International Journal of Academic Research in Business and Social Sciences

May 2016, Vol. 6, No. 5

ISSN: 2222-6990

Job Stress and Coping Mechanisms among Nursing Staff

in a Malaysian Private Hospital
Haslinda, A.
Faculty of Defence Studies and Management, National Defence University of Malaysia
[email protected]

Catherine Lim Tsuey Tyng

Graduate Business School, Open University Malaysia
[email protected]

DOI: 10.6007/IJARBSS/v6-i5/2164 URL: http://dx.doi.org/10.6007/IJARBSS/v6-i5/2164

Abstract
It is a common belief that nurses are exposed to many stressful demands and pressures. This
situation can lead to heightened risk of an array of health, safety and other problems. The main
purpose of this study is to examine the relationship between nurses’ jobs, the work
environment, characteristics of individual nurses and management support and coping
mechanisms to reduce job stress among nurses. This study uses a quantitative approach in
which questionnaires are distributed to nurses to collect data. International and local
perspectives on job stress and coping mechanisms among nursing staff are reviewed. Both the
current international and local literatures are reviewed using the key themes of nursing stress
and coping mechanisms. It is found that the major contributor to job stress among nurses is the
job itself. Heavy workload, repetitive work, and poor working environment were among the
stressors identified. It is hoped that the results of the study will clarify the relationship between
the job itself, the work environment, individual differences and management support with
coping mechanisms to reduce job stress among nursing staff in Malaysian private hospitals and
indicate what intervention is needed to reduce stress among nursing staff. It is also hoped that
the research findings will highlight the necessity for all stakeholders concerned to take
proactive measures to alleviate job stress among nursing staff.

Keywords: Nursing Stress, Coping Mechanism, Management Support, Work and

Environment.

Introduction
Job stress is the harmful physical and emotional responses that occur when the
requirements of the job do not match the capabilities, resources, or needs of the worker (UML
2014). Job stress matters to our health and our work. When we feel stressed, our bodies
respond by raising the concentration of stress hormones in our blood. When our bodies
continually respond to constant demands or threats, coping mechanisms stay in overdrive,

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which can be damaging to health over time (UML 2014). Research shows that excessive job
stress can lead to many long-term health problems, including cardiovascular disease, diabetes,
weakened immune function, high blood pressure, musculoskeletal disorders, substance abuse,
depression and anxiety. Stressful working conditions can also impact health indirectly by
limiting our ability or motivation to participate in other health-promoting behaviors such as
eating well and exercising (Emilia and Hassim, 2007).
Job stress has on numerous occasions been cited as a cause of suicide, whereby workers
take their own lives as a result of work pressure (Deccan Herald, 2011; Vause, 2010). Nurses in
hospitals are exposed to high levels of occupational stress resulting from heavy workloads,
extended working hours and severe time pressure. They are at a higher risk of suffering from
depressive disorders than is the general population (Tsai and Liu, 2012). Nursing, by its nature,
is a stressful profession (Malun, 2011). Nurses work in high-stress environments, since their
main responsibility focuses upon providing help to patients who are usually encountering life
crises. Given the high demand for effectiveness and efficiency in the delivery of private health
services, nursing staff have great responsibility to ensure that patients’ demands are satisfied.
Nursing focuses on activities that relate to diagnosis and treatment of human responses to
health and illness phenomena. However, inherent in this caring occupation are numerous
sources of built-in stress that become occupation hazards for nurses (Robert et al., 2012). There
are many components to this experience of stress, such as staff shortages, high levels of
responsibility, dealing with death and dying, dealing with patients’ relatives, coping with
unpredictable situations, making critical judgments about intervention and treatment and
balancing work and family commitments. For example, married nurses with children have to
address responsibilities as wife, mother and homemaker

Indeed, nursing has long been considered one of the most stressful professions. Stress
in nursing is attributed largely to physical labor, the suffering and emotional demands of
patients and families, work hours, shiftwork, interpersonal relationships and other pressures
that are central to the work nurses do, such as the use of sophisticated healthcare equipment,
increased workload and constant changes in the healthcare environment (Roberts et al. 2012).
It has been found that nurses suffer from higher levels of work-related stress than other
healthcare workers and that these stress levels pose health risks to nurses and weaken the
quality of care given to patients (Emilia and Hassim, 2007; Little John, 2012).
Occupational safety and health researchers and practitioners agree that nurses are
heavily exposed to myriad psychosocial stressors in their daily work. The term ‘psychosocial
stressor’ refers to stressful working conditions and job characteristics. Nurses seem to be
overexposed to a range of psychosocial stressors, which include lack of control, long work
hours, shiftwork, interpersonal conflicts, insufficient resources, poor reward systems and
inadequate structure of communication flow in hospitals and other healthcare settings (Kemper
et al., 2011; Roberts et al., 2012).
In Malaysia, nursing requires a great deal of collaboration with people of different
professions, social backgrounds and cultures, as well as the ability to take on various roles
during a single working day. These might include participation in teams, attendance during
rounds and meetings, field trips, palliative work and providing counselling to patients and their
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families and social services (Loo and Leap, 2012). These stressful situations obviously cause
problems for nurses in their daily work. Stress that is not well managed brings negative
consequences not only for employees, but also for patients and for the organization (Wang et
al., 2011).
Uncontrolled stress can cause emotional and physical illness such as coronary heart
disease, cancer, lung problems, diabetes, accidents and even suicide (Al Hosis et al., 2013). It is
not possible to completely eliminate stress from our daily lives, but appropriate ways of coping
with stress can be practiced in order to reduce stress. This requires a holistic approach.
Although research has been conducted on job stress and coping mechanisms among nurses in
public health services, job stress and coping among nurses in Malaysian private hospitals is yet
to be investigated. The above issues have stimulated the researcher to undertake a case study
on job stress and coping mechanisms among nurses in Malaysian private hospitals.

