INTRODUCTION:

Good physical health can work in tandem with mental health to improve a person’s overall quality of life. People have access to healthcare in order to keep their health at this optimal level. Good health is crucial for managing stress and leading a longer, more active life. Physical and mental health are perhaps the two types of health that are most commonly addressed. General health is impacted by one's financial, emotional, and spiritual well-being. Medical experts have linked them to less stress and improved mental and physical welfare.

Stress is a mental strain caused by extremely demanding circumstances. Stress can come from anywhere; any time may be from work, family, school, relationships etc.

But remember most of our stress comes from the perception of event no the way the event is. This perception depends on psychology of judgment that is my past experience is connecting to present event, our own emotional state not the stressor. Jealous or revenge on a person cause to be stressed. In short it is a gap between our expectation and reality, more the gap more the stress.

The quality of care provided by nurses can be significantly impacted by occupational stress, which can also negatively impact their quality of life. Caring is an interpersonal process that is defined by skilled nursing, interpersonal sensitivity, and close relationships, as well as by effective communication and the application of professional knowledge and skills. Job-related stress is negatively correlated with care quality because it results in a lack of empathy for patients and a rise in the frequency of practice errors¹^.

TaiChi is a graceful type of exercise that was formerly a part of ancient Chinese culture. It entails a series of movements carried out slowly, intently, and in tandem with deep breathing. TaiChi, also known as TaiChi Chuan, is a self-paced, non-competitive technique of light physical activity and stretching. Your body will be in constant motion since each posture leads seamlessly into the next. TaiChi offers a wide range of styles. Every style may gently highlight different tai chi ideas and techniques. Every style has its own variations. Some TaiChi styles could concentrate on maintaining good health, while others might concentrate on the martial arts component. Similar to yoga, Taichi is a form of meditative movement²

NEED FOR THE STUDY:

Stress is a common response to daily stresses, but it can turn unhealthy when it interferes with your daily activities. Stress is a very important part of life that affects how people develop from childhood to maturity. Some forms of stress can lead to antisocial behaviour and a loss of self-worth.

Stress is so pervasive that experts from all over the world have termed it the "epidemic" or "illness" of the 21st century, with particular life events like divorce, relocation, losing a loved one, or losing a job being thought to be the main causes.

American Institute of Stress had estimated that in 2020, 33% of adults reported experiencing high stress. 77% of people reported that stress negatively had influenced their physical health, 73% reported that stress negatively had impacted their mental health, and 48% report had sleeping difficulties as a result of stress^3.

India currently has 1.96 nurses per 1,000 people, according to information provided to the Rajya Sabha by the Union Health Ministry. According to the Indian Nursing Council, there are approximately 33.41 lakh registered nursing professionals in the nation, including 23,40,501 licensed practical nurses and licensed professional midwives, 10,080,05 nurse associates (9,43,951 auxiliary nurse midwives), and 56,854 lady health visitors. At present, there are 1.96 nurses for every 1,000 people in the nation.

Another Australian study found that 32.4% of nurses had depression, 41.2% had anxiety, and 41.2% reported work-related stress. 35% of Chinese nurses, 51% of Brazilian nurses, and 33% of French nurse supervisors reported having depressive symptoms. This variance in the prevalence of stress and its accompanying symptoms may result from the various organizational structures and management methods used by hospitals around the world^4.

One study in India found that 87.6% of nurses were stressed out, with 2.1% of them reported severe stress. 52% of nurses in a different study who reported feeling stressed out had severe stress.

When asked if they had an extremely stressful, upsetting, or traumatic experience as a result of COVID-19, nearly half (42 percent) of nurse respondents said “yes^”^5.

The National Nursing Workforce Survey, 2020 reported that they had felt stressed (75 percent), frustrated (65 percent), and overwhelmed (62 percent). Indira Kranthi Patham (IKP) Center for Public Health Technology reported that, In Thanjavur, 32.5% of staff nurses have health problems related to stress, and 32.5% of staff nurses have said as much. However, 65% of staff nurses have health problems related to stress, compared to 15% of staff nurses who reported neutral responses, 15% of respondents who disagree, and 5% of staff nurses who have health problems who strongly disagree.

TaiChi, which was initially created for self-defense, has developed into a graceful type of exercise that is now used to treat stress and a number of other health issues. Through its smooth, flowing movements, TaiChi has been compared as meditation in motion. One of the interventions that has the biggest benefits for nurses is TaiChi, which is creative, social, therapeutic, and recreational therapy. So, the researcher believed that this study needs to be conducted to evaluate the effectiveness of TaiChi exercises on stress among staff nurses in selected private hospital at Thanjavur.

