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CHAPTER I

THE PROBLEM AND ITS SCOPE

INTRODUCTION

Rationale

Nurses fill an interesting position in the provision of health care. Often they are

the sole intermediary between the doctor and the patient and also performs a multiple

and different tasks that are not limited to direct contact with the patients. In nursing

profession, nurses require a great deal with people in different profession collaboration

(Belachew et al., 2016). Nurses play a vital role in medical field. The primary role of

nurses is to care for their patients and to help them manage their physical needs,

prevent illness, and treat health conditions. They advocate interests of the patients in

keeping the patients’ dignity right through treatment and care. Nurses are also in

charge of ensuring that patients are able to understand their health, illnesses,

medications and treatment to the best of their ability. And also, nurses are involved in

decision making process for the treatment of the patients (Smith, 2019).

Nurses’ performance plays an important role in our society for they are one of the

medical practitioners who help in saving the lives of the people. The performance of the

nurses greatly affects the patients. As claimed by Tesfaye et. al., (2015), nurses

performance level is a cornerstone for better productivity of health care organizations.

Less performing nurses reduces hospital productivity, a reason for poor hospitalized

patient health outcome.

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Nurses play a huge role in the care of the patient (Cabriera, 2019). The patient’s

expectations of the performance of the nurses are to be productive, to help, and to

optimize the health of those for whom they are responsible.

Because of the assumptions of the patients to nurses’ performance, nurses are

subjected to more stress which arises from their work environment. Stress has been

described as critical point in the performance of nurses to be managed for efficient

health care services. There are some factors that causes job stress and might be

unaccommodating to the patients and especially to the nurses.

According to (Akbarbegloo & Zadeh, 2011), job stress is the result of interaction

between individuals and the working environment and every kind of physical and

psychological event which could lead to negative result in the performance of the

individuals and the organizations. Job stress can have a significant effect on

individuality of nurses and their abilities to accomplish their task and may cause

weakness in decision making, loss of concentration, apathy, and loss of motivation and

anxiety that can lead to the reduction of efficacy of the nurses.

As to nurses, there are a lot of major sources of stress. It also occurs when

choices and when the amount of external support are low. The longer the hours nurses

put on work, the higher the level of stress could nurses experienced.

To sum it up, nurses experienced job stress that may affect their performance in

a positive or in a negative way. This study is conducted to determine the level of job

stress among nurses and how it influences their performance.

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Through this study, the nurses may be helped in learning the easiest and effective

way of creating stress free working environment for themselves. It would be beneficial

for their patients, hospital management and nurse managers who could also adapt

effective measures in stress management among their workers. In addition, the

researchers might also suggest and conduct programs if ever the level of stress is

severe and beyond uncontrollable.

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Theoretical Background

The Inverted-U Curve Theory (Yerkes-Dodson) serves as the main foundation of

this study. This was developed by psychologists Robert M. Yerkes and John Dillinghan

Dodson in 1908. This theory gets its name from the curve created when there is a

correlation between pressure (or “arousal”) and performance. In this theory, the

relationship between stress and performance can be presented in a form of an inverted

U. It means that as arousal level increases, performance improves, but only to a point,

beyond which increases in arousal lead to deterioration in performance. Thus, some

arousal is thought to be necessary for efficient performance, but too much arousal may

lead to anxiety or stress, which degrades performance (Yerkes-Dodson, 1908).

Figure 1. Inverted- U Theory by Yerkes and Dodson (1908)

As to what Yerkes-Dawson explained in their theory, the left hand side of the graph in

Figure 1, shows the situation where people are not being challenged. In this theory,

they
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Main Theory LEGAL BASES

Inverted- U Theory by Yerkes and  Republic Act No. 11058

Dodson (1908)
 Work Health and Safety Act 2011

Regular Nurses of Garcia Memorial Provincial Hospital (GMPH)

 Age
 Gender
 Length in Service
 Employment ward

Level of Job Stress Level of Job Performance

Proposed performance enhancement seminar-workshop for nurses.

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Figure 1. Theoretical-Conceptual Framework

see no reason to work hard on a task, or they might feel in danger of approaching their

work in a slobbish and unmotivated way. The middle part of the graph shows where

people work at peak of their effectiveness. They are seemly motivated to work hard.

They are not so burdened that they are starting to struggle. In this part, people can

experience enjoyable and highly fruitful state in which they can do their best at work.

The right hard hand side of the graph shows where they are starting to fall apart under

pressure. They are oppressed by the volume and scale of demands on their attention,

and felt a lack of control on their situation (Mind Tools Ltd, 2019).

In other words, when a person experiences a low level of stress, he or she

does not manifest improved performance but when an individual experiences too high

level of stress, it may spend more time coping with stress and invest less effort in

performing the tasks, resulting in a relatively lower level of performance. Accordingly,

an average amount of stress causes the individual to expand maximal energy on

performing work (Taylor and Francis, n.d.).

The common denominator of every human being is stress. Sreelekha (2016)

defined stress as a bodily or mental tension which is the outgrowth from the factors that

tend to change an existent equilibrium. Also, according to Robbins et. al. (2007), stress

is a dynamic condition, in which an individual is confronted with an opportunity

constant, or demand related to what he or she desires and for which the outcomes are

preserved to be both uncertain and important.

Abualrub et. al (2008) believed that stress is a key factor that creates a

tremendous backwash to a certain person. It correlates with high turnover intentions

and absenteeism. It can also cause the deterioration of the body which can
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subsequently cost the substantial health problem of the employees. Moreover,

according to the World Health Organization (WHO) in 2014, stress collignated from

work is the second highest prominent health problem which targets both physical and

mental aspect of the people. Furthermore, Farquharson (2013) believed that job stress

can be damaging to a person’s physical and mental health, while its high levels have

been related to high staff truancy and low levels of productivity.

