Relationship of Workload Stress and Coping Among Nurses Working in the Emergency Departments of Public Sector Tertiary Care Hospitals of Peshawar

Relationship of Workload Stress and Coping Among Nurses Working in the Emergency Departments of Public Sector Tertiary Care Hospitals of Peshawar | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship of Workload Stress and Coping Among Nurses Working in the Emergency Departments of Public Sector Tertiary Care Hospitals of Peshawar iqdar ali, muhammad zubair khan, khalil ahmad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8570275/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The demanding nature of emergency department (ED) settings exposes nurses to significant workload stress, impacting their physical and mental well-being. This study explores the relationship between workload stress and coping strategies among nurses working in the emergency departments of tertiary care hospitals in Peshawar. A cross-sectional design was employed, and data were collected from a representative sample of nurses using validated tools to measure stress levels and coping mechanisms. The findings indicate a high prevalence of workload stress among ED nurses, with factors such as long working hours, patient overload, and resource limitations contributing significantly. Coping strategies varied among nurses, with problem-focused approaches, such as time management and teamwork, being moderately effective, while emotion-focused strategies, including seeking social support and relaxation techniques, showed a mixed impact on stress reduction. Notably, maladaptive coping behaviors, such as avoidance or emotional withdrawal, were associated with higher stress levels and reduced job satisfaction. Objective The objective of the current study was to find out correlation between workload stress and coping strategies, and assess the level of stress and type of coping. Materials and Method This was a cross-sectional study conducted in 3 of the public sector tertiary care hospitals in the capital of the province Peshawar Khyber Pakhtunkhwa Pakistan. A total of 220 nursing staff was recruited through simple random sampling technique. Data was collected using an adopted questionnaire from published inventories. Results The main findings of our study demonstrated that majority of nursing staff facing stress, 75% nursing staff has positive stress with 65.9% has having severe stress reflecting a significant burden severe prevalence. Correlation of coping and stress shows a value of -0.359 while the P value is 0.000 indicating a significant relationship, while the correlation of stress with workload show a value of -0.457 with p value of .000 indicating the stress is significantly related with the workload in these hospitals. By assessing the stress with demographics, the age has F-Value of 2.67 and working organization F-value 1.845 with significant level of .000 and .002 respectively. Conclusion The findings of our study suggest that nurses working the tertiary care hospital of Peshawar are facing stress due higher workload, majority of the nurses are facing severe stress while a very small number of nurses experience low level of stress, indicating a significant prevalence. Furthermore, this study also tries to find out the relationship between stress and coping strategies among nurses the results indicates a negative relationship between stress and coping strategies reveling that the stress will be increasing with a bad coping strategies. There is a vital need for the enhancement of coping strategies among the nurses specifically those working in these hospitals. Workload Stress Coping Strategies Emergency Department Nurses Hospital Figures Figure 1 Introduction 1.1 Background the Study The definition of work stress is an imbalance between a person's surroundings and themselves. Around the world, nursing is recognized as a very demanding profession. Nurses have significant challenges in their line of work due to a high caseload, dealing with death and dying, staff conflict, resource scarcity, and inadequate training. 1 Emergency Departments (EDs) are frequently unexpected settings for extremely acute patient treatment. Due to their heavy workload, emergency department nurses are particularly susceptible to turnover and run the risk of burnout and compassion fatigue. 2 Nurses may experience increased stress at work because of staffing shortages, quick changes in patients' health, and technological advancements. 3 A growing disconnect between an individual's capabilities and the demands of their work leads to burnout. Working as a nurse is inherently stressful and demanding in a complex organizational environment. Burnout and other added stressors negatively affect nurses' well-being, patient safety, and the health organization as a whole. 4 One of the stressors for nurses is their workload. The Australian Nursing and Midwifery Federation (ANMF) stated in 2013 that insufficient nurse-to-patient ratios and heavy workloads led to a higher rate of job turnover, with more experienced nurses and midwives quitting the nursing field over the course of the next 12 months. 1 Work-related stress is a reaction that people may have when they are subjected to pressures and demands at work that are out of line with their knowledge and abilities and that make it difficult for them to handle. 2 Clinical sources of stress include caring for patients who are dying, interacting with other nurses, feeling insecure about clinical competence and fearing failure, interacting with patients, having too much work to do, and providing nursing care. 3 1.2 Nurses Stressors and Stress Nursing care's immediacy and urgency are thought to be factors that contribute to stress and both physical and emotional tiredness. 4 While a small bit of stress might be healthy, too much stress can have serious consequences for the person. Additionally, the majority of research indicated that nurses faced a variety of stresses, including patient care, workloads and assignments, unfavorable encounters with instructors and staff, a lack of clinical competence, and workload. 5 Poor health is linked to the increased workload experienced by nurses. As a result, it is critical to comprehend the working environment and examine potential mitigating factors for the detrimental consequences of a heavy workload. Many people in Germany who have severe or life-threatening illnesses receive treatment in non-specialized palliative care facilities like hospitals, nursing homes, and outpatient clinics. 6 1.3 Coping Mechanisms Since coping mechanisms can lessen the impact of stressors on strains, the Transactional Model of Stress holds that coping is a crucial component of the stress process. Emotion-focused and problem-focused techniques are the two primary categories of coping mechanisms that have been distinguished by prior research. Subsequent research separated emotional-focused tactics into four categories: self-control, distance, escape-avoidance, and positive reappraisal. Coping strategies have been divided into two categories by other researchers: constructive or positive coping and destructive or negative coping. 7 Coping strategies are typically divided into two categories: emotional (short-term) and problem-oriented (long-term). While affective-oriented techniques handle the emotional aspect of the situation, problem-oriented solutions deal with stress-producing issues. Eating, sleeping, and smoking are examples of short-term coping strategies that momentarily ease tension without addressing the underlying cause of the stressful event. Long-term stress-reduction techniques include talking things out with others and drawing on prior experiences. 8 1.3 Problem Statement A study conducted in Saudi Arabia found that the main causes of stress in the emergency room were lack of personnel, the workload of the nurses, and their discontent with the financial incentives. Another study found that nurses in emergency room are frequently report stress and burn out due to multiple reasons like workload pressure, limited time for break, refreshment, dealing with difficult patients and attendants. The participants' levels of expertise in managing stress at work varied. The prevalence of ineffective coping strategies like alcohol use point to the need for more education. Courses on the effects of stress and burnout on patients, nurses, and family life should be included of nursing education programs, hospital orientation.11Different coping strategies are there to overcome the issues of burn out, and workload stress, but these depend on the culture and individual predispositions. In contrast, a study reported that emergency room nurses most frequently used conservative coping strategies. including praying and chatting to coworkers. 9 A study's conducted in Iran, the findings demonstrated that religious or spiritual beliefs make nursing care enjoyable, provide nursing interventions meaning and purpose, and enable nurses to cope with challenges at work. 10 However, in our Pakistan’s context the workload of nurses is multifold and stressful because of high patient flow and complex work environment. Moreover, the cultural and religions and other practices of nurses for coping with stress may be lacking or different, as this aspect is not being studied in our context. This study will try to find out the level of stress in emergency department nurses and their coping strategies to deal with such a burn out. Moreover, this study will provide a baseline data of stress and coping strategies of nurses and the state of practices in dealing with workload stress and burn out. 1.4 Significance of the Study Working as a nurse at a remote emergency room is both emotionally and physically demanding. Stress at work can lead to mental health problems among nurses, which can have physical repercussions. When nurses suffer these mental health problems, patient care and safety may be jeopardized. 11 Because; a nurse's capacity to function, work, and even thrive in the current healthcare environment has a significant impact on their overall job satisfaction. That may further influence patient care, including patient dissatisfaction, the key is to recognize and hopefully intervene in the spiral that ultimately leads to the syndrome of burnout. 12 This, study will try to find out the level of stress in emergency department nurses and their coping strategies to deal with such a burn out at baseline. Moreover, this study will provide a baseline data of stress and coping strategies of nurses and the state of practices in dealing with workload stress and burn out. The findings may help to provide baseline data and may identify any need for certain interventions. 1.5 Study Rationale None of the published study was found at national level, and very limited studies are available at the international level on Relationship of workload stress and coping among nurses working in the emergency departments of public sector tertiary care hospitals of Peshawar. There is no available published study on Relationship of workload stress and coping among nurses working in the emergency departments of public sector tertiary care hospitals of Peshawar. Therefore, it is important to conduct a study to assess the level of stress and coping strategies among nurses and the relation of stress and coping strategies. Materials and Methods 3.2. Study Design The study used a cross-sectional correlational study design. The researcher is supposed to measure the exposure and result of interest at one or more points in time in this sort of observational study design. Participants in this kind of research design are chosen according to certain factors of interest. A cross-sectional study method can be used to identify community features, but it cannot be utilized to establish a cause-and-effect link between disparate variables. This approach is frequently used to identify a population's key traits. The purpose of the data collection was to determine the degree of stress and type of coping among nurses according to Kessler’s Stress Scale (KSS) and Brief Cope Inventory (BCI). Furthermore, the potential correlation between such factors may aid in the development of hypotheses for future research. 3.3 Study Population The study focused on the emergency unit‘s nurses working in the public sector hospitals of Peshawar LRH, KTH and HMC and recorded their responses. 3.4 Study Settings The study was conducted in the emergency departments of Lady Reading Hospital Peshawar, Khyber teaching hospital and Hayatabad medical complex Peshawar. LRH, KTH and HMC are one of the largest public health care setting in the KP province where maximum numbers of patients are referred from different tehsil headquarter and district headquarter hospitals of different zones. Critically ill patients are also referred due to lack of facilities and are admitted in the critical care units of LRH, HMC and KTH. Furthermore, emergency departments experience high patient flow and more assigned nursing staff as compared to other hospitals. Therefore, the study was conducted in these public sector hospitals for better outcomes in the research findings. 3.5 Study Duration The study duration was approximately 5 to 6 months, in accordance with the thesis study timeline. After approval of proposal from ASRB, the study was conducted and completed approximately in six months as per thesis duration. Data collection, data entry, data analysis and final draft writing was also attached via Gantt chart during the proposal. 3.6 Sample Size All the Nurses were sampled who worked in emergency departments of LRH, KTH and HMC, MTI’s Hospital were included, having one year of experience in emergency departments. The total number of nurses who worked in the emergency department of these hospitals was 510. Out of these 510, 280 nurses worked in the emergency department of LRH, while the remaining 230 worked in the KTH and HMC emergency departments. 3.7 Sampling Technique Simple random sample method was used; it is a basic and widely used probability sampling technique where every individual in the population has an equal chance of being selected for the sample. It is a fair and unbiased method that ensures each member of the population is equally likely to be included. Simple Random Sampling is most effective when the population is homogeneous, and every individual is equally relevant to the study. The sample was proportionately taken i.e the total number of nurses working in these hospitals were 700 and those who are working in the emergency departments LRH, KTH and HMC were 350, 200 and 150 respectively. We recruited 50% Nurses from the emergency department of LRH, similarly 28 % from KTH and the rest of 21% from HMC. 3.8 Sample Selection 3.8.1 Inclusion Criteria Registered nurses directly involved in patient care who are working in the emergency department of public sector tertiary hospitals of KTH, LRH, HMC. Nurses having experience of more than six months. 