Level and awareness of stress among Jordanian nurses Mohammad Hussein [email protected] IntroductionStress  is a term in psychology and biology, first mentioned  in the biological context in the 1930s, it was defined in the that decades also it was under focused in that decades. After that in 1956, Hans Selye had published his research regarding the stress, he defined the stress according to the physiological  consequences of stress, in that publication he revised his definition for stress, defining stress as ”the state manifested by a specific syndrome which consists of all nonspecifically-induced change within a biologic system”. ( Townsend.M.C, 2004). From Selye definition he defined the stress according to the physiological consequences, later researchers defined the stress according to the physiological and psychological consequences.(Brown.K,2005).Stress is defined briefly a fact of nature forces from the inside or outside world affecting the individual health status. The individual responds to stress in many ways that affect the individual status as well as their environment. Because of the overabundance of stress in our modern lives, we usually think of stress as a negative experience, but from a biological point of view, stress can be a neutral, negative, or positive experience. (Velader 2001)In general, stress is related to both external and internal factors. The interaction between the individual and environment will produce some stressful events that will be negative or positive reaction toward the stressful events, the stressful event could be physical like injury or psychological like death of relatives. All stressful events like physical or psychological will produce similar reaction of the individual, physical stressors and psychological will produce same response, both will produce psychological response it may will be negative response like sever anxiety or positive  response like adaptation or self improvement.( Townsend. M. 2006). The response toward the stressful events differ from individual to individual it could be similar but not identical due to the individual differences , these differences as a result of the cultural, religious, educational and individual differences.(Brown,K.1999).The response severity or types if negative or positive is affected by the awareness toward the stress or what the stress sign and symptoms on the individual like physical signs (increase heart rate, increase blood pressure…etc) or psychological sign and symptoms (grieving, anxiety, addiction of substance).awareness can affected by many factors like educational level, health promotion, culture, and religion. (Kantor, E.2003)Awareness is defined as having knowledge of; “he had no awareness of his mistakes”; “his sudden consciousness of the problem he faced”; “their intelligence and general knowingness was impressive (Webster. M. 1969)The awareness is fully conscious status of the inside and outside events to promote full picture of the events in that has interaction with the individual (American psychology association, 1999).A brief history of stressA key to the understanding of the negative aspects of stress is the concept of milieu interieur (the internal environment of the body), that was approved the French physiologist Claude Bernard. In this concept, he described the principles of dynamic equilibrium. In dynamic equilibrium, constancy, a steady state (situation) or stimulus in the internal bodily environment is essential to survival. Therefore, the response of the internal body toward the external stimulus must be replaced to and compensated for if the organism is to survive. Examples of such external forces include food, oxygen concentration in the air, the energy of body, and the presence of dangerous animals. In addition, diseases were also defined as stressors that threatened the constancy of the milieu interieur. So the equilibrium between the external and internal body, this equilibrium has two parts the external and internal aspect which derived from the human inside. This will maintain the human in a balanced status toward the stimulus and the response of the body to avoid the status of disequilibrium, this disequilibrium will lead to unhealthy status of human which may cause clinical manifestation on the body (Worden, J.W, 2002).  The neurologist Walter Cannon coined the term homeostasis to further define the dynamic equilibrium that Bernard had described. He also defined two parts of stress emotional and physical. Derived from his experiment, he defined the “fight or flight” response which is similar to human and animals when they threatened or face some dangers. Further, Cannon traced these reactions according to excretion of neurotransmitter from the brain in the response to stress. The excretion these neurotransmitters produce the physiologic effects that seen in the fight or flight response, for example, a increased blood pressure, increased heart rate, etc.Hans Selye, another scientist who is known to have studied stress, extended Cannon’s observations. He included, as part of the body’s stress response system, the pituitary gland, a small gland at the base of the brain. He described the control by this gland of the secretion of hormones that will compensate the external stimulus effect on the body; this response is internal response which will appear in many pictures (Bateman, A.L, 1999).  What are the sign and symptoms of poor stress management?Poor management of stress will lead or be manifested by many signs and symptoms like increased blood pressure , headache, gastrointestinal irritability and increased heart rate…etc ,this as physical aspect or physical response toward the stimulus.Further, the psychological aspect will response or will be affected like engagement in negative behavior like smoking, drug abuse…etc. These different responses will lead to lead to acute or chronic disorder like heart diseases, psychosis…etc. (American psychiatric association, 2002).How can we manage the stress?Stress in the chronic cases can be managed by medication but the pharmacological treatment for the manifestations of the stress, psychologically the treatment will be for the psychological response of the stress to maintain the equilibrium, therefore the awareness of stress or stressors will prevent the long treatment or will prevent the pharmacological use to prevent the side effects of that treatment. Newly the new trend of treatment is depending on the psychological or behavioral modalities of treatment like psychological consultation, behavioral analysis and psychiatric modalities. (Mantel, D.L, 2005).The awareness for the concept of stress will prevent or minimized the need for treatment or prevent the complication of stress or the complication of the pharmacological treatment, also the awareness about the equilibrium between the external and internal is important in the individual model of treatment as a first defense line of stress chronicity and to prevent the stress effect on the humans (Baker, J.K, 2006). The concept of stress in the workplace is of great importance in working environment  for many causes, one of these causes is the relationship between stress level and the productivity of the workers, nurses as one of these worker could be affected by stress, especially nurses are generally considered a high risk group due to the working nature of the nurses and their attachment for the care of patients. Nurses are clock-round profession, also the sources of stress are many in environment of care.