How do patients experience stress caused by hospitalization and how do nurses perceive this stress experienced by patients. A comparative study.

Abstract

It has been acknowledged that, in general, stress caused by hospitalization and hospital care may hinder patient recovery and in some cases it may cause potentially life-threatening psychological changes. Hospitalization and subsequent treatment and medical care constitute a period of anxiety for the patients and a severe anxiety-causing situation. This fact has been confirmed by a large number of researches studying many different kinds of hospital care. Many factors were reported to contribute to this anxiety, including those relating to an illness such as pain, anxiety or improvement and recovery, and factors relating to hospital stay such as sleeping in a strange bed or sharing a hospital room with others. Most health professionals are aware of this and try to alleviate this stress by following various procedures in the hope that the patient gains some assurance and experiences less stress. However, how accurately are health professionals informed about those factors, which cause stress to patients, in a hospital area, as well as their importance? This research study aims at exploring these very areas. More specifically, the study used a sample consisting of 35 nurses and 100 patients to whom the same measurement tool was administered, incorporating all necessary changes, in order to measure what stresses patients most and what nurses believe that stresses them. The findings which stem from a comparison of the answers given are of great importance since both groups indicate that lack of knowledge about the course of the disease, questions, possibility of an incurable disease, and lack of relevant information provided are believed to be the most stressful factors, without implying of course that there is not a considerable degree of divergence between the two groups of answers. It is, therefore, imperative that nurses and all other healthcare professionals maintain a channel of continuous communication with the patients, so that stressful factors causing anxiety to patients and making recovery harder can be uncovered and dealt with promptly and efficiently.

Full text

ICU NURS WEB J
ISSN 1108-7366
ISSUE 7th July-October 2001
2001 ICUs and Nursing Web Journal
All rights reserved
1
By
Kotrotsiou Evagelia
Kotrotsiou Evagelia Kotrotsiou Evagelia
Kotrotsiou Evagelia RN, Bs.N, E.D, Ph.D, Assistant Professor of Nursing School, TEI Larissa
Theodosopoulou Heleni
Theodosopoulou HeleniTheodosopoulou Heleni
Theodosopoulou Heleni RN, Bs.N, Ph.D, Assistant Professor of Nursing School, University of
Athens
Papathanasiou Ioanna
Papathanasiou IoannaPapathanasiou Ioanna
Papathanasiou Ioanna, RN, Bs.N, General Hospital of Larissa.
Dafogianni Crisoula,
Dafogianni Crisoula, Dafogianni Crisoula,
Dafogianni Crisoula, RN, Bs.N, Ms.N, E.D., Ph.D, Professor of TEE Athens
Raftopoulos Vasilios,
Raftopoulos Vasilios, Raftopoulos Vasilios,
Raftopoulos Vasilios, RN, Bs.N, Ms.N, PhD candidate
Konstantinou Evagelos,
Konstantinou Evagelos, Konstantinou Evagelos,
Konstantinou Evagelos, RN, BsN, MsN, PhD, Clinical Nurse Evgenidion Hospital Athens
Correspondence Address:
Ms Kotrotsiou
Ms KotrotsiouMs Kotrotsiou
Ms Kotrotsiou Evagelia
Evagelia Evagelia
Evagelia RN, Bs.N, E.D., Ph.D
NIKAIA
LARISSA GR-41500
GREECE
"How do patients experience stress caused by
"How do patients experience stress caused by "How do patients experience stress caused by
"How do patients experience stress caused by
hospitalisation and
hospitalisation andhospitalisation and
hospitalisation and how do nurses perceive this
how do nurses perceive this how do nurses perceive this
how do nurses perceive this
stress experienced by patients?
stress experienced by patients? stress experienced by patients?
stress experienced by patients?
A comparative study"
A comparative study"A comparative study"
A comparative study"