3.8.2 Exclusion Criteria Nurses who do not want to participate in this study were excluded. Nurses who are on leave will be excluded from this study. 3.9. Research Instrument Demographic data section was formed by the researcher and approved by the Supervisor. To capture and measure the variables stress and coping among nurses, stress level was measured by validated stress scale Kessler’s stress scale and the type and degree of coping was measured by Brief Cope Inventory. Likert scale questionnaire comprised of 10 question for measuring the stress level among nurses having responses ranging from none of the time (score 1) A little of the time (score 2) Some of the time (score 3) Most of the time (score 4) All of the time (score 5) for past 4 weeks. Reponses was recorded from the nurses working the emergency department of LRH, KTH and HMC. The total internal consistency of the Psychological Distress Scale was α=0.844. Concurrent validity between this instrument and the Self Reporting Questionnaire was ρ=0.722 (p<0.001). The best cut-off point for screening mental distress among elderly people was a total score greater than 14, with sensitivity equal to 75.47% and specificity equal to 85.0%. For coping strategies and type of coping Brief Coping Inventory composed 28 Likert scale question, the responses were recorded according to the scale ranging from 1 to 4. Response 1 means (I have not been doing this at all) 2 = A little bit 3= A medium amount while 4 (I have been doing this allot). Moreover, type of coping was divided into three categories according to the scale given in inventory the results were calculated by separation of question numbers according to inventory guidelines i.e Problem-Focused Coping (question number 2, 7, 10, 12, 14, 17, 23, 25). Emotion-Focused Coping (question number 5, 9, 13, 15, 18, 20, 21, 22, 24, 26, 27, 28). Avoidant Coping (question number 1, 3, 4, 6, 8, 11, 16, 19). The scales in the resultant inventory proved to be quite trustworthy (Cronbach's alpha values vary from 0.72 to 0.89). 3.10 Data Collection Procedure After approval from Ethical Review Committee KMU, a permission later has been granted from the parent institute. Before the collection of data, permission has been granted from the principal of the colleges with sign and stamp. After the Ethical Approval from each of the college administration, data collection has been started. Moreover, a written consent has been taken from each of the participants before the data collection. All the participants have assured that the information will be only used for academic growth and will be confidential. Also, the name of the participants was kept option to assure privacy of information. Brief cope inventory for assessing coping and Kessler stress scale for assessing stress were used. 3.11 Data Analysis Procedure Data has been analyzed using SPSS version 22. After entering all the questions into SPSS, it has been analyzed by using different statistical test. 3.11.1 Descriptive Statistics Frequency and percentages obtained for categorical variables e.g., gender, name, name of the institute, current rank, and others in the form of tables. Data analyzed descriptively to determine the frequencies and percentages of participants. 3.11.2 Inferential Statistics Correlation analysis such as Pearson correlation was used to determine the relationship between variables such as stress and coping strategies among nurses working at LRH, KTH and HMC. Each score has categorized i.e stress into low moderate and sever and coping into impaired coping and good coping. Further categories were also developed like coping has divided into emotional; avoidant and problem focused coping strategies. 3.12 Ethical Considerations Approval was taken from ASRB, ERB, Hospital‘s Departments, and Participants. All ethical standards were followed during data collection and analysis. Participants’ were given the right to take part in the study on their own willingness and also given the right to withdraw at any stage of the data collection. Participants ‘rights of anonymity and confidentiality were ensured. RESULTS In this portion, different aspects of workload stress and coping strategies are explored, different demographic parameters has described through tables, charts. Pearson correlation independent T test and tukey HSD, LSD has explored. Table: 1 Age in Years Age Frequency Percent Valid Percent Cumulative Percent 1 20-30 years 146 66.4 66.4 66.4 2 31-40 years 69 31.4 31.4 97.7 3 41-50 years 5 2.3 2.3 100.0 Total 220 100.0 100.0 The data presented in Table 1 highlights the age distribution of the study participants. A majority, 66.4%, fall within the age range of 20-30 years , indicating that most participants are relatively young adults. Additionally, 31.4% of participants are aged 31-40 years , representing a smaller but still significant proportion of the study group. Only 5 participants , accounting for 2.3% of the total, are in the 41-50 years age range, making them the least represented age group in the study. This distribution suggests a predominant focus on younger demographics, with diminishing representation as age increases. Table: 2 Gender Distributions Gender Frequency Percent Cumulative Percent Male 62 28.2 28.2 Female 158 71.8 100.0 Total 220 100.0 The data in Table 2 reveals the gender distribution of participants in this study. It shows that the majority, 71.8% , are female , while the remaining 28.2% are male . This suggests that a significant proportion of the nurses working in these hospitals are women, reflecting the historically female-dominated nature of the nursing profession. The data underscores the continuing trend of higher female representation in nursing roles within the healthcare sector. Chart 3 highlights the marital status of the participants in the study. It shows that 125 participants are married , which constitutes the majority, indicating that a significant number of nurses are in committed relationships. Additionally, 94 participants are unmarried , representing a notable proportion of the study group. However, only 1 participant is divorced , reflecting an extremely low level of divorce among the nurses. This data suggests that most nurses in the study are either married or single, with divorce being an uncommon marital status within this demographic. Table: 4 Qualification Qualification Frequency Percent Cumulative Percent BSN, Post-RN 214 97.3 97.3 MSN 4 1.8 99.1 diploma nursing 2 .9 100.0 Total 220 100.0 Table 4 provides insights into the educational qualifications of the nursing staff in the hospitals. The majority of the staff had BSN (Bachelor of Science in Nursing) or Post-RN (Registered Nurse) degrees , indicating a high level of professional training among the nurses. Smaller portions of the staff were diploma holders , reflecting a decline in reliance on diploma-based qualifications in favor of higher education. Notably, only four participants possess a Master's degree in Nursing and are working at the bedside, which highlights the rarity of advanced degree holders in direct patient care roles. This distribution suggests that while higher education is prevalent among the nursing staff, advanced degrees are still relatively uncommon in bedside nursing positions. Table: 5 Working Experience Experience Frequency Percent Cumulative Percent 1-5 Years 174 79.1 79.1 6-10 Years 41 18.6 97.7 11 and Above 5 2.3 100.0 Total 220 100.0 Table 5 presents the distribution of participants based on their years of professional experience. The majority, 79.1% , have 1-5 years of experience, indicating that a significant portion of the nursing staff is relatively early in their careers. Additionally, 18.6% of participants have 6-10 years of experience, representing a smaller but still notable group of mid-career professionals. Only a minimal number of nursing staff have more than 11 years of experience, suggesting that highly experienced nurses are underrepresented in these hospitals. This distribution highlights a workforce predominantly composed of newer professionals, with fewer individuals in advanced stages of their careers. Figure 6 highlights the distribution of participants based on the hospitals where they work. The majority, 128 participants (58.2%) , are from Lady Reading Hospital , making it the most represented institution in the study. Additionally, 53 participants are from Khyber Teaching Hospital , accounting for a smaller but significant portion of the total. The least represented hospital is Hayatabad Medical Complex , with 39 participants . This distribution indicates that the study has a higher representation from Lady Reading Hospital, potentially due to its size, staffing capacity, or accessibility compared to the other two hospitals. Table: 7 Stress Due to Workload Answers Frequency Percent Cumulative Percent Yes 165 75.0 75.0 No 55 25.0 100.0 Total 220 100.0 Table 7 highlights the responses regarding workload-related stress among participants. The data shows that a significant majority, 75% , responded "yes" to experiencing stress due to workload, indicating that workload is a prevalent issue for most of the nursing staff. This suggests that the demanding nature of their roles, such as long hours, high patient-to-nurse ratios, or insufficient support, may contribute to stress levels. The findings emphasize the need for addressing workload management and implementing strategies to reduce stress among nursing staff to improve their well-being and job performance. Table: 8 Level of Stress Frequency Percent Cumulative Percent Likely to be well 26 11.8 11.8 Likely to have mild disorder 17 7.7 19.5 Likely to have moderate disorder 32 14.5 34.1 Likely to have severe disorder 145 65.9 100.0 Total 220 100.0 Table 8 outlines the stress levels among respondents, categorized into four groups. The findings reveal that 26 respondents (11.8%) are classified as "likely to be well," indicating they experience minimal or no stress. A smaller proportion, 17 respondents (7.7%) , are identified as "likely to have a mild disorder," bringing the cumulative percentage to 19.5% , showing that nearly one-fifth of participants face mild stress. Another 32 respondents (14.5%) fall into the category of "likely to have a moderate disorder," with a cumulative percentage of 34.1% , reflecting an increasing prevalence of stress. The largest group, comprising 145 respondents (65.9%) , is categorized as "likely to have a severe disorder," which highlights that the majority of participants experience high stress levels. These findings indicate that stress is a significant issue among the respondents, with the majority experiencing moderate to severe stress, emphasizing the urgent need for targeted interventions to address and alleviate stress in this population. Table: 9 Correlations of Stress and Coping Correlations Parameters Stress Coping Stress Pearson Correlation 1 -.359 ** Sig. (2-tailed) .000 N 220 220 Coping Pearson Correlation -.359 ** 1 Sig. (2-tailed) .000 N 220 220 **. Correlation is significant at the 0.01 level (2-tailed). Table 9 presents the correlation analysis between stress and coping mechanisms among the participants. The correlation coefficient of -0.359 indicates a moderate negative relationship between the two variables, meaning that as coping abilities decrease, stress levels are more likely to increase. This inverse relationship highlights the critical role of effective coping strategies in managing stress. Furthermore, the p-value (0.000) is significantly lower than the standard significance threshold of 0.01 , which leads to the rejection of the null hypothesis. This provides strong evidence to conclude that the correlation between stress and coping is statistically significant. In practical terms, these findings emphasize the importance of fostering robust coping mechanisms to mitigate stress levels among individuals. Table: 10 Correlations Stress into Workload Correlations Parameters Stress Workload Stress Pearson Correlation 1 -.457 ** Sig. (2-tailed) .000 N 220 220 Workload Pearson Correlation -.457 ** 1 Sig. (2-tailed) .000 N 220 220 **. Correlation is significant at the 0.01 level (2-tailed). Table 10 presents the correlation between stress and workload. The correlation coefficient of -0.457 indicates a moderate negative relationship between the two variables, suggesting that as workload increases, stress levels are more likely to rise. This inverse relationship implies that higher workloads are a contributing factor to greater stress among the participants. Additionally, the p-value (0.000) is well below the typical significance threshold of 0.01 , indicating that the relationship between workload and stress is statistically significant. As a result, we reject the null hypothesis and conclude that there is sufficient evidence to support the existence of a significant correlation between workload and stress. This highlights the importance of managing workload to help reduce stress levels among workers. Table: 11 Stress and type of Coping ANOVA Stress and type of Coping Sum of Squares df Mean Square F Sig. avoidant coping Between Groups 15.822 34 .465 2.384 .000 Within Groups 36.106 185 .195 Total 51.927 219 Emotion coping Between Groups 13.736 34 .404 1.904 .004 Within Groups 39.259 185 .212 Total 52.995 219 problem focus coping Between Groups 17.401 34 .512 2.533 .000 Within Groups 37.377 185 .202 Total 54.777 219 Table 11 shows the results of the ANOVA test indicate that all three types of coping strategies—avoidant coping, emotion-focused coping, and problem-focused coping—have a statistically significant influence on stress levels. Avoidant coping demonstrates a significant relationship with stress levels (F = 2.384, Sig. = 0.000), suggesting that this strategy meaningfully affects how individuals experience stress. Emotion-focused coping also significantly impacts stress levels (F = 1.904, Sig. = 0.004), though its F-statistic is the lowest among the three, implying a relatively weaker effect. Problem-focused coping exhibits the highest F-statistic (F = 2.533, Sig. = 0.000), indicating that it may have the strongest impact on stress levels compared to the other strategies. Overall, the analysis underscores the significant role that coping strategies play in influencing stress, with problem-focused coping showing the greatest effect. (Table-9) Table: 12 Coping in Age Group Tukey HSD Coping in Age Group Age in years (J) age in years Mean Difference (I-J) Std. Error Sig. 95% Confidence Interval Lower Bound Upper Bound 20-30 years 31-40 years 17.42208 * 2.07231 .000 12.5316 22.3125 