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ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.

1110sup201725

Freitas FMB de, Vannuchi MTO, Haddad MCL et al. Hardiness and occupational stress in nurses...

ORIGINAL ARTICLE
HARDINESS AND OCCUPATIONAL STRESS IN NURSES MANAGERS OF HOSPITAL
INSTITUTIONS
HARDINESS E ESTRESSE OCUPACIONAL EM ENFERMEIROS GESTORES DE INSTITUIÇÕES
HOSPITALARES
HARDINESS Y ESTRÉS OCUPACIONAL EN ENFERMEROS GESTORES DE INSTITUCIONES
HOSPITALARIAS
Franciely Midori Bueno de Freitas 1, Marli Terezinha Oliveira Vannuchi 2, Maria do Carmo Lourenço Haddad3,
Larissa Gutierrez de Carvalho Silva4, Mariana Angela Rossaneis5
ABSTRACT
Objective: to determine the presence of Hardiness in nurses managers of hospital institutions. Method: a
cross-sectional, quantitative study carried out in five hospitals, three public, one private and one
philanthropic, that provide care, of medium and high complexity, in Southern Brazil. The study population
comprised 62 nurses who held positions of head of service or area coordinators. Two instruments were used to
evaluate occupational stress and the Hardiness Scale. Results: it was identified that 56% of the nurse
managers reported stress in their activities and that 40% of the participants were considered to have a stress
resistant personality (Hardiness). There was an inverse correlation between Hardiness and Stress, since as the
Hardiness increases, the stress decreased. Conclusion: Managing requires a high level of demand and the
development of strategies to combat stress resulting from the responsibilities inherent to managerial
positions. Descriptors: Stress, Psychological; Nursing, Supervisory; Burnout, Professional; Occupational
Health.
RESUMO
Objetivo: determinar a presença de Hardiness em enfermeiros gestores de instituições hospitalares. Método:
estudo quantitativo, transversal, realizado em cinco hospitais, três públicos, um privado e um filantrópico,
que prestam atendimento, de média e alta complexidade, no Sul do Brasil. Fizeram parte da população de
estudo 62 enfermeiros que ocupavam cargos de chefia de serviço ou eram coordenadores de áreas. Foram
utilizados dois instrumentos para avaliar o estresse ocupacional e a Escala de Hardiness. Resultado:
identificou-se que 56% dos enfermeiros gestores referiram estresse em suas atividades e que 40% dos
participantes foram considerados com personalidade resistente ao estresse (Hardiness). Verificou-se uma
correlação inversa entre o Hardiness e o estresse, uma vez que na medida em que o Hardiness aumentou, o
estresse diminuiu. Conclusão: gerenciar requer um elevado nível de exigência e o desenvolvimento de
estratégias para combater o estresse resultantes das responsabilidades inerentes aos cargos gerenciais.
Descritores: Estresse Psicológico; Supervisão de Enfermagem; Esgotamento Profissional; Saúde do
Trabalhador.
RESUMEN
Objetivo: determinar la presencia de Hardiness en enfermeros gestores de instituciones hospitalarias.
Método: estudio cuantitativo, transversal, realizado en cinco hospitales, tres públicos, uno privado y un
filantrópico, que prestan atención, de media y alta complejidad, en el Sur de Brasil. Se realizaron parte de la
población de estudio 62 enfermeros que ocupaban cargos de dirección de servicio o eran coordinadores de
áreas. Se utilizaron dos instrumentos para evaluar el estrés ocupacional y la Escala de Hardiness. Resultado:
se identificó que 56% de los enfermeros gestores refirieron estrés en sus actividades y que el 40% de los
participantes fueron considerados con personalidad resistente al estrés (Hardiness). Se verificó una
correlación inversa entre el Hardiness y el estrés, ya que en la medida en que el Hardiness aumentó el estrés
disminuyó. Conclusión: administrar requiere un alto nivel de exigencia y el desarrollo de estrategias para
combatir el estrés resultante de las responsabilidades inherentes a los cargos gerenciales. Descriptores:
Estrés Psicológico; Supervisión de Enfermería; Agotamiento Profesional; Salud Laboral.
1
Nurse, Master Student in Nursing, Graduate Program in Nursing, State University of Londrina / UEL. Londrina (PR), Brazil. E-mail:
franmidori@hotmail.com; 2Nurse, PhD, Professor, Department of Nursing, State University of Londrina / UEL. Londrina (PR), Brazil. E-
mail: vannuchi@sercomtel.com.br; 3Nurse, PhD, Professor, Department of Nursing, State University of Londrina / UEL. Londrina (PR),
Brazil. E-mail: carmohaddad@gmail.com; 4Nurse, Doctorate student in Nursing, School of Nursing, Ribeirão Preto / USP. Ribeirão Preto
(SP), Brazil. E-mail: larissagutierrez@yahoo.com.br; 5Nurse. PhD, Professor, Department of Nursing, State University of Londrina / UEL.
Londrina (PR), Brazil. E-mail: marianarossaneis@gmail.com

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ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201725

Freitas FMB de, Vannuchi MTO, Haddad MCL et al. Hardiness and occupational stress in nurses...