Assessment of performance plays an important role in guaranteeing high quality

outcome. Job performance is the work related activities expected of an employee and

how well those activities were executed (Business Dictionary, 2019). According to

Homayan et al., (2013), job performance refers to how effective employees are in

accomplishing their tasks and responsibilities related to direct patient care. Improving

the performance of employees has been a topic of great interest to practitioners as well

as researchers. Realizing its performance, public organization seems to pay attention

on work performance in relation to formulating policies and enhancing service delivery

(Leeuw, 1996).

Tesfaye et al., (2015) claimed that nurses’ job performance level is the

cornerstone for better productivity of health care organizations. Nurses performance

remains long standing in deciding the quality service rendered for patients admitted to

hospitals. Nurses, as the largest human resource element of health care systems, have

a major role in providing ongoing, high- quality care to patients. The nurses are one of

the medical practitioners who are capable in saving lives and their performances have

a direct effect on health care productivity.

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Numerous literatures are presented herewith regarding the stress sources on

factors that may varied the efficiency of nurses’ performance. These include admitting

patients, patient care, discharging of patients, patient education and patient referral.

Stress from admitting patient might affect the efficiency of nurses performance.

According to Shekelle (2013), a reasonable nurse- patient ratio is 2-3 patients to one

nurse on a general care unit and a 1:1 ratio in intensive care units (ICUs); however, a

systematic review of 28 studies on nurse to patient staffing ratios demonstrated that the

average was three patients per nurse in the ICU, 4 per nurse on surgical units, and 4.4

per nurse on medical units (Shekelle, 2013). the increased ratio causes more physical

demands and emotional tension, precipitating to stress.

Also, stress from patient care is one of the factors that may vary the performance

of the nurses. According to Reference Md (2012) patient care is the services that is

given by the members of the health profession for the benefit of a patient. Camington

College (2013) believed that patient care plays an important role for it influenced

positive recovery experience and can improve the physical and mental quality of people

with serious sickness.

Clarke SP et. al (2008) believed that the quality of care that the nurses gives to

the patients is influenced by the nurses characteristics including knowledge and

experience as well as human factors such as fatigue. Quality of care is also influenced

by the system where the nurses work in, which involves staffing levels, and then needs

of all the patients a nurse or nursing staff is responsible for.

The American Association of Critical Care Nurses Delegation Handbook (2014)

suggests that there are two types of patient care, direct and indirect. Direct patient care
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refers to activities that “assist the patient in meeting their basic needs”. Indirect patient

are refers to activities that “focus on maintaining the environment in which nursing care

is delivered and only incidentally involves direct patient care”.

Also, nurses have a responsibility to ensure that patients are discharged from

hospital care in a safe and efficient manner (Hesselink, 2013). According to Waring et

al. (2014) discharge of patients is the point at which patients hospital care end, with

ongoing care transfer to other primary, community or domestic environments.

As stated by Alper et al. (2017), discharging patients from the hospital is a

difficult process that is loaded with challenges. It can also result in errors and delays of

medicine and communication of information.

To ensure that patients leave the hospital at the right time and care, hospital has

a discharge plan. Discharge planning is an interdisciplinary approach to continuity of

care and processes. It is describe as the critical link between treatment received in

hospital by the patients (Chin-Jung Lin et al., 2012).

Stressor as patient education may also be a great factor that influence

performance.As defined by EVIQ Education (2015), patient education is the process by

which professionals (such as nurses) provide specific and detailed educational

activities and information to patients, careers and family members so they can actively

participate in their health care and any treatment they may be receiving.

Furthermore, patient education is one of the fundamental aspects of holistic

nursing care. It empowers people towards health seeking behaviour and self care

leading to a healthy life and smooth recovery. Patient education plays a vital role in all

the aspects of care from prevention to treatment. Nurses educate the patients, so as
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the family members of the patients by providing information that is understandable and

appropriate, promoting awareness and optimal health (Aghakhani, 2012).

Moreover, Arkansas (2019) stated that effective patient education starts from the

time patients are admitted to the hospital and continues until they are discharged.

Nurses should take advantage of any appropriate opportunity throughout a patient’s

stay to teach the patient about self-care. Without proper education, a patient may go

home and resume unhealthy habits. These actions may lead to a relapse and a return

to the hospitals.

In the same way, patient referral stress may be a factor that affect the efficiency

of the nurses’ performance. As stated by Cervantes K, Salgado R, Choi M, et al.,

(2016), that referral is a process in which a health care provider, having an insufficient

resource such as equipment, knowledge and skills to perform a critical condition, seeks

the assistance of a higher level of health care facility that can provide a better health

care to take over the client’s case. It is also the cornerstone of a basic health care for it

is a complete and sustainable system with the direction of the two to connect the

primary health care units and hospitals which leads to continuous improvement

(Lancet, 2011).

Similarly, referral is an organized two- way relationship between the primary

health care provider and specialist in the hospitals. It is the responsibility of the primary

health care physician to deliver a clear message for the reason of referring a patient.

On the other hand, the specialist of the hospital is responsible for conveying a clear

feedback on the patient health condition.

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In accordance to AHQR (2016), in referring a patient to higher facility, it is the

nurses who are typically the first health provider to ask about the patient health

condition. Nurse’s role included consultation, follow-up treatment, patient education and

illness prevention (Stromberg et al., 2003; Griffiths et al., 2007). They are the linchpin in

the coordination of patients care and are best equipped to coordinate a successful

transition. Also, nurses create transitional care plans by compiling all the patient’s

information and creating instruction to be followed.

This study is also under various legal foundations. The laws being used as

foundation were the Republic Act No. 11058, and Work Health and Safety Act 2011.

According to Republic Act No. 11058 or “An Act Strengthening Compliance with

Occupational Safety and Health Standards” (OSHS), “the state shall ensure a safe and

healthful workplace for all working people by affording them full protection against all

hazards in their work environment”. As the hospital administrators who manages their

employees, they shall give their full cooperation to ensure a safe and healthy working

environment specifically to the nurses.