41-50 years 19.41918 * 6.45154 .008 4.1941 34.6442 31-40 years 20-30 years -17.42208 * 2.07231 .000 -22.3125 -12.5316 41-50 years 1.99710 6.56966 .950 -13.5067 17.5009 41-50 years 20-30 years -19.41918 * 6.45154 .008 -34.6442 -4.1941 31-40 years -1.99710 6.56966 .950 -17.5009 13.5067 *. The mean difference is significant at the 0.05 level. Table 12 shows the results of the Tukey HSD test, which compares coping scores across different age groups. The 20–30 years age group has a mean difference of 17.42 compared to the 31–40 years group, with a p-value of 0.000, indicating a significant difference. This means that younger individuals (20–30 years) cope much better than those in the 31–40 years age group. Similarly, the 20–30 years group has a mean difference of 19.42 compared to the 41–50 years group, with a p-value of 0.008, showing that the younger age group also copes significantly better than the older 41–50 years group. However, there is no significant difference in coping scores between the 31–40 years and 41–50 years groups, as shown by a mean difference of 1.997 and a p-value of 0.950. In summary, the younger age group (20–30 years) has better coping scores compared to both the 31–40 years and 41–50 years groups, while no major difference is found between the 31–40 years and 41–50 years age groups. Table-13 Coping and Stress among the staff of KTH, LRH and HMC Multiple Comparisons Dependent Variable (I) Working Organization /Hospital (J) Working Organization /Hospital Mean Difference (I-J) Std. Error Sig. 95% Confidence Interval Lower Bound Upper Bound Coping Tukey HSD LRH KTH 3.13930 2.68041 .472 -3.1862 9.4648 HMC .17849 3.00141 .998 -6.9046 7.2615 KTH LRH -3.13930 2.68041 .472 -9.4648 3.1862 HMC -2.96081 3.46201 .669 -11.1308 5.2092 HMC LRH -.17849 3.00141 .998 -7.2615 6.9046 KTH 2.96081 3.46201 .669 -5.2092 11.1308 LSD LRH KTH 3.13930 2.68041 .243 -2.1437 8.4223 HMC .17849 3.00141 .953 -5.7372 6.0941 KTH LRH -3.13930 2.68041 .243 -8.4223 2.1437 HMC -2.96081 3.46201 .393 -9.7843 3.8627 HMC LRH -.17849 3.00141 .953 -6.0941 5.7372 KTH 2.96081 3.46201 .393 -3.8627 9.7843 Stress Tukey HSD LRH KTH -2.72332 1.31073 .097 -5.8165 .3699 HMC -4.63962 * 1.46770 .005 -8.1033 -1.1760 KTH LRH 2.72332 1.31073 .097 -.3699 5.8165 HMC -1.91630 1.69293 .495 -5.9115 2.0789 HMC LRH 4.63962 * 1.46770 .005 1.1760 8.1033 KTH 1.91630 1.69293 .495 -2.0789 5.9115 LSD LRH KTH -2.72332 * 1.31073 .039 -5.3067 -.1399 HMC -4.63962 * 1.46770 .002 -7.5324 -1.7469 KTH LRH 2.72332 * 1.31073 .039 .1399 5.3067 HMC -1.91630 1.69293 .259 -5.2530 1.4204 HMC LRH 4.63962 * 1.46770 .002 1.7469 7.5324 KTH 1.91630 1.69293 .259 -1.4204 5.2530 *. The mean difference is significant at the 0.05 level. Table 13 analyzes the coping and stress levels among nurses from three hospitals: LRH, KTH, and HMC. For coping , both the Tukey HSD and LSD t ests show no significant differences in coping scores between the hospitals. The mean differences between hospitals (e.g., LRH vs. KTH with a mean difference of 3.19390) are not large enough to conclude that nurses at one hospital cope better than those at another. Additionally, the confidence intervals include zero, further supporting the finding that there are no significant differences in coping mechanisms between the hospitals. For stress , however, the results are different. The Tukey HSD test shows a significant difference in stress levels between LRH and HMC , with a mean difference of -4.63962 and a significance value of 0.005 . This suggests that nurses at HMC experience significantly higher stress than those at LRH . However, no significant differences are found between LRH and KTH , or KTH and HMC . Similarly, the LSD test also confirms a significant difference in stress levels between LRH and HMC. (Mean difference of -4.63962, p = 0.002), but no significant differences are observed in the other comparisons. While there are no significant differences in coping strategies across the three hospitals, nurses at HMC experience significantly, higher stress compared to those at LRH , with no significant stress differences between KTH and the other hospitals . DISUCSION, CONCLUSION 5.1 Workload Stress among Nurses The majority of respondents (65.9%) fall into the severe stress category, indicating a significant prevalence of high stress levels within the nurses working in the public sector tertiary care hospitals of Peshawar. Majority of the participant has stress due to workload, as 75% of the participants have answered the question “if they are having stress condition due to workload” in yes. Indicating that these participants have stress because of workload, they are facing. In a research examining the connection between nurses' job stress and workload, 83.3% of participants reported having a heavy workload, with a mean of 69.61 ± 49.9. Given that it is one of the biggest public hospitals in the city and receives many patients, this outcome is to be expected. High workloads among nurses have been shown in the majority of research and that workload leads to stress and burnout. 40 5.2 Relationship of Workload Stress and Coping The correlation coefficient (-0.359) was in negative and not near to zero, suggesting a moderate inversely proportional relationship between workload and coping i.e. if coping will be decreases it will more likely increases the stress. The p-value (0.000) was much lower than the typical significance level of 0.01. This indicates that there is a statistically significant correlation between stress and coping strategies. A study's findings offer several strategies for nurses to manage stress. The subjective interpretation and perception of the stressor, as well as the nurses' responses to it, are more significant. Understanding oneself is the first step towards coping. The nurses' second most common coping mechanism was asking for help. As an organization, the hospital needs to support nurses more as professionals and as persons. Nurses should have access to support resources that help them manage stress in both their personal and professional life. 41 5.3 Effect of Demographics upon Stress in Nurses This study show a significant association of workload stress with Age in years: p = 0.001, Gender of participants: p = 0.036, Present working designation: p = 0.009. These variables significantly influence stress levels. While there is no significant association of stress being observed in this study with the Marital status: p = 0.610, Professional education: p = 0.950, Working experience in years: p = 0.066, Working organization/hospital: p = 0.125. Indicating that these variable does not significantly influence stress level of the nurses working in these hospitals. Significant relationships were found between the dependent variables and the nurses' individual demographic traits, including age, education, marital status, and length of employment. For instance, a nurse's impression of stress was adversely connected with working tenure (r =.212, p <.01) and favorably connected with education (r =.128, p <.05) and married status (r =.205, p <.01). 42 5.4 Coping and Stress in Nurses The findings indicate a moderate negative correlation (correlation coefficient = -0.359) between workload and coping, meaning that as individuals' ability to cope decreases, their stress levels tend to increase. This relationship suggests an inverse proportionality between the two variables. The p-value (0.000), being significantly lower than the conventional threshold of 0.01. These results highlight a statistically significant relationship, emphasizing the critical role of effective coping mechanisms in managing workload-induced stress. This finding aligns with existing research suggesting that inadequate coping strategies can exacerbate stress levels, further underscoring the importance of interventions aimed at improving coping skills. The Denial and Behavioral Disengagement coping technique was substantially less frequently used by nurses in the high-manageability subgroup than by those in the low-manageability subgroup. Compared to respondents in the low and average manageability groupings, individuals in the high manageability category were substantially less likely to select the Focus on and Venting of Emotions coping method. 43 5.5 Effect of Demographics upon Coping in Nurses The study indicates a statistically significant effect of age in years: (p = 0.000) Working organization/hospital: (p = 0.002) upon the coping strategies of the participants of this. While there is no significant effect of gender (p = 0.105), Marital status (p = 0.095), Professional education (p = 0.572), Present working designation (p = 0.619), Working experience in years (p = 0.690) on the coping strategies among these nurses. According to research on the impact of gender on coping strategy selection, women are more likely than males to choose particular coping mechanisms. Specifically, it was shown that women consistently display emotional behaviours such as "prayer/daydreaming" and "search for divine intervention." This result is consistent with previous studies' findings that women employ emotion-regulation tactics more frequently than men do, whereas males tend to employ problem-solving strategies. Other studies do not indicate substantial differences between sexes, which might be ascribed to cultural variations, even if these findings were predicted. 44 5.6 Conclusion The study's findings reveal that nurses working in a tertiary care hospital in Peshawar are experiencing significant levels of stress, primarily due to their high workload. The majority of nurses are reported to be facing severe stress, highlighting the intense pressures and demands of their work environment. In contrast, only a small proportion of nurses are found to have low levels of stress, indicating that the burden of stress is widespread and severe among the nursing staff. This situation underscores the urgent need for interventions to manage workload and provide support systems to alleviate stress levels in this critical healthcare workforce. The study further tries to explore the relationship between stress and coping strategies among nurses and finds a negative correlation between the two. This indicates that poor or ineffective coping strategies are associated with higher levels of stress. In other words, nurses who rely on maladaptive coping mechanisms tend to experience increased stress levels. These findings highlight the critical importance of developing and enhancing effective coping strategies, particularly for nurses working in tertiary care hospitals where the workload and stress levels are already high. Strengthening coping mechanisms through training, counseling, and support programs could help nurses better manage stress and improve their overall well-being and performance. The findings of this study serve as a foundation for future interventional research aimed at identifying causal relationships between stress and its contributing factors to enable more effective stress management. The insights gained can guide the design of targeted interventions to address stress among nurses. Additionally, the study highlights the potential for organizing workshops to train nurses on effective coping strategies for stress management. These workshops could equip nurses with the necessary skills to handle workplace stress more effectively, leading to improvements in their mental health, enhanced patient care, and better overall organizational outcomes. By addressing stress in this way, both the well-being of nurses and the quality of healthcare delivery can be significantly improved. Abbreviations ASRB Advanced Studies and Research Board BSN BS in Nursing Sciences BCI Brief Cope Inventory CDSS Clinical Decision Support System CINAHL Cumulative Index to Nursing and Allied Health EU European Union HMC Hayatabad Medical Complex KTH Khyber Teaching Hospital KSS Kessler’s Stress Scale LRH Lady Reading Hospital MSN Masters of Science in Nursing Post-RN BSN Post Registered Nurse (Bachelors of Science in Nursing) PUBMED Public Medical Database SPSS Statistical Package for the Social Sciences UN United Nations WHO World Health Organization Declarations IRC and ERB Certificate This study was conducted as a part of MS Nursing thesis, the approval was taken from AS&RB (advance study and research review board) the meeting minutes for approval has obtained under the heading (minutes of KMU-AS&RB-161 st meeting) and the record is intact which maybe provided for further clarifications. Ethical approval: "This study was approved by the Advanced Studies & Research Review Board (AS&RB) at Khyber Medical University Peshawar, which serves as the local ethical and research review committee, Date: 25/9/2024 the study was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent." Consent of participation: All participants provided written informed consent prior to inclusion, after being fully informed about the study's purpose, procedures, risks, benefits, voluntary nature, and right to withdraw at any time without penalty. Consent was documented on approved forms, and participant confidentiality was maintained. Approved by AS&RB KMU Peshawar. Helsinki declaration: "This study was conducted in accordance with the Declaration of Helsinki (1964, as revised in 2013/2024). Ethical approval was obtained from AS&RB (Advance Studies and Research Review Board Khyber Medical University Peshawar): date: 25/09/2024. All participants provided written informed consent after receiving full information on study aims, procedures, risks, benefits, and their right to withdraw. Participant confidentiality was ensured through anonymized data storage and secure handling." Availability of Data The complete data of this research maybe available on request. Competing of interest The authors declare no competing of interest Funding The corresponding author declares that this particular research study has not funded by any organization or person. Authors’ contribution Iqdar ali: corresponding author, (Idea generation, data analysis, literature review, thesis write-up, manuscript crafting) Muhammad zubair: (Supervision, SPS data Analysis) Khalil Ahmad: (Data collection, literature search, approvals) Acknowledgement I dedicate this research study to my brother who always supported me and always on my side while studying and achieving my life goals. Consent of publication Not applicable. This study does not include any individual person’s data, images, or videos. All data were collected anonymously, and no identifiable personal information is reported in this manuscript. References Betke K, Basińska MA, Andruszkiewicz A. Sense of coherence and strategies for coping with stress among nurses. BMC Nurs 2021 20 (1):1‑10. DOI: 10.1186/s12912-021-00631-1 1 Zyga S, Mitrousi S, Alikari V, et