ICU NURS WEB J
ISSN 1108-7366
ISSUE 7th July-October 2001
2001 ICUs and Nursing Web Journal
All rights reserved
2
Abstract
AbstractAbstract
Abstract
It has been acknowledged that, in general, stress caused by hospitalisation and hospital care
may hinder patient recovery and in some cases it may cause potentially life-threatening
psychological changes. Hospitalisation and subsequent treatment and medical care
constitute a period of anxiety for the patients and a severe anxiety-causing situation. This
fact has been confirmed by a large number of researches studying many different kinds of
hospital care.1 Many factors were reported to contribute to this anxiety, including those
relating to an illness such as pain, anxiety or improvement and recovery, and factors
relating to hospital stay such as sleeping in a strange bed or sharing a hospital room with
others.2
Most health professionals are aware of this and try to alleviate this stress by following
various procedures in the hope that the patient gains some assurance and experiences less
stress.3
However, how accurately are health professionals informed about those factors which cause
stress to patients, in a hospital area, as well as their importance? This research study aims
at exploring these very areas. More specifically, the study used a sample consisting of 35
nurses and 100 patients to whom the same measurement tool was administered,
incorporating all necessary changes, in order to measure what stresses patients most and
what nurses believe that stresses them. The findings which stem from a comparison of the
answers given are of great importance since both groups indicate that lack of knowledge
about the course of the disease, questions, possibility of an incurable disease, and lack of
relevant information provided are believed to be the most stressful factors, without
implying of course that there is not a considerable degree of divergence between the two
groups of answers.
It is, therefore, imperative that nurses and all other healthcare professionals maintain a
channel of continuous communication with the patients, so that stressful factors causing
anxiety to patients and making recovery harder can be uncovered and dealt with promptly
and efficiently.

ICU NURS WEB J
ISSN 1108-7366
ISSUE 7th July-October 2001
2001 ICUs and Nursing Web Journal
All rights reserved
3
INTRODUCTION
INTRODUCTIONINTRODUCTION
INTRODUCTION
The term “stress” was used for first time in the English language in the 17th century and it
meant “affliction, distress, hardship, reverse”.4 During the 19th century the term took on a
new form and it meant, among other things, a strong influence exerted on an object or a
person.
In this century “stress” takes on yet another meaning and is considered to be a reaction to a
particular event. Generally speaking, “stress” is defined as a reaction or a stimulus. As a
reaction, the definition of stress is identified with specific changes taking place in a specific
biological system, in this case the human body, and it can be defined as the reaction of the
body to a certain biological demand. As a stimulus, the definition of stress is given in relation
to the events of the surrounding environment which cause these changes and are defined as
stressful events.5,6
LITERATURE REVIEW
LITERATURE REVIEWLITERATURE REVIEW
LITERATURE REVIEW
Stress is a physical and a psychological state always present in a human being, and forming
an integral part of his everyday life. An event may be perceived by an individual as stressful,
whereas another individual may not see it as such. For example, the experience of travelling
by plane may be perceived as marvellous whereas for somebody else it might prove to be
severe and anxiety-causing.7 On the other hand, the same person may find that the same
event causes stress in one situation, whereas in another it causes little or no emotional
involvement. There are, of course, situations affecting most people (e.g. unemployment,
sudden death, earthquake, separation) but each person interprets and assesses every
experience based on his subjective criteria and deals with it in his own, unique way.
Stress causing stimuli may be: biological
biological biological
biological (disease, surgery), chemical
chemical chemical
chemical (drugs, toxic
substances), microbial
microbialmicrobial
microbial (viruses, bacteria, parasites), psychological
psychological psychological
psychological (illness, death, separation,
divorce, failure), developmental
developmental developmental
developmental (premature birth, anatomical defects), socio
sociosocio
socio-
--
-cultural
culturalcultural
cultural
(inharmonious interpersonal relationships, financial difficulties), environmental
environmentalenvironmental
environmental
(unemployment, atmospheric pollution). 8
Reactions to stressful events are not necessarily harmful. Situations which cause a medium to
high level of emotional excitement increase a person’s efficiency since they rejuvenate
him/her and cause feelings of self-satisfaction, happiness, and enjoyment. When emotional
excitement (either positive or negative) reaches very high levels then a person’s ability to
perform is seriously affected, and sustenance of such high levels for prolonged periods of time
may prove to have negative effects on health. Furthermore, very low levels of emotional
excitement have similarly negative effects, too. It is correct to assume that we are more
productive when we experience intense emotional excitement which we regard as
“opportunity” or “challenge”. There is, of course, a critical point, differing from person to
person, beyond which the person’s level of productivity drops, when emotional excitement
increases a lot, and the person is left feeling counterproductive and often disorganized to a
greater or a lesser extent. The degree of disorganisation differs from person to person.