Moreover, the Work Health and Safety Act of 2011 also help and protecting the

health, welfare and safety of all the other people who might be affected at work. The

WHS Act also gives protection for the general public in order to ensure that their health

and safety is not at risk by work activities. Through this, it is the duty of the

management to give their best at implementing and securing a healthy and safe

working environment for their employees.

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There are multitudinous studies regarding job stress and on how it influences the

performance of the nurses. The findings of the following studies may provide basis or

comparison concerning job stress and on how it affects performance of the nurses.

Simanjorang et. al (2015) conducted a study entitled “The Influence of Job

Stressor to Performance of Medan-Indonesia”. The study was conducted to investigate

the influence of job stressors to the performance of nurses who work in Pirngadi

General Hospital of Medan-Indonesia which comprises of 150 nurses. Data were

analyzed by descriptive and inferential hypothesis. Results showed that work stressors

have significant influence to the performance of nurses.

In contrast, Azizollah et. al (2013) undertook a study entitled “The Relationship

between Job Stress and Performance among the Hospital Nurses”. The study aimed to

know the relationship between job stress and performance among the hospital nurses.

The respondents comprised of 491 nurses and were randomly chosen from the

hospital in Zahedan, Iran. In analyzing the data descriptive and inferential analysis were

used. The findings of the study showed that there was a negative correlation between

job stress and performance.

Moreover, Dayrit and Jabonete (n.d.) on “Reported Work-related Stressors

among Staff Nurses in Metro Manila”used a total of 277 registered nurses from the

Tertiary Government and Non-government Hospital in Metro Manila. A descriptive-

correlational and cross sectional design were used in the study. The result concluded

that age, civil status and length of service had a significant relationship to work-related

stress level. On the other hand, a number of patients handled per shift, educational
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attainment, type of hospital and area of assignment had no significant relationship to

work-related stress level.

In addition, there were also related studies that have been made to determine

the significant difference on the stress of the respondents in various fields to

respondent’s demographic profiling.

In accordance to age and gender, a study by Gupta, et. al, (2014) entitled “Effect

of Age and Gender on Occupational Stress: A Study on Teaching Fraternity” aimed at

finding the effect of age and gender on occupational stress among teachers which

comprises 120 teachers teaching in professional colleges situated on NH-2 Agra

Mathura highway. The data analysis is done through mean, SD and t-ratio. After

analyzing the data, the result revealed that male teachers experience higher

occupational stress than females. The males in the age group 41-50 experience

highest stress among all age group.

Furthermore, a study by Osumah (2017) entitled “Gender and Age Differences

on the Occupational Stress among University Lectures in Edo State, Nigeria” consisted

of 350 lecturers randomly selected from 7 universities. Two research questions and two

hypotheses where formulated to guide the study. The study indicated that there were

no significant differences between male and female in experiencing occupational

stress. The study also found out that there were significant differences between young

and older lecturers’ on their experiences on occupational stress.

Sabu (2017) conducted a study regarding a “Comparative Study of Stress Level of

Male and Female Nurses in ICU”. The study aimed to assess the perceived stress in

male and female nurses working in ICU that include 60 staff nurses working in different
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ICU of hospitals in India. It had been found out that there was no significant change in

the stress level of male and female staff nurses.

Additionally, Lee, et. al, (2016) formulated a study concerning “Gender Differences

in Job Stress and Coping Strategies Among Male and Female Nurses”. The objective

of the study was to identify gender differences in job stress and coping strategies

among male and female nurses. The samples of the study were gathered from three

general hospitals in Seoul an Gyeonagi province in South Korea which comprises of

169 nurses. In analyzing the data it uses statistical analyses. The result of the study

found out that male nurses have experienced more job stress than female nurses.

Years in service is also another demographic profile to be considered in

differentiating job stress among nurses. A study conducted by Olatunji (2013) entitled

“Effect of Tenure of Service on Job Stress and Nurse- Physician Collaboration among

Nurses and Doctors” supported the argument that the longer a worker works the higher

level of stress they have. The study has a total sample size of 191 participants which

included 89 doctors and 102 nurses who were randomly picked from different

department. The study concluded that tenure of service has a significant effect on job

stress among nurses. Workers who work within the span of more than 10 years

reported of having high level of stress compared to those workers who works in a fewer

years of experience.

Furthermore, the study conducted by Chang(2012) named “Stress, Depression,

and Intention to Leave among Nurses in Different Medical Units: Implication for

Healthcare Management/ Nursing Practice” which was conducted in the Regional

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Hospitals in Northern Taiwan comprised of 314 total of respondents surveyed. Using

cross- sectional Spearman correlation, one way ANOVA and multiple regression

analyses it came up with a result and found out that tenure of service was a significant

predictor to the level of stress of nurses.

Yet, the results of the study conducted by Elahi (2012) entitled “A Detailed Study

on Length of Service and Role Stress of Banking Sector in Lucknow Region” that

medium tenure group experienced medium stress and the short tenure group

experienced the maximum stress, pointing out the negative relationship between length

of service and role stress.

Another demographic profile to be considered in differentiating job stress is

employment ward Sahraian et al., (2013) conducted a study entitled “Occupational

Stress Among Hospital Nurses: Comparison of Internal, Surgical and Psychiatric

Wards”. The survey utilized 180 nurses who worked in different hospital ward setting

which include the surgical, internal, and psychiatric wards. It used HSE and statistical

analysis using SPSS software/ test and analysis of variance (ANOVA). Upon analyzing

the data gathered, they came up with a result that nurses of surgical and internal ward

showed a significantly higher level of stress compared with the nurses who worked in a

psychiatric ward.