The main objective of this research is to examine the job itself, the work environment,
individuals and management support and coping mechanisms to reduce job stress among
nurses in a selected private hospital.

Stress Coping Theories

Examination of the literature reveals several theories that are pertinent to stress. These include
transaction-based theory and complexity science theory. The conceptual outlook and
preliminary findings through secondary data analysis and a literature review on stress and
coping are informed by the transaction-based theory of stress and complexity science, concepts
from which are used as guidance in the design of this study.
The transaction-based theoretical view of stress proposes that stress does not exist as
an event, but rather as a result of the transaction between persons and their environment
(Lazarus and Folkman, 1987). Within this context, stress encompasses cognitive, affective, and
coping variables. A major theme of the transactional approach is the importance placed upon
the role of appraisal. The theory suggests that appraisal is the primary mediator of person-
environment transactions. Three types of appraisal exist within this framework, which
determine emotions and coping behavior: primary appraisal, secondary appraisal and
reappraisal (Lazarus and Folkman 1984). Primary appraisal is a cognitive process that relates to
an individual’s judgment about an encounter. The individual may determine an encounter to
involve a threat that is then appraised as stress. Secondary appraisal involves the process of
continually evaluating coping options to deal with primary appraisal. Reappraisal involves the
process of continued evaluating primary and secondary appraisals (Shirey, 2009). The
transaction-based theoretical view of stress identifies two forms of coping: problem-focused
and emotion-focused (Lazarus and Folkman, 1984). Problem-focused strategies are adaptive
strategies that involve managing or altering the problem with the environment or the person.
Emotion-focused strategies involve regulating the emotional response to the problem.
Individuals may use both types of strategies to deal with stressors. Emotion-focused (denial and
avoidance) forms of coping, however, can impair health by impeding adaptive health- and
illness-related behavior (Lazarus and Folkman, 1984). When primarily using emotion-focused
strategies, individuals may initially succeed in lowering emotional distress, but in the process,
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they fail to address a problem that may be responsive to suitable action (Lazarus and Folkman,
1984).
Complexity science encompasses multiple theoretical perspectives to study complex
adaptive systems (Zimmerman et al., 2001). Complex adaptive systems (CAS) are represented
as embedded parts that are interconnected and function within a larger ecosystem. For
example, individuals (nurses and nurse managers) are part of a larger system (health care
organization) that interacts with multiple other agents (physicians and patients) as part of a
whole (community). Complexity science allows researchers to explore the interconnectedness
of component parts within a framework of constant non-linear change, unpredictability,
adaptability and sustainability. Viewing the world within a complexity lens allows researchers to
understand the biological and flexible components of a CAS to better address specific
component parts and more positively impact the whole. Complexity within this study is
conceptualized as an antecedent or situation factor. Complexity in the health care work
environment is characterized by ambiguity, gaps/discontinuity, overload and uncertainty, which
may be perceived as demands. Understanding complexity within the health care work
environment is key, as the complexity in which health care workers make judgments and
decisions about their roles in patient care has an effect on outcomes (Shirey, 2009).

Coping Mechanisms to Reduce Job Stress

Generally, research into coping has focused on internal and external resources for coping with
stress, which deal with work and general life stresses (Roberts et al., 2012). Coping has been
defined as the process of struggling or dealing with responsibilities, problems, or difficulties.
Coping is also viewed as a dynamic process and response to a situation characterized by
uncertainty and important consequences (Latack and Havlovic, 1992). In these general
definitions, coping can be best illustrated as managing taxing circumstances, expending efforts
to solve life’s problems and seeking to master or reduce stress. The researcher views coping
with stress at the hospital as a process of handling, managing and/or contending with
difficulties or situations with the intention to reduce their impact or overcome them. Generally,
there are three actions to achieve effective coping, Firstly, one has to attempt to anticipate
potential stressors before encountering them and prepare appropriate plans of attack for the
various outcomes. Then one has to reduce the physical arousal caused by stressors. It is vital
that the individual has the capability to separate facts from emotion in order to reduce the
impact of stressors. Prior research has suggested that while using a variety of coping
mechanism when contending with workplace stressors (Lambert et al., 2004), people may tend
to select specific mechanisms. For example, Lambert et al. (2004) found that hospital nurses
from Japan tended to use self-control as a coping mechanism; nurses from South Korea
preferred positive reappraisal, while nurses from the USA favored the use of problem solving.
According to O’Brien and DeLongis (1996), in general, nurses tend to use problem-focused
coping mechanisms (problem solving, planning, positive reappraisal) when dealing with work-
related problems and emotion-focused coping mechanisms (distancing, denial, escape
avoidance) when contending with family- or health-related issues.