INTRODUCTION interesting for personal growth and not a


threat to safety. 8-9
Currently, psychological stress is one of the The interactions of the three
most studied variables due to its characteristics indicate that Hardiness has
consequences both physically and interventions in the preservation of health,
psychologically and it is a nonspecific reaction functioning as a resistance resource to protect
of the body to any demand, internal or individuals from stressors and is a possibility
external.1 Depending on the level of stress, it of coping with stress in the work of the nurse.
can be considered as positive for the Thus, the individual with the hardy
organism, resulting in reactions that lead the personality presents a more optimistic, valued
individual to move, to get enthusiastic, and improved attitude, which can increase
offering the best in himself for they work. satisfaction with work and profession, as well
However, if there is a level of stress that is as decrease health problems due to stress.7
beyond the control of the individual, they may The aim of this study, was to provide
present adverse reactions to his organism and information on the presence of hardiness, in
compromising their work.2 nurse managers, and, thus, contribute to the
Nursing professionals represent the largest identification of the weaknesses in these
contingent of human resources in hospital nurses in the face of stressful situations and
institutions, being the center of their work the search for coping strategies used to
the care of the human being. It is developed optimize the work process. Through the
through a close connection between the above, the purpose of this study, was to
patient / user and the worker, who determine the presence of Hardiness in nurse
experiences direct and uninterrupted pain, managers of hospital institutions.
death, suffering and many other feelings and
reactions triggered by the disease process, METHOD
which can lead to stress.3-4
A quantitative cross-sectional study in five
Occupational stress is one of the main hospitals located in a municipality of the State
difficulties faced by workers and a managerial of Paraná, Brazil. Three are public, one
challenge for the institutions. Its concept is private and one philanthropic, and they
related to a reaction that the individual may provide care of medium and high complexity.
have to the demands and pressures at work
The study population comprised 62 nurses
that do not fit his knowledge and abilities,
who held positions of head of service or
and which tests his ability to face the
coordinators of areas, called supervisors,
situation. The negative impacts of stress are
managers or directors. Nurses with at least,
manifold and can include physical,
one year of work in the management function
psychosomatic and psychosocial problems that
were included in the survey, and professionals
can lead to work accidents and low
who were on leave or leave were excluded.
productivity.5-6
They were considered as losses when they
To minimize occupational stress and its were not found after three search attempts,
influences on the health of the professional, or, still, those that refused to participate in
as well as all negative repercussions for the the study.
organization, some strategies are used. Among
Data were collected in 2014, through the
them, is the identification of the Stress-
application of two instruments. The first
Resistant Personality - Hardiness.7
questionnaire was about occupational stress
The Hardiness would be the finding that and was created in France by Professor
some individuals develop a resistance in Benjamin Stora of the HEC-ISA Center, who
relation to experienced stressors events. authorized replication in Brazil.2 The other
These characteristics would be derived from questionnaire was about the Hardiness Scale,
three components: commitment, control and a validated instrument for the Portuguese
challenge.8-9 language and for the use in nurses.7
Commitment is expressed by the ability to The first instrument has two parts, the
engage with what is done or what is relevant initial one seeks the socio-demographic and
to you, identifying the events, things and occupational data, and the second part, refer
people that are meaningful to you within your to data on occupational stress, subdivided into
environment. Control, however, refers to the three blocks. Block I has 49 questions
tendency to act and feel as if it were not regarding sources of stress. Block II contains
influenced by the contingents of life. The 35 statements related to stress symptoms.
challenge comprises a conviction, a belief that
In order to classify the subjects of the
instability is a normal occurrence in the
research as stressed or not in relation to the
individual's life, but that changes are
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ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201725

Freitas FMB de, Vannuchi MTO, Haddad MCL et al. Hardiness and occupational stress in nurses...