ICU NURS WEB J
ISSN 1108-7366
ISSUE 7th July-October 2001
2001 ICUs and Nursing Web Journal
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Stress is defined as the biochemical reaction of the body in its attempt to adapt to a stressful
stimulus, a threatening event or a new situation. More specifically, Selye defines stress as the
non cause-specific response of the body to any demand projected on it. Therefore, the
biological response of the body to demands for adaptation is always the same, regardless the
cause provoking it.5,6.
When we find ourselves under stressful conditions our bodily balance is disturbed. There are
internal biochemical changes taking place mobilizing us and putting us on a standby mode in
order to make us respond in some way. Nervous and endocrinous systems are directly
involved in the course of these changes.9,10.
The most widely accepted theories on stress are : “The Theory of General Adaptation
Syndrome” by Selye5,6,7 and “The Theory of Cognitive Assessment” by Lazarus.11,12,13
Hospitalisation Stress
Hospitalisation Stress Hospitalisation Stress
Hospitalisation Stress
Upon hospitalisation the patient hopes for restored health when, at the same time, he carries
the burden of the symptoms of his illness, because of which he was hospitalised in the first
place.14 Moreover, he fears for his life, his bodily integrity and real loss (separation from
family members, his everyday environment, work, everyday activities). The fear of the
unknown (the person has to trust strangers for his life), the fear of losing love and respect of
loved ones and the fear of losing control of vital bodily functions are provoked depending
upon the seriousness of his illness, duration of hospital stay and kind of treatment, whether it
be conservative or surgical.15,16,17
The patient’s reaction depends on both his individual character and the way he is treated by
the nurses, as well as environmental conditions.18,19,20 Large hospital rooms, waking up early
in the morning, lack of ways to keep the patient’s mind occupied, eating dinner in bed, noisy
environment and other patients’ presence all create an atmosphere which is very different
from normal life the individual used to lead up until then, and which leaves him feeling
alienated, with no privacy at all and making it even more difficult for him to adapt.21
Hospital treatments are not always accepted by the patient with hope and relief.22,23
Expectation of a surgical operation usually provokes fear of death, handicap or
disfigurement.
Psychological react
Psychological reactPsychological react
Psychological reactions to the physical
ions to the physical ions to the physical
ions to the physical 21
2121
21
Every disease is a threat to man. Therefore, whoever is preoccupied with the slightest hint of
disease and its possibly painful implications (involving its various tests, surgical operations,
hospitalisation time), as well as therapy phase and rehabilitation, finds himself in a state of
uncertainty.
The first reaction is anxiety about the outcome of the disease and a possible handicap. Many
times this anxiety crosses the morbid limits of stress. Intense emotional excitement and
accompanying stress disorder are often not in proportion with the gravity of the disease and

