1. The 3rd JNC international Conference The Heart of the Matter: Relevance of Nursing Responsiveness Job Stress Factors and Situations among Jordanian Staff Nurses at Governmental Hospitals
Rufaida Al-Aslamiah College for Nursing and Midwifery
Omaymah Al-Rajaby , RN,MSN Nursing “Presenter “
Ebtisam Haddad , RN,MSN Nursing
Fawziah Ass'sd, RN,BSN Nursing
Zeinab Al-Kurdi , RN,BSN Nursing
Nida'a Al-Anani ,BA English Language “Proofreader”
Luwiza Tuqan , BSC Computer Science “Print and Electronic Computer Services”
Kamal Sahawneh , BSC Public And Environmental Sciences

2. Purpose
The purpose of the study was to explore the major sources of job stress experienced by nurses working at MOH hospitals and its relationship to selected demographic variables and stress outcome.

3. Background According to MOH Statistics 2009
There are male and female staff nurses ,1985 midwives are working in different hospitals in Jordan , but 3036(24%) of the total number of staff nurses and 1203(60.6%) midwives are working at governmental hospitals
The percentage of staff nurses and midwives for every Jordanians is staff nurses and 3.32 midwives

4. According to The Jordanian Nurses and Midwives Council statistics 2007
The documented work place violence cases are 33 male and female staff nurses and 3 midwives are exposed to physical violence at the governmental hospitals
Otherwise , there are 4503(47%) about half of the total number of staff nurses and 36 midwives are working abroad
Such alarming statistics (staff turn over , shortage of staff nurses and work place violence ) reflect the significance of the study

5. Significance of Study
The study will provide a valuable information for nurses at different levels (administration , education and practice ) to deal with the problem of work-place stress.

6. Research Questions
What are the psychological environmental factors that contribute to nurses' job stress?
What are the social environmental factors that contribute to nurses' job stress ?
What are the physical environmental factors that contribute to the nurses' job stress?
What is the relationship between job stress and the selected respondents’ demographic variables; age, sex, marital status , job title , educational level, salary, practice area, experience, working shift, Unit department?
What is the relationship between job stress and the anticipated outcomes ?

7. Design and Sample Descriptive, Cross-sectional Survey Design was used.
A cluster sampling technique was used to select the sample. Three clusters were identified: north, middle, and south of Jordan. Simple random sample was used to identify the hospitals then a convenient sample of 436 registered nurses (RNs) was included in the study. Response rate was 87.2%

8. Instrument and Data Collection
A structured questionnaire consisted of three parts, 40 items divided into three stress sources categories, physical environment, social environment and psychological environment : Part one composed of 10 demographic questions, Part two “Nursing Stress Scale (NSS)” (Gray-Toft & Anderson, 1981) after modification with four responses on a Likert scale: “never stressful =1, occasionally stressful=2 , frequently stressful=3, very stressful=4)“.Part three is related to “outcomes of job stress” consisted of nine stress outcomes with two responses “no=1 and yes=2”.

9. Reliability & Validity
Reliability of whole scale was measured by using the co-efficient alpha; it was (R=0.82), while the Reliability of the original scale (NSS) (Gray-Toft & Anderson, 1981) was (R=0.89).
To examine the content validity of the instrument, a panel of three experts in nursing field were consulted, modifications were done according to their feedback . Moreover, a pilot study was conducted with 23 participants to determine the clarity of instrument, feedback indicated that the instrument was clear to the respondents.

