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Stress in the clinical setting - A concept analysis

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Stress in the clinical setting-A concept analysis University of Phoenix NUR513-Theoretical Foundations of Nursing July 24, 2005 Stress in the clinical setting-A concept analysis The nature of clinical nursing is changing at whirlwind speed. Job stress creates a threat to bedside nurses and, over time, their organizations. The difficulties nurses experience may be temporary or enduring. There may be factors caused by work or outside of work. No one is immune to stress and it can affect individuals at all levels. Nurses face many stressors such as inadequate staffing, lack of support dealing with death, interpersonal conflicts, unresponsive to leadership, and physical inefficiencies. This paper will examine the meaning of stress using the Walker and Avant method of concept analysis and explain the factors influencing stress and nurses in the clinical setting. This concept analysis will have eight parts. Using Walker and Avant, as based on the work of Wilson, "method of concept analysis provides a clear, concise method for exploring and clarifying a concept that has been used extensively" (Glaister, 2001, p.63). The steps of the process are: 1. choosing concept; 2. definition of concept and critical attributes; 3. example of model, contrary, borderline, related, and illegitimate cases; 4. proposition/statement for the concept; 5. list antecedents and consequences; 6. clinical examples of how concept would be used in practice; 7. definition of empirical referents; 8. conclusion: including how nursing theory can be an advantage or disadvantage in daily practice. Concept Analysis of Stress "Stress, like beauty, is in the eye of the beholder. An event that may cause you major concern could be a mere minor irritation to another" (Kowalski, 2001). Dr. Hans Selye borrowed the term stress from the field of engineering (where it refers to external mechanical forces, strains, and tensions) and implied it to the human body (The principles of stress, n. d.). "His experiments on rats in 1936 showed that various stressors such as cold, heat, infection, trauma, hemorrhage, fear and the injection of noxious substances, all produced the same effect" (The principles of stress, n.d.). ...read more.


Contrary case A contrary case is constructed to reflect none of the defining attributes of stress. This allows the reader to see the opposite of the concept. Avant (2000) states "the opposite method can also be helpful" (p. 5). Nurse K arrives 20 minutes prior to her shift. She feels refreshed because she has been off the previous three days. This intensive care has a scheduling rule nurses rotate on a two week or monthly basis depending on the nurse's preference. Nurse K receives report from the night shift nurse and begins her day assessing her patients and attending grand rounds. Nurse K takes an hour lunch off the unit because there is adequate staff. At the end of the day, Nurse K reports her assessment to the oncoming RN. After work, she goes to dinner with friends and goes immediately home to get some sleep. Nurse K is an example of a contrary case because it does not illustrate any of the defining attributes of stress. However, this case is highly unlikely in the nursing profession. Nurse K exemplifies the opposite of stress by stating she is well rested before coming to work, has power over her work schedule, is able to take a long lunch with friends, and does not exhibit maladaptive behaviors. Borderline case A borderline case is another example that reveals which factors are important to the concept and which are not (Avant, 2000, p.6). Several of the defining attributes are excluded deliberately. The night shift charge nurse, John, makes the patients assignments for the day shift staff at six o'clock in the morning. At 6:15 a.m. he receives two sick calls for day shift which begins at seven o'clock. John calls the in house agency, but is unable to replace the two sick calls. At the last minute, one of the nurses who were scheduled committee work for the day was reassigned to do clinical nursing and a night shift nurse decided to stay 4 extra hours. ...read more.


Nurses handle stress in an individualized manner and become angry or scared in critical situations causing them to make vital errors. Empirical Referents The empirical referents are the last step in the Walker and Avant concept analysis model. "Empirical referents are classes or categories of actual phenomena that by their existence or presence demonstrate the occurrence of the concept itself" (Glaister, 2001, p.67). Stress is an individualized concept and the attributes of stress cannot be measured, but can be measured empirically. In a research study conducted in Wales, a 120-item self report measure called "Pressure Management Indicator (PMI) was developed by Williams and Cooper from the Occupational Stress Indicator in order to address shortcomings in some scales of the Occupational Stress Indicator to measure the areas of stress nurses faced in a community hospital" (Cottrell, 2000). Another test that was developed to measure stress was the Hari's Stress Inventory. This test was a five point scale with 140 items questions to measure stress (Hari's Stress Inventory, n. d.). Few written test exist to measure stress. These tests are subjective reports from individuals and are helpful in understanding and measuring stress. Informal ways to measure stress are observation of body language, behaviors, moods, posture, and facial expressions, but can be biased by the data collector. Conclusion The nursing profession is rapidly changing as a result of stress related issues. The impact of stress is different from one individual to the next. The various types of emotional, physical, social, and spiritual responses that a person has to stress are set in motion by stress hormones. This paper revealed important issues nurses face on a daily basis and the effects of the stress on these nurses. If they are able to manage tension effectively, it can be very beneficial in getting daily tasks done in the clinical setting. Conversely, research has shown stress is more of a disadvantage to nurses. With increasing problems in the profession, there are a larger number of nurses leaving the occupation. As a result, many 'burnt out' nurses continue to practice in an increasingly stress laden environment. ...read more.

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