Conducting a study to a randomly selected 120 staff nurses using a comparative

descriptive design, Kashmir (n.d.)found out that nurses who worked in the emergency

ward experienced a severe level of stress whereas the nurses who worked in the

general ward only experienced moderate level of stress.

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In addition to this, the study of Rama Masa (2016) bearing the title, “Perceived

Stress in Nurses” uncovered that workers in a psychiatric department received the

highest stress followed by the nurses who were assigned in oncology, ICU/CCU and

EU department. Also, medical and surgical nurses were reported to have the lowest

level of stress received.

To sum it up, the researchers want to know how job stress influences the job

performance of the nurses. The main theory that served as the foundation of this study

is the Inverted- U Theory that was developed by psychologists Robert M. Yerkes and

John Dilinghan Dodson in 1908. The main assertion of this theory states that as arousal

level increases, performance improves but only to a point beyond which increases in

arousal lead to deterioration in performance.

Several legal foundations are utilized in the study as well including Republic Act No.

11058 and Work Health and Safety Act 2011. With the support of various foundations,

the study conducted was well- supported.

Through the study, it is expected that it will lead to a clear and better understanding

on how job stress influences job performance of the nurses.

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THE PROBLEM

Statement of the Problem

The main objective of this study is to determine the level of job stress among

regular nurses of Garcia Memorial Provincial Hospital (GMPH) and how this influences

their performance.

Specifically the study seeks to answer the following questions:

1. What is the profile of the respondents in reference to:

a. age;

b. gender;

c. length in service; and

d. employment ward?

2. What is the level of the respondents job stress in terms of:

a. Admitting patient;

b. patient care;

c. patient education;

d. discharging patients; and

e. referral of patients to higher center?

3. How efficient is the performance of the nurses?

4. Is there a significant difference in the stress of the regular nurses when

classified according to:

a. age;

b. gender;

c. years in service;
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d. employment ward?

5. Is there a significant relationship between the respondents job stress and

performance?

6. Based on the findings gathered, what actions would be offered to lessen the

job stress in order to enhance their performance?

Hypotheses

This study will hypothesizes the following:

1. There is no significant difference in the stress of the regular nurses when

classified according to age, gender, years in service and employment ward; and

2. There is no significant relationship between the regular nurses’ level of stress

and performance.

Significant of the Study

This research attempts to determine the level of job stress and how it influences

the performance of the nurses in Garcia Memorial Provincial Hospital (GMPH) and Don

Emilio del Valle Memorial Hospital (DEDVMH) as such, following could benefit from the

study in particular.

Nurses. The result of the study will provide useful information regarding how job

stress influences their performance those who are working in Garcia Memorial

Provincial Hospital (GMPH) and Don Emilio del Valle Memorial Hospital (DEDVMH).

Also, this study will help the nurses to come up with new strategies which can be

helpful to improve their performance.

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Administrators. Based on the findings of the study, administrators might be

able to implement intervention to improve nurses’ performances.

Patients. The result of the study will give patients care and service that they

deserve and are expected to deliver since nurses may be given a background about

the job stress.

Future Researchers. This study will help the future researchers to know more

about the job stress and how it influences the performance of nurses.

Scope and Limitation

This study focused on the job stress of the nurses and how it influences their

performance. The study was conducted at the Garcia Memorial Provincial Hospital

(GMPH) and Don Emilio del Valle Memorial Hospital (DEDVMH) and only included the

regular nursing staff in the distribution of the questionnaires. This study did not cover

any problem that is not related to the study. This study was done through the utilization

of questionnaire for nurses who have different personal background as a reference.

The nurses’ performance is also checked based on their profile in terms of: (a) age; (b)

gender; (c) length in service; and (d) employment ward. It also includes the level of

nurse job stress in terms of:(a) admitting patient; (b) patient care; (c) health education;

(d) discharging patient; and (e) referral of patients to higher center. By these, the

researchers will be able to know the relationship of job stress to their performances.
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Other non-medical and medical staffs such as administrators and doctors are not

included in this study.

RESEARCH METHODOLOGY

Research Design

This study utilized the survey approach of conducting research, especially the

descriptive-correlational design since the main goal of the study was to determine the

significant relationship between the respondents’ job stress and performance.

According to Burns and Grove (2005), descriptive studies are used when little is

known on a particular phenomenon. Furthermore, it describes the current status of the

identified variables, determine the frequency and magnitude in which it occurs and

categorizes the information. This is utilized in the study to describe and determine the

level of the respondents job stress and efficiency in their performance, as well as their

profile.

On the other hand, Creswell (2003) defines correlational design as a research

design that attempts to determine the scope of the relationship between two or more

variable using statistical data. This design is used to review if changes in one or more

variable are related to the changes in another variable measurement if job stress and

performance were made before correlation approach was applied to determine any

significant difference between the variables.

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Jointly, a descriptive-correlation design describes the variables and then

determines the connection that happens naturally between the variables. In addition,

Lappe (n.d.) stated that the design is used for depicting how one phenomenon is

related to another. This is utilized to know the relationship between job stress on the

performance of nurses.

Research Environment

This research was conducted in the only hospital in the Municipality of Talibon,

Bohol and one of the hospital in the Municipality of Ubay, Bohol, specifically the Garcia

Memorial Provincial Hospital and Don Emilio del Valle Memorial Hospital.

This institution was selected as the research environment since it is the largest

and closest health-care institution in Talibon. Moreover, the researchers of this study

were Senior High School students who are living in Talibon which means that they

could save time, money, and effort.

Research Respondents

Twelve (12) regular nurses from Garcia Provincial Memorial Hospital (GMPH) in

Talibon and thirteen (13) regular nurses from Don Emilio Del Valle Memorial Hospital in

Ubay were tapped as respondents of the study. In determining the respondents,

researchers utilized purposive sampling and convenience sampling. It includes those

regular nurses for they are more exposed and have longer experience than contractual

nurses and those who are convenient to answer the questionnaire. In selecting the
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respondents, researchers went to the health care institution to ask permission for the

list of regular nurses to be used by the researcher as respondents of the study.

