Research in Nursing
The Effect of Stress on the Cardiovascular System in Nurses
By Vanessa Barreto
Introduction
The leading cause of mortality in the United States is heart disease. About 697,000 people in the United States died from heart disease in 2020, that’s one in every five deaths (Centers for Disease Control and Prevention (CDC), 2022). Stress, among other factors, contribute to the risk of the development of heart disease. Due to their occupation, nurses are exposed to high levels of stress. The purpose of this study is to identify if there is a relationship between stress in nurses and their susceptibility to heart disease.
Portrait of Vanessa Barreto at work
Nurses experience stress due to multiple occupational related factors which can increase their risk for chronic health problems such as cardiovascular diseases (Saberinia, 2020). Nursing is associated with high job demands and needs as well as high expectations and responsibilities (Babapour et al., 2022). According to Starc (2018), high frequency of patients, understaffing, and long working hours contribute to increased levels of stress in nurses.
A study conducted by Juneau (2019) showed that job strain and long working hours contribute to about 13% increased risk of heart disease and 33% increased risk of stroke. Long working hours can increase stress levels which is a major risk factor for cardiovascular disease (Juneau, 2019). Juneau (2019) also concluded that work overload is another factor contributing to an increased risk of cardiovascular disease. Long hours, work overload, and shift work associated with the nursing practice can be stressful and contribute to an elevated risk of developing heart disease (Sarafis, 2016). These occupational factors are important to recognize because increased stress can lead to burnout. There are multiple studies in the literature that assess the impact of stress on the development of heart disease. However, there is little research linking stress in nurses with incidence of heart disease, which is why this research study is important.
Methods
This is a cross-sectional correlational study which gathered data on the relationship between stress and susceptibility to heart disease among nurses in the United States. The research protocol involved an online survey using Qualtrics Survey Software. Participants were selected using snowball sampling. Participants who responded to requests on Facebook and LinkedIn were asked to share the survey link with other nurses per snowball sampling. Data was collected from 587 registered nurses. Inclusion criteria were nurses who have at least one year of recent (within the last 12 months) of patient care experience and whose place of work is located within the United States. Exclusion criteria were new nurses with less than one year experience and any profession that was not in nursing. The sample was registered nurses specifically because nursing is a high-risk occupation that involves exposure to stress. Data collected included demographic information. Measures included The Perceived Stress Scale (PSS) and questions regarding the common environmental factors that contribute to stress in nurses.
The Perceived Stress Scale (PSS) measured levels of stress amongst nurses. Using Cronbach’s coefficient alpha, the reliability of the PSS is 0.78 (Lee, 2012). The validity of the PSS has been confirmed across multiple studies (Baik et at., 2017). The Perceived Stress Scale was created by Cohen, Kamarck, and Mermelstein (1983) and is a widely used tool in measuring the perception of stress. The questionnaire consists of ten questions that ask about feelings and thoughts during the last month that correspond with stress. Participants were asked to indicate how often they felt or thought a certain way on a Likert scale of 0=never to 4=very often. Scores ranging 0-13 would be considered low perceived stress, scores 14-26 would be considered moderate perceived stress, and scores 27-40 would be considered high perceived stress. The higher the score, the higher the perceived stress experienced by the participant. The PSS was used twice in the questionnaire. One scale measured stress at home, while the other scale measured stress at work. The PSS scale was adapted to measure work related stress.
Information on environmental stress factors was collected using a researcher designed tool. The questions were developed after a literature review of environmental factors that contribute to stress in nurses. The questionnaire asked questions regarding hours worked per week, how many patients cared for during one shift, if staffing was a factor contributing to stress levels, and if participants worked overtime. These are all environmental factors that can contribute to increased stress levels in nurses.
Data was analyzed using the IBM Statistics Package for Social Scientists (SPSS) version 2021 software. Descriptive statistics were computed for each variable. A Pearson correlation coefficient analysis was used to identify the relationship between variables.
Results
This study examined the possible relationship between increased stress in nurses and their susceptibility to heart disease. The total number of responses to the survey was 677 participants. The respondents with missing data were removed from the analysis which resulted in a total of 587 participants in the final analysis.
The majority of participants identified as female between the ages of 20 to 30 and were primarily white. Most participants resided in the northeast, southwest, and the west. Additionally, most participants identified their religion as Christianity. The majority of participants either had 1-5 years of work experience or 5-10 years of work experience and worked in an acute facility. Most participants worked 36 to 48 hours per week and worked 8 hours per shift. Additionally, 74.7% of participants believed that staffing is a factor contributing to their increased stress levels at work.
There was a weak positive correlation between increased levels of stress and incidence of cardiovascular disease, including a diagnosis of hypertension. Increased levels of stress and a diagnosis of hyperlipidemia showed a weak negative correlation. Additionally, there was a weak positive correlation between increased levels of stress and hours worked per week. Increased levels of stress and the amount of overtime worked showed a weak negative correlation. The correlations from the variables in the study remained the same whether it was stress at work or stress at home.
Discussion
The data analysis showed statistically significant correlations between increased levels of stress and incidence of cardiovascular disease, including hypertension. Since the results showed that there is a statistically significant positive correlation between the variables; stress and incidence of heart disease, including hypertension, it can be hypothesized that when there is an increased amount of stress, the incidence of heart disease and the diagnosis of hypertension also increase. Current literature reinforces this correlation.
The positive correlations between stress, heart disease, and hypertension suggest that nurses are affected by increased stress levels. The data also suggests that work hours are a contributing factor to stress levels in nurses as there was a positive correlation between increased levels of stress and hours worked per week. Increased stress levels place nurses at a higher risk of developing heart disease, including hypertension. The data collected in this study adds to previous research on the effects of stress in the development of heart conditions and fills a gap by addressing this issue in the nursing population. The data acquired may increase awareness of how stress can increase the susceptibility of heart disease in nurses and can lead to prevention interventions specific to the nursing population. Further studies should be done to understand what other factors are causing negative correlations between increased levels of stress and a diagnosis of hyperlipidemia. Additionally, more research is needed to examine factors causing negative correlations between increased levels of stress and the amount of overtime worked.
References
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Centers for Disease Control and Prevention. (2022, October 14). Heart Disease Facts. Centers for Disease Control and Prevention. Retrieved December 13, 2022, from https://www.cdc.gov/
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). Perceived Stress Scale [Database record]. APA PsycTests. https://doi.org/10.
Juneau, M. (2019, May 6). Overwork can increase the risk of cardiovascular disease. Prevention Watch. Retrieved December 15, 2022, from https://
Lee, E.-H. (2012, September 18). Review of the Psychometric Evidence of the Perceived Stress Scale. ScienceDirect. Retrieved December 14, 2022, from https://www.sciencedirect.com/
Saberinia, A., Abdolshahi, A., Khaleghi, S., Moradi, Y., Jafarizadeh, H., Sadeghi Moghaddam, A., Aminizadeh, M., Raei, M., Khammar, A., & Poursadeqian, M. (2020). Investigation of Relationship between Occupational Stress and Cardiovascular Risk Factors among Nurses. Iranian journal of public health, 49(10), 1954–1958. https://doi.org/10.
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Starc J. (2018). Stress Factors among Nurses at the Primary and Secondary Level of Public Sector Health Care: The Case of Slovenia. Open access Macedonian journal of medical sciences, 6(2), 416–422. https://doi.org/10.3889/