questions of blocks I and II, the average of the With respect to graduate studies, 7% had a
questionnaire was calculated, and, after that, doctorate degree, 14%, master's degree and
of each of the participants. It was considered 77%, specialization. Only one person did not
stressed what was equal to or above the perform any graduate studies. Of the
average, and as not stressed those who were specializations, 15% were focused on health
below average. management.
Block III is composed of questions regarding Regarding the employment bond issue, it
working conditions and was analyzed by was highlighted that 63% of the statutory,
means of simple frequency. The Hardiness 14%, of contractors and 23% had other types
Scale is a self-report instrument that features of ties. The statutory employment relationship
30 Likert-type items with affirmations about was the one that had the largest number of
life, and the interviewee should mark how he participants due to the participation of three
feels about each. Their score ranges from zero public hospitals in the research. Of the 44% of
(nothing true) to three (completely true). The nurses who were stressed according to the
result of the Hardiness Scale is obtained by sources of stress, 74% were statutory. When
summing the items, having the scores of items linking stress and double employment, only
three, four, five, six, eight, 13, 16, 18, 19, 20, two of the five who worked in two jobs were
22, 23, 25, 28 and 30 inverted to then, be stressed. In relation to the time of work in the
added, allowing for the result for total position, there was predominance of up to
composition of the scale and by three two years, with 37% of the individuals. From
domains, as follows: Commitment (one, six, two to four years, 19%; four to eight years,
seven, 11, 16, 17, 22, 27, 28 and 30), Control 23%; eight to 12 years, 7%; and over 12 years
(two, two, three, three, eight, nine, 12, 15, were found 14% of those studied.
18, 20, 25 and 29) and Challenge (four, five, As for the working time in the institution,
ten, 13, 14, 19, 21, 23, 24 and 26). Scale 25% were identified in the institution for more
scores can range from zero to 90 for the full than 20 years and 14% in less than two years.
scale composition; and for domains between Regarding work shifts, 60% worked full
zero and 30. time; 19%, at night; 16%, in the morning;
The hardy individual was the one who 2.5%, in the evening and 2.5% in rotation
obtained a high score in the sum total of the between schedules. Nursing managers who
three domains, or at least two of them. The had another employment relationship
mean value above 20 points for each subscale corresponded to 12% of respondents.
(commitment, control and challenge) was Of the participants, 58% did not have this
considered for this study and as hardy the job as the main source of family income.
individual who obtained the value in two or When questioned if they had leisure, 72%
more of these subscales. answered affirmatively, being leisure with the
To verify if there was a relationship of family the most cited. When questioned if
Hardiness to stress, the Correlation they perceived stress in their work, 56% of
Coefficient Test (Spearman) was used, with a nurse managers reported stress in their
significance of p <0.05 and a 95% confidence activities.
limit. For the data analysis, the statistical When verifying if the participants of the
software IBM SPSS Statistics 20, BioEstat 5.0 study had resistance to the stress (Hardiness),
and Microsoft Excel 2010 were used. it was verified that 40% were considered
This research had the project approved in hardy individuals. Regarding its subscales, the
the Committee of Ethics in Research with control strategy was the one with the highest
human beings with opinion CEP / UEL no. score (39.5%), followed by the control (37%)
116/2012 and CAAEE 0580381 2.4.0000.5231. and the challenge, with only one individual
(2%).
RESULTS
When performing the correlation between
The research was composed of 62 nurses, stress and Hardiness through the Spearman
43 of whom answered the questionnaires. The Coefficiency Test, it was verified that there
majority of the population was composed of was no significant value (correlation
women (84%), aged between 25 and 57 years, coefficient = -0.44 and the value of ρ = 0.08).
with a mean age of 39 years. Regarding However, although there is no significance, an
marital status, 56% had a stable union, 14% inverse correlation can be seen once the
were divorced and 30% were single. Those result is negative. That is, this result
who had children totaled 63% of the demonstrated that as the Hardiness increases
interviewees, of whom, 40% had two children. the stress decreases.

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J Nurs UFPE on line., Recife, 11(Suppl. 10):4199-205, Oct., 2017 4201
ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201725

Freitas FMB de, Vannuchi MTO, Haddad MCL et al. Hardiness and occupational stress in nurses...

