ACKNOWLEDGEMENT

During my studies at Om Health Campus, and particularly during

the course of this research, I have received both great personal
assistance and profound technical education from many people.
Firstly I would like to express my gratitude to Purbanchal
University, Om Health Campus, Chabahil, Kathmandu for me the
opportunity to conduct this study as a partial fulfillment of post
basic bachelor of nursing programme.
I wish to express my heartfelt gratitude to my research advisor
Associated professor Ms Milan Lopchan, for introducing me to the
topic and constructive suggestions throughout the work. I am
highly obligated to her kind help, support and supervision during
completion of this work.
My deep and cordial gratitude also goes to BN faculties, faculties
chief Ms Maiya Ranjitkar for their valuable suggestion.
I am also thankful to Matron Ambika Shrestha , stffs and all
patients of medical, surgical and general ward of Om Hospital and
Research Centre, Chabahil, Kathmandu for their great cooperation during my data collection period.
I am very much indebted to staffs of Om Health Campus for their
inspiration and fruitful suggestions. I offer special thanks to my
colleagues for their co-operation, inspiration and regular
assistance during my studies and also during the preparation of
this research.

Last but certainly not least, I express my gratitude to my Mum

Padma
Kunwar,my
late.Grandfather
Bam
Bahadur
Kunwar,Grandmother Damber kumari Kunwar and My Husband
Ram Bahadur Chettri for their internal help, support and
inspiration in my every step of life.
Ur
mila Kunwar

Abstract
This descriptive study was carry out with the purpose to find out
contributing factors of stress among hospitalized adult patients
at Om Hospital and Rsearch Centre,Chabahil, Kathmandu. Total 50
patients who were admitted at hospital were interviewed with
semi structured questionnaires.
A non probability purposive sampling technique was used. The
questionnaires wa developed into two parts. First part consists of
Socio-demographic data and second part consists of contributing
factors of stres
Majority of respondents 16(32%) were of age group 30-39 years
and minority of respondents 8(16%) were age group25-29 years.
Majority of respondents 38(76%) were married and minority of
respondents 12(24%) were unmarried
Majority of respondents 16(32%) were Brahman
whereas,only2(4%) were from Rai/Limbu.
Majority of respondents 37(74%) were Hindu and minority of
respondents 2(4%) were from other(kirat).
2

Majority of respondents 14(28%) were Higher secondary

education level and minority of respondents 2(4%) were primary
educational level.
Majority of respondents 15/15(30/30%) were farming and
business and minority of respondents were 4(8%) from Daily wage
earner.
Majority of respondents 33(66%) were no experience of previous
hospitalization and minority of respondents 17(34%) were have
experience of previous hospitalization.
Majority of respondents 10(20%) were 2 times experience of
hospitalization and minority of respondents 2(4%) were more than
4 times experience of hospitalization.

Table of Contents
Acknowledgement
Abstract
List of tables
List of figures
CHAPTER 1: INTRODUCTION
1.1 Background of the study
1.2 Rational of the study
1.3 Objectives of the study
3

1.4 Variables of the study

1.5 Operational definition of the relevant terms
1.6 Hypothesis
1.7 Significance of the study
CHAPTER 2: REVIEW OF RELATED LITERATURE
2.1 Review of literature
2.2 Summary of the literature review

CHAPTER 3: RESEARCH METHODOLOGY

3.1 Research design
3.2 Study area
3.3 Population of the study
3.4 Sample size
3.5 Sample technique
3.6 procedure of data collection
3.7 Instrumentation
3.8 Validity and reliability of the instruments
3.9 Pre-testing
3.10 Ethical consideration
3.11 Process of data generation, processing and analysis
4

CHAPTER 4: ANALYSIS AND INTERPRETATION

OF DATA
4.1 Part 1: Socio-demographic data
4.2 Part 2: Contributing factors of stress

CHAPTER 5: FINDINGS< CONCLUSION AND

RECOMMENDATION
5.1 Findings of the study
5.2 Discussion and conclusion of the study
5.3 Recommendation
5.4 Implication for the nursing practice
5.5 Difficulties faced during study
5.6 Strength of the study
5.7 Limitation of the study

BIBLIOGRAPHY
ANNEXES
Annex 1 Work Plan
Annex 2Questionnaries
Annex 4 Campus Letter
5

CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY

Stress is defined both in terms of its physical and psychological

dimensions and involves an increasing sense o f the loss of
control over the environment, producing fear and uncertainty.
Stress is a problem in the terms of stress in the workplace
because work related stress contributes to a variety of problems
both for the individual experiencing stress and for the
organization for which he or she works. The problems can range
from reduced performance to open violence.
Women men are seen as having greater stress than women
because men have long experienced stress in the workplace, but
as more and more women enter the workplace as well, they are
also subject to the same levels of stress.
Certain life experiences are stressful in varying degrees, and
incoming college students experiences stress for a variety of
reasons, including workload demands, culture shock, added
responsibilities, living away from home for the first time, and so
on.
Harvard researchers estimated that 60-90% of doctors visited are
caused by stress.
Stress in itself can be a good thing when the level of stress is not
too high and when the individual is able to control the stress and
its effects. Marks greener emphasizes that stress is a response to
change in the environment and that any change can lead to
stress, even if the change itself is enjoyable stress is not a new
problem, though it is better recognized today as a concern for the
business world and as a contributing factors in the development
of a stress.
7

It appears from a review of the literature that stress is directly

related to physical and mental illness at all ages of development
and across all socio-economic strata from infants who have a
higher asthma morbidity because of stress related factors to
workers who suffer burnout and illness from occupational related
stressors, increasing numbers of Americans are suffering from the
physical and mental effects of stress. This research will focus on
the correlation between stress and physiological illness. Stress
related physiological illness is increasing in the United States
while some people become physically ill from the effects of stress,
others see, able to cope with it in amore effective manner?
Stress is anything that exerts our bodies physically, mentally
and /or emotionally. We all have observed people who experience
stress and handle it effectively and we have observed other who
experience similar stress, but become irritable, tense and /or
physically ill? (Berry, 1999,1). Stress from emotional tension
appears more likely to be associated with physiological illness
than stress from work or exercise further, research has shown that
type.
A-personalities are more susceptible to the deleterious health
effects of stress (Berry, 1999, 1).
While many people experience stress in the work place. Stress
and its negative impact on health appear to affect people at all
ages of development.
Lots of essays.com
(Stress and illness)
8

1.2 RATIONALE OF THE STUDY

Stress is an unpleasant experience and a part of daily life.
Everyone faces stress in his or her day to day life in different
situation, the stress can be increased substantially when admitted
to hospital Further more, stress in contributed by several factors
such as, hospital environment, behavior of staffs, certain
procedures equipments and financial arrangements.
It is believed that when that stress becomes more severe, it
affects the patients condition, prolonging the course of illness.
Hence, it is important to fine out the factors that cause stress
during hospitalization.
In Nepal, in most of the health care centers, and hospitals where
patients were admitted nurses along with other health care
providers are only providing their attention to treat physically and
clinically whereas, psychological aspect of a patient seems
somehow neglected. Because everyone wants to be recognized as
an individual and to feel that he is important to someone else.
The need for attention increase in response to illness thus a nurse
should respect and accept patient as a person.
So the main purpose of this study was to assess the contributing
factors of stress among hospitalized patients.
On the other hand, very few researches have been conducted
regarding this topic in Nepal. So researcher interested to conduct
this research study.

1.3 OBJECTIVE OF THE STUDY

1.3.1 General objective
9

 To assess the contributing factors of stress among

hospitalized patients.
1.3.2 Specific objectives
To find out the socio-demographic characteristics of
respondents.
To identify contributing factors of stress among hospitalized
patients.

1.4 VARIABLES OF THE STUDY

1.4.1 Independent variables

Attitude and behavior of hospital staffs.

Lack of orientation on admission.
Hospital environment.
Disease condition and prognosis
Nursing procedures and certain equipments.
Loss of independence.
Financial problem.
Home separation.
Diet restriction.

1.4.2 Dependent variables

Contributing factors of stress among hospitalized patients.

1.5 OPERATIONAL DEFINITIONS OF THE TERMS

10

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

1.6 HYPOTHESIS
Rural areas patients have more stress than urban areas
patients.
Illiterate patients have more stress than literate patients

Hospitalized experienced patients have less stress than

patients of inexperienced of hospitalization.