al. Assessing Factors That Affect Coping Strategies Among Nursing Personnel. Mater Socio Medica 2016 28 (2):146. DOI: 10.5455/msm.2016.28.146 Lee WL, Tsai SH, Tsai CW, Lee CY. A study on work stress, stress coping strategies and health‑promoting lifestyle among district hospital nurses in Taiwan. J Occup Health 2011 53 (5):377‑383. DOI: 10.1539/joh.11‑010 Labrague LJ, McEnroe‑Petitte DM, Gloe D, et al. A literature review on stress and coping strategies in nursing students. J Ment Health 2017 26 (5):471‑480. DOI: 10.1080/09638237.2016.1244721 2 Labrague LJ, McEnroe‑Petitte DM, De Los Santos JAA, Edet OB. Examining stress perceptions and coping strategies among Saudi nursing students: A systematic review. Nurse Educ Today 2018 65:192‑200. DOI: 10.1016/j.nedt.2018.02.018 Burgess L, Irvine F, Wallymahmed A. Personality, stress and coping in intensive care nurses: A descriptive exploratory study. Nurs Crit Care 2010 15 (3):129‑140. DOI: 10.1111/j.1471‑6712.2010.00838.x Xu H (Grace) et al. Stressors and coping strategies of emergency department nurses and doctors: A cross‑sectional study. Australas Emerg Care 2019 22 (3):180‑186. DOI: 10.1016/j.auec.2018.10.005 3 Shdaifat EA, Jamama A, Al‑Amer M. Stress and Coping Strategies Among Nursing Students. Glob J Health Sci 2018 10 (5):33. DOI: 10.5530/gjhs.2018.5.33 Shankaraiah S, Lalitha K. Stress and coping among psychiatric nurses. Nurs J India 1990 81 (2):64‑65, 70. Chang EM et al. The relationships among workplace stressors, coping methods, demographic characteristics, and health in Australian nurses. J Prof Nurs 2006 22 (1):30‑38. DOI: 10.1108/13665630610673265 Andolhe R et al. Stress, coping and burnout among intensive care unit nursing staff: Associated factors. Rev da Esc Enferm 2015 49 (Special Issue):57‑63. DOI: 10.1590/1983‑1447.2015.49.2.009 Isa KQ, Ibrahim MA, et al. Strategies used to cope with stress by emergency and critical care nurses. Br J Nurs 2019 28 (1):38‑42. DOI: 10.12968/bjon.2019.28.1.38 Chart Chart 3 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files chart3.png Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8570275","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":619158055,"identity":"21fa2429-9c5e-4c67-b870-a958a5ec171e","order_by":0,"name":"iqdar ali","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBACNgYGAyCykeNnbwByDSyI1VKQZizZcwCkRYIoi4BaPhxO3HAjAcQhQgsfe/LGzxUGh40lZz6/uuFHgQQDf3t3An6H8TwrljxjkC7HL51TdrMH6DCJM2c34NcikWMg2WBgbSw5OyftBg9Qi4FELkEtxj8bDJgTN9w8k3bzD5FazIC2OAO9z37sNnG28Dwrs2wwAAVyDtttGQMJHoJ+kW9P3nyz4Q8oKo8/u/kGxGjvxa+FgSEBxuAxAJMElKNoYX9AhOpRMApGwSgYiQAAdX5Fyl9Wt4cAAAAASUVORK5CYII=","orcid":"","institution":"Rabbani Institute of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"iqdar","middleName":"","lastName":"ali","suffix":""},{"id":619158059,"identity":"2982ee72-d1f3-4f03-9f6f-02985b917754","order_by":1,"name":"muhammad zubair khan","email":"","orcid":"","institution":"Khyber Medical University","correspondingAuthor":false,"prefix":"","firstName":"muhammad","middleName":"zubair","lastName":"khan","suffix":""},{"id":619158060,"identity":"c276c58a-1ebb-46e3-817b-0c9b83c8b7ae","order_by":2,"name":"khalil ahmad","email":"","orcid":"","institution":"Hayatabad Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"khalil","middleName":"","lastName":"ahmad","suffix":""}],"badges":[],"createdAt":"2026-01-10 19:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8570275/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8570275/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106533726,"identity":"f0ebaa74-6217-4928-9063-5d7596b62ccd","added_by":"auto","created_at":"2026-04-09 14:58:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":42278,"visible":true,"origin":"","legend":"\u003ch4\u003e\u003cstrong\u003eFigure: 6 Working Organizations\u003c/strong\u003e\u003c/h4\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8570275/v1/772862b7c2fa281f2c1b275b.png"},{"id":107705872,"identity":"8cbee45d-c55a-4a4d-83e1-9a39607caed5","added_by":"auto","created_at":"2026-04-24 09:15:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":617991,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8570275/v1/fb2a8754-c71e-47bd-a39e-64f58e7a150d.pdf"},{"id":106533699,"identity":"37e3605b-a9d8-46c7-b88f-a5dfad21f756","added_by":"auto","created_at":"2026-04-09 14:58:00","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":81292,"visible":true,"origin":"","legend":"","description":"","filename":"chart3.png","url":"https://assets-eu.researchsquare.com/files/rs-8570275/v1/da73b80d0acc039b983c13a9.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eRelationship of Workload Stress and Coping Among Nurses Working in the Emergency Departments of Public Sector Tertiary Care Hospitals of Peshawar\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003ch2 id=\"_Toc184508343\"\u003e\u003cstrong\u003e1.1 Background the Study\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe definition of work stress is an imbalance between a person\u0026apos;s surroundings and themselves. Around the world, nursing is recognized as a very demanding profession. Nurses have significant challenges in their line of work due to a high caseload, dealing with death and dying, staff conflict, resource scarcity, and inadequate training.\u003csup\u003e1\u003c/sup\u003e Emergency Departments (EDs) are frequently unexpected settings for extremely acute patient treatment. Due to their heavy workload, emergency department nurses are particularly susceptible to turnover and run the risk of burnout and compassion fatigue.\u003csup\u003e2\u003c/sup\u003e Nurses may experience increased stress at work because of staffing shortages, quick changes in patients\u0026apos; health, and technological advancements.\u003csup\u003e3\u003c/sup\u003e A growing disconnect between an individual\u0026apos;s capabilities and the demands of their work leads to burnout. Working as a nurse is inherently stressful and demanding in a complex organizational environment. Burnout and other added stressors negatively affect nurses\u0026apos; well-being, patient safety, and the health organization as a whole.\u003csup\u003e4\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne of the stressors for nurses is their workload. The Australian Nursing and Midwifery Federation (ANMF) stated in 2013 that insufficient nurse-to-patient ratios and heavy workloads led to a higher rate of job turnover, with more experienced nurses and midwives quitting the nursing field over the course of the next 12 months.\u003csup\u003e1\u003c/sup\u003e\u0026nbsp; \u0026nbsp;Work-related stress is a reaction that people may have when they are subjected to pressures and demands at work that are out of line with their knowledge and abilities and that make it difficult for them to handle.\u003csup\u003e2\u003c/sup\u003e\u0026nbsp; Clinical sources of stress include caring for patients who are dying, interacting with other nurses, feeling insecure about clinical competence and fearing failure, interacting with patients, having too much work to do, and providing nursing care.\u003csup\u003e3\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003ch2 id=\"_Toc184508344\"\u003e\u003cstrong\u003e1.2 Nurses Stressors and Stress\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNursing care\u0026apos;s immediacy and urgency are thought to be factors that contribute to stress and both physical and emotional tiredness.\u003csup\u003e4\u003c/sup\u003e While a small bit of stress might be healthy, too much stress can have serious consequences for the person. Additionally, the majority of research indicated that nurses faced a variety of stresses, including patient care, workloads and assignments, unfavorable encounters with instructors and staff, a lack of clinical competence, and workload.\u003csup\u003e5\u003c/sup\u003e Poor health is linked to the increased workload experienced by nurses. As a result, it is critical to comprehend the working environment and examine potential mitigating factors for the detrimental consequences of a heavy workload. Many people in Germany who have severe or life-threatening illnesses receive treatment in non-specialized palliative care facilities like hospitals, nursing homes, and outpatient clinics.\u003csup\u003e6\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc184508345\"\u003e\u003cstrong\u003e1.3 Coping Mechanisms\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eSince coping mechanisms can lessen the impact of stressors on strains, the Transactional Model of Stress holds that coping is a crucial component of the stress process. Emotion-focused and problem-focused techniques are the two primary categories of coping mechanisms that have been distinguished by prior research. Subsequent research separated emotional-focused tactics into four categories: self-control, distance, escape-avoidance, and positive reappraisal. Coping strategies have been divided into two categories by other researchers: constructive or positive coping and destructive or negative coping.\u003csup\u003e7\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCoping strategies are typically divided into two categories: emotional (short-term) and problem-oriented (long-term). While affective-oriented techniques handle the emotional aspect of the situation, problem-oriented solutions deal with stress-producing issues. Eating, sleeping, and smoking are examples of short-term coping strategies that momentarily ease tension without addressing the underlying cause of the stressful event. Long-term stress-reduction techniques include talking things out with others and drawing on prior experiences.\u003csup\u003e8\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc184508346\"\u003e\u003cstrong\u003e1.3 Problem Statement\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA study conducted in Saudi Arabia found that the main causes of stress in the emergency room were lack of personnel, the workload of the nurses, and their discontent with the financial incentives. Another study found that nurses in emergency room are frequently report stress and burn out due to multiple reasons like workload pressure, limited time for break, refreshment, dealing with difficult patients and attendants. The participants\u0026apos; levels of expertise in managing stress at work varied. The prevalence of ineffective coping strategies like alcohol use point to the need for more education. Courses on the effects of stress and burnout on patients, nurses, and family life should be included of nursing education programs, hospital orientation.11Different coping strategies are there to overcome the issues of burn out, and workload stress, but these depend on the culture and individual predispositions. \u0026nbsp;In contrast, a study reported that emergency room nurses most frequently used conservative coping strategies. including praying and chatting to coworkers.\u003csup\u003e9\u003c/sup\u003e A study\u0026apos;s conducted in Iran, the findings demonstrated that religious or spiritual beliefs make nursing care enjoyable, provide nursing interventions meaning and purpose, and enable nurses to cope with challenges at work.\u003csup\u003e10\u0026nbsp;\u003c/sup\u003eHowever, in our Pakistan\u0026rsquo;s context the workload of nurses is multifold and stressful because of high patient flow and complex work environment. Moreover, the cultural and religions and other practices of nurses for coping with stress may be lacking or different, as this aspect is not being studied in our context. This study will try to find out the level of stress in emergency department nurses and their coping strategies to deal with such a burn out. Moreover, this study will provide a baseline data of stress and coping strategies of nurses and the state of practices in dealing with workload stress and burn out.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e1.4\u0026nbsp;\u003cstrong\u003eSignificance of the Study\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eWorking as a nurse at a remote emergency room is both emotionally and physically demanding. Stress at work can lead to mental health problems among nurses, which can have physical repercussions. When nurses suffer these mental health problems, patient care and safety may be\u0026nbsp;jeopardized.\u003csup\u003e11\u0026nbsp;\u003c/sup\u003eBecause; a nurse\u0026apos;s capacity to function, work, and even thrive in the current healthcare environment has a significant impact on their overall job satisfaction. That may further influence patient care, including patient dissatisfaction, the key is to recognize and hopefully intervene in the spiral that ultimately leads to the syndrome of burnout.\u003csup\u003e12\u003c/sup\u003e This, study will try to find out the level of stress in emergency department nurses and their coping strategies to deal with such a burn out at baseline. Moreover, this study will provide a baseline data of stress and coping strategies of nurses and the state of practices in dealing with workload stress and burn out. The findings may help to provide baseline data and may identify any need for certain interventions.\u003c/p\u003e\n\u003ch2 id=\"_Toc184508348\"\u003e\u003cstrong\u003e1.5 Study Rationale\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNone of the published study was found at national level, and very limited studies are available at the international level on Relationship of workload stress and coping among nurses working in the emergency departments of public sector tertiary care hospitals of Peshawar. There is no available published study on Relationship of workload stress and coping among nurses working in the emergency departments of public sector tertiary care hospitals of Peshawar. Therefore, it is important to conduct a study to assess the level of stress and coping strategies among nurses and the relation of stress and coping strategies.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003ch3\u003e\u003cstrong\u003e3.2. Study Design\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe study used a cross-sectional correlational study design. The researcher is supposed to measure the exposure and result of interest at one or more points in time in this sort of observational study design. Participants in this kind of research design are chosen according to certain factors of interest. A cross-sectional study method can be used to identify community features, but it cannot be utilized to establish a cause-and-effect link between disparate variables. This approach is frequently used to identify a population\u0026apos;s key traits. The purpose of the data collection was to determine the degree of stress and type of coping among nurses according to Kessler\u0026rsquo;s Stress Scale (KSS) and Brief Cope Inventory (BCI). Furthermore, the potential correlation between such factors may aid in the development of hypotheses for future research.