants and 14 non-stuttering
However, most of the researches done at workplace
participant as a control group complete the fear of
revealed incongruence results. A comparative
negative evaluation scale (FNES). The t-test shows a
research was done by (L. W. Plexico, Hamilton,
significant difference between the two groups which
Hawkins, & Erath, 2019), looked at the relationship
indicated that the stuttering group score significantly
between workplace discrimination, vigilance, and job
higher in FNES than non-stuttering control group.
satisfaction between PWS to those who do not. The
64% in the group of stuttering score higher than 18
survey was filled out by the participant and evaluated
on the FNES, whilst none of the controls scored higher
six distinct factors, including discrimination in the
than 18 (Bricker-Katz et al., 2009).
workplace and general attitudes. Stuttering was
Furthermore, this study highlight that individual who
linked to decreased work satisfaction in this research.
stutter may become hyper aware of their speech and
A higher level of stereotyping was also linked to
worry about how others perceive them, leading them
stuttering. The current study findings also suggest
to worse self-esteem and become a victim of
that stereotyping is link with stuttering. In line with
stigmatization. This study confirmed the finding of a
this a qualitative research on the effects of stuttering
previous study conducted by Blood et al. stated that
on job performance, 37.5% indicated a negative
victimization experience, self-esteem, life orientation,
impact, 25% of participants expressed mixed
and life happiness were examined in two groups of
emotions while 37.5% of participants had no
students. Stutters reported higher victimization,
influence at all (Klompas & Ross, 2004). Additionally,
worse self-esteem, and less life direction(Blood et al.,
a study concluded that stuttering might have a
2011).
negative impact on work productivity and job
4.4 Impact of Stuttering on Self-esteem of a Nurse satisfaction. This may cause stress and anxiety, and it
may also affect one's reputation at work (Parsons,
In this study almost all the participants
Ntani, Muiry, Madan, & Bricker-Katz, 2022). The
encounter low self-esteem because of their stuttering.
current study also revealed that stuttering may
In line with previous studies also confirmed
impact clinical care if the working environment is
stuttering negative impact on self-esteem. As in
stressful.
previous studies, a research found that participants'
marital lives did not appear to have been impacted by 4.6 Stuttering Effect on Relationship with the
stuttering. Most participants reported that stuttering Colleagues and Patient
had a negative impact on their sense of self-esteem
The current study findings revealed that
and their perception of oneself as well as triggered
stuttering has no impact on relationships with
intense feelings (Klompas & Ross, 2004). Similar to
coworkers since speaking with coworkers is less
this, a research found a common theme of negative
stressful. The result support previous study finding
self-perception caused by their stuttering
on relationship with colleagues. Nine participants out
experiences(Nang et al., 2018).
of 16 reported that their stuttering did not affect their
The current study reveals that bullying and the
relationship with colleagues. While five participants
misconception associated with stuttering effect self-
reported that they have effect on their relationship
esteem of an individual. A retrospective study by
(Klompas & Ross, 2004). Similarly, in a study 40% of
(Hugh-Jones & Smith, 1999), showed the same as it
the participant marked not at all to impact of
was carried out to look at the reasons behind and
stuttering on relationship with friends, family and
patterns of bullying among stuttering students. The
peers, while 46.7% of the participants marked
majority of participants reported experiencing
sometime and 13.3% marked almost always (Bajaj et
bullying in school, and the risk of doing so is linked to
al., 2014).
the experience of having trouble making friends. The
Current study findings also suggest that it may affect
majority of them claimed that bullying had immediate
relationship when a person is with communication
negative effects on them, and some claimed that
with a senior or colleague of high status. Which
bullying had some long-term impacts on them.
support the findings of a study, where 62.5% of the
Additionally, in a study victimization experience, self-
participants reported that stuttering impact their
esteem, life orientation, and life happiness were
relationship with teacher, while 37.5% reported that
examined in two groups of students. Stutters
their stuttering didn’t impact their relationship with
reported higher victimization, worse self-esteem, and
teacher (Klompas & Ross, 2004). In contrast, the same
less life direction(Blood et al., 2011).
study also found that half of the participant stated
that their stuttering did not influenced their
relationship with managers and supervisors, while

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 PSYCHIATRY NURSING JOURNAL

43.7% have shown an effect on their relationship makers, and research. Health care professionals and
(Klompas & Ross, 2004). policy makers should have sound knowledge about
In this study more than half, which is 60% of the stuttering and need to inform the public that
participant reported that stuttering can act as a stuttering is not a disability. They should take
barrier in relationship with patient. While, 40% of the measures to clarify the misconceptions and dispel
participant reported that stuttering didn’t affect their myths about stuttering in order to eliminate the
relationship. Because patient are in need of help and perceived stigma surrounding stuttering. It is
they are subordinate to us. Overall there is no important for health care professional to treat stutter
literature on the effect of stuttering on relationship nurses with respect and support, and to recognize
with patients but the finding was supported by a and appreciate the valuable contributions they make
research report of (Bricker-Katz et al., 2009), that to the healthcare team. Policy makers should
reported stuttering always affect working investigate stressors for stutter nurses and to make
environment. They limit communication and limit policies that favor stutters in order to provide them
progression of work. Similarly, in a study 82% of the stress free environment for their work. Managers and
participants report that stuttering affect their supervisors should explore and discus strategies
employment, while 18% did not believe that their toward stuttering and to create simple successful
stuttering affect their job performance(Schlagheck, environment to communicate with a stutter. The
Gabel, & Hughes, 2009). study further indicated that nurses who stammer are
equally capable of giving excellent nursing care as
4.7 Management Strategies for Stuttering
those who do not stutter, given the necessary support
The majority of participants claimed that they and accommodations. As there is little information in
were trying management strategies to get rid of their the literature about stuttering nurses in the literature,
stuttering. Support from experts was significant; therefore further study is necessary to examine the
participants reported receiving speech therapy and difficulties faced by these professionals.
medical advice. This finding is consistent with the
research literature for example, a case study result
showed that speech therapy reduce stuttering and
5. CONCLUSSION
increase vocalization of the words. The result further Nursing care is a crucial aspect of the healthcare
demonstrates that holistic speech therapy brought system, and nurses need to be able to communicate
positive outcome in stuttering people(McGill & effectively with patients to provide high-quality care.
Schroth, 2022). Stuttering can sometimes affect a nurse's ability to
In line with the above literature a study was communicate with patients and may impact their
conducted to understand the successful management clinical practice in various ways e.g. in
of stuttering from the participants’ perspective. communication with patient, with supervisor or
Mentors, local and national support groups, family someone of superior status. However, Stuttering does
and friends, as well as professional counseling, are not necessarily impact a nurse's ability to provide
preferred resources by the participants. The compassionate and competent care. By using
participants said that having access to support strategies to manage to stutter and seeking support
networks, gave them the ability to communicate with from colleagues and supervisors, a nurse who stutters
other stutterers, be open about their stuttering, and can effectively communicate with patients and excel
share knowledge on stuttering(L. Plexico, Manning, & in their clinical practice.
DiLollo, 2005).
In addition, the study emphasizes the value of 6. REFERENCES
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