RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA

SYNOPSIS

FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.Name of the candidateMS. P. NALINI JULIET THANGAM

2. Name of the institution

Diana College of nursing

No. 68, Chokkanahalli, Jakkur

Post, Bangalore-64

3.Course of study and subject Masters of science in Nursing

Psychiatric Nursing

4.Date of admission to course 10-06-2009

5.Title of the topic

A STUDY TO ASSESS THE LEVEL OF

STRESS AND COPING STRATEGIES AMONG

NURSES WORKING IN CASUALTY UNITS

OF SELECTED HOSPITALS, BANGALORE

WITH A VIEW TO PROVIDE AN

INFORMATION BOOKLET.

6. Brief resume of the intended work

INTRODUCTION:

Stress, a buzzword of the 90s, is an everyday fact of life. At one point or the other

everybody suffers from stress. Relationship demands, physical as well as mental

health problems, pressure at workplaces, traffic snarls, meeting deadlines, growing-

up tensions-all of these conditions and situations are valid causes of stress. In fact, a

certain amount of stress is necessary for survival. Stress refers to a broad group of

experiences in which external or internal demands, or both, tax or exceeds a person’s

resources or coping capabilities. The source of stress, external or internal, is called a

stressor.1

Stress is the emotional and physical strain caused as a result of our response to what

happens around us. Stress can affect anyone-kids, teenagers, adults and the elderly. It

is an inborn instinct which helps the person to deal with everyday difficulties. But, if

it goes on for too long, it can harm the physical as well as psychological health,

making it difficult to handle day-to-day living.2

Stress or stressors undergoes many changes in our body. Our nervous system and

certain hormones get activated. These hormones quicken our heart rate, breathing,

metabolism and blood pressure. Our body begins to sweat as a preventive measure to

keep its temperature cool. These responses by the body to counter a stressful

situation, helps to handle the event effectively and perform well even under pressure.

However after tackling the stressful event, the body returns to normal. This natural

ability of the body to deal with stress is called as stress response. Any event where

the body fails to respond in this manner can cause stress.2

Stress is important for nurses for it influences nurses working performance or their

problem solving ability and their ability to supply their self-care needs. In the meta-

analyses study in which investigated factors affecting work satisfaction of nurses, it

was pointed out that job satisfaction could not be explained by a single factor; instead

it was related to various factors. A study showed that stress and organizational

devotion are emphasized as being the most important variables affecting job

satisfaction. Heavy workload, unsupportive work environment, and stress are the

most common reasons of work dissatisfaction and resigning from work among

nurses. 3

Nurse’s occupational stress appears to vary according to individual and job

characteristics, and work-family conflict. Common occupational stressors among

nurses are workload, role ambiguity, interpersonal relationships, and death and dying

concerns. Emotional distress, burnout and psychological morbidity could also result

from occupational stress. Nurses’ common coping mechanisms include problem

solving, social support and avoidance. Perceived control appears to be an important

mediator of occupational stress. Coping and job satisfaction appear to be reciprocally

related. Shift work is highly prevalent among nurses and a significant source of

stress. 4

Nurse’s high job stress is well documented. In particular, the job stress of nurses

working in acute and specialized care units has been widely studied. Heavy work

load, poor staffing, dealing with death and dying, inter-staff conflict, strain of shift

work, careers and lack of resources and organizational support have been identified

as the major source of job stress5

Emergency services are the need of any hospital and are very vital and integral unit

of the modern hospital. The atmosphere of the unit is highly demanding and

emotionally charged. The attending nurses are working under pressure to attend each

and every patient to the level of satisfaction for the patient and their family members.

This service is provided non-stop, round the clock, and throughout the year and the

rule of thumb in emergency is the preparedness for 'flexible workload'. A thriving

well-resourced, forward looking and innovative emergency department is key to the

success of the hospital.6

"Medical emergency is defined as a situation when the patient requires urgent and

high quality medical care to prevent loss of life and limb and initiate action for the

restoration of normal healthy life." Emergency services, which can be provided by

any hospital depends upon the number of beds, and the policy of the hospital. In

general in our country smaller hospitals run accident and emergency services called