\u003c/p\u003e\n\u003ch2 id=\"_Toc184508369\"\u003e\u003cstrong\u003e3.3 Study Population\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study focused on the emergency unit\u0026lsquo;s nurses working in the public sector hospitals of Peshawar LRH, KTH and HMC and recorded their responses.\u003c/p\u003e\n\u003ch2 id=\"_Toc184508370\"\u003e\u003cstrong\u003e3.4 Study Settings\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in the emergency departments of Lady Reading Hospital Peshawar, Khyber teaching hospital and Hayatabad medical complex Peshawar. LRH, KTH and HMC are one of the largest public health care setting in the KP province where maximum numbers of patients are referred from different tehsil headquarter and district headquarter hospitals of different zones. Critically ill patients are also referred due to lack of facilities and are admitted in the critical care units of LRH, HMC and KTH. Furthermore, emergency departments experience high patient flow and more assigned nursing staff as compared to other hospitals. Therefore, the study was conducted in these public sector hospitals for better outcomes in the research findings.\u003c/p\u003e\n\u003ch2 id=\"_Toc184508371\"\u003e\u003cstrong\u003e3.5 Study Duration\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study duration was approximately 5 to 6 months, in accordance with the thesis study timeline. After approval of proposal from ASRB, the study was conducted and completed approximately in six months as per thesis duration. Data collection, data entry, data analysis and final draft writing was also attached via Gantt chart during the proposal.\u003c/p\u003e\n\u003ch2 id=\"_Toc184508372\"\u003e\u003cstrong\u003e3.6 Sample Size\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll the Nurses were sampled who worked in emergency departments of LRH, KTH and HMC, MTI\u0026rsquo;s Hospital were included, having one year of experience in emergency departments. The total number of nurses who worked in the emergency department of these hospitals was 510. Out of these 510, 280 nurses worked in the emergency department of LRH, while the remaining 230 worked in the KTH and HMC emergency departments.\u003c/p\u003e\n\u003ch2 id=\"_Toc184508373\"\u003e\u003cstrong\u003e3.7 Sampling Technique\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eSimple random sample method was used; it is a basic and widely used probability sampling technique where every individual in the population has an equal chance of being selected for the sample. It is a fair and unbiased method that ensures each member of the population is equally likely to be included. Simple Random Sampling is most effective when the population is homogeneous, and every individual is equally relevant to the study. The sample was proportionately taken i.e the total number of nurses working in these hospitals were 700 and those who are working in the emergency departments LRH, KTH and HMC were 350, 200 and 150 respectively. We recruited 50% Nurses from the emergency department of LRH, similarly 28 % from KTH and the rest of 21% from HMC.\u003c/p\u003e\n\u003ch2 id=\"_Toc184508374\"\u003e\u003cstrong\u003e3.8 Sample Selection\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003ch3 id=\"_Toc184508375\"\u003e\u003cstrong\u003e3.8.1 Inclusion Criteria\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cul class=\"decimal_type\" style=\"list-style-type: circle;\"\u003e\n \u003cli\u003eRegistered nurses directly involved in patient care who are working in the emergency department of public sector tertiary hospitals of KTH, LRH, HMC.\u003c/li\u003e\n \u003cli\u003eNurses having experience of more than six months.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3 id=\"_Toc184508376\"\u003e\u003cstrong\u003e3.8.2 Exclusion Criteria\u003c/strong\u003e\u003c/h3\u003e\n\u003cul class=\"decimal_type\" style=\"list-style-type: circle;\"\u003e\n \u003cli\u003eNurses who do not want to participate in this study were excluded.\u003c/li\u003e\n \u003cli\u003eNurses who are on leave will be excluded from this study.\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch2 id=\"_Toc184508377\"\u003e\u003cstrong\u003e3.9. Research Instrument\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eDemographic data section was formed by the researcher and approved by the Supervisor. To capture and measure the variables stress and coping among nurses, stress level was measured by validated stress scale Kessler\u0026rsquo;s stress scale and the type and degree of coping was measured by Brief Cope Inventory. Likert scale questionnaire comprised of 10 question for measuring the stress level among nurses having responses ranging from none of\u0026nbsp;the time\u0026nbsp;(score\u0026nbsp;1) A little of\u0026nbsp;the time\u0026nbsp;(score\u0026nbsp;2) Some of\u0026nbsp;the time\u0026nbsp;(score\u0026nbsp;3) Most of\u0026nbsp;the time\u0026nbsp;(score\u0026nbsp;4) All of the\u0026nbsp;time\u0026nbsp;(score\u0026nbsp;5) for past 4 weeks. Reponses was recorded from the nurses working the emergency department of LRH, KTH and HMC.\u0026nbsp;The total internal consistency of the Psychological Distress Scale was \u0026alpha;=0.844. Concurrent validity between this instrument and the Self Reporting Questionnaire was \u0026rho;=0.722 (p\u0026lt;0.001). The best cut-off point for screening mental distress among elderly people was a total score greater than 14, with sensitivity equal to 75.47% and specificity equal to 85.0%.\u003c/p\u003e\n\u003cp\u003eFor coping strategies and type of coping Brief Coping Inventory composed 28 Likert scale question, the responses were recorded according to the scale ranging from 1 to 4. Response 1 means (I have not been doing this at all) 2 = A little bit 3= A medium amount while 4 (I have been doing this allot). Moreover, type of coping was divided into three categories according to the scale given in inventory the results were calculated by separation of question numbers according to inventory guidelines i.e Problem-Focused Coping\u0026nbsp;(question number 2, 7, 10, 12, 14, 17, 23, 25). Emotion-Focused Coping\u0026nbsp;(question number 5, 9, 13, 15, 18, 20, 21, 22, 24, 26, 27, 28). Avoidant Coping\u0026nbsp;(question number 1, 3, 4, 6, 8, 11, 16, 19). The scales in the resultant inventory proved to be quite trustworthy (Cronbach\u0026apos;s alpha values vary from 0.72 to 0.89).\u003c/p\u003e\n\u003ch2 id=\"_Toc184508378\"\u003e\u003cstrong\u003e3.10 Data Collection Procedure\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003eAfter approval from\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eEthical Review Committee KMU, a permission later has been granted from the parent institute. Before the collection of data, permission has been granted from the principal of the colleges with sign and stamp. After the Ethical Approval from each of the college administration, data collection has been started. Moreover, a written consent has been taken from each of the participants before the data collection. All the participants have assured that the information will be only used for academic growth and will be confidential. Also, the name of the participants was kept option to assure privacy of information. Brief cope inventory for assessing coping and Kessler stress scale for assessing stress were used.\u003c/p\u003e\n\u003ch2\u003e\u003cspan id=\"_Toc184508379\"\u003e\u003cstrong\u003e3.11 Data Analysis Procedure\u003c/strong\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003eData has been analyzed using SPSS version 22. After entering all the questions into SPSS, it has been analyzed by using different statistical test.\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc184508380\"\u003e\u003cstrong\u003e3.11.1 Descriptive Statistics\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eFrequency and percentages obtained for categorical variables e.g., gender, name, name of the institute, current rank, and others in the form of tables. Data analyzed descriptively to determine the frequencies and percentages of participants.\u0026nbsp;\u003c/p\u003e\n\u003ch3 id=\"_Toc184508381\"\u003e\u003cstrong\u003e3.11.2 Inferential Statistics\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eCorrelation analysis such as Pearson correlation was used to determine the relationship between variables such as stress and coping strategies among nurses working at LRH, KTH and HMC. Each score has categorized i.e stress into low moderate and sever and coping into impaired coping and good coping. Further categories were also developed like coping has divided into emotional; avoidant and problem focused coping strategies.\u003c/p\u003e\n\u003ch2 id=\"_Toc184508382\"\u003e\u003cstrong\u003e3.12 Ethical Considerations\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eApproval was taken from ASRB, ERB, Hospital\u0026lsquo;s Departments, and Participants. All ethical standards were followed during data collection and analysis. Participants\u0026rsquo; were given the right to take part in the study on their own willingness and also given the right to withdraw at any stage of the data collection. Participants \u0026lsquo;rights of anonymity and confidentiality were ensured.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn this portion, different aspects of workload stress and coping strategies are explored, different demographic parameters has described through tables, charts. Pearson correlation independent T test and tukey HSD, LSD has explored. \u0026nbsp;\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eTable: 1\u003c/strong\u003e\u003c/h4\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in Years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 181px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eValid Percent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative Percent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e20-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e66.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e66.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e66.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e31-40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e97.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e41-50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe data presented in Table 1 highlights the age distribution of the study participants. A majority, 66.4%, fall within the age range of \u003cstrong\u003e20-30 years\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e indicating that most participants are relatively young adults. Additionally, \u003cstrong\u003e31.4%\u003c/strong\u003e of participants are aged \u003cstrong\u003e31-40 years\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e representing a smaller but still significant proportion of the study group. Only \u003cstrong\u003e5 participants\u003c/strong\u003e, accounting for \u003cstrong\u003e2.3%\u003c/strong\u003e of the total, are in the \u003cstrong\u003e41-50 years\u003c/strong\u003e age range, making them the least represented age group in the study. This distribution suggests a predominant focus on younger demographics, with diminishing representation as age increases.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eTable: 2\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eGender Distributions\u003c/strong\u003e\u003c/h4\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative Percent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e71.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe data in Table 2 reveals the gender distribution of participants in this study. It shows that the majority, \u003cstrong\u003e71.8%\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e are \u003cstrong\u003efemale\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e while the remaining \u003cstrong\u003e28.2%\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eare \u003cstrong\u003emale\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e This suggests that a significant proportion of the nurses working in these hospitals are women, reflecting the historically female-dominated nature of the nursing profession. The data underscores the continuing trend of higher female representation in nursing roles within the healthcare sector.\u003c/p\u003e\n\u003cp\u003eChart 3 highlights the marital status of the participants in the study. It shows that \u003cstrong\u003e125 participants are married\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003ewhich constitutes the majority, indicating that a significant number of nurses are in committed relationships. Additionally, \u003cstrong\u003e94 participants are unmarried\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e representing a notable proportion of the study group. However, only \u003cstrong\u003e1 participant is divorced\u003c/strong\u003e, reflecting an extremely low level of divorce among the nurses. This data suggests that most nurses in the study are either married or single, with divorce being an uncommon marital status within this demographic.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eTable: 4\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eQualification\u003c/strong\u003e\u003c/h4\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQualification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative Percent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBSN, Post-RN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e97.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e97.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eMSN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e99.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003ediploma nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4 provides insights into the educational qualifications of the nursing staff in the hospitals. The majority of the staff had \u003cstrong\u003eBSN (Bachelor of Science in Nursing)\u003c/strong\u003e or \u003cstrong\u003ePost-RN (Registered Nurse) degrees\u003c/strong\u003e, indicating a high level of professional training among the nurses. Smaller portions of the staff were \u003cstrong\u003ediploma holders\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e reflecting a decline in reliance on diploma-based qualifications in favor of higher education. Notably, only \u003cstrong\u003efour participants\u003c/strong\u003e possess a \u003cstrong\u003eMaster\u0026apos;s degree in Nursing\u0026nbsp;\u003c/strong\u003eand are working at the bedside, which highlights the rarity of advanced degree holders in direct patient care roles. This distribution suggests that while higher education is prevalent among the nursing staff, advanced degrees are still relatively uncommon in bedside nursing positions.