Occupational stress in nursing is common worldwide, ranging from 9.2% to 68%. Caring for the weak, sick, and traumatized client can impose a stress on the nurse [1] . The nurses in different departments are exposed to a broad variety of stressors including unpredictable work conditions, experience exposure to traumatizing incidents such as aggression, amputation, and extreme suffering of clients and potential violence, including patients under the influence of drugs and alcohol, and crime suspects brought in by police [2] .

Occupational stress has become one of the most severe health problems in the contemporary world [3] . Job stress can cause health related problem such as hypertension, cardiac problems, reduce immunity, contribute to substance abuse and reduce the overall status of mental and physical wellbeing. In fact, stress becomes a natural part of daily life for caregivers such as nurses, doctors and hospital administrators [4] . Occupational stress in nursing is the physical and emotional reactions that occur when the nurse’s abilities and resources cannot deal with the demands and requests of their work [5] . The nursing profession in general is increasingly characterized by job stress [6] . According to American Journal of Industrial Medicine (2014), more than 70% of interviewed nurses indicated acute and chronic impacts of stress and exhaustion on their safety and health concerns. Several studies indicated that there are individual, social, environmental and organizational factors that lead to high levels of occupational stress among nurses [7] .

Habib and Shirazi pointed out that nursing is a stressful job and identified the stressors as workload, close interaction with patients, high emotional involvement and being responsible of patients’ life [7] . Also, there are issues related to physical hazards at workplace such as work injuries, uncertain job security and the fear of layoff [8] , meanwhile, taking into consideration that the most of nurses are females and they experience stress more frequently than males [8] . This could be explained by the fact that female nurses are emotionally sensitive group, and also, they have an additional social role as a wife, woman and mother. In addition to occupational demands, they should satisfy their family’s needs such as nutrition, economic deals, educational matters, socializing kids, and family relations. These multiple roles impose severe burden and roles interactions, personal relationships at work and home, personal resources and job’s natural complication, which can cause various hazards. In addition, occupational stress of nursing at hospitals is reported to be significantly higher than nurses in other working setting [9] . In psychiatric setting, there is challenging task for nurses because they have to care for both the mental and physical health of the patient and this leads to additional burden on these nurses [2] .

Stress causes mental health disorders for psychiatric nurses, some common stressors include poor working relationships between nurses and doctors and other health care professionals, demanding communication and relationships with patients and relatives, emergency cases, high work load, understaffing and lack of support or positive feedback from senior nursing staff [10] . Also, psychiatric nurses have an isolated occupation environment that includes locked ward entrances, as a result, the potential for patient conflict with the associated risk of both physical and mental danger or violence perpetrated by aggressive patients is potentially present. In addition, psychiatric nurses are required to seclude or restrain patients to prevent them from harming themselves or others. Moreover, psychiatric nurses are dealing with high potential drugs and medication which consider a stressor for psychiatric nurses more than other nursing specialties. Therefore, the structures of occupational stressors experienced by psychiatric nurses potentially differ from those of other employees [11] .

Zeller and Levin [1] reported that occupational stress is a major challenge worldwide. Work stress affects individual mental and physical health as well as organizational health in diverse ways. These include the fact that stressed workers are more likely to be unhealthy, poorly motivated, less productive and less safe at work. Also, high level of occupational stress reduces the quality of nursing care [12] , and can threaten patients’ lives and security [7] .

There are several traditional means of managing everyday stress. This evolves physical exercise, emotional and psychological therapies, change in work approach or medications. The choice of management procedure adopted is usually subjective to the source, nature of the stress and the resources available to the individual under stress (Cohen et al., 2002). It is believed that the best management practice of stress is to learn how to cope with it using healthy and positive coping strategies. The first step of effective stress management is to understand one-self better and understand stress triggers and how one can react to stressful situations. In the nursing field, the ability to render high quality health and nursing services to the patients in spite of occupational stress is considered as an effective coping [13] . Most literatures that worked on stress and coping tried to link the coping strategies to the type and sources of the stressor. Lockley, Barger [14] established a safe hour work limit for nurses in order to prevent the high rate of fatigue related medical errors and injuries. Therefore, there is a need to limit the number of working hours done by nurses to help them to manage the stress arising from long working hours. The shifts and the duration of shifts can be controlled by a combined effort of the nurse managers and the nurses working in the hospitals. Fielden and Peckar [15] agreed that stress is associated to the number of working hours nurses do in the hospital.

Availability of social support also helped in reducing the negative effect of the stress on their performance. Consequently, social support was identified as an effective coping strategy. Sharma, Sharp [16] stated that nurses are believed to have lower level of burnout than surgeons and they agreed that this is as a result of better working practice, the type of responsibilities and the management structure. By this, a better-organized management structure and organized individual working practice are seen as effective way of managing or coping with working stress. Therefore, social support and working group are considered effective coping strategies for stress [17] . Other preventive strategies include effective communication strategies during end of life care, prevention of management conflicts [17] .