'Casualty' during the non outpatient department (OPD) hours and share facility with

the OPD. Out of all aspects of medical care, emergency is the most crucial and vital,

as the patient and attendants perceive it as an emergency, which called for urgent

action. Therefore, not only it's the life of patients is at stake but also the image and

reputation of the hospital and the health care providers. From the point of

administration, it is one of the most stressful, and sensitive areas, which can trigger

off serious chain reactions hampering the functioning of the hospital.7

The casualty nurses do not have the luxury of a leisurely assessment; every second

counts. Most emergency situation includes elements of danger and confusion, thus

the physical and emotional stress factors may be extreme. Casualty is the stressful

period for the nurses. The factors which might alter the harmony of the systems are

classified as factors related to knowledge, environment and emergency care in the

casualty. If these stimuli are perceived as positive stressors it leads to early treatment

process, whereas if the nurses perceives them as negative stressors then it leads to

delayed care.8

Stressors are of two types namely positive and negative stressors. Negative stressors

are uncontrollable and lead to maladaptive behavior. Positive stressors are

controllable and lead to growth. Some of the hospital areas such as recovery room,

emergency room and intensive care unit are prone to be emotionally affected by

many events and produce stress to the nurses.9

Coping is a cognitive and behavioral effort to manage specific external and/or

internal demands that are appraised as taxing or exceeding the resources of the

persons. Coping is the means by which we think, feel, and act to advance our cause.

Coping helps advance a sense of increased control over the situation and is

characterized by dynamics and changes that are a function of continuous appraisals

and reappraisals of the shifting person-environment relationship. Coping

effectiveness is dependent on the match between coping efforts and other variables in

the stress-coping process, including one’s values, beliefs, and commitments10

6.1. NEED FOR THE STUDY:

Nursing personnel work in a wide range of health services settings including

hospitals, nursing homes, and ambulatory and community-based environments. In

performing their duties, they encounter a remarkable range of work-related hazards.

Some evidence suggests that fatigue related overwork and staffing patterns, including

shift work, can contribute to injuries and stress among staff providing nursing

services. Factors such as the physical work environment, organizational and

institutional characteristics and policies, and personal work habits contribute to

exposure to the risk of injury and stress.11

In a study of intensive care unit nurses, the investigators concluded that individuals

high on state-anxiety were not only at risk for burnout, but also for making medical

errors. In another study, higher trait-anxiety predicted psychological distress. In

addition, relationships with other staff—coworkers, physicians, head nurses, other

departments—were also predictors of psychological distress.12

Verbal abuse from physicians was noted to be stressful for staff nurses. In a study of

260 RNs, conflict with physicians was found to be more psychologically damaging

than conflict within the nursing profession. However, a study exploring verbal abuse

among 213 nursing personnel (95 percent RNs) found the most frequent source of

abuse was other nurses (27 percent). Families were the second most frequent source

of abuse (25 percent), while physicians ranked third (22 percent).13

WHO predicts that by 2020, Mental illness like stress and depression will be the

second leading cause of disability worldwide, after heart disease. The incidence of

stress within European society is on the increase and accounts for over 50% of all

absence from work. An annual survey of integrated disability management

programmes, found that incidence of disability are increasingly related to slowly

developing work-induced stress.14

The Canadian Mental Health Association says that emotions disturbances and stress

accounts for 20-30% of all employees. About 20% increase in stress cases was

reported by employee assistance programmes according to the Managing Director of

the Canadian Institute of Stress. 15

It has also been found that different nurses experience job stress differently. Some

studies reported that senior registered nurses and charge nurses experienced a higher

degree of stress than other ranks of nurses. However, other studies found that stress

level was significantly higher in junior nurses than in the senior nurses. There are

also studies reporting that the longer nurses had worked in their units the more likely

they were to experience stress regardless of their seniority. 16

The stress-resistant nurses were also distinguished by a less frequent use of defensive

or avoidance coping in handling their emotional reactions to stress. They perceived

greater family support than did the distressed nurses. Implications of the findings and

limitation of the study were discussed. 17

Now a day’s stress has become more common to all the casualty nurses when they

are facing the emergency situation. The investigator identified nurses who work in a

hospital set up or community set up have lot of ‘work stress’ due to work load, shift

work, overtime etc. So, the investigator has planned to help the nursing staff by

undertaking this study to assess the stress level and coping strategies in groups of

nursing staffs working in the casualty and also provide an information booklet on

stress management.

6.2.Review of Literature

A literature review is a written summary of the state of existing knowledge on

research problem. The task of reviewing research literature involves the

identification, selection of critical analysis and written description of existing

information on a topic (Polit & Hungler, 2003).

