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Volume 2, 2017, Issue 1, Pages 6-9; Paper doi: 10.15412/J.JCC.02020102; Paper ID: 20018.
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Patients’ Perception of Stressors in Medical-Surgical Units
(Research Paper)
  • 1 Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
  • Correspondence should be addressed to Zohreh Kalani, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Tel: ; Fax: ; Email:


Studies have shown that hospitals and its settings are effective factors for inducing worry, anxiety and stress in patients. Stress, affects patient's ability to fight disease and reduces the therapeutic efficacy. Studies have shown that nurse judgment of stressors often is different with the patient's perception of stress and stressors. This descriptive study was conducted at two general hospitals in Yazd city (Iran) to find out the perception of stress among hospitalized patients. Two hundred sixty patients hospitalized in medical-surgical units were selected; a hospital stress rating scale questionnaire with 45 potentially stressful situations was used. The questionnaires were filled through interview. Data were analyzed using descriptive statistics. The most frequently perceived stressful hospital experiences were “exertion in unusual conditions” and “lack of ensures the diagnosis and treatment” (respectively 2.71  1.31 and 2.69  1.47). Paying attention to these findings helps clinical nurses and other health care team to enable predicts stressors, plan interventions and modify the nursing care provided.


Hospital stressor, Patient, Medical-surgical units, Nursing


tress is a mental and physical strain due to threats, danger, life changes and everyday challenges (1). The hospital environment is unknown, unfamiliar and stressful for many patients. In this setting, patients are confronted with the tools and equipment that seem threatening, unfamiliar faces, suffering and sometimes dying patients (2). Medinas-Amorós et al. suggested the physical and social configuration of hospitals implies the possibility of introducing inpatients to adverse psychological effects. These effects have been described and analyzed by different authors over the past few years (1). The process of hospitalization, treatment, complex medical care and surgical interventions cause stress, anxiety and worrying times for patients. Hospital treatment and stress can affect patients' recovery and in some cases potentially causes life-threatening physiological changes (3). Stressful conditions may trigger an inflammatory response in the brain and other systems. This response can cause different symptoms that depend on the intensity and quality of stressors (4). It is certain that the response to stress depends on the importance, severity and duration of stressful factors. If the number and intensity of these factors increase, physical and mental balance is disturbed and illness may develop (5). Surely, the stress has adverse effects on the patient's ability to cope with illness and the recovery process. Volicer study (1979) showed that there was a relation between pains reported by patient with stress-related hospitalization. The patients with high stress, had have more pain and worse physical status during staying in hospital and less recovery after discharge, compared with other patients (6). Unfortunately, majority of hospitals and their staffs consider the patients’ problems as a normal issues and because of familiarity with the environment, don’t understand that the hospital is a horrible place for people who are hospitalized (2). Studies have shown the nurse’s judgment about stressors is not correct and different with patient’s understood about stress and stressors (3, 7). Nurses do not understand patients’ grief, anxiety and stress as it really is, and there are big differences between their perceived stress levels caused by various factors with patients' perceptions (3). Meissner suggested that in order to give good nursing care, we must accurately assess our patients (9). The content of the nursing interventions are often based on nurses’ perceptions of patients’ concerns and priorities rather than on the patients’ own perceptions. The two perspectives, patients’ and nurses’, differ in both magnitude and type (10). Identification of the most important stressors for hospitalized patients is important for nurses because it helps them prioritize and develop appropriate and effective interventions. Thus, this study designed to determine the stressors in medical-surgical units for patients.


This descriptive cross-sectional study was developed at the medical-surgical units of two general hospital of Yazd. The sample size detected 260 patients using the formula, consisted of individuals from both genders, aged over 18 years, conscious, with lengths of stay in the hospital between 2 and 10 days, and who agreed to sign the informed consent form. Patients who were unable to effectively communicate verbally and those who did not want to or could not properly answer the questions on the questionnaire were excluded from the study. Was carefully to patients at the time of data collection, with respect to time, place, and people are fully conscious and are not in severe pain. In a literature review the researchers developed the tool guided by Hospital Stress Rating Scale developed by Volicer, that used in several studies (1, 6). The severity of 45 stressors was examined as a rating variable in five degrees. The patients were asked to rate each over a scale of 5 points from 0 to 4 (0 not at all and 4 very stressful). The mean score of each factor was calculated by the following formula. Total of the number of stressors with a score zero multiplied by zero and the number of stressors with a score one multiplied by one and so on, divided by the number of patients who have rated that factor. Ethics committee of Shahid Sadoughi University of Medical Sciences approved this study protocol.


The majority of patients were male (62.6%), illiterate or at primary school level (65.1%), and married (83.5%). Distribution of patients was similar in age groups (Table 1 ).

Table 1. Distribution of Patients by Characteristics

The highest-ranking stressors in all patients were as follows “lack of ensures the diagnosis and treatment” and “exertion in unusual conditions” (respectively 2.71  1.31 and 2.69  1.47). The mean of scores in all stressors has shown in Table 2.

Table 2. Mean (SD) of Perceived Stressors by Patients

As shown in this table, these two factors were more stressful in men (2.62  1.33 and 2.63  1.47). Although, in women, the highest-ranking stressors was “Insufficient cover in front of others” (3.06  1.21), and in the next step was “lack of ensures the diagnosis and treatment” (2.85  1.27). Perceptions of responses to stress of each person are structured by his or her culture, family, genetic inheritance and life experiences (1). Results of our study in Yazd showed that in medical–surgical units, the mean score of 16 stressors are above of 2, that indicates more than a third of stressors are higher than average. The mean of intensity of stressors in women compared to men were higher. Volicer and Burns also shown the women perception of stressors is higher than men in surgical units (14). Our study also showed the “lack of confidence about the diagnosis and treatment” is one of the two stressors with the highest mean rate in all patients and also men and women separately. This factor, as well as in each age group was one of the most important factors. Our analysis confirms that, the less stress factors were related to environmental factors (for example hospitalization in a room with strangers and warmer or colder than desired, unpleasant odors in the environment and hospital equipment). However, in Medinas-Amorós et al. study in chronic obstructive pulmonary disease (COPD) patients, these items were the most powerful stress factors (1). Stress caused by the uncertainty of the diagnosis and the correct patient treatment options, puts the communication with patients on the agenda and the priority, once again. The factors related to relationship with patients and their information such as lack of information about disease, diagnosis and treatment were the highest stressful factors in our study (factors no. 41-45 shown in Table 2. Yasodha and Veeralakshmi also suggested that 47% of the hospitalized patients experienced stress due to lack of information regarding hospital (15).


This study with identifying more stressful experiences for the patient during hospitalization may help nurses to improve nursing cares. In the hospital set up, nurses should help the patients to reduce the stress with clarifying the doubts regarding their condition or anything that will remove the stress. Also according to the results, the importance of communication with patients, as an aspect of all health care workers, especially nurses, are emphasized.

Not mentioned any funding/ support by authors.


Thanks to the patients who have participated in this study and Shahid Sadoughi University of medical sciences for financial Support.


Not applicable.


The author (s) declared no potential conflicts of interests with respect to the authorship and/or publication of this paper.


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Paper Title: Patients’ Perception of Stressors in Medical-Surgical Units
Paper Details: Volume 2, Issue 1, Pages: 6-9
Paper doi:10.15412/J.JCC.02020102
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Copyright © 2018 Zohreh Kalani et al. This is an open access paper distributed under the Creative Commons Attribution License.
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