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eTable: 5\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eWorking Experience\u003c/strong\u003e\u003c/h4\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperience\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative Percent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e1-5 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e79.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 153px;\"\u003e\n \u003cp\u003e79.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e6-10 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 153px;\"\u003e\n \u003cp\u003e97.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e11 and Above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 153px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5 presents the distribution of participants based on their years of professional experience. The majority, \u003cstrong\u003e79.1%\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e have \u003cstrong\u003e1-5 years\u003c/strong\u003e of experience, indicating that a significant portion of the nursing staff is relatively early in their careers. Additionally, \u003cstrong\u003e18.6%\u003c/strong\u003e of participants have \u003cstrong\u003e6-10 years\u003c/strong\u003e of experience, representing a smaller but still notable group of mid-career professionals. Only a minimal number of nursing staff have more than \u003cstrong\u003e11 years\u003c/strong\u003e of experience, suggesting that highly experienced nurses are underrepresented in these hospitals. This distribution highlights a workforce predominantly composed of newer professionals, with fewer individuals in advanced stages of their careers.\u003c/p\u003e\n\u003cp\u003eFigure 6 highlights the distribution of participants based on the hospitals where they work. \u0026nbsp; The majority, \u003cstrong\u003e128 participants (58.2%)\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e are from \u003cstrong\u003eLady Reading Hospital\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e making it the most represented institution in the study. Additionally, \u003cstrong\u003e53 participants\u003c/strong\u003e are from \u003cstrong\u003eKhyber Teaching Hospital\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eaccounting for a smaller but significant portion of the total. The least represented hospital is \u003cstrong\u003eHayatabad Medical Complex\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e with \u003cstrong\u003e39 participants\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e This distribution indicates that the study has a higher representation from Lady Reading Hospital, potentially due to its size, staffing capacity, or accessibility compared to the other two hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable: 7\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStress Due to Workload\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"589\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnswers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative Percent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7\u003c/strong\u003e highlights the responses regarding workload-related stress among participants. The data shows that a significant majority, \u003cstrong\u003e75%\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e responded \u003cstrong\u003e\u0026quot;yes\u0026quot;\u003c/strong\u003e to experiencing stress due to workload, indicating that workload is a prevalent issue for most of the nursing staff. This suggests that the demanding nature of their roles, such as long hours, high patient-to-nurse ratios, or insufficient support, may contribute to stress levels. The findings emphasize the need for addressing workload management and implementing strategies to reduce stress among nursing staff to improve their well-being and job performance.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eTable: 8\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eLevel of Stress\u003c/strong\u003e\u003c/h4\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCumulative Percent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;Likely to be well\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eLikely to have mild disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Likely to have moderate disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eLikely to have severe disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e65.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 8 outlines the stress levels among respondents, categorized into four groups. The findings reveal that \u003cstrong\u003e26 respondents (11.8%)\u003c/strong\u003e are classified as \u0026quot;likely to be well,\u0026quot; indicating they experience minimal or no stress. A smaller proportion, \u003cstrong\u003e17 respondents (7.7%)\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e are identified as \u0026quot;likely to have a mild disorder,\u0026quot; bringing the cumulative percentage to \u003cstrong\u003e19.5%\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eshowing that nearly one-fifth of participants face mild stress. Another \u003cstrong\u003e32 respondents (14.5%)\u003c/strong\u003e fall into the category of \u0026quot;likely to have a moderate disorder,\u0026quot; with a cumulative percentage of \u003cstrong\u003e34.1%\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e reflecting an increasing prevalence of stress. The largest group, comprising \u003cstrong\u003e145 respondents (65.9%)\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e is categorized as \u0026quot;likely to have a severe disorder,\u0026quot; which highlights that the majority of participants experience high stress levels. These findings indicate that stress is a significant issue among the respondents, with the majority experiencing moderate to severe stress, emphasizing the urgent need for targeted interventions to address and alleviate stress in this population.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 650px;\"\u003e\n \u003ch4\u003e\u003cstrong\u003eTable: 9\u003c/strong\u003e\u003c/h4\u003e\n \u003ch4\u003e\u003cstrong\u003eCorrelations of Stress and Coping\u003c/strong\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 397px;\"\u003e\n \u003cp\u003eCorrelations Parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e-.359\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eCoping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e-.359\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 214px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 650px;\"\u003e\n \u003cp\u003e**. Correlation is significant at the 0.01 level (2-tailed).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9\u003c/strong\u003e presents the correlation analysis between stress and coping mechanisms among the participants. The correlation coefficient of \u003cstrong\u003e-0.359\u003c/strong\u003e indicates a \u003cstrong\u003emoderate negative relationship\u003c/strong\u003e between the two variables, meaning that as coping abilities decrease, stress levels are more likely to increase. This inverse relationship highlights the critical role of effective coping strategies in managing stress. Furthermore, the \u003cstrong\u003ep-value (0.000)\u003c/strong\u003e is significantly lower than the standard significance threshold of \u003cstrong\u003e0.01\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e which leads to the rejection of the null hypothesis. This provides strong evidence to conclude that the correlation between stress and coping is statistically significant. In practical terms, these findings emphasize the importance of fostering robust coping mechanisms to mitigate stress levels among individuals.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eTable: 10\u003c/strong\u003e\u003c/h4\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 601px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelations\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Stress into Workload\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 291px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelations Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorkload\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e-.457\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eWorkload\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e-.457\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e**. Correlation is significant at the 0.01 level (2-tailed).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 10 presents the correlation between stress and workload. The correlation coefficient of \u003cstrong\u003e-0.457\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eindicates a \u003cstrong\u003emoderate negative relationship\u003c/strong\u003e between the two variables, suggesting that as workload increases, stress levels are more likely to rise. This inverse relationship implies that higher workloads are a contributing factor to greater stress among the participants.\u003c/p\u003e\n\u003cp\u003eAdditionally, the \u003cstrong\u003ep-value (0.000)\u003c/strong\u003e is well below the typical significance threshold of \u003cstrong\u003e0.01\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e indicating that the relationship between workload and stress is statistically significant. As a result, we reject the null hypothesis and conclude that there is sufficient evidence to support the existence of a significant correlation between workload and stress. This highlights the importance of managing workload to help reduce stress levels among workers.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eTable: 11\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eStress and type of Coping\u003c/strong\u003e\u003c/h4\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"613\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 613px;\"\u003e\n \u003cp\u003eANOVA Stress and type of Coping\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSum of Squares\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003edf\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Square\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eavoidant coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e15.822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e2.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e36.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e51.927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eEmotion coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e13.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e39.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e52.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eproblem focus coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eBetween Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e17.401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e2.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eWithin Groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e37.377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e54.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 11 shows the results of the ANOVA test indicate that all three types of coping strategies\u0026mdash;avoidant coping, emotion-focused coping, and problem-focused coping\u0026mdash;have a statistically significant influence on stress levels. Avoidant coping demonstrates a significant relationship with stress levels (F = 2.384, Sig. = 0.000), suggesting that this strategy meaningfully affects how individuals experience stress. Emotion-focused coping also significantly impacts stress levels (F = 1.904, Sig. = 0.004), though its F-statistic is the lowest among the three, implying a relatively weaker effect. Problem-focused coping exhibits the highest F-statistic (F = 2.533, Sig. = 0.000), indicating that it may have the strongest impact on stress levels compared to the other strategies. Overall, the analysis underscores the significant role that coping strategies play in influencing stress, with problem-focused coping showing the greatest effect. \u003cem\u003e(Table-9)\u003c/em\u003e\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eTable: 12\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eCoping in Age Group\u003c/strong\u003e\u003c/h4\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"638\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 638px;\"\u003e\n \u003ch4\u003eTukey HSD Coping\u003cstrong\u003e\u0026nbsp;in Age Group\u003c/strong\u003e\u003c/h4\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e(J) age in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eMean Difference (I-J)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 189px;\"\u003e\n \u003cp\u003e95% Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003eUpper Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e20-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e31-40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e17.42208\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.07231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e12.5316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e22.3125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e41-50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e19.41918\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.45154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e4.1941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e34.6442\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e31-40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e20-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-17.42208\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.07231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e-22.3125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e-12.5316\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e41-50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e1.99710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.56966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e.950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e-13.5067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e17.5009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e41-50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e20-30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-19.41918\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.45154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e-34.6442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e-4.1941\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e31-40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e-1.99710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6.56966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e.950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e-17.5009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e13.5067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 638px;\"\u003e\n \u003cp\u003e*. The mean difference is significant at the 0.05 level.