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The Effect of the Job Itself, the Work Environment, Individual Differences and Management
Support On Stress
A variety of studies have shown that quantitative work overloads are potent sources of nurses’
stress in hospitals, in which nurses are asked to do more work than they can complete in a
specific period of time (Yau et al., 2012; Saha et al., 2010; Saleh et al, 2013; Kravits et al., 2010;
Emilia and Hassim, 2007). According to the Borneo Post (2011), this might be due to shortage of
nurses. Work that is repetitive or too specialized, poorly defined job scope, being tasked to take
responsibility for others and working on rotating shifts are among the conditions related to the
job itself and have an impact on nurses. Another source of job stress is associated with nurses’
role/undefined job scope at the hospital (Rickard et al., 2012; Roland, 2014; Nuruddin, 2000). A
great deal of research in this area has concentrated on role ambiguity and role conflict as job
stressors (Orly et al., 2012; Al Hosis, 2013; Wang et al., 2011; Lan et al, 2014). Role ambiguity
refers to an employee who is uncertain about how to perform on the job or what is expected in
the job, or to unclear relationships between job performance and expected consequences
(Yang et al., 2014).

Stress has also been related to the physical work environment in several studies. Poor
working conditions such as crowded work areas, noise, heat, strong odors and dangerous
conditions are considered potential sources of stress at the hospital (Moustaka and
Constantinidis, 2010; Cavalheiro et al., 2008). Motowidlo et al. (1986) conducted two studies
on occupational stress and its relations with antecedent variables and job performance among
nurses in four hospitals. The findings of the study indicated that work overload, uncooperative
patients, criticism, negligent co-workers, being frequently relocated at work, lack of trust in the
workplace, lack of participation in decision making and inadequate staff skills caused stress to
hospital nurses. As a result, nurses performed their jobs less effectively. Similar finding were
reported in studies conducted by Currid (2008) and Lau and Imilia (2011). Nurses’ jobs involved
working in shifts. A person who works in shifts frequently experiences physical distress or
mental distress, or both (Ulas et al., 2012; Lo et al., 2010; Admi et al: Circadian Age, 2009; Da
Rocha and De Martino, 2010).

Individual factors such as lack of self-confidence, finding it difficult to work with

colleagues, feelings of job insecurity, lack of skills and inability to control emotions might led to
nurses’ stress. Lack of adequate skills in the workplace has been identified in prior studies as a
source of stress (Al-Hussein 2009). Happell et al. (2013) conducted a study on nurses to
investigate the effects of lack of skill and inability to control emotions. They concluded that
lack of skill leads to lack of confidence, which can lead to stress. However, their study was
limited to six focus group and the findings cannot be generalized.

The lack of supportive relationships or poor relationships with peers, colleagues and
superiors are also potential sources of stress, leading to low trust and low interest in problem
solving (Kane, 2009; Jones, 2013: Khamisa et al., 2013). Relationships at hospital can be
classified into relationships with superiors, colleagues, subordinates, patients and others that

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directly or indirectly impact the nurses at the hospital. The most common factor causing job
stress among nurses were relationship issues, i.e. lack of support from superiors, poor
relationships with superiors and poor relationship with colleagues and subordinates, as well as
issues involving career development, i.e. lack of promotion, lack of job security and job
requirements that exceed one’s skill and abilities). It was suggested that there is a need for
hospital management to explore ways to improve the working relationship in the hospital
(Lexshimi et al., 2007).

Methods

For the purpose of this study, a descriptive and cross-sectional or correlational research design
will be used to describe demographic profiles, while a cross-sectional or correlational design
will be used to understand to relationship between variables. A descriptive research design will
be used because it is undertaken in order to ascertain and be able to describe the
characteristics of the variables of interest in a situation. Descriptive research is preplanned and
structured in design so the information collected can be statistically inferred on a population
(Dahlan, 2009). Further, the data that is collected is from the answers given by the respondents
through the questionnaire. This research is a quantitative study using a cross-sectional research
design which looks at the relationship between the job itself, the work environment, the
individual, management support and coping mechanisms to reduce job stress among nurses in
a Malaysian Private Hospital in the Klang Valley. Cross-sectional designs, also known as
correlational research designs, have no control groups and there is no randomization (Creswell
2008).
In any research, the sampling selection from the population being studied is crucial for
the credibility of the study and its results. Therefore, the correct choice of samples should be
made and a sample should be chosen in an appropriate way so that we can obtain later
conclusions for the whole population being studied. Parahoo (2006, p.258) defines a population
as “the total number of units from which data can be potentially be collected”. A population
element is the individual participant or object from which measurement is taken. The target
population is the complete group of objects or elements relevant to the research project. They
are relevant because they possess the required information that the research project is
designed to collect (Zikmund, Babin, Carr, & Griffin, 2013). The population in this study
comprises staff nurses working in private hospital wards. The hospital has a total number of 301
trained nurses. Because of time and cost constraints, it was also necessary to confine the survey
to one private hospital in Klang Valley Malaysia. This made it possible for the researcher to have
relatively easy access to the participants.
Data for this study was collected using a questionnaire survey distributed to staff nurses
at a private hospital in Klang Valley. A pilot study was conducted before the main study.
According to Baker (2002), a pilot study is a mini-version of a full scale study or a trial run
conducted in preparation for the complete study, and can also involve specific pre-testing of
research instruments, including questionnaires. The main purpose of the pilot study is to test

