An observational study of stress and coping among ICU nurses in Iraq through the lens of the Lazarus and Folkman model

Abstract

Intensive Care Unit (ICU) nurses face high-stress environments due to critical patient conditions, intense workloads, and emotional challenges. Understanding the specific stressors and coping mechanisms is vital for developing effective support interventions, which necessitates a framework like Lazarus and Folkman's model. For this reason, Lazarus and Folkman’s Transactional Model of Stress and Coping provides a theoretical framework to assess how nurses perceive and manage stress during their work. A descriptive cross-sectional study was conducted among ICU nurses at three public hospitals in Iraq. The study utilized a purposive sampling method to recruit participants. A total of 350 nurses participated in all phases of the study. Data collection was performed using the Nursing Stress Scale (NSS) and the Ways of Coping Questionnaire (WCQ), both of which were tested for validity and reliability. Statistical analyses included descriptive statistics, t-tests, ANOVA, and Pearson correlation. The study revealed that ICU nurses experience moderate to high stress levels (mean=82.4±14.6), with primary stressors being workload, death and dying, administrative deficiencies, and interpersonal conflict. Particularly, problem-focused coping strategies were used more commonly (mean=72.1±11.4) than emotion-focused strategies (mean=64.5±13.2). A negative correlation was found between stress and problem-focused coping (r=–0.48, p<0.001). Furthermore, a positive correlation was observed with emotion-focused coping (r=0.41, p<0.001). Higher stress levels were associated with younger age, female, and less ICU experience. The findings indicate that ICU nurses in Iraq experience significant occupational stress during the work. This highlights the importance of accentuating problem-focused coping strategies and organizational perspective in nursing. The study underlines the necessity for stress management interventions personalized to the Iraqi nurses working in the ICU.

Keywords: Coping, emergency nursing practice, Intensive Care Unit, nurses, stress