to its position, related to the continuous need


DISCUSSION
for personnel management and conflicts
The research population was composed, generated by the diversity of professional
mostly, of females, a common situation found profiles, as well as to the collections of the
among Nursing professionals in Brazil. This superior heads and subordinates on the
fact occurs through the professionalization of conduct and decisions to be taken or have
the human capacity to care, present in the already taken place.2
characteristics of women.10 When analyzing the participants regarding
The mean age of 39 years showed that the whether or not they possessed Hardiness, it
population was composed of more was observed that only 17 had this personality
experienced nurses, an important fact to resistant to stress. The research also
occupy a managerial position, which requires demonstrated an inverse relationship between
professional experience, among other things. Hardiness and stress. Corroborating with a
The time in the organization or in the sector study carried out with medical residents, one
in which they act is indicated as a factor that confirms the assertion that one of the positive
accredits the nurse to carry out their effects of Hardiness is the modification of the
activities, giving them greater autonomy and perception of the stressors.14
decision power. This, together with the It is noted that all individuals, who were
technical knowledge of the managers and considered Hardiness, scored on the control
associated with the conceptual and relational subscale. This shows that the nurse with high
aspects, is consolidated as a fundamental control tries to maintain an influence on the
competence for the exercise of the results, instead of being impotent and passive
management. in the face of the situations (14). These
Emphasis is placed on the significant characteristics are evident in nurse managers
number of professionals who have undergone who have responsibilities to their staff and to
a postgraduate course, evidencing the concern the work process.
that nurses are having with the professional The ability to control allows the individual,
improvement, since the products of the to perceive, in many stressful events,
training performed can revert to the quality of predictable consequences, and consequently
care provided to clients. The realization of a to manipulate the stimuli to their benefit. In
specialization course stimulates the this way, they benefit mainly, by the high
performance of others, as shown in a study degree of autonomy. In addition to a stress-
about the profile and competencies of Nursing control training, it is worth emphasizing the
managers in accredited hospitals, showing importance of institutional programs that aim
that after the specialization, a large part of to develop social skills related to
the professionals opted to undertake post- communication and interpersonal relationship
graduate courses Stricto sensu ( masters and skills.15-6
doctorates), which are of an academic and Research4 shows that the higher the
research nature, with essentially scientific Hardiness value in the commitment subscale,
objectives, while specialization has a practical the greater is the nurse appreciation. These
/ professional meaning.12 professionals do not easily give themselves up
Only five nurses took graduate courses in to the pressure and get deeply involved in
Nursing Administration. Although not a what they do. This being, of great relevance,
relatively high number, the experience gained because they are in an environment where the
in the management of care over the years, focus is not only the patient, but, also, the
attitudes, managerial skills, personal values, family.
and the ability to work with what the Only one nurse obtained the Challenge
institution can offer, are also issues important subscale. This means that, for a portion of this
for the nurse to be competent for the population, there is a difficulty in dealing with
management and considered by the the unexpected and with the changes, in
organization in the selection of management order to seek resources to meet sudden
positions. Care management requires situations evaluated as stressors. The
knowledge and experience, since it is a Challenge domain refers to the belief that
process that materializes through a set of change is customary, which is understood as
practices that are interdependent and an opportunity for personal growth. Thus, the
complementary to one another.13 effects of stress are minimized, since the
Occupational stress was present in 24 situation is assessed by the individual as a
nurses who managed this study. In the Nursing challenge rather than a threat. Organizations
work process, managing requires a high level and their managers can no longer afford not
of demand, due to the competencies assigned
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ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201725

Freitas FMB de, Vannuchi MTO, Haddad MCL et al. Hardiness and occupational stress in nurses...

to learn how to respond effectively to the will eliminate the stressors , but, rather, will
challenges posed by stress.17 modify the perception to stress and instigate
A study conducted on Bournout Syndrome18 strategies for its confrontation. Because it can
and associated factors in health professionals be apprehended, it is suggested that
from a public hospital suggest through the institutions, through the sectors of permanent
results that personalities characterized by education and human resources, have it as an
commitment, control and challenge are alternative to minimize labor stress, and, as a
associated with higher levels of personal consequence, will bring valuation and
fulfillment and lower levels of exhaustion and motivation to the professional.
distant attitudes. They emphasize that the
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ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201725

Freitas FMB de, Vannuchi MTO, Haddad MCL et al. Hardiness and occupational stress in nurses...

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English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4199-205, Oct., 2017 4204
ISSN: 1981-8963 DOI: 10.5205/reuol.10712-95194-3-SM.1110sup201725

Freitas FMB de, Vannuchi MTO, Haddad MCL et al. Hardiness and occupational stress in nurses...

Submission: 2016/09/24
Accepted: 2017/09/22
Publishing: 2017/10/15
Corresponding Address
Mariana Angela Rossaneis
Universidade Estadual de Londrina
Av. Robert Koch, 60
Bairro Operária
CEP: 86038-350  Londrina (PR), Brazil

English/Portuguese
J Nurs UFPE on line., Recife, 11(Suppl. 10):4199-205, Oct., 2017 4205

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