ICU NURS WEB J
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many times the patient admits to the fact that he shouldn’t have worried so much.24 The
presence of the disease and the limitations it may entail (diet, bed confinement, medications)
trigger deeper, childish fears which help keep the patient in a prolonged state of anxiety,
which is damaging to his speedy and effective recovery.25 Each individual’s perception of a
healthy and integral physical self, includes and coincides with full functionality,
performance, vigour, social prevalence, success in one’s profession, masculinity or femininity,
etc. Every event which lessens this image causes stress and diminishes self-confidence. An
abrupt change in the integral physical self (for example, a mastectomy or an amputation) can
cause a reaction of panic or an acute psychotic episode. Fear of pain, the danger of
professional failure due to severe illness, financial loss, breaking of friendly and emotional
bonds, all cause insecurity and stress. Hospitalisation can deteriorate psychic reaction of the
physically ill, if it is seen as ‘worsening, old age, a journey with no return.’
A pessimistic attitude towards a physical disease makes treatment a difficult task and involves
physical depression symptoms (headaches, anorexia, tiredness, etc.) Adoption of such an
attitude depends not only on the character of the disease and whether it is curable or not, but
also on immediacy of life-threatening danger, handicap or deformation which is associated
with it, prolonged hospitalisation, repercussions on one’s profession, etc. When there is no
timely and helpful treatment, many such ill individuals end up as hypochondriacs who are
always preoccupied with their health abandoning other important aspects of their lives.
Medical and nursing staff can largely contribute, so that no neurotic situations are developed,
by aiming at the following26 :
• detailed briefing of patients,
• having a talk with them and answering to all their questions,
• continuous presence and frequent communication with both the patient and his family
members.
However, contrary to the wide majority, for certain people a hospital constitutes a place of
refuge and hope for a permanent solution to their health problems. These individuals can
become dependent on hospitalisation and this passive behaviour is not always helpful. These
individuals do not want to be discharged from the hospital, especially when inabilities are
still present after therapy treatment (unable to sustain themselves, handicap).27 These patients
who return home often lose their friends, and their job. It is the so called ‘home-return
depression’.
RESEARCH
RESEARCHRESEARCH
RESEARCH
As it was previously mentioned, stress is an important factor of human psychism largely
affecting the outcome of possibly every disease they may contract. The degree of stress
experienced in case they are hospitalised is even greater.
The objectives
objectives objectives
objectives of this
research study are the following :

ICU NURS WEB J
ISSN 1108-7366
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1. To put down the views of patients about those factors which stress them more when
they are hospitalised.
2. To compile nurses’ points of views about stress experienced by patients due to their
hospitalisation and imminent medical and nursing interventions.
3. To compare the results, in order to check whether there are any deviations and
statistically important differences between patient and nurse views.
Measurement Instrument
Measurement InstrumentMeasurement Instrument
Measurement Instrument
An anonymous questionnaire was used as a measurement tool,28 it contained 22 questions,
21 of which are closed-type grading questions (minimum, medium, very much) and the 22nd
question is of the open-type checking possible inadequacies of the questionnaire. The
questionnaire was suitably adapted so that it could be used for both samples, i.e. nurses and
patients alike.
Research Sample
Research SampleResearch Sample
Research Sample
The research sample consisted of 100 patients and 35 nurses of a Greek hospital.
• The one hundred patients were between the ages of 15 and 83 years. Fifty-three of them
were male and 47 were female.
Their educational background was as follows :
1. No education at all (11)
2. Primary school educated (54)
3. High-school or Lyceum graduated (26)
4. Technological Institute or University graduates (7)
5. Postgraduate education (2)
According to their professional status they were categorised as follows :
1. Unemployed (8)
2. Self-employed (20)
3. Employees (13)
4. Housekeeping (18)
5. Old age pensioners (41)
Marital status of the sample is as follows :
1. Single (19)
2. Married (76)
3. Widowed (5)
4. Divorced (none)
• All 35 subjects of the second sample were all female, nurses, of technological education
without a postgraduate title. Of these, 31% are in possession of a title in professional
specialization. The age of the subjects of this sample varied between 24 and 49 years,