10. Results

14. Distribution of Nurses by Demographic Variables%
Nurse Position
Head Nurse
Midwife
Supervisor
Staff Nurse 36 14 49
324
8.5
3.3
11.6
76.6
Working Area
Medical
Surgical
Maternal
ICU-CCU
Emergency
Pediatric
Mental Health 76 78 40 97 37 30 23
19.9
20.5
10.5
25.5
9.7
7.9
6.0
Years of Experience
Less Than 5 years
5 – 10 years
years
Over 16 years
193
116 44
44.8
26.9
18.1
10.2
Working Shift
A Shift
B Shift
C Shift
Always Change
192 19 25
183
45.8
4.5
43.7

15. Distribution of Nurses by Types of Stress
Stressors
Mean SD
Physical Environment
2.77
0.64
Work Load
0.71
Work Condition
0.69
Psychological Environment
2.64
0.55
Death & Dying Issues
2.67
0.72
Lack Of Administrative Support
2.51
0.79
Uncertain Concerning Treatment
2.50
0.67
Emotional Conflict
2.22
0.76
Social Environment
2.58
0.57
Conflict With Physician
2.65
Conflict With Supervisor
2.48
0.85
Conflict With Administrator
2.45
Nurse –Nurse Conflict
2.06
0.86
Over all stress

16. Differences in Gender Mean Scores Regarding Different Sources Of Stress
P-Value T
Mean
Stressor
0.0001
3.83
Physical Environment
2.86
Female
2.62
Male
0.049
1.98
Social Environment
2.621
2.509
0.018
2.37
Psychological Environment
2.68
2.55
0.004
2.87
Over all stress
2.71

17. Psychological Environment
Differences In Working Unit Means Scores Regarding Environmental Stress
Over All
Psychological Environment
Social Environment
Physical Environment
F=3.003
F=2.822
F=2.698
F=3.016
P-Value=0.007
P-Value=0.011
P-Value=0.014
Mean
Unit
2.59
2.60
2.54
2.68
Surgical
2.77
2.71
2.85
Maternity
2.80
2.79
2.95
ICU-CCU
2.51
2.49
2.44
2.65
Emergency
2.58
2.55
2.47
Pediatric
2.72
2.69
3.04
Mental Health

18. Differences in Working Hospital Mean Scores Regarding Environmental Stress
Over All
Social Environment
Physical Environment
F=2.550
F=2.535
F=2.626
P-Value=0.027
P-Value=0.028
P-Value=0.024
Mean
Hospital
2.71
2.63
2.85
Al-Basheer
2.76
2.88
Al-Zarka
2.50
2.49
2.58
Al-Eman
2.70
2.81
Al-Karak
2.79
2.69
3.04
Al-Fuhais
2.56
2.44
Prinice Faisall

19. Differences in Nurses' Income Mean Scores Regarding Environmental Stress
Over All
Social Environment
Physical Environment
Salary
F=3.448
F=4.895
F=2.991
P-Value=0.033
P-Value=0.008
P-Value=0.051
Mean
2.49
2.38
2.58 JD
2.65
2.78 JD
2.75
2.70
2.87
500 JD & over

20. NOTE:
No Significance result with Education, shift ,age and marital status but with overall 5 years experience the nurses perceived high level of stress

21. Results of Stepwise Linear Regression
P-Value T
Beta
Overall Stress
0.15
0.012
2.45
0.122
Having No Social Life
F= P-Value=0.015
Physical Environment
0.021
0.004
2.92
0.144
Not Satisfied with Your Job
F= P-Value=0.004
Social Environment
0.18
2.51
0.124
Having no Social Life
0.028
0.040
1.06
0.102
Planning to Change Job
F= P-Value=0.003

22. Limitation
The study was being applied only for governmental hospitals so we recommended the following :

23. Recommendation
Replication of the study to the other health sectors besides focusing on hospitals and units which found to be highly stressed
Applied stress management, mentorship and preceptorship programs in clinical areas
Improving communication skills and leadership management style
Implementing recognition strategies in clinical areas
Integrating stress management program into nursing curriculum for undergraduate students

24. Conclusion
This study suggests that nurse administrators should assess the different types of work stress and put a strategy plan in order to eliminate or reduce the physical, social, and psychological sources of stress and consequently build stress management programs for nursing staff.

25. Rufaida Al-Aslamiah College for Nursing and Midwifery

26. Thanks