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the validly and reliability of the instrument. A pilot study enables the researcher to take
appropriate action to correct any defect or error detected prior to the main study.
Researchers use the term ‘instrument’ to refer to a measurement device such as a
survey, test or questionnaire. For this study, structured self–administered questionnaires were
used as the research instrument. They consisted of a set of questionnaires distributed to the
respondents for feedback. Measurement can be defined as ‘the assigning of numbers or other
symbols to characteristics of objects according to certain pre-specified rules” (Malhotra, 1999,
p.248). Measurement of the variables is an integral part of research and an important aspect of
research design. It should be possible to measure the variables that have been chosen in order
to test the hypothesis and to find answers to complex questions. The questionnaires distributed
consist of six sections. The first section requested the respondents’ personal information. The
main objective of the questions constructed was to collect information about the respondents’
demographic characteristics from the aspect of gender, status, race, age and years of working
experience in the nursing field. The second section was on descriptive analysis of coping
mechanisms to reduce job stress, while the third section was designed to enable descriptive
analysis of the job itself, followed by descriptive analysis of the work environment and of
individuals, and the last section was on descriptive analysis of management support.
It was necessary to adopt an appropriate rating scale to measure attitude responses.
While there are several rating scales, only three of them were considered by the researcher for
this study. The first was the simple attitude scale, which requires respondents to either state
their agreement or disagreement to a question. The scale was not adopted, as it did not cater
for fine distinctions in the attitudes of the respondents. The second option involved category
scales, which provide for several response categories. However, the effective use of these
scales is dependent on the wording of each question. Consequently, each statement would
require the use of a different descriptive dimension (Cavana, Delahaye & Sekaran, 2000, cited in
Dhalan, 2009). For this reason, this scale was not considered appropriate. The third option is
the Likert scale, which is a summated weighting method. It enables respondents to indicate
their degree of agreement or disagreement on a five-point scale with scores being assigned to
alternative responses. The five points are: ‘strongly disagree’, ‘disagree’, ‘uncertain’, ‘agree’,
and ‘strongly agree’. Given the composition of the survey sample, the Likert scale was
considered best suited for this research, as it enabled some of the respondents to adopt an
uncertain position on issues that they considered to be sensitive.
Ethics in research refers to a code of conduct or expected societal norm of behavior
while conducting research (Sekaran & Bougie, 2010). The goal of ethics in research is to ensure
that no one is harmed or suffers adverse consequences from research activities (Copper and
Schindler, 2001). According to Polit and Beck (2006), researchers must deal with ethical issues
when their intended research involves human beings. Ethical approval was requested in writing
from the Director of Nursing and the Hospitals Ethic Committee of the hospital involved in the
research. The ethics committee was informed of the value of the research and the main ethical
principles that would be considered in conducting this research study are respect for person,
confidentiality and beneficence/non-maleficence.

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Correlation is a technique for investigating the relationship between two quantitative,

continuous variables. Pearson Correlation was used to determine whether there was a
significant relationship between variables and to ensure that the research objectives were met.
Bougie and Sekaran (2009) explain that a perfect positive correlation between two variables is
represented by a correlation coefficient of 1.0 (plus 1), while a perfect negative correlation
would be represented by a correlation coefficient of -1.0 (minus 1). In this study, correlation
analyzed the relationship between the job itself, the work environment, the individual and
management support with coping mechanisms to reduce job stress. Multiple Linear Regression
is a method used to model the linear relationship between a dependent variable and one or
more independent variables. To determine which variables help to explain the variation of
coping mechanism to reduce job stress in the Klang Valley Private Hospital, Multiple Regression
analysis was used to determine the extent to which each independent variable (the job itself,
the work environment, the individual and management support) describes the dependent
variables (coping mechanisms to reduce job stress) among nurses in this private hospital in
Klang Valley and to ensure that the research objective was met.

Findings
Relationship Between Coping Mechanisms To Reduce Job Stress And The Job Itself
Table 1, below, shows the result for correlations between coping mechanisms to reduce job
stress and the job itself. The results illustrate that the Pearson Correlation Coefficient between
these two variables is moderate and significant, where r = 0.378 and p = 0.0001. The Pearson
Correlation coefficient (r = 0.378) shows that there is a moderate linear relationship between
those two variables. This finding also shows that there is a significant relationship between
coping mechanisms to reduce job stress and the job itself, as p<0.0001. The rule of the thumb is
that if the p value is greater than 0.05, this indicates that there is no significant relationship.
However, if the p value is less than 0.05, then there is a significant relationship. In this case, the
p value is smaller than the alpha value which has been set (p=0.05).

Table 1: Pearson Correlation of Respondents’ Coping Mechanism to Reduce Job Stress on Job
Itself
Job Itself

Coping Mechanism To Pearson

.378**
Reduce Job Stress Correlation

Sig. (2-tailed) .000

N 182

**. Correlation is significant at the 0.01 level (2- tailed).

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Relationship Between Coping Mechanisms To Reduce Job Stress And Work Environment
Correlation was used to analyse whether there is a significant relationship between coping
mechanisms to reduce job stress and the work environment. As explained above, if the p value
is greater than 0.05, this indicates that there is no significant relationship. However, if the p
value is less than 0.05, then there is a significant relationship. Table 2, below, shows the
correlations between coping mechanisms to reduce job stress and the work environment. The
results illustrate that the Pearson Correlation coefficient for these two variables is positive and
significant where r = 0.511 and p = 0.001. The Pearson Correlation coefficient (r = 0.511) shows
that there is a moderate linear relationship between those two variables. This relationship is
significant, as its p value is 0.0001. This is smaller than the alpha value which has been set
(p=0.05).