ICU NURS WEB J
ISSN 1108-7366
ISSUE 7th July-October 2001
2001 ICUs and Nursing Web Journal
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7
with a mean age of 34.88 years and a typical deviation of 7.7 years. The sample was
considered to be experienced since their average experience was 12.1 years with a typical
deviation of 8 years. It should be noted, that all staff shifts were covered.
Results
ResultsResults
Results
The findings show that most of the patients answered that all factors they were asked about
cause them the highest degree of stress. More specifically, the ten most important factors
which most of them answered cause them much stress are the following :
Most important factors causing
Most important factors causing Most important factors causing
Most important factors causing much
muchmuch
much
stress
stressstress
stress, according to patients
, according to patients, according to patients
, according to patients
Question
Issue
Percentage
21
Possibility of incurable disease
88%
16
Pain / Possibility of feeling pain
85%
17
Imminent surgical operation
77%
12
Lack of understanding the instructions
75%
8
Not being aware of test results
73%
9
Lack of sufficient briefing
72%
11
Questions left unanswered
68%
14
Lack of nurse time devoted to patients
67%
15
Feeling that the patient becomes a burden to nurses
64%
5
Testing procedures
59%

ICU NURS WEB J
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2001 ICUs and Nursing Web Journal
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In comparison, nurses believe that the following factors are those causing much stress to
patients :
Most important factors causing
Most important factors causing Most important factors causing
Most important factors causing much
muchmuch
much
stress
stressstress
stress, according to nurses
, according to nurses, according to nurses
, according to nurses
Question
Issue
Percentage
21
Possibility of incurable disease
100%
17
Imminent surgical operation
90.63%
8
Not being aware of test results
76.32%
11
Questions left unanswered
71.88%
9
Lack of sufficient briefing
65.71%
1
Not being able to go back to work/house
61.54%
16
Pain / Possibility of feeling pain
61.11%
5
Testing procedures
55.26%
12
Lack of understanding the instructions
54.05%
6
Lack of privacy
47.22%
Comparison of the two tables reveals converging views since eight out of ten most stressful
factors are common to both. What is striking is the fact that while, on the one hand, patients
indicated that the feeling that they may become a nuisance to nurses, and lack of time
devoted to them because of too much work, on the nurses part, cause them much stress, on
the other hand nurses didn’t believe as much and answered that lack of time devoted causes
patients medium stress (62,16%), and the feeling that they may become a nuisance to nurses
causes them minimum or medium stress, while only 11,11% believed that patients are
stressed to a high degree when they think they become annoying.
Many nurses answered that many factors cause medium stress to patients.

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Factors which cause
Factors which cause Factors which cause
Factors which cause medium
mediummedium
medium
stress
stressstress
stress to patients, according to nurses
to patients, according to nurses to patients, according to nurses
to patients, according to nurses
Question
Issue
Percentage
4
Sleeping in a different bed
76.32%
10
Questions asked by nurses concerning
gathering of information
67.44%
13
Noise in hospital
63.16%
14
Lack of nurse time devoted to patients
62.16%
20
Bad quality food
59.46%
18
Intravenous infusions or injections
55.26%
3
Sleeping in a strange environment
50%
7
Adaptation to new routine procedures
50%
2
Separation from relatives and friends
47.22%
19
Using a chamber pot
43.24%
On respective questions, most of the patients answered that respective factors cause them a
lot of stress. This difference in views, which may mean that nurses underestimated the degree
of stress experienced by patients, is of importance and it constitutes a point in which
psychiatry can intervene within the frame of liaison relationships, in the form of a series of
educational sessions for nurses, so that they can perceive correctly the degree of stress
experienced by patients and implement various methods to reduce it.
Stress-causing factors about which the patients and nurses were asked fall into four categories
:
1.
1.1.
1.
Factors relating to environment and change of way of life
Factors relating to environment and change of way of lifeFactors relating to environment and change of way of life
Factors relating to environment and change of way of life
These include keeping the patient away from home, work, relatives or friends and, generally
speaking, every other sudden change in normal everyday life of the patient.
It is noted that this group does not contain very strong factors since six out of eight of these
factors were assessed by the nurses as medium and percentage figures of patients who
classified them as high are lower compared to those concerning all the remaining factors.