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 12 shows the results of the Tukey HSD test, which compares coping scores across different age groups. The 20\u0026ndash;30 years age group has a mean difference of 17.42 compared to the 31\u0026ndash;40 years group, with a p-value of 0.000, indicating a significant difference. This means that younger individuals (20\u0026ndash;30 years) cope much better than those in the 31\u0026ndash;40 years age group. Similarly, the 20\u0026ndash;30 years group has a mean difference of 19.42 compared to the 41\u0026ndash;50 years group, with a p-value of 0.008, showing that the younger age group also copes significantly better than the older 41\u0026ndash;50 years group. However, there is no significant difference in coping scores between the 31\u0026ndash;40 years and 41\u0026ndash;50 years groups, as shown by a mean difference of 1.997 and a p-value of 0.950. In summary, the younger age group (20\u0026ndash;30 years) has better coping scores compared to both the 31\u0026ndash;40 years and 41\u0026ndash;50 years groups, while no major difference is found between the 31\u0026ndash;40 years and 41\u0026ndash;50 years age groups.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003eTable-13\u003c/strong\u003e\u003c/h4\u003e\n\u003ch4\u003e\u003cstrong\u003eCoping and Stress among the staff of KTH, LRH and HMC\u003c/strong\u003e\u003c/h4\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" style=\"width: 601px;\"\u003e\n \u003cp\u003eMultiple Comparisons\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003eDependent Variable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e(I) Working Organization /Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 95px;\"\u003e\n \u003cp\u003e(J) Working Organization /Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003eMean Difference (I-J)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 42px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 121px;\"\u003e\n \u003cp\u003e95% Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLower Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eUpper Bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eCoping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eTukey HSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.13930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e2.68041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-3.1862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e9.4648\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.17849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.00141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-6.9046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e7.2615\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-3.13930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e2.68041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-9.4648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.1862\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-2.96081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.46201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-11.1308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e5.2092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-.17849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.00141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-7.2615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e6.9046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.96081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.46201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-5.2092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e11.1308\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eLSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.13930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e2.68041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-2.1437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e8.4223\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e.17849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.00141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-5.7372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e6.0941\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-3.13930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e2.68041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-8.4223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e2.1437\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-2.96081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.46201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-9.7843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.8627\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-.17849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.00141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-6.0941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e5.7372\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.96081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e3.46201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-3.8627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e9.7843\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eStress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eTukey HSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-2.72332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.31073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-5.8165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e.3699\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-4.63962\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.46770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-8.1033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e-1.1760\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.72332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.31073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-.3699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e5.8165\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-1.91630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.69293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-5.9115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e2.0789\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4.63962\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.46770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.1760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e8.1033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.91630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.69293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-2.0789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e5.9115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003eLSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-2.72332\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.31073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-5.3067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e-.1399\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-4.63962\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.46770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-7.5324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e-1.7469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.72332\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.31073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e.1399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e5.3067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e-1.91630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.69293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-5.2530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.4204\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eHMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4.63962\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.46770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e1.7469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e7.5324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eKTH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.91630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e1.69293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e-1.4204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e5.2530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"top\" style=\"width: 601px;\"\u003e\n \u003cp\u003e*. The mean difference is significant at the 0.05 level.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 13 analyzes the coping and stress levels among nurses from three hospitals: LRH, KTH, and HMC. For \u003cstrong\u003ecoping\u003c/strong\u003e, both the \u003cstrong\u003eTukey HSD\u003c/strong\u003e and \u003cstrong\u003eLSD\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;t\u003c/strong\u003eests show no significant differences in coping scores between the hospitals. The mean differences between hospitals (e.g., LRH vs. KTH with a mean difference of 3.19390) are not large enough to conclude that nurses at one hospital cope better than those at another. Additionally, the confidence intervals include zero, further supporting the finding that there are no significant differences in coping mechanisms between the hospitals. For \u003cstrong\u003estress\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e however, the results are different. The \u003cstrong\u003eTukey HSD\u003c/strong\u003e test shows a \u003cstrong\u003esignificant difference\u003c/strong\u003e in stress levels between \u003cstrong\u003eLRH and HMC\u003c/strong\u003e, with a \u003cstrong\u003emean difference of -4.63962\u003c/strong\u003e and a \u003cstrong\u003esignificance value of 0.005\u003c/strong\u003e. This suggests that nurses at \u003cstrong\u003eHMC\u003c/strong\u003e experience significantly higher stress than those at \u003cstrong\u003eLRH\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e However, no significant differences are found between \u003cstrong\u003eLRH and KTH\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003eor\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eKTH and HMC\u003c/strong\u003e. Similarly, the \u003cstrong\u003eLSD\u003c/strong\u003e test also confirms a significant difference in stress levels between \u003cstrong\u003eLRH and HMC.\u003c/strong\u003e (Mean difference of -4.63962, p = 0.002), but no significant differences are observed in the other comparisons. While there are no significant differences in coping strategies across the three hospitals, nurses at \u003cstrong\u003eHMC\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eexperience significantly, higher stress compared to those at \u003cstrong\u003eLRH\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e with no significant stress differences between \u003cstrong\u003eKTH and the other hospitals\u003c/strong\u003e.\u003c/p\u003e"},{"header":"DISUCSION, CONCLUSION ","content":"\u003ch2\u003e\u003cstrong\u003e5.1 Workload Stress among Nurses\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe majority of respondents (65.9%) fall into the severe stress category, indicating a significant prevalence of high stress levels within the nurses working in the public sector tertiary care hospitals of Peshawar. Majority of the participant has stress due to workload, as 75% of the participants have answered the question \u0026ldquo;if they are having stress condition due to workload\u0026rdquo; in yes. Indicating that these participants have stress because of workload, they are facing.\u003c/p\u003e\n\u003cp\u003eIn a research examining the connection between nurses\u0026apos; job stress and workload, 83.3% of participants reported having a heavy workload, with a mean of 69.61 \u0026plusmn; 49.9. Given that it is one of the biggest public hospitals in the city and receives many patients, this outcome is to be expected. High workloads among nurses have been shown in the majority of research and that workload leads to stress and burnout.\u003csup\u003e40\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc184508388\"\u003e\u003cstrong\u003e5.2 Relationship of Workload Stress and Coping\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe correlation coefficient (-0.359) was in negative and not near to zero, suggesting a moderate inversely proportional relationship between workload and coping i.e. if coping will be decreases it will more likely increases the stress. The p-value (0.000) was much lower than the typical significance level of 0.01. This indicates that there is a statistically significant correlation between stress and coping strategies.\u003c/p\u003e\n\u003cp\u003eA study\u0026apos;s findings offer several strategies for nurses to manage stress. The subjective interpretation and perception of the stressor, as well as the nurses\u0026apos; responses to it, are more significant. Understanding oneself is the first step towards coping. The nurses\u0026apos; second most common coping mechanism was asking for help. As an organization, the hospital needs to support nurses more as professionals and as persons. Nurses should have access to support resources that help them manage stress in both their personal and professional life.\u003csup\u003e41\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc184508389\"\u003e\u003cstrong\u003e5.3 Effect of Demographics upon Stress in Nurses\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study show a significant association of workload stress with Age in years: p = 0.001, Gender of participants: p = 0.036, Present working designation: p = 0.009. These variables significantly influence stress levels.\u003c/p\u003e\n\u003cp\u003eWhile there is no significant association of stress being observed in this study with the Marital status: p = 0.610, Professional education: p = 0.950, Working experience in years: p = 0.066, Working organization/hospital: p = 0.125. Indicating that these variable does not significantly influence stress level of the nurses working in these hospitals.