Professional Stress and Health among Critical Care Nurses in Serbia

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Professional Stress and Health among Critical Care Nurses in Serbia

The aim of this study was to identify and analyse professional stressors, evaluate the level of stress in nurses in Intensive Care Units (ICU), and assess the correlation between the perception of stress and psychological and somatic symptoms or diseases shown by nurses. The research, designed as a cross-sectional study, was carried out in the Intensive Care Units (ICU), in health centres in Serbia. The sample population encompassed 1000 nurses. Expanded Nursing Stress Scale (ENSS) was used as the research instrument. ENSS revealed a valid metric characteristic within our sample population. Nurses from ICUs rated situations involving physical and psychological working environments as the most stressful ones, whereas situations related to social working environment were described as less stressful; however, the differences in the perception of stressfulness of these environments were minor. Socio-demographic determinants of the participants (age, marital status and education level) significantly affected the perception of stress at work. Significant differences in the perception of stressfulness of particular stress factors were observed among nurses with respect to psychological and somatic symptoms (such as headache, insomnia, fatigue, despair, lower back pain, mood swings etc.) and certain diseases (such as hypertension, myocardial infarction, stroke, diabetes mellitus etc). In view of permanent escalation of professional stressors, creating a supportive working environment is essential for positive health outcomes, prevention of job-related diseases and better protection of already ill nurses.

Cox T, Griffiths A, Cox S, Rial-González E. Research on Work-Related Stress. Luxemburg: European Agency for Safety and Health at Work; 2000.

Peruničić B. Bolesti u vezi s radom [Work-related diseases, in Serbian]. In: Vidaković A, editor. Medicina rada I. Beograd: KCS; Institut za medicinu rada i radiološku zaštitu "Dr Dragomir Karajović", Udruženje za medicinu rada Jugoslavije; 1997. p. 929-46.

Michi S. Causes and management of stress at work. Occup Environ Med 2002;59:67-72.

Diamantopoulou A. Europe under stress. In: Working on stress. Magazine of the European Agency for Safety and Health at Work 5 [displayed 8 February 2006]. Available at

European Commission. Guidance of work-related stress. Spice of life or kiss of death? Luxembourg: Office for Official Publications of the European Communities, 2002 [displayed 11 March 2008]. Available at

Verhaeghe R, Mak R, Van Maele G, Kornitzer M, De Backer G. Job stress among middle-aged health care workers and its relation to sickness absence. Stress Health 2003;19:265-74.

Chan KB, Lai G, Ko YC, Boey KW. Work stress among six professional groups: the Singapore experience. Soc Sci Med 2000;50:1415-32.

McVicar A. Workplace stress in nursing: a literature review. J Adv Nurs 2003;44:633-42.

Smith A, Brice C, Collins A, Matthews V, McNamara R. The scale of occupational stress: a further analysis of the impact of demographic factors and type of job. HSE Contract Research Report 311/2000. Suffolk: Health and Safety Executive; 2000.

Stacciarini JMR, Tróccoli BT. Occupational stress and constructive thinking: health and job satisfaction. J Adv Nurs 2004;46:480-7.

Feskanich D, Hastrup JL, Marshall JR, Colditz GA, Stampfer MJ, Willett WC, Kawachi l. Stress and suicide in the Nurses' Health Study. J Epidemiol Commun Health 2002;56:95-8.

Kawano Y. Association of job-related stress factors with psychological and somatic symptoms among Japanese hospital nurses: effect of departmental environment in acute care hospitals. J Occup Health 2008;50:79-85.

Nedić O, Filipović D, Šolak Z. Job stress and cardiovascular diseases with health workers. Med Pregl 2001;54:423-31.

Gonge H, Jensen LD, Bonde JP. Are psychosocial factors associated with low-back pain among nursing personnel? Work Stress 2002;16:79-87.

Piko B. Psychosocial work environment and psychosomatic health of nurses in Hungary. Work Stress 2003;17:93-100.