ICU NURS WEB J
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Factors relating to environment and change of way of life
Factors relating to environment and change of way of lifeFactors relating to environment and change of way of life
Factors relating to environment and change of way of life
Question
Issue
Percentage of
patients
(%)
Percentage of
nurses
(%)
4
Sleeping on a different bed
44 (H)
76.32 (Μ)
13
Noise at hospital
40 (H)
63.16 (Μ)
20
Bad quality food
46 (H)
59.46 (Μ)
3
Sleeping in a strange environment
48 (H)
50.00 (Μ)
7
Adaptation to new routine procedures
51 (H)
50.00 (Μ)
2
Separation from relatives and friends
48 (H)
47.22 (Μ)
1
Keeping away from work/house
48 (H)
61.54 (H)
6
Lack of privacy
54 (H)
47.22 (H)
Where H
H H
H : High degree of stress
M
MM
M
: Medium stress
L
L L
L : Low stress

ICU NURS WEB J
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2.
2.2.
2.
Factors relating to ignorance and outcome of patient condition
Factors relating to ignorance and outcome of patient conditionFactors relating to ignorance and outcome of patient condition
Factors relating to ignorance and outcome of patient condition
This group consists of four very strong stress-causing factors. It also includes the most
stressful factor of all in both groups, namely the possibility of an incurable disease.
Factors relating to ignorance and outcome of patient condition
Factors relating to ignorance and outcome of patient conditionFactors relating to ignorance and outcome of patient condition
Factors relating to ignorance and outcome of patient condition
Question
Issue
Percentage of
patients
(%)
Percentage of
nurses
(%)
8
Unaware of test results
73 (H)
76,32 (H)
9
Lack of briefing
72 (H)
65,71 (H)
11
Questions left unanswered
68 (H)
71,88 (H)
21
Possibility of incurable disease
88 (H)
100,00 (H)
Where H
H H
H : High degree of stress
M
MM
M
: Medium stress
L
L L
L : Low stress
At this point, the role of nurses and all other members of the medical staff is a decisive one,
since they can reduce the patients’ degree of stress experienced due to ignorance, by properly
informing them about their condition, course and development of their disease.

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3.
3.3.
3.
Factors relating to hospitalisation procedure
Factors relating to hospitalisation procedureFactors relating to hospitalisation procedure
Factors relating to hospitalisation procedure
The whole of hospitalisation procedure is in part a very stressful factor in the same way a
surgical operation, pain and various tests can be. On the contrary, the use of a chamber pot,
intravenous infusions and injections by nursing staff are not considered to be stressful causes.
Factors relating to hospitalisation procedure
Factors relating to hospitalisation procedureFactors relating to hospitalisation procedure
Factors relating to hospitalisation procedure
Question
Issue
Percentage
of patients
(%)
Percentage
of nurses
(%)
5
Testing procedures
59 (H)
55,26 (H)
17
Surgical operation
77 (H)
90,63 (H)
16
Feeling of pain
85 (H)
61,11 (H)
18
Intravenous infusions or injections
52 (H)
55,26 (Μ)
19
Using a chamber pot
54 (H)
43,24 (Μ)
Where H
H H
H : High degree of stress
M
MM
M
: Medium stress
L
L L
L : Low stress
3.
3.3.
3.
Factors concerning nurse
Factors concerning nurseFactors concerning nurse
Factors concerning nurse-
--
-patient relationships
patient relationshipspatient relationships
patient relationships
Nursing staff-patient relationships are not considered to be very powerful stressful factors by
the nursing staff, except in the case when patients do not understand the instructions given
to them. On the contrary, patients consider them stressful factors, since a high percentage
figure answered that two other causes, besides lack of understanding of instructions, causing
them a lot of stress was lack of nurse time devoted and the feeling they may become a
nuisance.
A better level of communication between nurses and patients would result in elimination of
such differences in views and improvement of relationships so that they would not be a
stressful cause for the patients.