Table 2: Pearson Correlation of Respondents’ Coping Mechanism to Reduce Job Stress on

Work Environment
Work

Environment

Coping Mechanism To Pearson Correlation .511**

Reduce Job Stress
Sig. (2-tailed) .000

N 182

**. Correlation is significant at the 0.01 level (2- tailed).

Relationship Between Coping Mechanism To Reduce Job Stress

Correlation was used to analyse whether there is a significant relationship between coping
mechanisms to reduce job stress and individual. Table 3 shows the results for correlations
between coping mechanism to reduce job stress and individual. The Pearson Correlation
coefficient for these two variables is positive and significant, where r = 0.512 and p = 0.001.
The Pearson Correlation coefficient (r = 0.512) shows that there is a moderate linear
relationship between those two variables. This relationship is significant, as the p value of
0.0001 is smaller than the alpha value set (p=0.05).

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Table 3: Pearson Correlation of Respondents’ Coping Mechanism to Reduce Job Stress on

Individual
Individual

Coping Mechanism Pearson

.512**
To Reduce Job Correlation
Stress
Sig. (2-tailed) .000

N 182

**. Correlation is significant at the 0.01 level (2- tailed).

Relationship Between Coping Mechanisms To Reduce Job Stress And Management Support
Correlation was used to analyse whether there is a significant relationship between coping
mechanisms to reduce job stress and management support. Table 4 shows the correlations
between coping mechanisms to reduce job stress and management support. The Pearson
Correlation coefficient for these two variables is weak and significant, where r = 0.233 and p =
0.002. The Pearson Correlation coefficient (r = 0.233) show that there is a weak linear
relationship between those two variables. This relationship is significant, as the p value is
0.002, which is smaller than the alpha value set (p=0.05).

Table 4: Pearson Correlation of Respondents’ Coping Mechanism to Reduce Job Stress on

Management Support
Management Support

Coping Mechanism Pearson

.233**
To Reduce Job Stress Correlation

Sig. (2-tailed) .002

N 182

**. Correlation is significant at the 0.01 level (2- tailed).

The Most Significant Factors Influencing Job Stress

To determine which variables can help to explain the variation in coping mechanisms to reduce
job stress in the Malaysian Private Hospital in Klang Valley, four independent variables were
proposed for a multiple linear regression model. These variables are the work itself, the work
environment, the individual and management support. To determine the best set of predictor
variables to predict the most significant factor influencing job stress, the enter regression
method was used. Based on the enter method used, four predictor variables were found to be
of significance in explaining coping mechanisms to reduce job stress. The four variables were
the Job Itself, the Work Environment, the Individual, and Management Support. These variables
contributed in significance [Job itself (t = 3.705, p = 0.0001), work environment (t = 4.208, p =
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0.0001), individual (t = 3.569, p = 0.0001) and management support (t = 1.076, p = 0.283)] to

the variation of the dependent variable (Coping Mechanism to Reduce Job Stress). The R-
squared value of 0.389 implies that the four predictor variables explain about 38.9 percent of
the variation in the coping mechanism to reduce job stress. This is quite a respectable result.
The ANOVA tables revealed that the F-statistic (F-28.147) is moderate and the corresponding p-
value is highly significant (0.0001), being lower than the alpha value of 0.05. This indicates that
the slope of the estimated linear regression model lines is not equal to zero, confirming that
there is a linear relationship between coping mechanisms to reduce job stress and the four
predictor variables. The coefficient with the largest Beta value, 0.301, is the work environment.
This means that this variable makes a greater contribution to explain the dependant variable
(coping mechanism to reduce job stress), where the variance explained all other predictor
variables in controlled model. The second largest Beta value of 0.260 is for the individual, while
the third is 0.229, which is for the job itself. The beta for management support is the smallest
(0.066), indicating that this variable has made the smallest contribution to coping mechanisms
to reduce job stress.

Table 5: Regression Analysis of Job Itself, Work Environment, Individual, Management

Support and Coping Mechanism to Reduce Job Stress
Unstandardized Standardized
Coefficients Coefficients