The review of literature in this study is organized under the following headings:

1. Literature related to stress of nurses working in the casualty unit.

2. Literature related to coping strategies of nurses working in the casualty unit.

3. Literature related to relationship between stress and coping strategies of the nurses

working in the casualty unit.

1. Literature related to stress of nurse working in the casualty unit:

A descriptive approach was carried out among casualty nurses of a selected hospital to

assess the stress and coping among casualty nurses. A sample of 110 nurses was

chosen by using convenient sampling technique. Out of 110 nurses, 46 were having

high stress score and remaining 54 nurses were found having less stress scores. The

findings revealed that majority of nurses were having high stress scores and poor

coping level.18

A study was conducted to assess the perceived stress among nurses working in a

casualty. 60 samples were selected for the study by using the simple random

sampling. The data was collected by using stress scale. The study findings revealed

that stress levels are high among the nurses with the sources of feeling nervous,

irritating life hassles and inability to control the environmental problems.23

A study was conducted in Northern Ireland to explore the attitude of casualty nurses

in attempting suicide. The nurse’s age and length of experience in casualty were the

independent variables. A total of 142 nurses from 11 hospitals in Northern Ireland has

questionnaire circulated to them, with a 66.9% response rate. The results revealed that

older and the more experienced nurses seems to have more positive attitude than the

younger or the less experienced nurses.24

A descriptive study was conducted based on stress module. A simple random

sampling technique was used to select 31 subjects from the hospitals. Among 31

samples, 3.2% perceived mild stress, 90.32% perceived moderate stress and 6.46%

perceived severe stress. The study findings revealed that most of the nurses were in

the moderate stress level.25

A cross sectional study was conducted to find the different sources of occupational

stress and the level of job satisfaction among nurses working at a tertiary care hospital

in Rawalpindi from March 2005 to June 2005. Majority of participants (70%) felt

secure in their organization. Similarly 74% of participants were satisfied with their

job. The result showed the nurses at a tertiary care hospital have a high index of

occupational stress and majority of it generates from the administrative

disorganization of the firm and less from the personal or the monitory factors.26

2. Literature related to coping strategies of nurses working in the casualty unit:

In recent years conviction has grown that it is how nurses cope with stress, not stress

that influences their psychological well-being, social functioning, and somatic health”.

“Effective adaptation to stressful events entails the complex interplay of several

different factors. These include the nature of the event itself, the individual’s cognitive

appraisal of the event, personal and social coping resources available to the individual,

and the actual coping strategies that the person employs”.27

A cross sectional survey design was used to describe and compare the job satisfaction,

coping strategies, personal and organizational characteristics among nurses working in

a hospital in Turkey. 186 nurses from cumhuriyet university hospital completed

personal data form, Minnesota satisfaction questionnaire and ways of coping

inventory. Response rate was 74.4%. It was found that job satisfaction score of nurses

showed moderate (mean: 3.46 + 0.56). Organizational and individual nurse

characteristics were not found to be associated with job satisfaction. But, job

satisfaction of the nurses who is bounded by a contract was found higher than that of

permanent staff nurses (p < 0.05). The job satisfaction of Turkish hospital nurses was

at a moderate and that of the nurses who succeeded to coping with the stress was

heightened. Higher levels of job satisfaction were associated with positive coping

strategies.28

A study was conducted to examine links between coping style, situational appraisals

and subsequent use of coping strategies in response to acute stress among nurses in

Australia (N = 190, 93 men and 97 women, ranging in age from 18 to 44 years).

Regression analyses indicated that nurses’ approach and avoidance coping responses

varied across four emergency related stressful situations. In addition, both hospital

and situational factors accounted for significant variations in nurses’ approach coping

responses, with situational factors better predictors of approach coping than hospital

dispositions. The results showed that the interactional model of coping in which

nurses’ use of coping strategies is at least a partial function of situational demands.28

A survey was conducted to assess the Deakin Coping Scale and in the qualitative

reports of nurses’ coping strategies. Data from 201 nurses working in public and

private hospitals revealed four reliable factors: appraisal, challenge/commitment, use

of social resources and avoidance, which together explained 57% of the variance. The

factor structure was cross-validated among nurses. A second-order factor analysis

revealed these factors loaded onto a latent variable labeled management of demands

that was stable across genders. Three factors contributed positively to the management

of demands, while avoidance contributed negatively. The negative contribution of

avoidance suggests that emotion-based strategies are not effective in the management

of demands.29

In a series of research studies involving hospital nurses, it was found that although

nurses identified the top two stressors and the variations in coping methods. The most