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Factors concerning nurse
Factors concerning nurseFactors concerning nurse
Factors concerning nurse-
--
-patient relationships
patient relationshipspatient relationships
patient relationships
Question
Issue
Percentage
of patients
(%)
Percentage
of nurses
(%)
10
Questions asked by nurses concerning gathering of
information
48 (H)
67,44 (Μ)
12
Lack of understanding the instructions
75 (H)
54,05 (H)
14
Lack of nurse time devoted to patients
67 (H)
62,16 (Μ)
15
Feeling that the patient becomes a burden to nurses
64 (H)
44,44(L,Μ)
Where H
H H
H : High degree of stress
•
• •
• : Medium stress
L
L L
L : Low stress
Conclusion
Conclusion Conclusion
Conclusion –
––
– Discussion of results
Discussion of results Discussion of results
Discussion of results
It is obvious from the analysis of the findings that patients experience a high degree of stress
upon hospitalisation and factors which cause them more stress have to do with not knowing
enough about their condition, unanswered questions, the outcome of their disease and lack
of briefing. What is surprising is the fact that nursing staff are aware that these are the most
aggravating factors, and at the same time they take no steps towards their elimination. This is
largely due to the fact that according to the doctor-central health model used in this country,
it is believed that the treating doctor is the most suitable person responsible to inform the
patient about his condition, with the result that most nurses do not even consider taking up
patient briefing and handling stressful situations he/she may experience.
Every day nurses come into contact with patients and it is they, among all health
professionals, who remain at their side most of the time due to the nature of their profession.
They can, therefore, help to effectively handle stress experienced by patients within the
hospital area, provided of course that they are properly trained to do so. The most important
qualifications they must possess are the following29 :
• To have enough time to listen to the patient,
• To discuss the patient’s problem with him/her, in all honesty,
• To be available at any time the patient seeks their help,

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• To behave naturally, with no pretence or coldness.
• To protect the patient’s dignity during physical examination, hospital stay, and
treatment,
• To show love and concern for the patient’s condition,
• To be objective, accept the patient in a condescending way and not criticize his/her
behaviour,
• To be kind,
• To inspire trust, by showing consistency, determination and discretion.
Nurses and patients need to share their energy and resources, and devote themselves to the
common cause, i.e. treatment. Together, they can handle issues relating to what the disease
means to the patient and his immediate family, and they can work towards the patient’s self-
awareness and self-development.30 Let’s not forget, however, that patients are consumers of
healthcare services, and as such they are entitled to31 :
• Expect a systematic and accurate investigation of all health relating matters which keep
them preoccupied, by nurses and other medical staff who are thorough and well-
organised in their work.
• Be informed about the condition of their health and ask that all their questions be
answered, in such a way so that they fully understand the information given to them.
• Receive healthcare by medical and nursing staff who are aware of the diagnosis and able
to provide safe and effective care.
• Be sure that they will receive kind treatment and genuine concern for their condition.
• Ask that all matters of personal confidentiality be respected.
• Be briefed about any suggested course of action.
• Retain the right to agree and disagree with nursing treatment without compromising
their relationship with the nursing staff.
• Receive help as soon as possible without any trouble or delays.
• Receive medical and nursing care of the highest level.
Proper use of liaison relationships between a patient and all health professionals working in
the hospital and are involved with psychological health (psychologists, psychiatrists,
psychiatric nurses, social workers) can play an important role in dealing with stress
experienced by hospitalized patients.
By the term ‘liaison’ we mean all those educational and advisory interventions of the
psychological health professional in a non-psychiatric environment in order to ensure the
promotion of all psycho-social parameters of patient care, proper staff training, and
improvement of relationships between staff members and patients and among staff members
themselves.3
This liaison function as far as psychological health is concerned can be achieved by three
methods :