Model B Std Error Beta Std Error P

(Constant) 1.388 .226 6.136 .000

Job Itself .190 .051 .229 3.705 .000

Work Environment .209 .050 .301 4.208 .000

Individual .190 .053 .260 3.569 .000

Management
.034 .031 .066 1.076 .283
Support

*Notes: R = .624a; R2 = .0.389; Adj. R2 = .0.375

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Conclusion
Nursing is a profession that faces high demands in terms of quality services for human beings.
Nurses need to care for themselves before they can provide care for their clients. Recognizing
the impacts of job-related stress and making use of effective coping methods play a vital role in
reducing stress. This study contributes to three different aspects. It adds to the existing
literature on job stress and coping mechanisms among nurses. Therefore, it expands the
knowledge that is available in relation to nurses’ job stress and coping mechanisms. Other
researchers or anyone interested to know about job stress and coping mechanism among
nurses can use this research to gain more knowledge. Another aspect of the study’s
contribution is regarding the policy of the organization, which is a Malaysian Private Hospital in
Klang Valley. After obtaining the results of the study, policy changes can be made with this
study as a reference and guideline. Before this study, research on job stress and coping
mechanisms among nurses in Malaysia was focused primarily on public hospitals. This study can
help to some extent in developing effective coping system to alleviate job stress among nurses.
This study has identified the most significant factor influencing job stress encountered
among nurses. It has also identified the preferred coping mechanism among nurses to reduce
job stress in the working environment in local private health services. This will enable the
management and nursing unit of the Malaysian Private Hospital in Klang Valley, and nurses
themselves, to take steps to alleviate or minimize the issue of job stress in private health
services in Malaysia. The work environment was identified as the most significant factor
influencing job stress encountered among nurses. This information gathered can be used in
developing effective coping systems and strengthening the Employee Assistance Programs in
the workplace to combat job stress. Further, the management can work with individuals, teams
or groups to educate and train nurses to cope effectively with job stress. The management are
also able to apply strategies or interventions to deal with job stress among nurses to protect
them from becoming victims of exposure to stress. For example, conducting a stress audit
enables the management to identify both target and strategy for stress management actions.
Nurses need to be provided with continued management support, appropriate training
programs to deal with potentially stressful conditions in the health facility, and a work
environment that fosters open communication with the top management and allows them to
make contributions to workplace decisions which affect them.
To this end, the management and the nursing unit can implement an open-door policy
whereby nurses can share their problems and propose suggestions to the management and
superiors. Employees’ participation and involvement in the decision-making process will help to
reduce any threat or fear associated with potentially sensitive stress issues in the workplace.
Lastly, the Ministry of Health in Malaysia should carry out an assessment of the relationship
between the current recruitment, training and development of nurses, promotion, the grading
system, general employment policies and practices of nursing staff, equal opportunities,
organizational culture issues, and attitudes and behavior of nurses and job stress in private
health services in Malaysia, because attention has previously been centered on public health
services.

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Although this study provides useful information on job stress and coping mechanisms,
and their relationships with the job itself, the work environment, individual and management
support in a Malaysian Private Hospital in Klang Valley, there are also limitations embedded in
the research methodology. This study used a quantitative method. The questionnaires used
might not have been able to provide in-depth data with respect to respondents’ personal
beliefs and attitudes. For the future research, qualitative research methods are recommended.
The answers obtained through the use of qualitative methods such as interviews could be used
to support or compliment quantitative methods. Secondly, this research is specific to one
Malaysian private hospital in Klang Valley. This is due to time constraints and the limited budget
for the research. The study was completed in a relatively short time, and this could affect the
outcome, which might not be comprehensive and accurate. Therefore, the researcher
recommends that future work should focus on large representative sampling. Moreover, the
sample in this study included mainly female nurses: thus, future sampling should make greater
efforts to include a larger sub-sample of male nurses, as the coping mechanisms to manage
work-related stress may vary depending on gender. Moreover, it is also suggested that future
studies should cover other parts of the private health services so that generalization on the
issue of job stress and coping mechanisms among nurses in local private health services in
Malaysia can be made with more confidence. It may also be beneficial to conduct research on
nurses in public health services so that similarities and differences between public and private
health services can be assessed. The correlations between demographic factors, causes and
effects of job stress, and coping mechanisms need to be explored in order to determine how
different individuals perceive stress and how they cope with it in the workplace. Another area
that could be of interest is to focus on how individual personality traits influence the ability to
cope with job stress.

REFERENCES
Admi, H., Tzischinsky, O., Epstein, R., Herer, P., and Lavie, P., (2008). Shift Work in Nursing: Is it
Really a Risk Factor for Nurses' Health and Patients' Safety? Nursing Econ. 26 (4), pp: 250-
257.
Al Hosis1, K.F., Mersal F. A. and Keshk, L.I., (2013). Effects of Job Stress on Health of Saudi Nurses
Working in Ministry of Health Hospitals in Qassim Region in KSA. Life Science Journal, 10
(1), pp: 1036- 1044.
Al-Hussein, R. Y., (2009). Point Prevalence of Depression, Anxiety and Stress among Nurses and
Para-Medical Staff in Teaching Hospitals in Mosul.
http://recil.grupolusofona.pt/bitstream/handle/10437/4996/ANACAROLINACOELHOLEITE
PACHECO1.pdf?sequence=1 (Accessed 18 May 2016)
Borneo Post, (2011). Staff Shortage Makes Nursing Jobs Harder.
http://www.theborneopost.com/2011/12/01/staff-shortage-makes-nursing-jobs-harder/.
(Accessed 18 May 2016.)
Bougie, R. and Sekaran, U. (2009). Research Method for Business (5th Ed). West Sussex, United
Kingdom: John Willey & Sons.