commonly used coping strategies, in descending order of preference were: planful

problem-solving, self-control, and seeking social support for Australian nurses;

positive reappraisal, self-control, and planful problem-solving for Chinese nurses;

self-control, seeking social support, and planful problem-solving for Japanese nurses;

planful problem-solving, self-control, and seeking social support for New Zealand

nurses; positive reappraisal, self-control, and seeking social support for South Korean

nurses; self-control, planful problem-solving, and positive reappraisal for Thai nurses;

and planful problem-solving, self-control, and positive reappraisal for USA (Hawaii)

nurses. Thus, it can be seen that nurses, regardless of country, tended to prefer planful

problem-solving, seeking social support, self-control, and positive reappraisal as

coping strategies in the workplace. 29

3. Literature related to relationship between stress and coping strategies of

casualty nurse:

This paper examined the relationships between workplace coping strategies,

occupational attributional style, and job satisfaction among a sample of 190 nurses

employed with a Veterans Affairs Medical Center. As an occupational group, nurses

experience high levels of chronic workplace stressors. Participants completed a

questionnaire packet containing the Brief COPE, the Minnesota Satisfaction

Questionnaire (MSQ)-Short Form, and the Occupational Attributional Styles

Questionnaire (OASQ). The results indicated that a positive occupational attributional

style was associated with greater use of problem solving/cognitive restructuring

coping styles and less use of avoidance coping styles to deal with workplace stress.

This pattern of coping strategies was also associated with greater job satisfaction. 26

The relation of problem-solving confidence, perceived tolerance of stressors, and

situation-specific coping efforts to occupational burnout was examined among 88

nurses in physical rehabilitation units. Participants completed measures of problem

solving and burnout, and were administered a questionnaire that required them to list

stressors encountered at work and their ability to tolerate this stressor. Participants

were also asked to list their typical ways of coping with this stressor. Consistent with

predictions, confidence in one's ability to handle problems and perceived tolerance

were significantly predictive of lower burnout scores, regardless of time spent on the

job. Of the coping variables, emotion-focused coping was significantly associated

with higher burnout scores. Post-hoc analyses of self-reported coping activities

indicated that some coping efforts (e.g., taking time off from work, confronting a

supervisor) could be construed as symptoms of burnout, according to theoretical

conceptualizations. 27

A study was conducted to explore nurse’s occupational stressors and coping mechanism.

In nurses occupational stress appears to vary according to individual and job

characteristics and work-family conflict. Common occupational stressors among nurses

are workloads, role ambiguity, interpersonal relationship and death and dying concerns.

Emotional distress, burnout and psychological morbidity could also result from

occupational stress. Nurse’s common coping mechanisms include problem solving, social

support and avoidance. Perceived control appears to be an important mediator of

occupational stress. Coping and job satisfaction appear to be reciprocally related. Shift

work is highly prevalent among nurses and a significant source of stress. Prophylactic

and curative measures are important for nurses at both personal as well as organizational

levels. 30

Statement of the problem:

A descriptive study to assess the level of stress and coping strategies among nurses

working in casualty units of selected hospitals, Bangalore with a view to provide an

information booklet.

6.3. Objectives:

To assess the level of stress and coping strategies among nurses working in the

casualty unit.

To find out the relationship between stress and coping strategies of nurses working in

the casualty unit.

To find out the association between the level of stress among nurses working in the

casualty unit and their selected demographic variables.

To find out the association between the coping strategies among nurses working in the

casualty unit and their selected demographic variables.

Operational Definitions:

Assess:

It refers to the statistical measurement of stress and coping strategies among nurses

working in the casualty unit as observed from the scores based on rating scale.

Stress:

It denotes the state of physical and emotional instability of nurses working in the

casualty unit during emergency situation as measured by the stress rating scale.

Level of stress:

It is categorized as mild, moderate and severe with arbitrary distribution of stress scores

to indicate the degree of stress experienced by nurses working in the casualty unit.

Coping:

It refers to the cognitive and behavioral efforts adopted by the nurses working in the

casualty unit to alleviate emotional distress.

Coping strategies:

It refers to the remedial measures such as changes in thinking, behavior and lifestyle used

by the nurses working in the casualty unit in order to cope with stress problems.

Nurse:

It refers to a professionally qualified and registered nurse working in the casualty or

emergency ward.

Hypothesis:

Ho1: There is no significant relationship between the stress and coping strategies of

nurses working in the casualty unit.