Research Instrument

This study utilized a survey questionnaire which consisted of two parts. The first

part was all about the respondent’s demographic profile and the name and address of

the respondents which is optional.

The second part was the self-made survey questionnaire that was based on the

Individual Performance Commitment and Review (IPCR) of the nurses that was given

by the head nurse of Garcia Memorial Provincial Hospital (GMPH). It covers the five

sub- variables of this study namely; (1) admitting patient, (2) provision of care which

was changed into patient care, (3) discharging patients, (4) health teaching which was

also changed into patient education, and (5) referral of patients to higher center.

The core function of the IPCR were used as a phrase of the survey questionnaire

for the nurses so that the researchers will be able to measure the stress of the nurses

in each function and the performance of the nurses will be determined through

documentary analysis.

The survey questionnaire utilized in this study contains 14 items which measures

the stress of the nurses on their job. The two sub- variables “ admitting patients” and

“patient care”are appropriated with 6 items and 5 items respectively. The other three
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sub- variables namely” health education”, “discharging patients”, and “referral of

patients to higher center”are appropriated with one item each.

Table 1 presents the 5 sub-variables of stress along with the item numbers that

corresponds to each sub-variable.

Table 1. Item Number on Each Sub Variables of Stress

Sub- variables of stress Items

Admits patient 1,2,3,4,5,6

Patient care 7,8,9,10,11

Health education 12

Discharge patient 13

Referral to patients to higher center 14

The survey questionnaire uses 5-point Likert Scale with the range of responses

including; (1) never stressful; (2) seldom stressful; (3) sometimes stressful; (4) most of

the time stressful; (5) always stressful.

Individual Performance Commitment and Review (IPCR) of the nurses is used in

rating the performance of the nurses. The IPCR is used to ensure that the nurses

achieves the objectives set by the hospital management . The IPCR includes includes

assigned function, duties, responsibilities, and performance measures or targets

aligned with those specific core functions.

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Research Procedure

The step for the accomplishment of the research study includes the drafting of a

letter that is to be sent to the hospital head to ask for permission to conduct the study

and attach a consent and letter that states that the nurses are to answer voluntarily the

given questionnaires. The study has a two- part questionnaire with the inclusion of

IPCR (Individual Performance Commitment and Review) requested from the hospital

and will serve as a basis to measure the performance of nurses. Through purposive

sampling and convenience sampling, the nurses from GMPH and DEDVMH who

served as the respondents of the study were determined.

After obtaining due approval from the hospital head of GMPH and DEDVMH to

collect data, the researchers will proceed towards administering the questionnaire to

the respondents and were retrieved afterwards.

The collected data are tallied, tabulated, and then subjected to statistical analysis.

These collected data were illustrated and interpreted and will become a bases for some

recommendations to be proposed.

The researchers believe that the collected data from the responses of the nurses

of the research study are reliable and valid to complete and satisfy the research posted

by this study.

DEFINITION OF TERMS
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The terms defined in this section already appeared in the other parts of this

chapter, but it is still important to put these significant terms for the readers’ better

understanding and comprehending of the whole research. These important terms to be

defined are the following:

Admitting Patient

In this study, it means giving access to or allowing entrance of a patient who can be

admitted to the emergency room or to the hospital. When the patient is admitted to the

E.R, he or she is an inpatient. In either situation the patient should examined,

diagnosed, and receive treatment.

Discharging Patient

This is the point at which patients’ hospital care end, with on going care transfer to

other primary, community or domestic environments (Waring et al., 2014).

Patient Education

The process by which health professionals provide specific and detailed

educational activities and information to patients, carers and family members so they

can actively participate in their health care and any treatment they may be receiving

(EVIQ Education , 2015).

Job Performance
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As mentioned by Homayan et al., (2013), it refers to how effective employers are in

accomplishing their tasks and responsibilities of their work. As used in this study, it

pertains to how nurses perform their functions on their job based on their ratings in their

Individual Performance and Commitment Review (IPCR) form.

Job Stress

In this study, it refers on the stress that nurses get when they feel pressured and

out of control over their work due to some factors. Moreover, job stress refers to a

physiological condition in which work- related duties and responsibilities become

burdensome and overwhelming to the point that it imposes unhealthy effects on the

mental and physical wellness of employees (Workplace testing, 2019).

Patient Care

It is the service rendered by members of the health profession under thesupervision

of the health workers for the benefit of the patients (Dorland, 2012).

Referral

It is defined as a process in which a health care provider at one level of the health

care system having insufficient resources such as equipment, skills and knowledge to

manage a critical condition, t seeks the assistance of a better resource health care

facility or health care provider at the higher level of health care system to take over the

management of the client’s case (Cervantes K, Salgado R, Choi M, et al., 2016).

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REFERENCES
 28

Abualrub. (2008). Job Stress, Recognition, Job Performance and Intention to stay
awork among Jordian Hospital Nurses. Retrieved from Journal of Nursing
Management:
https://www.researchgate.net/publication/5527336_job_stress_recognition_job_perf
ormance_and_intention_to_stay_at_work_among_jordian_hospital_nurses/amp