( Hipwell A., Tyler P.A. & Wilson C.M, 1989).Measurement the level of stressAccording to A.Molassiotis and others the defined the stress as subjective data, but according to many researches the stress can be measurable data( objective data), but the objectivity can be different from individual to individual according to individual definition of stress and according to the individual ability for hidden the stress.( McLeod T , 2007)1.1 Detailed Description of the Research:The research discusses the need for measure the level of stress and awareness of stress among Jordanian nurses and how to manage the stress that can be as outcome from their jobs and the environment of their working.This research also discuss the factors that can increase or decrease the level of stress among Jordanian nurses, also it discusses the management of stress and how nurses can manage the stress in their environment.1.2 Problem Statement After this huge development in the life the stressors were increased, this effect on the life of humans as a consequences for that development. Nurses are working in many places in Jordan like hospitals, primary health centers and clinics. Each area differ than others, from that developments in the life, stressors increase the risks in the life.Nurses workers in Jordan are like in other countries working clock-round in the health areas, they sustainable to suffer from stress. So the problem is how the nurses in Jordan can measure and mange their problem of stress.Stress affect on the productivity of the nurses, for this the awareness and management is important to prevent low productivity. So the problem statement is”A STUDY TO ASSESS THE LEVEL OF  STRESS AMONG JORDANIAN NURSES WHO ARE WORKING IN HOSPITALS”.        1.3 Aim and objectives of the Proposed study:The main aim is to determine the level of stress and awareness of stress among Jordanian nurses.SPECIFIC OBJECTIVES1 To determine the level of stress among Jordanian nurses.2 To measure the level of stress among the Jordanian nurses and relationship between awareness of stress and the level of stress.3 To describe how nurses in Jordan manage the stress that result from the environment of working.1.4 Scope of the study:This study will focus on the measurement of stress among Jordanian nurses in the different working places or environments, also on the awareness of Jordanian nurses toward the stress as a concept of life.1.5 Expected Results:1  One of expected result that will be relationship between awareness of stress and the stress level among Jordanian nurses.     2   The level of stress will be inversely relationship with awareness of stress2.0 Literature reviewA study was conducted by Hughes H, Umeh K. in 2005 to “assess stress differentials between psychiatric nurses (PNs) and general nurses” . it discussed the level of stress among the psychiatric nurses comparing to the nurses who working in general hospital, also it discussed the effect of social support on the level. It discussed that the lower level of stress will affect by the social support, it recommended to adapt the working environment to manage the stress. A study was conducted by Snelgrove SR. in 1999 to “Assess occupational stress and job satisfaction: a comparative study”. This study used self reporting questionnaire to assess the relationship between stress level and job satisfaction. It reported that the level will be diminished in case of clinical supervision.A study was conducted by Lyons JS, Hammer JS, Johnson N, Silberman M. in 2001 to “compare of levels of occupational stress across multiple units of a multi specialty hospital”. This study used designed scale to assess component of stress in the medical working environment, it recommended that all nurses suffered from stress regardless of the unit that nurses were working in.3.0 Research Methodology:The research methodology which is suggested of this study is an agreeable method among the experts mental health nursing research. The method has been excellently chosen, described and accepted by many researchers because it emphasizes the awareness of stress (confidential stress awareness questionnaire), obtained from the NCVO’s HRBank free version, And stress scale to assess the level of stress.  3.1   participants and setting:The participants will be all nurses in all psychiatric and general hospitals in Jordan, the participants will have the willing to participate in this study.BIBLIOGRAPHY Baker, J.K. (1999) Secret of stress. 1st editionBateman, A.L. (1999). Understanding the process of grieving and loss. Journal of American psychiatric nurse association Hipwell A., Tyler P.A. & Wilson C.M. (1989) Sources of stress and dissatisfaction among nurses in four hospital environments. British Journal of Medical PsychologyHughes H, Umeh K.  Work stress differentials between psychiatric and general nurses. Department of Social Sciences, Nottingham Trent University, Burton Street, Nottingham, UK.Lyons JS, Hammer JS, Johnson N, Silberman M.  Unit-specific variation in occupational stress across a general hospital. Northwestern University Medical School. Gen Hosp Psychiatry. 2001Mantel, D.L. (2005). Laws on death and dying. Advance for providers of post-acute care. McLeod T. Work stress among community psychiatric nurses. Br J Nurs. 2007 May 22-Jun 11;6(10):569-74. Northern Birmingham Mental Health Trust, Highcroft Hospital, Birmingham.  Snelgrove SR. Occupational stress and job satisfaction: a comparative study of health visitors, district nurses and community psychiatric nurses. Department of Nursing, Midwifery and Health Care, Moriston Hospital, Swansea, UK. J Nurs Manag. 1999Townsend, C.M (2006). Psychiatric mental health nursing. Sixth edition Webster, M (1969) Dictionary of English. 3rd editionWorden, J.W. (2002).Greif and grief therapy. 3rd edition Mantel, D.L. (2005). Laws on death and dying. Advance for providers of post-acute careOnline referencesAmerican psychology association www.APA.net  NCVO’s  www. NCVO.com