1.7 SIGNIFICANCE OF THE STUDY

Hospitalized patients will be benefited by this study because
if the nurse who is caring them have knowledge to find out
contributing factors of stress to reduce then.
This study will be helpful for matron and supervisors of OM
Hospital and Research center, chabahil, Kathmandu because
after identifying the contributing factors of stress to reducing
stress in hospitalized patients
Moreover this study will be more significant to nurse because
she can became aware of circumstances that are likely to
produce stress and can help patient in adjustment to the
11

hospital by fulfilling various needs by achieving knowledge

regarding stress reduction.
Furthermore, nursing tutors will be benefited form this study,
it will help them to each and help the student to find out the
factors that contributes to stress and reducing mechanism in
hospitalized adult patients.
Last but certainly not the least this study will help researcher
to improve knowledge and skill regarding appraisal and
management to stress in hospitalized patients after
identifying the contributing factors.

1.8 DELIMITATION OF THE STUDY

The study was limited up to OM Hospital and Research
center, chabahil, Kathmandu.
Only 50 samples were taken for the study.
Total time for study was 4 weeks.
Researchers herself funded budget for research.

CHAPTER II
LITERATURE REVIEW
Nancy. K and RNP.A (2004) concluded in the study of
patients satisfaction with nurse practitioner service that
12

there was high level of patients satisfaction with those nurse

practitioner who were aged and married, as they provided
services to meet patients expectation including respect and
politeness with patient.
Burggraf (2006) explained that patients may want to have
pictures of their loved ones near them and to use their own
pillows from home. They may wish to pray with one another
using a special tea, herbal remedy, vitamin, lotion, perfumes
or cologne may help better normalize the experience of
hospitalization and it is found that patients are more
comfortable to share their feelings with married nurses
rather than unmarried because they believe that married
nurses are likely to understand their feelings
Jenkinss (2006) concluded in the study sources of stress
and psychological well being of patients well being through
dealing with patients and relatives. Reactions to stress
elicited a range of adaptive and maladaptive coping styles.
This study recommends sending nurses on management and
administration courses and stress-management programs.
Coy (2002) mentioned that stress plays a role in vulnerability
to disease. A patient when comes to hospital expects
respective behavior and positive attitude from nurses.
Nurses who have high professional education are likely to
have to have more knowledge regarding stress and coping
and work to minimize stress of a patient.
Emory. S (1953) Stated that nurses however, expert on physical
procedures are not sufficiently knowledgeable on reducing
13

patients suffering than nurses who are expert in psychological

aspect
Healthcare Research and Quality (2004) issued a synthesis of
nursing research studies that details the impact that staffing
levels, have on patient outcomes. The report cites studies
showing that hospitals with lower nurse staffing levels and
fewer registered nurses compared with licensed practical nurse
or nurses aides tend to have higher rates of poor patient
outcomes.
Mohoughton.N (1969) stated that the more commitment of a
nurse towards fulfilling patients needs the more knowledge she
possess. If the patient will often confide his fears, worries, or
some information bearing on his illness.
Pun.k (1995) mentioned in the study opinions of patients
about nursing care gi ven in different ward in S.S.G hospital,
Boroda, Gujrat tht various need of patients were poorly met by
less experienced nurses than nurse who have more working
experience.
Potter.P.A (2004) stated that throughout the life all individuals
including patients/nurse may have experience with illness or
hospitalization, personal memories, of changes in normal
activities, affected usual roles can help can one to become
empathetic with clients who are experiencing can provide
useful insight in how to work effectively with a current client.

Summary of literature Reviewed

14

The researcher in developing concept and nature of the current

stud used all there studies and literatures.

CHAPTER III
RESEARCH METHODOLOGY
3.1 RESEARCH DESIGN
A descriptive research design method was used to find out the
contributing factors of stress.

3.2 STUDY AREA

The study was carried out in different departments of OM Hospital
and Research Centre Chabahil Kathmandu.

3.3 POPULATION OF THE STUDY

Patients hospitalized at OM Hospital and Research Center
Chabahil Kathmandu were the population of the study.

3.4 SAMPLE SIZE

50 patients hospitalized at OM Hospital and Research Centre
Chabahil Kathmandu.
15

3.5 SAMPLING TECHNIQUE

Non probability purposive sampling was used for data collection

3.6 PROCEDURE OF DATA COLLECTION

Formal approval from the research in hospital authority was
obtained. Data was obtained after verbal permission from each
respondent before data collection. Interview techniques were
applied and close end with face to face interview technique.