Ho2: There is no significant association between the level of stress among nurses

working in the casualty unit and their demographic variables.

Ho3: There is no significant association between the coping strategies of nurses working

in the casualty unit and their demographic variables.

Assumptions:

Casualty nurses may have certain level of stress during emergency situations.

Casualty nurses may use some type of coping strategies corresponding to the problem.

Delimitations:

The study will be limited to nurses working in the casualty unit and who are,

attending the emergency care in a hospital.

able to understand English.

7. Material and methods

7.1Source of data Data will be collected from nurses working in the

casualty unit attending the emergency care in selected

hospitals, Bangalore.

7.2 Method of data collection

Research design Non-experimental descriptive design will be used.

Setting Casualty units of selected hospitals, Bangalore.

Population The population will be nurses working in the casualty

unit

Sample The nurses working in the casualty unit of selected

hospitals in Bangalore will be the samples for the study

Sample size The sample size will be 50 nurses working in the

casualty units of selected hospitals.

Sampling technique Convenient sampling technique will be used to select

the nurses working in the casualty unit at selected

hospitals.

Inclusion criteria The study will include:

1. Nurses working in the casualty unit who are willing

to participate.

2. Nurses working in the casualty unit and who will be

available during the period of data collection.

Exclusion criteria The study will exclude:

Nurses working in the casualty unit but are attending

the emergency care outside the hospital.

Tools Modified Nursing Stress scale will be used to assess the

level of stress and Modified Folk man and Lazarus

Coping scale will be used to assess the ways of coping

Data collection Prior to the period of data collection, the investigator

will obtain written permission from the concerned

authorities of the selected hospitals. Data will be

collected from nurses working in the casualty unit by

the investigator herself.

Data analysis , Presentation and

Interpretation

The collected data will be analyzed by using descriptive

statistics such as percentage and standard deviation to

assess the level of stress and coping strategies of nurses

working in the casualty units and inferential statistics

[chi-square] will be used to find the association of

demographic variables with stress and coping

strategies. The findings will be presented in the form of

graphs, figures and tables.

7.3Does the study require any investigation or intervention to be conducted on

nurses working in other wards? If so describe briefly.

Yes, study will be conducted among nurses working in other wards in selected hospitals,

Bangalore.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, informed consent will be obtained from concerned subjects and authority of

institution. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity

will be maintained with honesty and impartiality.

Ethical Committee

Title of the topic A STUDY TO ASSESS THE LEVEL OF STRESS AND

COPING STRATEGIES AMONG NURSES WORKING

IN CASUALTY UNITS OF SELECTED HOSPITALS,

BANGALORE WITH A VIEW TO PROVIDE AN

INFORMATION BOOKLET.

Name of the candidate Ms. P .NALINI JULIET THANGAM

Course of study and subject Masters of science in Nursing

Mental Health Nursing specialty.

Name of the guide Prof. Kalaiselvi

Head of the Department

Department of Mental Health Nursing

Diana college of nursing, Bangalore

Ethical committee Approved

Members of Ethical committee:

1. Prof. Veda vivek

Principal and HOD

Department of Community Health Nursing

Diana College of Nursing, Bangalore – 64.

2. Prof. Elizabeth Dora

Head of the Department

Department of Child Health Nursing

Diana College of Nursing, Bangalore – 64.

3. Prof. Kalaivani

Head of the Department

Department of Obstetrics and Gynecological Nursing

Diana College of Nursing, Bangalore – 64.

4. Prof. Vasantha Chitra.D

Head of the Department

Department of Medical Surgical Nursing

Diana College of Nursing, Bangalore – 64.

5. Prof. Kalai Selvi. S.

Head of the Department

Department of Psychiatric Nursing

Diana College of Nursing, Bangalore – 64.

6. Prof. Rangappa

Biostatistician, Bangalore.

8. List of references

1. Mary .c.Towwnsend.Psychiatric Mental Health Nursing.5th edition.Jaypee publishers;

2007.

2. Josephine Jacquline Mary. Stress Management of Health Care Personnel. Nightingale

Nursing Times 2009 June 3; 4 (11): 14 – 16.

3.M.Nagarathnam,B.Vengamma,K.Reddemma.Coping and Stress.Nightgale Nursing

Times 2009 April;5:11-14

4.Dr.Sailaxmi Gandhi,Dr.Lalitha.K.Percieved stress in nurse.Nightgale Nursing Times

2008 October;4-6.

5.Jeya Kuruvilla.Essentials of Critical Care Nursing.1st edition.Jaypee publishers;2007.

