Research Paper on Managing Stress: Emergency Care Nursing Professionals

Scientific Background

The human organism, when exposed to hostile stimuli to its well-being referred to as stressors, triggers neuroendocrine changes to promote the necessary adaptation to the recovery of its balance, the fight or flight reaction. The concept of stress in health describes the organism's effort to reorganize itself in the face of threats to its homeostasis (Taylor, Dollard, Dormann, & Bakker, 2019). Stressors can be classified as external, internal and social, respectively represented by climate change, different feelings and unhealthy working environments (Elbarazi, Loney, Yousef, & Elias, 2017).

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The Hospital Organization

An organization is a system composed of human activities with complex and diverse multidimensional personalities, values, norms, and behaviors aligned to achieve common goals. (Gallo, Mihalcova, Vegsoova, Dzurov-Vargova, & Busova, 2019). According to these authors, the interdependence of an organization and its environment is an essential constraint, especially in the case of health organizations, which are subject to numerous and changing influences, namely: Demographics and mobility; Economic and financial; Social and cultural; Legislative; Technological and functional. The functions of hospital organizations are the care to be provided to its users. In recent years, much has been said about "hospital humanization", with the main objective being that the studies carried out on this subject have as a primary objective the quality of services provided to those seeking medical care (Pascuci, Meyer Jr, Nogueira, & Forte, 2017). Working conditions, motivation and, consequently, the well-being of health professionals have been sidelined or even completely neglected.

The Nursing Profession and its Characteristics

The nursing profession is linked to the notion of "caring", a notion that refers to the provision of care and that is also related to the notion of people's survival. It should be noted, as a benchmark of the nursing profession, the nurse Florence Nightingale, who, in the middle of the 19th century, performed work on hygiene, public health, hospital management, and administration. According to her, the action of nursing has as main objective to put the patient in the best conditions so that nature can act (Goncalves et al., 2019).

Nursing, in a recent perspective, has been the target of several attempts at definition, with the aim of being able to clearly articulate the roles and functions of the nursing profession. Despite the evolution of nursing definitions, there is, however, no single universally accepted definition. From the classic definitions of nursing, we highlight the definition formulated by Virginia Henderson (1966), an influential nurse who described the role of nursing as helping the individual, healthy or ill, in the performance of activities that contribute to maintaining their health or their recovery, in such a way, having to perform this function in order to make the individual as independent as possible, that is, to achieve their previous independence (Minton & Batten, 2016).

Van Dam and Ford (2019) define nursing as the meeting of the nurse with a patient and their family, during which the nurse observes, helps, communicates, understands and teaches; in addition, contributes to conservation of an optimal state of health and provides care during the illness until the patient is able to assume the inherent responsibility for the full satisfaction of their basic needs. On the other hand, when necessary, nursing provides terminally ill patients with comprehensive and kind help. For Giddens (2017), the fundamental competence of nursing is helping individuals and groups to function more optimally, in any state of health in which they find themselves. According to the author, nursing includes the functions of caring for health and illness, to its maximum extent, from conception to death. This model thus contemplates the importance of psychosomatic and psychosocial factors in life, which affect health and disease. In this sense, the objective of nursing will, therefore, be promoting, conserving and restoring health, paying special attention to biological, psychological and socio-cultural factors, absolutely respecting the rights and needs of the person to whom this type of service is provided (Minton et al., 2016).

Being a Nursing Professional implies, in addition to the knowledge of a series of techniques and skills, the apprehension of the psychological needs of the healthy or sick person. For this, the nurse must have a high empathic capacity, in the sense of knowing how to put oneself in the other's place, being, at the same time, aware that the use of psychological strategies, in the hospital environment, results not only in benefit for the patient but also for themself (Luken & Sammons, 2016). In the hospital, the work of health professionals is carried out in care units organized according to the various medical specialties. In this context, nurses working in these units perform their work in teams of 15, 20, 30 or more, depending on the needs and the type of care required (Rana & Soodan, 2019). In terms of physical space, most care units provide nurses with an office for the boss, a workroom, where all the activities of nursing professionals are carried out, with the exception of direct care for the patient. As such, nurses do not have a space for team meetings, or for a few moments of relaxing.