Quality of life (QOL) is one of the most important aspects of human health, which is embedded in physical, cultural, and social contexts. Various studies have indicated that favorable QOL depends on working conditions and family life [17] . Therefore, working life is one of the factors affecting QOL. On the other hand, hospitals as an organization may put the clients and specially nurses under a serious load of stress, which subsequently affects their physical and emotional health. Occupational stress has a large negative effect on QOL and may lead to reduced work performance, early retirement, dissatisfaction and physical damage [18] . Health related problems from stress such as migraine, hypertension, and irritable bowel syndrome can plague a nurse both at work and on their off-duty time and may require regular intake of medications, and restriction of social activities affecting nurses’ QOL. Psychological problems such as chronic fatigue syndrome, secondary traumatic stress, and nursing burnout may also occur due to stress. It is logical to theorize that a nurse’s quality of life is affected by these health conditions. Clearly, nurses play an effective role in improving patients’ QOL, to do so; initially they themselves should have a high QOL. Nayomi [19] reported that the physical, social, and psychological QOL of nurses is lower than factory workers. The main goal of the study was to compare the level of occupational stress, ways of coping and the quality of life among nurses who work in general and psychiatric hospital in Jeddah city, KSA.This study was conducted in Jeddah city, the second biggest city in Kingdom of Saudi Arabia. The study included three main hospitals in Jeddah, two of them were governmental hospitals and one was a private hospital. The first hospital was King Abdul Aziz hospital which is a general hospital occupied with 445 beds with total of 850 nurses. The second hospital was Mental Health hospital which is a psychiatric hospital has 120 beds with total of 183 nurses. In addition, Dr. Suleiman Fakeeh hospital is a private hospital with 530 beds and it has 920 nurses. The sample of general hospital was obtained from seven workplaces: intensive care unit (ICU), emergency unit (ER), surgical unit, medical unit, operation room (OR), outpatient unit, and nursing offices whilst the sample of psychiatric hospital was obtained from three workplaces: inpatient unit, the outpatient unit, and nursing offices.

Nursing is a stressful profession that deals with intense human aspects of health and illness. General and psychiatric nurses experience different levels of occupational stress. In this study, compared to the nurses working in the general setting, those working in the psychiatric setting had a higher statically level of occupational stress (p = 0.001). There are several possible reasons that could explain psychiatric nurses had higher level of stress than general nurses. The main reason is that psychiatric nurses in this study worked in restricted environments, such as closed wards with isolation rooms that mainly serve acute and potentially violent patients [21] . Moreover, a considerable proportion of these patients displayed aggressive behavior previously and were compulsively admitted. Therefore, they were exposed to psychological and physical stress and aggression at work more frequently than nurses in general care setting [21] . In addition, there is a strong need for continuous education and training about workplace violence; particularly how to support each other and being sensitive to subtle signs that can indicate proneness to aggressive behavior [22] . However, this type

SD: Standard Deviation.

of training is not universally implemented or inadequate in psychiatric hospitals. For example, a survey of 300 randomly selected nurses from five psychiatric hospitals in China found that 75.6% were not satisfied with the lack of continuing training on violence [22] .

The finding is supported by a study conducted by Qi, Xiang [23] who compared the level of work-related stress between female nurses working in psychiatric and general hospitals in China. It was found that compared to the nurses working in the general hospital, those working in the psychiatric setting had a higher level of stress. Another study designed by Jenkins and Elliott (2004) stated that psychiatry nursing has similarities to other nursing specialties, however, its difference is that psychiatric nurses have more deep relationships with their patients, engage in preventing self-harm and often face higher levels of challenging behaviors in the environment (Jenkins and Elliott, 2004). In contrast to the above finding, Jenkins and Elliott [24] conducted a study to investigate occupational stress levels among general and psychiatric nurses and found that general nurses reported stress levels that were significantly higher than those of psychiatric nurses and that they would be more likely to use workplace counseling services. Another study designed by Hussein, Aniza [25] concluded that psychiatric nurses are protected from stress through social support from the multi-disciplinary team [25] .

Furthermore, Al Hosis et al. (2013) highlighted that the impact of occupational stress on the well-being of Saudi nurses working in the ministry of health hospitals (MOH) in AL-Qassim region in KSA found that nurses’ occupational stress was not affected by their educational level. Also, a significant relationship was found between work setting and communication subscale. This goes in coincidence with the research conducted by Flannery et al. (2007), Hanrahan et al. (2010) these studies explained that psychiatric nurses constantly manage patients and families from all levels of people and is essential to deal with manifold communications. Both hurts from work and verbal attacks from patients will increase psychiatric nurses’ occupational burnout. Yada et al. (2015) investigated the specificity and structures of occupational stress in psychiatric dementia nurses (PDNs) caring for elderly patients with serious behavioral and psychological symptoms of dementia occupational stress in PDNs revealed physical workload and work environment to be more significant stressors.

The study showed that occupational stress is a global phenomenon and it affects the nurses in all the countries in which researches had been conducted on occupational stress. The results noted that there was variety in occupational stress level between nurses working in the general setting and nurses working in the psychiatric setting.

The authors declare no conflicts of interest regarding the publication of this paper.

Alharbi, S. and Hasan, A.A. (2019) Occupational Stress, Coping Strategies, and Quality of Life among Nurses in General and Psychiatric Setting in Jeddah City―KSA. Open Journal of Psychiatry, 9, 124-137. https://doi.org/10.4236/ojpsych.2019.92010