3.7 INSTRUMENTATION
Data collected by using close ended questionnaire on the
objectives with simple and understandable language to assess
knowledge on reducing stress among the nurses of Om Hospital
and Research Center, Chabahil, Kathmandu through interview.

3.8 VALIDITY AND RELIABILITY OF THE INSTRUMENTS

The validity of the instrument was done by consulting the Advisor
and Expert Teachers. Reliability was maintained by pre-testing the
instruments. Some questionnaires were modified according to
need and suggestions received from advisor and experts.

3.9 ETHICAL CONSIDERATIONS

The permission was obtained from the related authority in Om
Hospital and Research Center, Chabahil, Kathmandu.
The patients were explained verbally about the research study by
using informed consent.
16

Nobody was forced for participation and confidentiality and

anonymity was maintained.

3.10 PLAN/PROCEDURE FOR DATA GENERATION ,

PROCESSING AND ANALYSIS
After completion of data collection, checked for its completeness
and accuracy and categorized according to research objectives
and analyzed through descriptive statistical method. Percentage
frequency and findings presented in figures and tables. The
inferential
Statistical test was used to test stated hypothesis i.e. X 2 test.

CHAPTER 4

Analysis and interpretation of data

After data collection, the data are analyzed on the basis of
objectives and arranged on relevant tables, graphs and pie charts.
The major findings are presented into four parts.

Part 1: Socio demographic data

Part 2: Contributing factors of stress.
Part 1: Socio demographic data
Table 1: Distributon of respondents according to
sociodemographic characteristics
17

Variables

Frequency
n=50

Percentage(10
0%)

Age
20-24years

11

22%

25-29years

16%

30-39years

16

32%

40years and above

15

30%

Unmarried

12

24%

Married

38

76%

Brahman

16

32%

chettri

11

22%

Newar

12%

Tamang/gurung/maga
r

12

24%

Rai/limbu

4%

Marital status

Ethnic group

18

Others(chaudhary,B.k. 3
,etc..)

6%

Religion
Hiund

37

74%

Buddhist

16%

Christian

6%

Muslim

0%

Others(kirat)

4%

Illiterate

14%

Can read and write

14%

Primary

4%

Secondary

14%

SLC

10%

Higher secondary

14

28%

Bachelor and above

16%

Farming

15

30%

Service

12%

Daily wage earner

8%

Bussiness

15

30%

Education

Occupation

19

Others(students)

10

20%

Yes

17

34%

NO

33

66%

2 times

10

20%

3 times

10%

4th times

0%

>4 times

4%

Previous
hospitalization
experience

If, Yes

Majority of respondents 16(32%) were of age group 30-39 years

and minority of respondents 8(16%) were age group25-29 years.
Majority of respondents 38(76%) were married and minority of
respondents 12(24%) were unmarried
Majority of respondents 16(32%) were Brahman
whereas,only2(4%) were from Rai/Limbu.
Majority of respondents 37(74%) were Hindu and minority of
respondents 2(4%) were from other(kirat).

20

Majority of respondents 14(28%) were Higher secondary

education level and minority of respondents 2(4%) were primary
educational level.
Majority of respondents 15/15(30/30%) were farming and
business and minority of respondents were 4(8%) from Daily wage
earner.
Majority of respondents 33(66%) were no experience of previous
hospitalization and minority of respondents 17(34%) were have
experience of previous hospitalization.
Majority of respondents 10(20%) were 2 times experience of
hospitalization and minority of respondents 2(4%) were more than
4 times experience of hospitalization.

TABLE 2: Distribution of respondents according to

contributing factors of stress that lead to stress in
hospitalized adult patients.
S.
N.

Variables

1.

Hospitalization is a
stressful situation

Yes

46

92%

No

8%

Attitude and behavior of

hospital staffs.

Yes

14

28%

No

36

72%

Hospital environment

Yes

24

48%

2.

3.

YES Frequency
NO

21

Percentage

n =50

No

26

52%

Anxiety and fear with

equipments used in nursing
procedure

Yes

25

50%

No

25

50%

Financial problems

Yes

37

74%

NO

13

26%

Yes

43

86%

14%

Yes

21

42%

No

29

58%

Hospital rules and regulation Yes

11

22%

No

39

78%

Yes

29

58%

No

21

42%

10. Feeling of comfortable to

take meal inside hospital

Yes

21

42%

No

29

58%

11. Sleeping in the hospital bed

Yes

25

50%

No

25

50%

12. Feeling comfortable to

explain your quarries to the
Doctor and nurse

Yes

42

84%

No

16%

13. Feeling comfortable when

Yes

45

90%

4.