483
www.hrmars.com
 International Journal of Academic Research in Business and Social Sciences
May 2016, Vol. 6, No. 5
ISSN: 2222-6990

Cavalheiro, A. M., Moura Junior, D.F., and Lopes, A. C. (2008). Stress in nurses working in
intensive care units. Revista Latino-Americana de Enfermagem.
http://www.scielo.br/scielo.php?pid=S010411692008000100005&script=sci_arttext.
(Accessed 18 May 2016.)
Cavana, R. Y, Delahaye, B. L & Sekaran, U. (2001). Applied Business Research. West Sussex,
United Kingdom: West Sussex, United Kingdom: John Wiley & Sons Inc
Circadian Age, (2009) Lowering Stress and Anxiety on Your Nursing Shift.
http://www.nursetogether.com/lowering-nursing-stress-shift. (Accessed 18 May 2016.)
Cooper, D.R. & Schindler, P.S., (2008) Business Research Methods (10th Ed). Boston, USA:
McGraw-Hill.
Creswell, J.W. (2008). Qualitative Inquiry & Research Design: Choosing Among Five Approaches
(2nd Ed). Thousand Oaks, CA: Sage
Currid, T. (2008). Experience of Stress in Acute Mental Health Nurses. Nursing Times 104 (2), pp:
39-40
Da Rocha, M. C. P. and De Martino, M. M. F., (2010). Stress and Sleep Quality of Nurses Working
Different Hospital shifts. Rev Esc Enferm USP, 44 (2), pp: 279-85
Dahlan, A. N., (2009). The Critical Success Factors for the Effective Performance of Malaysian
Government Linked Companies. Unpublished PhD Thesis. Southern Cross University.
http://epubs.scu.edu.au/theses/168/ (Accessed 18 May 2016.)
Deccan Herald, (2011). Job Stress Drives Man to Suicide.
http://www.deccanherald.com/content/154312/job-stress-drives-man-suicide.html.
(Accessed 18 May 2016).
Malun W. (2011). The Relationship between Work-Life Balance and Stress among Nurses in Kota
Kinabalu Hospitals. http://Eprints.Ums.Edu.My/7571/1/Mt0000000261.Pdf. (Accessed 18
May, 2016).
Emilia, Z. and Hassim N. (2007). Work-related Stress and Coping: A Survey on Medical and
Surgical nurses in a Malaysian teaching hospital.
http://www.researchgate.net/publication/228668639_Work-
related_stress_and_coping_A_Survey_on_Medical_and_Surgical_nurses_in_a_Malaysian
_teaching_hospital. (Accessed 18 May, 2016).
Happell, B., Reid-Searl, K., Dwyer, T., Caperchione, C.M., Gaskin, C.J. and Burke, K.J., (2013).
How Nurses Cope With Occupational Stress Outside Their Workplaces. Collegian. 20 (3),
pp: 195-9.
Kemper, K., Bulla, S., Krueger D., Ott, M. J. , McCool, J. N. and Gardiner P., (2011). Nurses'
experiences, expectations, and preferences for mind-body practices to reduce stress.
BMC Complement Altern Med. 11, pp: 11-26.
Khamisa, N., Peltzer,K and Oldenburg, B., (2013). Burnout in Relation to Specific Contributing
Factors and Health Outcomes among Nurses: A Systematic Review. International Journal
of Environmental Respiratory Public Health. 10 (6): 2214–2240
Kravits, K.; McAllister-Black, R.; Grant, M.; and Kirk, C., (2010). Self-care Strategies for nurses: A
Psycho-educational Intervention for Stress Reduction and the Prevention of Burnout.
Applied Nursing Research, 23, pp: 130–138

484
www.hrmars.com
 International Journal of Academic Research in Business and Social Sciences
May 2016, Vol. 6, No. 5
ISSN: 2222-6990

Lambert V., Lambert C., Inouye J., Itano J., Kim S., Kunaviktikul W., Sitthimongkul Y.,
Ponthavornkamol K., Gasemgitvattana S., Ito M.. (2004). Cross-Cultural Comparison of
Workplace Stressors, Ways of Coping and Demographic Characteristics as Predictors of
Physical and Mental Health among Hospital Nurses in Japan, Thailand, South Korea and
the USA (Hawaii). International Journal of Nursing Studies; 41, pp: 671–684.
Lan, H. K.,Subramanian, P., Rahmat, N. and Kar, P.C., (2014). The Effects of Mindfulness Training
Program on Reducing Stress and Promoting Well-Being among Nurses in Critical Care
Units. Australian Journal of Advanced Nursing, 31 (3).
Latack, J. C. and Havlovic, S.J., (1992).Coping with Job Stress: A Conceptual Evaluation Framework
for Coping Measures. Journal of Organizational Behavior. 13 (5), pp: 479-508.
Lazarus, R.S. and Folkman, S. (1984). Stress, Appraisal, and Coping. New York, NY: Springer
Publishing.
LittleJohn, P. (2012). The Missing Link: Using Emotional Intelligence to Reduce Workplace Stress
and Workplace Violence in our Nursing and other Health Care Professions. Journal of
Professional Nursing. 28 (6), pp: 360-368
Lo, S. H., Lin, L.Y., Hwang J.S., Chang, Y.Y., Liau, C.S. and Wang, J.D., (2010).Working the night
shift causes increased vascular stress and delayed recovery in young women.
Chronobiology International. 27(7), pp: 1454-68.
Loo, S. B. and Leap, H. L., (2012). Job Stress and Coping Mechanisms among Nursing Staff in
Public Health Services. International Journal of Academic Research in Business and Social
Sciences, 2 (7), pp: 131-176
Lua, P.L.and Imilia, I., (2011). Work-Related Stress among Healthcare Providers of Various
Sectors in Peninsular. Malaysian Journal of Psychiatry, 20 (2), pp: 30-40
Malhotra, Y. (1999). 'Knowledge Management for Organizational White-Waters:An Ecological
Framework', Knowledge Management, pp. 18-21.
Motowidlo, S. J., Packard, J. S. and Manning, M. R., (1986). Occupational Stress: Its Causes and
Consequences for Job Performance. Journal of Applied Psychology,, 71 (4), pp: 618.
Moustaka, E. and Constantinidis, T.C., (2010). Sources and Effects of Work-related Stress in
Nursing. Health Science Journal, 4 (4)
Nuruddin, M. P., (2000). Job Stress among Staff Nurses at Sarawak General Hospital in Kuching
Division Sarawak.
http://ir.unimas.my/3705/1/Job%20stress%20among%20staff%20nurses%20at%20Saraw
ak%20general%20Hospital%20in%20Kuching%20division%20Sarawak.pdf. (Accessed 18
May 2016).
O’Brien T and Delongis A. (1996). The Interactional Context of Problem, Emotion, and
Relationship-Focused Coping: The Role of the Big Five Personality Factors. Journal of
Personality; 64, pp: 775–813.
Orly, S., Rivka,B., Rivka, E. and Dorit,S., (2012). Are Cognitive–Behavioral Interventions Effective
in Reducing Occupational Stress Among Nurses? Applied Nursing Research, 20, pp: 152-
157.
Parahoo K. (2006) Nursing Research: Principles, Process and Issues (2nd Ed). Houndsmill:
Palgrave Macmillan,.