Aghakhani. (2012). Nurses Attitude to Patient Education Barriers in Educational

Hospitals of Urmia University of Medical Sciences. Retrieved from iranian journal of
nursing and midwifery research:
https://ww.researchgate.net/publication/236047285_nurses_attitude_to_patient_edu
cation_barriers_in_educational_hospital_of_Urmia_University_of_Medical_Sciences
/download
Alper, E. (2017). Hospital Discharge and Readmission. Retrieved from
https://www.update.com/contents/hospital-discharge-and-readmission
American Association of Critical Care Nurses Delegation Handbook. (2014). Retrieved
from https://www.yumpu.com/document/view/11478957/aach-delegation-handbok-
american-association-of-critical-care
Arkansas. (2019). The nurses role in patient education. Retrieved from
https://degree.astate.edu/articles
Azizollah. (2013). The relationship between Job Stress and Performance among
Hospital Nurses. Retrieved from
https://www.researchgate.net/publication/267393908_the_relationship_between_job_
stress_and_performance_among_hospital_nurses
Business Dictionary. (2019). Retrieved from Job Performance:
http://www.businessdictionary.com/definition/job-performance.html
C., G. (2007). A nurse and pharmacist led treatment advice clinic for patients attending
an HIV outpatients clinic. Retrieved from Journal for advanced nursing:
https://acadeic.oup.com/heapro/article/28/4/490/556908
Cabriera. (2019). How can nurses make a difference in the health of their patients?
Retrieved from Share Care: https://www.sharecare.com/health/nursing/how-nurses-
difference-health-patients
Camington College. (n.d.). Retrieved from The Importance of Patient Care:
https://carrington.edu/blog/student-tips/health/the-importance-of-patient-care/
Cervantes. (2016). Rapid Assessment of Referral Care System: A Guide for Program
Manager. Retrieved from The Basic Support for Institutionalizing Child Survival
Project for the United States Agency for International Development:
a83f9a1a08e3410492cd695980d9cd488d5e.pdf
 29

Chang. (2012). Stress , depression, and intention to leave among nurses in different
medical units: implications for healthcare management/nursing practice. Retrieved
from Health Policy: http://www.ncbi.nl,.nih.gov/m/pubmed/23017221
Clarke. (2008). Nursing Staffing and Patient Care Quality and Safety. Retrieved from
https://www.ncbi.nlm.nih.gov/m/pubmed/21328775/nursing_staffing_and_patient_car
e_quality_and_safety
Creswell. (2003). Research Design: Qualitative, Quantitative and Mixed Methods
Approaches. Thousand Oaks, CA: Sage .
Dayrit, J. &. (2018). Reported Work-related Stressors Among Staff Nurses in Metro
Manila, Philippines. Retrieved from
https://www.researchgate.net/publication/325817354_nurses_in_metro_manila_philip
pines
Elahi. (2012). A detailed Study on Length of Service and Role Stress of Banking
Sectorin Lucknow Sector. Retrieved from Research Journal of Management
Sciences: https://www.isca.in/IJMS/Archive/v1/i5/3.iSCA-RJMS-2012-
047.pdf&ved=2ahUKEwjkqKjg9lblAhXDad4KHYf7CX0QFjAAegQIAxAB&usg=AovV
aw0selM37KaLjB17xes2lrY2
EVIQ Education. (2015). Retrieved from Patient Education Resource:
https://education.eviq.org.au/patient-education-resource
Farquharson. (2012). Stress amongst nurses working in a healthcare telephoneadvice
service: relationship with job satisfaction, intention to leave, sickness absence,and
performance. Retrieved from Journal of Advanced Nursing:
https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---
safework/documents/publication/wcms_466547.pdf
Grove, B. &. (2005). The Practice of Nursing Research: Conduct, Critique and
Utilization. 5th Edition, Elsevier Saunders, Missouri .
Gupta. (2014). Effect of Age and Gender on Occupational Stress: A Study on Teaching
Fraternity. Retrieved from International Journal of Engineering Technology,
Management and Applied Sciences:
http://ijetmas.com/admin/resources/project/paper/f420140720-1405837452_
Hesselink, G. (2013). Quality and Safety of Hospital Discharge: A Study on experience
and perceptions of patients, relatives and care provider. International Journal for
Quality in Health Care .
Homayan. (2013). Impact of job performance level on nurses in public sector of
hospitals. Retrieved from American journal of applied sciences:
https://pdfs.semanticscholar.org/eb56/4f282bee5d9624b252347c38e02bc6016e.pdf&
ved=2ahUKEwjArc2vi4fAhWkd94KHV0FCSAQF;ABegQ1DBAG&usg=AOvVaw3B5w
GVr_Df8MFaBTKuWbUm
 30

J., B. (2016). Making Care Transitions Safer: The Pivotal Role of Nurses. Retrieved
from Agency for Health Research and Quality:
https://www.ahrq.gov/news/blog/ahrqnews/pivotal-role-of-nurses.html
Joohyun, L. (2016). Gender Differences in Job Stress and Stress Coping Strategies
Among Korean Nurses. Retrieved from International Journal of Bio-Science and Bio-
Technology:
https://www.researchgate.net/publication/315025964_job_stress_and_stress_coping
_strategies_among_male_and_female_korean_nurses&ved=2ahUKE
Kashmir. ((n.d)). Level of Stress among Staff Nurses Working in Emergency and
General Wards of Skim Hospitals: A Comparative Study. Retrieved from International
Journal of Advanced Research: http://www.journalijar.com/article/16521.level-of-
stress-among-staff-nurses-working-in-emergency-and-general-ward-of-skim-hospital-
a-comparative-study./
Lancet. (2011). Current situation of the referral system in family practice in Shebein El-
Koum District, Menoufia Governorate, Egypt. Retrieved from Healt Financing
Reforms in Southest Asia: Challenges in Achieving Universal Coverage:
http://www.mmj.eg.net/article.asp?issn=1110-
2098;year=2015;volume=28;issue=2;spage=360;epage=366;aulast=Farahat#ref2
Leeuw. (1996). Performance Auditing, New Public Management and Performance
Improvement: Questions and Answers. Retrieved from Accounting, Auditing &
Accountability Journal: https://doi.org/10.1108/09513579610116385
Lin, C.-J. (2012). Discharge Planning. International Journal of Gerontology .
Masa, R. (2016). Perceived Stress in Nurses: A Comparative Study. Retrieved from
Global Journal of Health Science:
https://www.ccsnet.org/journal/index.php/gjhs/articles/view61491
Mind Tools Ltd. (2019). Retrieved from Inverted U:
https://www.mindtools.com/pages/article/inverted-u.htm
Olantunji. (2016). Effect of Tenure of Service on Job Stress and Nurse Physician
Collaboration among Nurses and Doctors. Retrieved from Journal of Nursing and
Health Science: https://www.iosrjournals.org/iosr-jnhs/papers/2012-
issue1/AO210104.pdf%3Fid%3D6975&ued=2ahukEwiN_Yq61lblAhxdm94khvQ2b-
OqfJaaEGq1AhAB&usg=ABvVaw3uWg_1kx1rRnm82LzZzkmH
Osumah. (2017). Gende and Age Differences in the Experience of Occupational Stress
among University Lectureres in Edu State, Nigeria. Retrieved from Academic Journal
Article Gender and Behavior: https://www.questia.com/library/journal/IP4-
2113738239/gender-and-age-differences-in-the-experience-of-occupational-stress-
among-university-lecturers-in-edu-state-nigeria
 31