6. P.K. Devi, Shakthi Guptha,N.K.Parmar,Sunit Kant. Emergency Medical service and

disaster management, 1st edition, Jaypee publishers; 2001.

7.American journal of Critical Care 2007 May;16: 480 - 484.

8.Lalitha Krishnaswamy.Stress and Coping.The Journal of Nursing.2005 March;1:1-6.

9.K. Thenarasu Evaluvation of stress management programme for Nurses, Nightingale

nursing times 2005May;16: 24 – 31.

10.Webster L, Hackett R. Burnout and leadership in community mental health systems.

Admin Policy Mental Health 1999;26:397-9. 

11.Arafa, Nazel, Ibrahim, Attia. Predictors of psychological well-being of nurses in

Alexandria, Egypt. Nurse Practioner 2003; 5: 313-20.

12.  Virk, Kumar C. Occupational stress and work motivation in relation to age, job level

and type-A behavior in nursing professionals. J Indian Academy Applied Psychology,

2001; 27: 51-5.

13. Lavanco. Burnout syndrome and type A behavior in nurses and teachers in Sicily. J

Psychological Health 1997; 2: 523-8.

14.  Rout. Stress amongst district nurses: a preliminary investigation. J Clin Nursing.

2000; 2. 303-9

15. Parikh P, Taukari A, Bhattacharya T. Occupational Stress and Coping among Nurses.

Health Management,2004; 6: 115-27.

16.Malta. Stress at Work. A Concept in Stress. Human Factors Limited. Business

Psychology and Strategy Development 2004.

17. Col (Mrs) Karsh Prasad, occupational stress index, Nightingale Nursing Times 2007;

2: 36.

18. N. Mathar Mohindoen, stress management, 2009; 5: 36-40.

19. R. Sreevani, Allabout your stress, Nightingale Nursing Times,2006;1: 24-27.

20. Mr. Binu. U, Ms. Saniya Jose, Ms. Sherimol Joseph, Astudy perceived stress and

coping behavior among nursing students in selected colleges in Mangalore, Nightingale

Nursing Times,2007; 57-59.

21.V. Indra, Effective decision making and problem solving in nursing process

application, Nightingale Nursing Times, 2007; 58.

22. Mrs. Meena Kumari, Mrs. Shantham Sweet Rose, Dr.Mrs. Mary cherian, Perceived

stress and coping stratergies, Nightingale Nursing Times,2007; 12-17.

23. Anita Sardesai, An overview on disaster nursing, Nightingale Nursing Times, 2005;

48-51.

24. M. Latha, Study on factors influencing stress for patient and nurse, Nightingale

Nursing Times, 2006; 36-67.

25. Dr. Karobi Das, Your stress busters, Nightingale Nursing Times, 2006; 60-63.

26. Mr. R. Rajesh, A study to assess the psychological wellbeing among nurses working

in selected ICU at SRH, Parur,Chennai, Nightingale Nursing Times, 2008; 60-63.

27. G. Neelakshi, Stress management through self management, Nightingale Nursing

Times, 2006; 43-44.

28. Annalus of emergency medicine, 2007, 12;7: 426-428.

29.Kajiwara Mutsuko, Stressors and stress coping ways among nurses, Bulletin of

Yamanashi Medical University, 2002;19: 65-70.

30. Elliot, Timothy R, Shewchuk, Richard, Hagguland, Kristofer, et al, Occupational

burn out tolerance for stress, and coping among nurses in rehabilitation units,

Rehabilitation psychology, 1996; 41(4); 267-284.

9.Signature of candidate

10. Remarks of the guide

NOW A DAY’S STRESS HAS BECOME MORE

COMMON TO ALL THE NURSES WORKING IN

CASUALTY WHEN THEY ARE FACING THE

EMERGENCY SITUATION. HENCE THE

RESEARCH TOPIC SELECTED FOR THE

CANDIDATE IS SUITABLE.

11.Name and designation of guide Prof. Kalaiselvi S.

Head of the Department

Department of Mental Health Nursing

Diana college of nursing, Bangalore

Signature

HOD

Prof. Kalaiselvi S.

Head of the Department

Department of Mental Health Nursing

Diana college of nursing, Bangalore

Signature

12. Remarks of the Chairman & Principal

The topic selected for the candidate is researchable and feasible and forwarded for needful action.

Signature