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• direct psychological care provision to the physically ill by members of the group for
psychological health.
• training and support of the rest of the medical and nursing staff in the provision of
psychological care to patients and in stress handling.
• research in order to gain a better understanding of psychosomatic disease, stress caused
by physical diseases, and the effectiveness of a special councilor as far as reduction of
stress in patients and staff alike is concerned.
LITERATURE
1. Wilson-Barnett J. (1979) : Stress in hospitalisation: Patients Psychological Reaction
to illness and Health care. Churcill - Livingstone, Edinburg.
2. Carr J.A. and Powers M.J. (1986): Stressors in associated with coronary bypass
surgery. Nursing Research 35(4), 243-246.
3. Raya A. (1993): Mental Health Nursing - Psychiatric Nursing. Greece.
4. Carrieni V. - Lindsey.(1989): Pathophysiological Phenomena in Nursing. C. West.
5. Selye H. (1965): Stress Syndrome. Am J. Nurs 65(3): 97-99.
6. Selye H. (1978): The stress of life. 2nd ed. New York : Mc Gray - Hill.
7. Papadatou Danae (1989): Introduction to Psychology-Educational Notes. Zsta
Publications.
8. Murray RB., HuelskoetterMM. (1983): Psychiatric mental health nursing - Giving
emotional care. Englewwod Gliffs, N.J.
9. Hatziminas Ι. (1979): Abridged Physiology. Parisianos Publications. Athens.
10. Kuber - Rosse. (1974) : Interviews mit Sterbenden. Edit : Kernuz, Berlin.
11. Lazarus RS. (1966): Psychological stress and coping process. Edit: Hill Book, N.Y.
12. Lazarus RS - Launier R.(1978): Stress related transaction between person and
environment. Edit : Mc Graw - Hill Book, N.Y.

ICU NURS WEB J
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16
13. Lazarus RS. - Chonenf .(1983): Coping and adaptation in health and illness. Edit :
Free Press N.Y.
14. Luban Boris - Ploza, Walter Polbinger, Frieder K. Roger, Kurt Laberch - Hofman.
(1997): The psychosomatic patient in every day medical practice. Parisianos
Publications. Athens.
15. Hanson Peter, G. (1985) : The joy of stress. Ontario : Hanson Stress Manag. Organ.
16. Peplau H. (1968): A working definition of anxiety. In : Burd SF, Marshall MA eds.
Some clinical approaches to psychiatric nursing. New York : Macmillan.
17. Αlevizos Β. : Stressful Disorders and Physical Diseases.
18. Freud Sigmund (1977) : Anew series of traditions for an introduction to
psychoanalysis. Translated by : Claire Trikalioti. Epicouros Publications. Athens.
19. Freud Sigmund (1979): Studies on Psychoanalysis. Translated by : George
Tampourakis. Epicouros Publications. Athens.
20. Freud Anna (1966): Ego and Defence Mechanisms. Translated by : Theodore
Paradellis. 1978 Kastaniotis Publications. Athens.
21. Ierodiakonou Χ., Fotiades Χ., Dimitriou Ε. : Psychological problems in Physical
Diseases.
22. Manos Ν. (1988) : Fundamental Elements of Clinical Psychiatry. Thessaloniki.
University Studio Press.
23. Logothetis Ι. (1981) : Introduction to Psychiatry. 2nd edition. Thessaloniki.
24. Lango D.(1978) : Communications and human behaviour . In: Longo D.,Williams R.
eds. Clinical practice in psychosocial nursing : Assessment and intervention. New
York : Appleton - Century - Groffts.
25. Shontz F. (1975) : The psychological aspects of physical illness and disability. New
York : Macmillan.
26. Κalantzi - Αzizi Αnastasia. Applied clinical psychology in health.
27. Speileberg Charles (1980) : Stress and Anxiety. Psychogios Publications. Athens.
28. Biley F.C. (1989) : Nurses' perception of stress in preoperative surgical patients.
Journal of Advanced Nursing 14, 575-581.
29. Αthenaiou D., Μπακόλη Ι. (1999): Development of psychiatry and of psychiatric

ICU NURS WEB J
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nurse in the psychiatric hospital of Corfu. Records of the 26th Panhellenic Nursing
Conference.
30. Papathanasiou Ι., Kotrotsiou Ε. (1999) : Communication in nursing procedures. A
challenge for the nursing care of the future. Records of the 26th Panhellenic Nursing
Conference.
31. Κotrotsiou Ε. (2000) : Educational Notes for use in class in the subject of ‘Nursing
A1-Fundamental Nursing’. Larissa.