Reference Md. (2012). Retrieved from What is Patient Care?:

https://www.reference.md/files/D005/mD005791.html
Republic Act No. 11058. (2017). Retrieved from An Act Strengthening Complaince with
Occupational Safety and Health Standards:
www.lawphil.net/statues/repacts/2018/ra_11058_2018.html
Republic Act No. 7305 . (2009). Retrieved from Magna Carta for Public Health Workers:
www.pcw.gov.ph/law/republic-act-7305
Robbins. (2007). Theoritical Framework of Stress Management. Retrieved from
https://shodhganga.inflibnet.ac.in/bitstream/IO603/54301/11/11_chapter%25204.pdf
Sabu. (2017). A Comparative Study of Stress Level of Male and Female Nurses in
ICU.Retrieved from Texila International Journal of Clinical Research:
http://www.semanticscholar.org/paper/a-comparative-study-of-stress-level-of-male-
and-female-nurses-in-icu/2149b089cf0421ef918ce1e722dcd36b61sf4bef2
Sahraian, A. (2013). Occupational stress among hospital nurses: comparison of
internal, surgical, and psyciatric wards. Retrieved from Article in complementary
therapies in nursing and midwifery:
https://www.researchgate.net/publication/270571246_occupational_stress_among_h
ospital_nurses_comparison_of_internal_surgical_and_psychiatric_wards
Shekelle. (2013). Nurse-Patient Ratios as a Patient Safety Strategy: A Systematic
Review. Retrieved from Annals of Internal Medicine:
https://.google.com/amp/s/www.researchgate.net/publication/298426437_Nurses_Ra
tios_as_a_Patient_Safety_Strategy_A_Systematic_Review/amp. Annals for
International Medicine
Simanjorang. (2015). The influences of job stressor to performance of nurses in
Pirngadi General Hospital of Medan Indonesia. Retrieved from International journal of
nursing, midwife and health related cases: http://www.eajournals.org/w-
content/uploads/The-influence-of-job-stressor-to-performance-of-nurses-in-pirngadi-
general-hospital-of-medan-%25E2%2580%2593-
indonesia.pdf&ved=2ahUKEwjX8qj5_4bIAhlllgKHTn9CbQ
Smith. (2019). Role of a Nurse. Retrieved from News Medical Life Sciences:
https://www.news-medical.net/health/Roles-of-a-Nurse.aspx
Sreelekha. (2016). Stress among Nurses in Tertiary Care Hospitals. Retrieved from The
International Journal of Indian Psychology:
https://www.researchgate.net/publication/319165442_stress_among_nurses_in_a_te
rtiary_care_hospitals
Stromborg. (2003). Nurse-led heart failure clinics improve survival and self care
behaviour in patients with heart failure. Retrieved from A prospective, randomized
 32

trial, european heart journal:

https://academicoup.com/heapro/article/28/4/490/556908/
Tesfaye. (2015). Assessment of factors affecting performance of nurses. Retrieved
from Journal of nursing and care: https://www.omicsonline.org/open-
access/assessment-of-factors-affecting-performance-of-nurses-working-at-jimma-
university-specialized-hospitals-in-jimaa-town-oromia-regions-2167-1168-
1000312.php?aid=65245
V., S. (2019). News Medical Life Sciences. Retrieved from Roles of a Nurse:
https://www.news-medical.net/health/Roles-of-a-Nurse.aspx
Waring. (2014). An Ethnographic Study of Knowledge Sharing Across the Boundaries
between Care Processess, Services, and Organiztion: The Contribution to Safe
Hospital Discharge. NUHR Journal Library .
Work Health And Safety Act of 2011. Retrieved from www.worksafe.qld.gov.au/laws-
and-compliance/workplace-health-and-safety-laws/laws-and-legislation/work-
health0and-safety-act-2011
Yerkes-Dodson. (1908). Retrieved from Inverted U:
https://www.mindtools.com/pages/article/inverted-u.htm
Zadeh, A. &. (2011). Occupational tension and coping strategies in nurses in
psychological ward of Tabriz Razi hospital. Retrieved from Modern Care:
http://www.en.journals.sid.ir/ViewPaper.aspx? ID=219191
 33

Appendices
 34

APPENDIX A

CORRESPONDENCES

San Jose National High School

Talibon, Bohol

October 4, 2019

MIGUELITO S. JAYOMA, MD, FPSGS, FPSC, MHM

Chief of Hospital II
Garcia Memorial Provincial Hospital
Talibon, Bohol

Dr. Jayoma:
Greetings of peace!

The undersigned is a Senior High School student of San Jose National High School,
Talibon, Bohol. I am presently taking up Practical Research 2 - Quantitative Research
subject. I am the group leader of our research study entitled “Job Stress on the
Performance of Nurses in Garcia Memorial Provincial Hospital (GMPH)”

In line with the subject requirement, I would like to request your good office to allow me
and my members in conducting a data collection through survey and documents from
the current medical health workers of Garcia Memorial Provincial Hospital. These data
are required for the accomplishment of the study which aims to determine the level of
stress that might affect to their performance.