STATEMENT OF THE PROBLEM:

A Study to assess the effectiveness of TaiChi exercise on stress among staff nurses in selected private hospital at Thanjavur.

OBJECTIVES OF THE STUDY:

· To assess the pretest and posttest levels of stress among staff nurses in selected private hospital at Thanjavur.

· To evaluate the effectiveness of TaiChi exercise on stress among staff nurses in selected private hospital at Thanjavur.

· To determine the association between posttest level of stress among staff nurses and their selected demographic variables.

HYPOTHESES:

All the hypotheses will be tested at 0.05 level of significant

H1: There will be a significant difference in pretest and posttest levels of stress among staff nurses in selected private hospital at Thanjavur.

H2: There will be a significant association between the posttest level of stress among staff nurses and their selected demographic variables.

MATERIALS AND METHODS:

Research approach:

· Quantitative research approach was used in this study.

Research Design:

Pre experimental, one group pretest posttest design.

One group

O₁

O₂

O₁ = Pretest X = Intervention O₂= Posttest

VARIABLES:

· Independent variable - TaiChi exercise

· Dependent variable - Stress

· Demographic variable - Age, residence, religion, year of experience, monthly income, educational qualification ,duration of working hours, area of working, hobbies, marital status, type of family.

SETTING OF THE STUDY:

The investigator selected Our lady of Health Hospital for the experiment. It is located near the landmark of the Manimandapam. It consists of 300 beds and have various departments like medicine and surgery, obstetrics and gynaecology, paediatrics, ENT, orthopedics, cardiology, nephrology, hepatology, diabetology, paediatric surgery, gastroenterology, physiotherapy. The participants of the Our lady of Health Hospital staff nurses were 75. Among them, 40 staff nurses were selected for the study purpose.

POPULATION:

The population comprised of staff nurses.

SAMPLE:

The sample comprised of staff nurses with stress in selected private hospital at Thanjavur.

SAMPLE SIZE

The sample size comprised of 40.

SAMPLING TECHNIQUE

Non probability Purposive sampling technique was used for this study.

CRITERIA FOR SAMPLE SELECTION

Inclusion criteria

Staff nurses

· Who were below 40 years.

· Who were working in hospital.

· Who were willing to participate in the study.

· who had an experience of more than 3 years in clinical area.

Exclusion criteria:

Staff nurses

· Who were not available at the time of data collection.

· Who already had exposed to TaiChi exercises .

· Who had physical injury at the time of data collection.

DESCRIPTION OF THE DATA COLLECTION TOOL

· Part-1: Demographic variables- Age, residence, religion, year of experience, monthly income, educational qualification, duration of working hours, area of working, hobbies, marital status, type of family.

· Part-2: standardized perceived Stress scale was used in this study. The Tool was originally developed in 1983 by Sheldon cohen.

This is one of the standardized scales, which was used to screen the samples with stress. The name of the scale was ‘’Perceived Stress scale’. It consists of 10 items. The maximum score was 4 & the minimum score was 0. This is a 5 point rating scale.

Statements	Question No	Scores
POSITIVE	4, 5, 7 and 8	Never	4
		Almost never	3
		Some times	2
		Fairly often	1
		Very often	0
NEGATIVE	1, 2, 3, 6, 9 and 10	Never	0
		Almost never	1
		Some times	2
		Fairly often	3
		Very often	4

In this scale the items 1,2,3,6,9 and10 were considered as negative statements, so the rating was given as Never = 0 Almost, Never = 1 Sometimes = 2 Fairly Often = 3& Very Often=4. Whereas the items 4, 5, 7 and 8 were considered as positive statements, so the rating was given as Never = 4 Almost Never = 3 Sometimes =2 Fairly Often =1 & Very Often = 0 (i.e in reverse order).

Scoring Procedure

Scoring Range	Scoring Category
0-13	Low stress
14-26	Moderate stress
27-40	High perceived stress

Validity and Reliabiity of The Tool:

· Validity:

Validity of the tool was obtained from nursing experts in the field of mental health nursing. The tool was corrected according to their suggestions and recommendations

· Reliability:

The reliability of the tool was established by Test- retest method. (‘r’value = 0.9976)

The tool was feasible and practicable.