485
www.hrmars.com
 International Journal of Academic Research in Business and Social Sciences
May 2016, Vol. 6, No. 5
ISSN: 2222-6990

Polit, D. F. and Beck C.T., (2006) Essentials of Nursing Research: Appraising Evidence of Nursing
Practice (7th Ed). Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins..
Rickard, G., Lenthall, S., Dollard, M., Opie, T., Knight, S., Dunn, S., Wakerman, J., MacLeod, M.,
Seiler,J., and Brewster-Webb, D. (2012). Organizational Intervention to Reduce
Occupational Stress and Turnover in Hospital Nurses in the Northern Territory, Australia.
Collegian. 19 (4), pp: 211-232
Roberts, R., Grubb, P. L. and Grosch, J. W., (2012). Alleviating Job Stress in Nurses.
http://www.medscape.com/viewarticle/765974_2. Accessed 2 October2014.
Roland, G., (2014). Occupational Stress among Mauritian Nurses. International journal of
Emerging Trends in Science and Technology, 01(04), 463-476.
Saha, D., Sinha, R. K. and Bhavsar, K., (2010). Job Stress among Staff of a Super Speciality
Hospital. Online Journal of Health and Allied Sciences, 10 (1), pp: 1-4
Saleh, A.M., Saleh, M.M., and AbuRuz, M. E., (2013).The Impact of Stress on Job Satisfaction for
Nurses in King Fahad Specialist Hospital-Dammam KSA. Journal of American Science, 9 (3)
Sekaran, U. and Sekaran, U. and Bougie, R., (2010). Research Methods for Business: A Skill
Building Approach, (5th Ed). West Sussex, United Kingdom: John Wiley & Sons, Inc
Shirey, M. R., (2009). Stress and Coping in Nurse Managers: A Qualitative Description.
file:///C:/Users/user/Downloads/MRShirey%20Dissertation%20PDF%20E%20090106%20
Rev%20ii.pdf. (Accessed 18 May 2016)
Tsai Y. C. And Liu C. H., (2012). Factors and Symptoms Associated with Work Stress and Health-
Promoting Lifestyles among Hospital Staff: A Pilot Study in Taiwan. BMC Health Services
Research, 12 (1), pp: 199
Ulas,T., Buyukhatipoglu, T., Kirhan,I., Dal,M.S., Eren, M.A., Hazar, A. and Aydogan,T., (2012).The
effect of day and night shifts on oxidative stress and anxiety symptoms of the nurses.
European Review for Medical and Pharmacological Sciences, 16, pp: 594-599.
UML, (2014). Stress@Work: An Introduction to Job Stress.
http://www.uml.edu/docs/IntroductionToJobStress_tcm18-42460.pdf. (Accessed 18 May,
2016).
Vause, J. (2010). Inside China Factory Hit by Suicides. CNN World.
http://www.cnn.com/2010/WORLD/asiapcf/06/01/china.foxconn.inside.factory/.
(Accessed 18 May, 2016).
Wang, W., Kong, A. W. M. and Chair, S. Y., (2011). Relationship between job stress level and
coping strategies used by Hong Kong nurses working in an acute surgical unit. Applied
Nursing Research, 24, pp: 238–243.
Yang, J., Liu, Y., Chen, Y. and Pan, X., (2014). The Effect Of Structural Empowerment and
Organizational Commitment on Chinese Nurses' Job Satisfaction. Applied Nursing
Research, 27, pp: 186–191.
Yau, S.Y., Xiao, X.Y., Lee, L.Y., Tsang, A.Y., Wong, S.L. and Wong, K.F., (2012). Job stress among
nurses in China. Applied Nursing Research, 25 (1), pp: 60-64
Zikmund, W. G., Babin, B. J., Carr, J.C. and Griff, M., (2013). Business Research Methods. (9th Ed).
Ohio, USA: South-Western College Publication

486
www.hrmars.com
 International Journal of Academic Research in Business and Social Sciences
May 2016, Vol. 6, No. 5
ISSN: 2222-6990

Zimmerman, B., Lindberg, C. & Plsek, P. (2001). Edgeware: Insights from Complexity Science for
Health Care leaders. Dallas, TX: VHA, Inc.

487
www.hrmars.com