5.

6.

Separation from home

No
7.

8.

9.

Restricted diet

Spreading cross infection

22

your relatives visit in the

hospital

5
No

10%

14. Feel loneliness in the

Yes
hospital even though there
No
are many people around you

17

34%

33

66%

15. Uncomfortable changing

your routine work

Yes

33

66%

No

17

34%

16. Feel bad when your

knowledge doesnt match
with doctor and nurses

Yes

26

52%

No

24

48%

17. Feel good when doctor

explain about disease
condition

Yes

50

100%

0%

24

48%

26

52%

No

18. Feeling stress due to sharing Yes

room with strange
No
neighbours

23

Figure 1: Distribution of respondents according to

hospitalization is a stressful situation.
24

Figure 2: Distribution of respondents according to attitude and behavior of hospital

staff

25

Figu
re3: distribution of respondents according to hospital environment

Figure4:

26

Figure :5

No14%

Yes
86%

Figure:

27

Yes42%

No- 58 %

figure :7

Figure : 8

28

Figure :9

Fig:10

29

Fig :11

fig 12

Fig:13

30

Fig: 14

Fig: 15

Fig: 16

31

Fig:17

Fig: 18

Chapter 5
Findings, conclusion and
recommendations
32

The study was conducted to identify the contributing factors of

stress among hospitalized patients.

5.1 Findings of the study

The collected data were thoroughly analyzed and interpreted in
terms of findgs and stated objectives.The major findings of the
study are as follows.

5.1.1 Demographic findings

Majority of respondents 16(32%) were age group of 30-39years
and minority of respondents 8(16%) were age group of 2529years.
Majority of respondents 38(76%) were married and minority of
respondents 12(24%) were unmarried.
Majority of respondents 16(32%) were Brahman whereas, only
2(4%) were from Rai/Limbu.
Majority of respondents 37(74%) were Hindu and minority of
respondents 2(4%) were from other(kirat).
Majority of respondents 14(28%) were Higher secondary
education level and minority of respondents 2(4%) were primary
educational level.
Majority of respondents 15/15(30/30%) were farming and
business and minority of respondents were 4(8%) from Daily wage
earner.

33

Majority of respondents 33(66%) were no experience of previous

hospitalization and minority of respondents 17(34%) were have
experience of previous hospitalization.
Majority of respondents 10(20%) were 2 times experience of
hospitalization and minority of respondents 2(4%) were more than
4 times experience of hospitalization.

5.1.2 Contributing factors of stress

Majority of respondents 46(92%) agreed that hospitalization is a
stressful situation for patients and 4(8%) do not agreed. Total
50(100%) patients know about the factors that leads to stress in
hospitalized patients. Among them, majority of respondents
43(86%) were due to separation from home, 37(74%)were due to
financial problems 25(50%) were due to anxiety and fear due with
equipments used in nursing procedures, 21(42%) were due to
restricted diet, 11(22%) were due to hospital rules and regulation,
29(58%) due to spreading of cross infection,29(58%) due to
feeling uncomfortable to take meal, 33(66%) due to changing
routine work, 26(52%) due to disease doesnt match with doctor
and 24(48%) were stressed due to sharing room with strange
neighbor.

5.2 Discussion and conclusion of the study

5.3Recommendation
For hospital
34

 It seems important that specific orientation and holistic

nursing care to patients should be provided .
Result of the study can be helpful to improve the standard of
nursing in the hospital.

For the study

A similar type of study can be replicated in other hospitals.

Similar type of study can be done extensively in a large

scale.

Study can be done in different people such as out patients,

visitors to know
the contributing factors of stress.

5.4 Implication for nursing practice

The study will provide background to study related to

hospital stress in future.

This study will help the nursing personnel to plan care

focused education to strengthen the nursing services.

5.5

Difficulties faced during

35

the study

 Journals, research reports and were not available for review

literature.

BIBLIOGRAPHY
www.who.int/hinary
www.scholar.google.com.pub.med
www.med.IND.NIC.IN
www.njog.org.np
www.docstoc.com/docs/20166585
www.Lots of essay.com(stress and illness)

ANNEX I
WORK PLAN FOR RESEARCH WORK

36

37