Method of Data Collection:

The main study was conducted in our lady of health hospital, Thanjavur. Formal written permission was obtained from the head of the institution and written permission was obtained from the hospital authority to conduct the study. Self introduction and explanation regarding the nature, purpose, and benefits of the study was given to the samples by the investigator. 75 staff nurses participated. The investigator conducted the pretest by Sheldon Cohen Standardized Perceived Stress scale to assess the level of stress. Non probability purposive sampling technique was used to select the samples. 40 Staff Nurses were selected. The investigator obtained the oral consent from the selected samples prior to the study and their Demographic variables were also collected. After the pretest the Taichi exercise was performed to the staff nurses with stress. Every day evening the investigator gathered them and taught them about TaiChi exercise for 25 minutes for 21 days. The Taichi exercise was demonstrated by the investigator for the first 7 days and asked them to do along with the investigator. From 8^th -21^st day the staff nurses re-demonstrated the series of steps in TaiChi exercise along with the supervision of the investigator. The investigator conducted posttest with Sheldon Cohen Standardized Perceived Stress Scale to assess the effectiveness of the Taichi exercise. The data was analyzed by the descriptive and inferential statistics.

Plan for Data Analysis

S. No	Data Analysis	Methods	Remarks
1.	Descriptive statistics	Frequency and percentage	To describe the demographic variables of staff nurses with stress
1.	Descriptive statistics	Mean and standard deviation	To assess the pretest and posttest level of stress among staff nurses with Taichi exercise
2.	Inferential statistics	Paired ‘t’ test	To evaluate the effectiveness of TaiChi exercise
2.	Inferential statistics	Chi- square test	To determine the association between the posttest level of stress among staff nurses with their selected demographic variables

RESULTS:

The objective of the study was to evaluate the effectiveness of TaiChi Exercise on stress among staff nurses in selected private hospital. The collected data were grouped and analyzed by using descriptive and inferential statistics.

Table 1: Frequency and percentage distribution of pretest and posttest of the levels of stress among staff nurses. N=40

Level of Stress	Pre Test		Post Test
Level of Stress	f	(%)	f	(%)
Low Stress	0	0	34	85
Moderate Stress	13	32.5	6	15
High Perceived Stress	27	67.5	0	0
Mean Standard deviation	31.68±5.111		11.18±3.544

Table 4.3 shows that frequency and percentage distribution of pretest and post test of the levels of stress among staff nurses. In pretest, majority of staff nurses 27(67.5%) had high perceived stress and 13(32.5%) had moderate level of stress and the mean and standard deviation of the level of stress among staff nurses is 31.68±5.111. In posttest, majority of staff nurses 34(85%) had low stress and 6(15%) had moderate level of stress and the mean and standard deviation of the level of stress among staff nurses is 11.18±3.544 respectively.

Table 2: Effectiveness of TaiChi exercises on stress among staff nurses. N=40

Mean

Standad Deviaton

Paired t’ test

Table value

Taichi Exercise On Stress

Pretest

31.68

5.111

31.32

(S)

1.685

Posttest

11.18

3.544

Table 4.4 shows that, the mean score of Effectiveness of TaiChi exercise on stress among staff nurses in the pretest was 31.68 ± 5.111and the mean score in the posttest was 11.18±3.544. The calculated paired t’ test value of t = 31.32 shows statistically significant difference of effectiveness of TaiChi exercise on stress among staff nurses.

DISCUSSION:

The focus of the study was to evaluate "The Effectiveness of Taichi exercise on stress among staff nurses in selected private hospital at Thanjavar.” A Pre experimental one group pretest posttest design with purposive sampling technique was used in the study. The data were collected from 40 Staff Nurses with moderate to High perceived Stress.

The study findings were discussed in detail with relation to the findings of the other studies which the investigator reviewed. The study was conducted among 40 Staff Nurses with moderate to high perceived stress level at selected private hospital Thanjavur.

Samples were selected by using non probability purposive sampling technique. Collected data from 75staff nurses and assessed the stress were evaluated through Sheldon Cohen standardized perceived stress scale to assess the stress level. The selected participants were gathered every day evening and taught them about Taichi exercise for 25 minutes for 21 days.

The present study is based on general system theory were proposed in the 1950's. One of its major proponents. Ludwig Von Bertalanffy (1980) introduced system theory as a universal theory that could be applied to many fields of study.

The first objective was to assess the pretest and posttest levels of stress among staff nurses in selected private hospitals at Thanjavur.

In the assessment of pretest level of stress displays that 13(32.5%) staff nurses had moderate level of stress, 27(67.5 %) staff nurses had high perceived level of stress and none had low level of stress.

