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Nurses environment include an enclosed atmosphere, time pressures, excessive noise or undue quiet, sudden swings of from intense to mundane tasks, no second chances, unpleasant sights and sounds, and long standing pain. Nurses are trained to deal with these factors but chronic stress takes a toll when there are additional stress factors like home stress, conflict at work, inadequate training, and poor supervision. Stress is known to cause emotional exhaustion in nurses and lead to negative feelings toward those in their care. It is important to identify the extent and sources of stress in a healthcare organization to find stress management strategies to help the individual and the environment. Jeremy Stranks stated that a stressor causes stress. Stress is commonly associated with how well or badly people cope with changes in their lives - at home, within the family, at work or in social situations. The causes of stress are diverse, and can be seen on the following pages. No two people respond to the same stressor in the same way or to the same extent. THEORETICAL FRAMEWORK The theoretical framework for the study was drawn from the Stress, Appraisal and Coping Theory developed by Lazarus and Folkman (1984).

According to this theory, a distressor is perceived as stressful when the situation is appraised by the person as exceeding his or her resources and endangering his or her well-being. Doing something and refraining from doing something about the stressful situation are ways of coping. Coping is the constantly changing cognitive and behavioral efforts for managing specific external or internal demands that are appraised as exceeding the resources of the person. It is the process by which a person manages the appraisal. The function of coping includes managing or alleviating the problem causing the distress and regulating the emotional response to the problem. Once the person has successfully coped with a situation, reappraisal occurs. Reappraisal allows for feedback about the outcome and allows for adjusting to the new situation. Successful coping results in adaptation. Adaptation is the capacity of a person to survive and flourish. Adaptation affects three important areas: somatic health, psychological well-being, and social functioning, and when one area is affected; all three areas are affected. In the current study, the various stresses studied are related to physical, environmental, organizational, and emotional problem. To cope up with these stressors, the strategies adopted were hobbies and

leisure time activities, self-care, seeking social support and maladaptive behavior. The three adaptation outcomes i.e. physical, psychological and social health was not studied.

CONCEPTUAL FRAMEWORK Research paradigm is shown on Figure 1. This included the input, the process, and the output. The input contains the profile of the staff nurses of service areas in Far Eastern University- Dr. Nicanor Reyes Medical Foundation Medical Center, the distressors depending on different factors and the level of its effect on their performance towards quality nursing care, the different stress management strategies they performed and how helpful these adapted strategies are. In the process, questionnaires were distributed and observations were conducted to gather pertinent information from the respondents, it also included the analysis and evaluation of the gathered data and information from the respondents using statistical treatment such as frequency count, percentage, average mean, weighted means, and analysis. The output consists of the findings about the stress management performed by the respondents.

INPUT Staff Nurses Profile The distressors experienced by the staff nurses Effects of distressors as perceived by the staff nurses The level of distressors experienced by staff nurses as to different factors The strategies being adopted by staff nurses to cope with the level of distress affecting their performance The effectiveness of adopted strategies in coping with distressors experienced by the nurses

PROCESS

OUTPUT

Distribution of Questionnaires Observation Analysis and Evaluation using statistical treatment 1. Frequency Count 2. Percentages 3. Average Mean 4. Weighted Mean

Distressors Affecting the Nurses at FEUNRMF Medical Center Performance Towards Quality Nursing Care

FIGURE 1 Paradigm of Conceptual Framework

Research paradigm used in this study is illustrated in Figure 1. It shows the steps accepted by the researchers in order to come up with the output of the study. It best describes the idea of the procedural design used by the researchers.

STATEMENT OF THE PROBLEM Generally, this academic pursuit aims to determine the level of stress and coping mechanisms of staff nurses in a selected tertiary hospital in Quezon City. Specifically, this study seeks answers to the following questions: 1. What is the profile of the respondents in terms of: 1.1 Age; 1.2 Gender; 1.3 Civil status; 1.4 Length of stay and; 1.5 Average number of hours of duty per day/shift? 2. What are the distressors experienced by the staff nurses that affect their performance towards quality nursing care? 3. What are the effects of distressors as perceived by the staff nurses?

4. What is the level of distressors experienced by the staff nurses affecting their performance towards quality nursing care as to: 4.1 Physical factors 4.2 Environmental factors 4.3 Organizational factors 4.4 Emotional factors 5. What strategies being adopted by the staff nurses to cope with the level of distress affecting their performance towards quality nursing care? 5.1 Hobbies and leisure time activities 5.2 Self-care 5.3 Seeking social support 5.4 Maladaptive behaviors 6. How effective are the strategies being adopted by the nurses in helping them cope with the distressors affecting their performance towards quality nursing care? ASSUMPTION The researchers assume that the nurses of Far Eastern UniversityDr. Nicanor Reyes Medical Foundation Hospital experience certain stress brought about by different factors that are later on exhibited on various conditions primarily during their extracurricular activities and personal life. The factors contributing to the stress they encountered are interrelated to