Thank you very much and God bless.

Respectfully yours,

JANE JEREMAE G. ITEM

Group Leader
 35

Noted:

GISELO B. CAJES, Ph.D

Research Adviser

MARCELA R. BAUTISTA, Dev. Ed. D

Principal IV

Approved:
MIGUELITO S. JAYOMA, MD, FPSGS, FPSC, MHM
Chief of Hospital II, GMPH
 36

September 19, 2019

Miguelito S. Jayoma, MD, FPSGS, FPCS, MHM

Head of GMPH

Garcia Memorial Provincial Hospital

San Jose, Talibon, Bohol

Dr. Jayoma:

Good Day!

We humbly request your good office for the list of all regular nurses who are working in your
hospital. These data are required for the accomplishment of our study which aims to determine
the level of stress that might affect to their performance.

We understand that the institution promulgates privacy of information regarding its staffs.
Hence, we would be using the list with utmost confidentiality.

We are hoping for your positive response. Thank you.

Respectfully Yours,

JANE JEREMAE G. ITEM

Group Leader

Noted by:

GISELO B. CAJES

Practical Research 2 Teacher

Approved by:

MIGUELITO S. JAYOMA, MD, FPSGS, FPCS, MHM

Head of GMPH
 37

APPENDIX B

SURVEY QUESTIONNAIRE

Job Stress on the Performance of Nurses in Garcia Memorial Provincial Hospital

(GMPH)

PART I

Personal Information

Name: (Optional) _________________________________________________

Surname First Name Middle Name

Address: (Optional) ________________________________________________

1. Age: _______

2. Gender:

______ Male

______ Female

3. Years in Service:

Length of service in the institution: ______ years, if less than one year ______
months.

4. Specialized area:
 38

______ Operating/ Delivery Room

______ Ward/ ER

______ OPD

PART II

Instructions: Please put a check in the box for each questions that comes closest to
reflecting your opinion about it.

Questions: Never Seldom Sometimes Most of Always

Stressful Stressful Stressful the Stressf
(1) (2) (3) timeStre ul
ssful (5)
(4)
1. I get stressed in assessing
and gathering patients data

2. I get stressed in vital signs

taking

3. I get stressed in carrying

doctor’s order

4. I get stressed in preparing

drugs

5. I get stressed in
administering drugs

6. I get stressed in attending

OPD patients outside office
hour
7. I get stressed in receiving
endorsement

8. I get stressed in doing

nursing rounds

9. I get stressed in
documenting
 39

10. I get stressed in performing

some nursing procedures
11. I get stressed in assisting
some minor surgical
procedures
12. I get stressed in explaining
the patient’s health
condition
13. I get stressed when
discharging some patients
14. I get stressed on referring
some patients to higher
centers
 40

APPENDIX C

Republic of the Philippines

PROVINCE OF BOHOL

City of Tagbilaran

GARCIA MEMORIAL PROVINCIAL HOSPITAL

Talibon, Bohol

INDIVIDUAL PERFORMANCE COMMITMENT AND REVIEW (IPCR)

I, FELIZE MARIE G. MAQUILING, NURSE I of Garcia Memorial Provincial Hospital of the Provincial Government of Bohol,
commit to deliver and agree to be rated of the attainment of the following targets in accordance with the indicated measures for the
period of July 01, 2017 to December 31, 2017.

FELIZE MARIE G. MAQUILING

Ratee

Date: December 05, 2017

 41

Reviewed by Date Approved by Date

LEAH B. AUXTERO, RN HAROLD B. GALLEGO, MD, CSEE

Output Success Indicator Actual Rating REMARKS

MFO/PAP (Target + Measure) accomplishments Q1 E2 T3 A4
STRATEGIC CORE FUNCTIONS
STRATEGIC: Sustaining effective Health
Programs: CURATIVE/
REHABILITATIVE
CORE 100% of patients admitted and
FUNCTION provided quality Health nursing
1: Admits care within 5 mins from arrival
Patient
 Assess
and
gather
patients
data
 Vital
signs
 42

taking
 Carry
doctors
order
 Prepare
and
administ
er drugs
 Attend
OPD
patients
outside
office
hour

CORE 100% of patients

FUNCTION 2: needs attended
Provision of immediately and
care Quality health
 Receive nursing care
endorseme provided effectively
nt and do within duty hours
nursing
rounds
 Carry
doctors
orders
 Prepare
and give
medications
 Documentat
ion
 Perform
nursing
procedures
 Assist minor
surgical
 43

procedures

SUMMARY OF RATINGS TOTAL FINAL NUMERICAL RATING FINAL ADJECTIVAL RATING

CORE 100% of
FUNCTION 3: comprehensive
Health health teachings
teachings provided to patients
and their Significant
others within days
of confinement
CORE 100% of patient
FUNCTION 4: discharged
Discharge (advised, per
patients request and against
advise) within 5
minutes
CORE 100% of patient
FUNCTION 5: referrals facilitated
Referrals of and conducted
patients to immediately within
Higher center 5 minutes upon
instruction
FINAL
AVERAGE
RATING
 44

MFOs- Strategic/ COre

Functions

MFOs- Support
Functions
 45

Comments and Recommendations for Development Purposes

 46

Prepared by: Date: Assessed by: Date: Final Rating by: Date: Date:

FELIZE G. 12-5-15 LEAH B. HAROLD B. JOSEFINA

MAQUILING, AUXTERO, RN GALLEGO, MD, RELAMPAGOS
BSN, RN CSEE

Employee Division Head Department Head PMT

Legend: 1- Quality 2- Efficiency 3- Timeliness 4- Average

47