In the assessment of posttest level of stress displays that 34(85%) had low level of stress, 6 (15%) had moderate level of stress and none had high perceived level of stress.

The findings of the present study are supported by the following studies.

My study consistent with one group pre experimental study of effectiveness of Progressive Muscle Relaxation Therapy on Level Of Stress Among Staff Nurses Working In Selected Hospitals at Vadodara City which is conducted by Ms. Palak Patel and Sumandeep Vidyapeeth (2011). The findings of the study revealed that in pre test most of the nurses 53.3% had moderate stress, 40.0% had mild stress and 6.7% had severe stress. In post test most ofsthe nurses had mild stress 73.3 % and no stress 26.7%. The paired t’ test value for the pre test and post test value of stress is 11.149 at P< 0.05 level.

The second objective was to evaluate the effectiveness of Taichi Exercise on stress among staff nurses in selected private hospital at Thanjavur.

In the current study the pre test mean value of level of stress was 31.68 with standard deviation 5.111, and in the posttest mean value of level of stress was 11.18with standard deviation 3.544 and the 't' value was (Calculated value) 31.32 with reference to the table value of 1.685. Observed value was higher than the table value which was significant at 0.05 level. Since there was significant difference in pretest and posttest levels of stress among staff nurses, it reveals the effectiveness of Taichi exercise. Hence the research hypothesis H₁ was accepted.

The findings of the present study are supported by the following studies.

This objective was supported by a study conducted by Indrapalsingh (2009), who conducted a pre-experimental study on reducing stress using Taichi exercises in selected nursing institutes at Pune city. The sample size was 60, students were selected through simple random sampling technique and splited into two groups, 30experimental and 30 control groups. The analysis shows mean 41.40 with Standard Deviation of 16.76, t value 7.486 at p< 0.05 level. Thus the findings reveals that the stress decreased after intervention.

The third objectives was to determine the association between post test level of stress among staff nurses and their selected demographic variables.

Chi-square values were calculated to determine the association of the level of Stress among staff nurses with their selected demographic variables such age, residence, religion, year of experience, monthly income, educational qualification, duration of working hours, area of working, hobbies, marital status, type of family, frequency of night duty in a month.

The demographic variable residence, educational qualifications, duration of working hours, area of working, hobbies, marital status, and frequency of night duty in a month had shown statistically significant association between the posttest level of stress among staff nurses and their selected demographic variables. The other demographic variables had not shown statistically significant association between the posttest level of stress among staff nurses and their selected demographic variables.

The findings of the present study are supported by the following studies.

Harsha (2002) conducted a study to assess the effectiveness of Taichi exercises on stress and anxiety among adolescent college students at Bagalkot, Karnataka, with the objective to associate the knowledge with their demographic variables such as age, gender, religion, type of family, previous school education and other source of information. About 50 students participated. The researcher found that there was no association found between the stress and their selected demographic variables.

CONCLUSION:

The study was conducted to assess the effectiveness of TaiChi exercise on stress among staff nurses. The study findings revealed that there was a significant difference in the pretest and posttest level of stress. So the investigator found out that the TaiChi exercise was effective in reducing stress among staff nurses thereby increasing the health status and by developing the self confidence of the staff nurses.

ACKNOWLEDGEMENT:

The authors are thankful to The Managing Directors of Our Lady Health Hospital, Thanjavur.

REFERENCES:

1. Pavlos Sarafis, Eirini Rousaki.The impact of occupational stress on nurses’ caring behaviors and their health related quality of life. NLM, BMC Nurs. 2016; 15(3): 11-17.

2. Guohua Zheng.Assess the effectiveness and safety of Tai Chi Chuan (TCC) on physical and psychological health. Int J Behav Sci. 2015; 4(1); 605-617.

3. Rica Bhattacharyya, Brinda Sarkar. Indian professionals suffer higher stress level than most workers globally. The Economic Times/News. (2021) [Cited 2021Oct 28]. Available from: https://economictimes.indiatimes.com.

4. Shamona Maharaj, Ty Lees, and Sara Lal. Prevalence and Risk Factors of Depression, Anxiety, and Stress in a Cohort of Australian Nurses. IJERPH. 2018; 61(4):313-319.

5. Judith E. Arnetz, Courtney M. GoetzNurse Reports of Stressful Situations during the COVID-19 Pandemic. IJERPH. 2020; 62(3): 783-787.

Received on 01.10.2023 Modified on 10.11.2023

Asian J. Nursing Education and Research. 2024; 14(1):46-50.

DOI: 10.52711/2349-2996.2024.00009