what field they show the consequence of being stressed. The researchers believe that in accordance with the stress they experience, the nurses also use different coping mechanisms that help them adapt to that condition. The researchers also foresee that only a minimal percent of the nurses in FEU-NRMF Medical Center are unable to cope up with stress and that there is a higher percentage of nurses that are capable to adapt. The assumptions are summarized as follows: 1. Major stressors that are experienced by nurses mostly originate from handling patients; 2. Manifestations of being stressed are mostly innate and is in moderately being shown during their shift; 3. Stress management or coping strategies are highly implied by the respondents; 4. A high percentage of the findings shows that the coping mechanism implied by the nurses of FEU-NRMF Medical Center helps them achieve a relaxed and calm state. SIGNIFICANCE OF THE STUDY The researchers believe in the merits of the study especially to the following: To the researchers, conduction of this kind of study enabled them to determine the common distressors experienced by staff nurses and their effect on the performance of nurses towards quality nursing care.

Through this newly discovered knowledge, the researchers have compiled the most effective coping mechanisms and stress-relieving techniques applicable to certain stressful situations the nurses may utilize to improve quality of nursing care rendered to patients. To the nurses, the findings of this research will enhance their productivity and capabilities in providing the best quality of nursing care to patients and provide them insight on how to utilize all their energy to their duties and responsibilities at work. Further, this research will serve as a guide in how they will be able to handle and manage stressful situations both inside and outside work place. To the patients, who are recipients of the health care services provided by the nurses, and who will benefit in this research simply because of its potential to improve quality of nursing care they will receive. The nurses who will render care to them will be able to provide the best health care services if they can handle and manage stress effectively. With the improved efficiency of nurses, quality nursing care will be rendered, thus, contribute to the faster recovery of the patients. Patients will be satisfied with the care they are receiving.

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To the FEU-NRMF Medical Center, the findings may help them in assessing the stress level of their health workers and thus, find and suggest ways for them to cope and adapt with it through the suggested selections in this study. Through this, their employees will be able to render quality nursing care and thus provide excellent service contributing to the well-being and improvement of the whole institution. To the student-nurses, this study will help them in the present, as student-nurses and in the future, as nurses in terms of improving their ability to cope with the distressors they are and will be experiencing in the future. With the introduced knowledge about distress and stress-coping mechanisms, they will be able to handle and manage distressors which in turn, will prepare them for their career and make them efficient nurses rendering quality health care services. Moreover, to the academe, this study can help them in formulating and planning programs that will lessen, if not eliminate, the stress experienced by the nurses in the clinical area. Development of such

programs against stress will help the academe produce more efficient and more competent nurses through comprehensive and quality education.

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To the parents, this study will give insights to the parents about the distressors encountered by their children, who may be aspiring nurses, and to strengthen them by means of giving emotional and moral supports in ways that may help them face and manage their stress during their duties. To the future researchers, this study can serve as reference material to those students who will conduct the same or related studies

SCOPE AND DELIMITATION This thesis was entitled Distressors Affecting the Nurses at FEUNRMF Medical Center Performance Towards Quality Nursing Care.The primary focus of this study was directed toward discovering the various factors that causes distress to the respondents and the different stress management techniques that the staff nurses usually utilize and perform to alleviate their stress towards rendering effective quality nursing care to their patients. The data however were limited from those gathered from the staff nurses ages 20 to 45 years old who are working at service wards 5A, 5B,

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4A, 4B and 4C of Far Eastern University- Dr. Nicanor Reyes Medical Foundation Medical Center as respondents of the study.

DEFINITION OF TERMS To convey clearly the meaning of the words used in this researchers defined the terms used operationally, as follows: Coping Mechanisms refer to the adaptation methods or techniques performed by the staff nurses to alleviate effects of stress. Management is an act or art of managing the whole system of care and treatment of a sick individual. Staff nurses pertain to the nurses of Far Eastern University- Dr. Nicanor Reyes Medical Foundation Medical Center who works for 8- 12 hours. Stress relief techniques are plans utilized and performed by the staff nurses to alleviate their stress and to render effective quality nursing care to their patients. Distressors are the stress-triggering factors affecting the

performances of the staff nurses towards quality nursing care.

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Quality nursing care is a series of effective and efficient services rendered to the patient in the health care field by the staff nurse in the form of patient safety, patient satisfaction, and patient assurance. Self-care pertains to activities that staff nurses initiate and perform to alleviate the stress they experience at work that contribute to their continuing health and well-being. Social support is a network of family, friends, neighbors, and community, members that is available to the staff nurses in periods of stress episodes. Physical Factors are changes in the body condition that contributes to development of stress that may lessen quality of work among staff nurses towards quality nursing care. Environmental factors refer to conditions experience by the staff nurses that may affect work productivity and quality towards quality nursing care. Organizational factors refer to conditions at work that staff nursing find difficult to handle under stressful episodes. Hobbies and leisure time activities refer to activities that staff nurses enjoy during their free time to alleviate stress from work.

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Maladaptive behaviors refer to types of behaviors that inhibit the staff nurses ability to adjust to particular stressful situations. This type of behavior is often used to reduce the staff nurses anxiety, but the result is dysfunctional and non-productive.