Gray-Toft P, Anderson JG. The nursing stress scale: development of an instrument. J Psychopathol Behav Assess 1981;3:11-23.

Gray-Toft P, Anderson JG. Stress among hospital nursing staff: Its causes and effects. Soc Sci Med A 1981;15:639-47.

Golubic R, Milosevic M, Knezevic B, Mustajbegovic J. Work-related stress, education and work ability among hospital nurses. J Adv Nurs 2009;65:2056-66.

Hall DS. Work-related stress of registered nurses in a hospital setting. J Nurses Staff Dev 2004;20:6-14.

Hamaideh SH, Mrayyan MT, Mudallal R, Faouri IG, Khasawneh NA. Jordanian nurses' job stressors and social support. Int Nurs Rev 2008;55:40-7.

Healy C, McKay M. Identifying sources of stress and job satisfaction in the nursing environment. Aust J Adv Nurs 1999;17:30-5.

Hipwell AE, Tyler PA, Wilson CM. Sources of stress and dissatisfaction among nurses in four hospital environments. Br J Med Psychol 1989;62:71-9.

Mäkinen A, Kivimäki M, Elovainio M, Virtanen M. Organization of nursing care and stressful work characteristics. J Adv Nurs 2003;43:197-205.

Foxall M, Zimmerman L, Standley R, Captain BB. A comparison of frequency and source of nursing job stress perceived by intensive care, hospice and medical-surgical nurses. J Adv Nurs 1990;15:577-84.

Milutinović D, Grujić N, Jocić N. Identifikacija i analiza stresogenih faktora na radnom mestu medicinskih sestara - komparativna studija četiri klinička odeljenja [Identification and analysis of stress factors at nursing workplace. A comparative study of four clinical departments, in Serbian]. Med Pregl 2009;62:68-73.

Mrayyan MT. Job stressors and social support behaviors: comparing intensive care units to wards in Jordan. Contemp Nurse 2009;31:163-75.

Cavalheiro AM, Moura Junior DF, Lopes AC. Stress in nurses working in intensive care units. Rev Lat Am Enfermagem 2008;16:29-35.

French SE, Lenton R, Walters V, Eyles J. An empirical evaluation of on expanded Nursing Stress Scale. J Nurs Meas 2000;8:161-78.

Cha E-S, Kim KH, Erlen, JA. Translation of scales in cross-cultural research: issues and techniques. J Adv Nurs 2007;58:386-95.

Galanakis M, Stalikas A, Kallia H, Karagianni C, Karela C. Gender differences in experiencing occupational stress: the role of age, education and marital status. Stress Health 2009;25:397-404.

Escot C, Artero S, Gandubert C, Boulenger JP, Ritchie K. Stress levels in nursing staff working in oncology. Stress Health 2001;17:273-9.

Lin K-C, Huang C-C, Wu C-C. Association between stress at work and primary headache among nursing staff in Taiwan. Headache 2007;47:576-84.

Yip YB. The association between psychosocial work factors and future low back pain among nurses in Hong Kong: a prospective study. Psychol Health Med 2002;7:223-33.

Portela LF, Rotenberg L, Waissmann W. Self-reported health and sleep complaints among nursing personnel working under 12h night and day shifts. Chronobiol Int 2004;21:859-70.

Paulsson K, Ivergåed T, Hunt B. Learning at work: competence development or competence-stress. Appl Ergon 2005;36:135-44.

Arnetz BB, Wiholm C. Technological stress: psychophysiological symptoms in modern offices. J Psychosom Res 1997;43:35-42.

Heraclides A, Chandola T, Witte DR, Brunner EJ. Psychosocial stress at work doubles the risk of type 2 diabetes in middle-aged women: evidence from the Whitehall II study. Diabetes Care 2009;32:2230-5.

Pukkala E, Härmä M. Does shift work cause cancer? Scand J Work Environ Health 2007;33:321-3.

McNeely E. The consequences of job stress for nurses' health: time for a check-up. Nurs Outlook 2005;53:291-9.

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