Regarding the type of schedule, nurses work an average of 35 hours per week, divided into 8-hour shifts, which can be practiced in the morning (from 8 to 16 hours), in the afternoon (from 16 to 24 hours) and at night (from 24 to 8 hours) (Ferri et al., 2016). Most of the time, the number of hours of work can still be prolonged for several reasons, such as excessive activities to be carried out, time spent on the shift (transmitting information), delay on the part of colleagues, or even by unexpected and urgent patients. However, in most cases, the increase in hours of work outside the normal working hours of nurses is not subject to any compensation.

From the above, it is easy to understand some of the constraints experienced by nurses, both in the context of their work and in the exercise of their functions. Such constraints are reflected mainly in the feelings of identity and autonomy. Although nursing constitutes the largest professional group in the health sector, these professionals are sometimes not given the opportunity to participate in their policy decisions, whether at higher or more intermediate levels.

To better understand some of the causes of this problem, it is important to mention that, due to technical evolution and scientific knowledge (since the beginning of the 20th century), nurses started to accumulate a diversity of roles, such as manager of the nursing unit care, support for the sick person and, with special emphasis, that of collaborator in the doctor's work.

According to Giddens (2017), in this broad set of functions, nurses have always been granted a certain "space of power", but it is a virtual power, since there is always someone to control such power, even if in a subjective way. For this reason, nurses have always played an essential role in hospital institutions, but always occupying a rear seat. In this way, nursing professionals began to organize themselves and let them organize them, in the sense that they would accept the duty to care for people without ever demanding the right to determine how they would satisfy such a duty. As such, nurses have always been expected to respond to the obligation to care under any circumstances (Pascuci et al., 2017).

Nurses occupy their time in a multitude of multipurpose tasks and activities. However, it is known that they are constantly dominated by a sense of ambivalence, as they are not doing what is their duty, due to the huge amount of daily tasks that they must perform and in a timely manner. Such reality, when perceived, causes feelings of irritation and frustration in nurses, feeling conditioned by factors of the context that lead them to reach outside their professional and personal ideal. In view of this, decision-making in the organization of nurses' work must be based on individual needs and not on personal, institutional or other technical interests, norms or routines. To this end, it is necessary to restructure the functioning of services through new dynamics of interpersonal relationships at work, cancellation, and release of stereotyped behaviors, the definition of qualitative objectives, in short, a philosophy, as a citizen and human being.

Problem Statement

Occupational stress causes biopsychosocial disorders which include a high blood pressure, increased heart rate, muscle pain, sweating, anxiety, fatigue, irritability, insomnia, eating disorders, decreased ability to concentrate and other deleterious effects on the individual, which through intensification of stimuli are responsible for the fall in general performance and deterioration of the health of the professional (Elbarazi et al., 2017). Stress is also a predisposing factor for sleep disorders since the sleep/wake cycle is linked to hypothalamic activity, where the release of cortisol acts to induce wakefulness (Goncalves, Fontes, Simaes, & Gomes, 2019). The presence of a high level of stress is associated with an increase in the Body Mass Index - BMI, due to the action of cortisol on the mechanisms of hunger, resulting in overweight and even obesity, considered risk factors for the development of cardiovascular diseases (Geiker et al., 2018).

The mental health of professionals in the emergency department is affected by several factors, such as subjective, cultural, social and economic issues that also influence the work environment. The reality of the nurse's work, as already mentioned, is quite different from that of the other health professionals. The nurse is a health professional who provides global care to a patient. In addition to hygiene, food, and other care, the nurse provides psychological support to the patient and family, administers medication and monitors all signs and symptoms inherent to the patient's situation, taking into account their social needs (Taylor, Dollard, Clark, Dormann, & Bakker, 2019). In the development of these activities, there is, therefore, a versatility that, however, is not accompanied by autonomy and differentiation of well-defined functions, which leads to conflicts and ambiguity of role.

Nursing work is extremely exhausting, not only due to the aspects mentioned but also due to the requirements related to the practice of rigid schedules and shift work. Thus, it becomes easy to understand the problem of the nursing profession, which is said to be of a complied submission, which is faced with difficult situations and before which cannot stop thinking about power, autonomy, and status, but must act first. For this reason, the work of nurses, in a hospital environment, is a type of work developed in highly stressful circumstances, which can lead to problems such as Demotivation; Professional dissatisfaction; Burnout; Absentee...