\u003c/p\u003e\n\u003cp\u003eSignificant relationships were found between the dependent variables and the nurses\u0026apos; individual demographic traits, including age, education, marital status, and length of employment. For instance, a nurse\u0026apos;s impression of stress was adversely connected with working tenure (r =.212, p \u0026lt;.01) and favorably connected with education (r =.128, p \u0026lt;.05) and married status (r =.205, p \u0026lt;.01). \u003csup\u003e42\u003c/sup\u003e\u003c/p\u003e\n\u003ch2 id=\"_Toc184508390\"\u003e\u003cstrong\u003e5.4 Coping and Stress in Nurses\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe findings indicate a moderate negative correlation (correlation coefficient = -0.359) between workload and coping, meaning that as individuals\u0026apos; ability to cope decreases, their stress levels tend to increase. This relationship suggests an inverse proportionality between the two variables. The p-value (0.000), being significantly lower than the conventional threshold of 0.01. These results highlight a statistically significant relationship, emphasizing the critical role of effective coping mechanisms in managing workload-induced stress. This finding aligns with existing research suggesting that inadequate coping strategies can exacerbate stress levels, further underscoring the importance of interventions aimed at improving coping skills.\u003c/p\u003e\n\u003cp\u003eThe Denial and Behavioral Disengagement coping technique was substantially less frequently used by nurses in the high-manageability subgroup than by those in the low-manageability subgroup. Compared to respondents in the low and average manageability groupings, individuals in the high manageability category were substantially less likely to select the Focus on and Venting of Emotions coping method. \u003csup\u003e43\u003c/sup\u003e\u003c/p\u003e\n\u003ch2 id=\"_Toc184508391\"\u003e\u003cstrong\u003e5.5 Effect of Demographics upon Coping in Nurses\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study indicates a statistically significant effect of age in years: (p = 0.000) Working organization/hospital: (p = 0.002) upon the coping strategies of the participants of this. While there is no significant effect of gender (p = 0.105), Marital status (p = 0.095), Professional education (p = 0.572), Present working designation (p = 0.619), Working experience in years (p = 0.690) on the coping strategies among these nurses.\u003c/p\u003e\n\u003cp\u003eAccording to research on the impact of gender on coping strategy selection, women are more likely than males to choose particular coping mechanisms. Specifically, it was shown that women consistently display emotional behaviours such as \u0026quot;prayer/daydreaming\u0026quot; and \u0026quot;search for divine intervention.\u0026quot; This result is consistent with previous studies\u0026apos; findings that women employ emotion-regulation tactics more frequently than men do, whereas males tend to employ problem-solving strategies. Other studies do not indicate substantial differences between sexes, which might be ascribed to cultural variations, even if these findings were predicted. \u003csup\u003e44\u003c/sup\u003e\u003c/p\u003e\n\u003ch2 id=\"_Toc184508392\"\u003e\u003cstrong\u003e5.6 Conclusion\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study\u0026apos;s findings reveal that nurses working in a tertiary care hospital in Peshawar are experiencing significant levels of stress, primarily due to their high workload. The majority of nurses are reported to be facing severe stress, highlighting the intense pressures and demands of their work environment. In contrast, only a small proportion of nurses are found to have low levels of stress, indicating that the burden of stress is widespread and severe among the nursing staff. This situation underscores the urgent need for interventions to manage workload and provide support systems to alleviate stress levels in this critical healthcare workforce.\u003c/p\u003e\n\u003cp\u003eThe study further tries to explore the relationship between stress and coping strategies among nurses and finds a negative correlation between the two. This indicates that poor or ineffective coping strategies are associated with higher levels of stress. In other words, nurses who rely on maladaptive coping mechanisms tend to experience increased stress levels. These findings highlight the critical importance of developing and enhancing effective coping strategies, particularly for nurses working in tertiary care hospitals where the workload and stress levels are already high. Strengthening coping mechanisms through training, counseling, and support programs could help nurses better manage stress and improve their overall well-being and performance.\u003c/p\u003e\n\u003cp\u003eThe findings of this study serve as a foundation for future interventional research aimed at identifying causal relationships between stress and its contributing factors to enable more effective stress management. The insights gained can guide the design of targeted interventions to address stress among nurses. Additionally, the study highlights the potential for organizing workshops to train nurses on effective coping strategies for stress management. These workshops could equip nurses with the necessary skills to handle workplace stress more effectively, leading to improvements in their mental health, enhanced patient care, and better overall organizational outcomes. By addressing stress in this way, both the well-being of nurses and the quality of healthcare delivery can be significantly improved.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASRB Advanced Studies and Research Board \u003c/p\u003e\n\u003cp\u003eBSN BS in Nursing Sciences\u003c/p\u003e\n\u003cp\u003eBCI Brief Cope Inventory\u003c/p\u003e\n\u003cp\u003eCDSS Clinical Decision Support System \u003c/p\u003e\n\u003cp\u003eCINAHL Cumulative Index to Nursing and Allied Health\u003c/p\u003e\n\u003cp\u003eEU European Union\u003c/p\u003e\n\u003cp\u003eHMC Hayatabad Medical Complex\u003c/p\u003e\n\u003cp\u003eKTH Khyber Teaching Hospital\u003c/p\u003e\n\u003cp\u003eKSS Kessler\u0026rsquo;s Stress Scale\u003c/p\u003e\n\u003cp\u003eLRH Lady Reading Hospital\u003c/p\u003e\n\u003cp\u003eMSN Masters of Science in Nursing \u003c/p\u003e\n\u003cp\u003ePost-RN BSN Post Registered Nurse (Bachelors of Science in Nursing) \u003c/p\u003e\n\u003cp\u003ePUBMED Public Medical Database\u003c/p\u003e\n\u003cp\u003eSPSS Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003eUN United Nations \u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eIRC and ERB Certificate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted as a part of MS Nursing thesis, the approval was taken from \u003cstrong\u003eAS\u0026amp;RB (advance study and research review board)\u003c/strong\u003e the meeting minutes for approval has obtained under the heading \u003cstrong\u003e(minutes of KMU-AS\u0026amp;RB-161\u003csup\u003est\u003c/sup\u003e meeting)\u003c/strong\u003e and the record is intact which maybe provided for further clarifications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026quot;This study was approved by the \u003cstrong\u003eAdvanced Studies \u0026amp; Research Review Board (AS\u0026amp;RB)\u003c/strong\u003e at Khyber Medical University Peshawar, which serves as the local ethical and research review committee, Date: 25/9/2024 the study was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of participation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent prior to inclusion, after being fully informed about the study\u0026apos;s purpose, procedures, risks, benefits, voluntary nature, and right to withdraw at any time without penalty. Consent was documented on approved forms, and participant confidentiality was maintained. Approved by \u003cstrong\u003eAS\u0026amp;RB KMU Peshawar.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHelsinki declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026quot;This study was conducted in accordance with the Declaration of Helsinki (1964, as revised in 2013/2024). Ethical approval was obtained from \u003cstrong\u003eAS\u0026amp;RB (Advance Studies and Research Review Board Khyber Medical University Peshawar):\u0026nbsp;\u003c/strong\u003edate: 25/09/2024. All participants provided written informed consent after receiving full information on study aims, procedures, risks, benefits, and their right to withdraw. Participant confidentiality was ensured through anonymized data storage and secure handling.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe complete data of this research maybe available on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe corresponding author declares that this particular research study has not funded by any organization or person.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIqdar ali: corresponding author, (Idea generation, data analysis, literature review, thesis write-up, manuscript crafting)\u003c/p\u003e\n\u003cp\u003eMuhammad zubair: (Supervision, SPS data Analysis)\u003c/p\u003e\n\u003cp\u003eKhalil Ahmad: (Data collection, literature search, approvals)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI dedicate this research study to my brother who always supported me and always on my side while studying and achieving my life goals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This study does not include any individual person\u0026rsquo;s data, images, or videos. All data were collected anonymously, and no identifiable personal information is reported in this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBetke K, Basińska MA, Andruszkiewicz A. Sense of coherence and strategies for coping with stress among nurses. BMC Nurs 2021 20 (1):1‑10. DOI: 10.1186/s12912-021-00631-1 1\u003c/li\u003e\n\u003cli\u003eZyga S, Mitrousi S, Alikari V, et al. Assessing Factors That Affect Coping Strategies Among Nursing Personnel. Mater Socio Medica 2016 28 (2):146. DOI: 10.5455/msm.2016.28.146\u003c/li\u003e\n\u003cli\u003eLee WL, Tsai SH, Tsai CW, Lee CY. A study on work stress, stress coping strategies and health‑promoting lifestyle among district hospital nurses in Taiwan. J Occup Health 2011 53 (5):377‑383. DOI: 10.1539/joh.11‑010\u003c/li\u003e\n\u003cli\u003eLabrague LJ, McEnroe‑Petitte DM, Gloe D, et al. A literature review on stress and coping strategies in nursing students. J Ment Health 2017 26 (5):471‑480. DOI: 10.1080/09638237.2016.1244721 2\u003c/li\u003e\n\u003cli\u003eLabrague LJ, McEnroe‑Petitte DM, De Los Santos JAA, Edet OB. Examining stress perceptions and coping strategies among Saudi nursing students: A systematic review. Nurse Educ Today 2018 65:192‑200. DOI: 10.1016/j.nedt.2018.02.018\u003c/li\u003e\n\u003cli\u003eBurgess L, Irvine F, Wallymahmed A. Personality, stress and coping in intensive care nurses: A descriptive exploratory study. Nurs Crit Care 2010 15 (3):129‑140. DOI: 10.1111/j.1471‑6712.2010.00838.x\u003c/li\u003e\n\u003cli\u003eXu H (Grace) et al. Stressors and coping strategies of emergency department nurses and doctors: A cross‑sectional study. Australas Emerg Care 2019 22 (3):180‑186. DOI: 10.1016/j.auec.2018.10.005 3\u003c/li\u003e\n\u003cli\u003eShdaifat EA, Jamama A, Al‑Amer M. Stress and Coping Strategies Among Nursing Students. Glob J Health Sci 2018 10 (5):33. DOI: 10.5530/gjhs.2018.5.33\u003c/li\u003e\n\u003cli\u003eShankaraiah S, Lalitha K. \u003cem\u003eStress and coping among psychiatric nurses.\u003c/em\u003e Nurs J India 1990 81 (2):64‑65, 70. \u003c/li\u003e\n\u003cli\u003eChang EM et al. \u003cem\u003eThe relationships among workplace stressors, coping methods, demographic characteristics, and health in Australian nurses.\u003c/em\u003e J Prof Nurs 2006 22 (1):30‑38. DOI: 10.1108/13665630610673265\u003c/li\u003e\n\u003cli\u003eAndolhe R et al. \u003cem\u003eStress, coping and burnout among intensive care unit nursing staff: Associated factors.\u003c/em\u003e Rev da Esc Enferm 2015 49 (Special Issue):57‑63. DOI: 10.1590/1983‑1447.2015.49.2.009\u003c/li\u003e\n\u003cli\u003eIsa KQ, Ibrahim MA, et al. \u003cem\u003eStrategies used to cope with stress by emergency and critical care nurses.\u003c/em\u003e Br J Nurs 2019 28 (1):38‑42. DOI: 10.12968/bjon.2019.28.1.38\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Chart","content":"\u003cp\u003eChart 3 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Workload, Stress, Coping Strategies, Emergency Department, Nurses, Hospital","lastPublishedDoi":"10.21203/rs.3.rs-8570275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8570275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe demanding nature of emergency department (ED) settings exposes nurses to significant workload stress, impacting their physical and mental well-being. This study explores the relationship between workload stress and coping strategies among nurses working in the emergency departments of tertiary care hospitals in Peshawar. A cross-sectional design was employed, and data were collected from a representative sample of nurses using validated tools to measure stress levels and coping mechanisms. The findings indicate a high prevalence of workload stress among ED nurses, with factors such as long working hours, patient overload, and resource limitations contributing significantly. Coping strategies varied among nurses, with problem-focused approaches, such as time management and teamwork, being moderately effective, while emotion-focused strategies, including seeking social support and relaxation techniques, showed a mixed impact on stress reduction. Notably, maladaptive coping behaviors, such as avoidance or emotional withdrawal, were associated with higher stress levels and reduced job satisfaction.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe objective of the current study was to find out correlation between workload stress and coping strategies, and assess the level of stress and type of coping.\u003c/p\u003e\u003ch2\u003eMaterials and Method\u003c/h2\u003e \u003cp\u003e This was a cross-sectional study conducted in 3 of the public sector tertiary care hospitals in the capital of the province Peshawar Khyber Pakhtunkhwa Pakistan. A total of 220 nursing staff was recruited through simple random sampling technique. Data was collected using an adopted questionnaire from published inventories.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe main findings of our study demonstrated that majority of nursing staff facing stress, 75% nursing staff has positive stress with 65.9% has having severe stress reflecting a significant burden severe prevalence. Correlation of coping and stress shows a value of -0.359 while the P value is 0.000 indicating a significant relationship, while the correlation of stress with workload show a value of -0.457 with p value of .000 indicating the stress is significantly related with the workload in these hospitals. By assessing the stress with demographics, the age has F-Value of 2.67 and working organization F-value 1.845 with significant level of .000 and .002 respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings of our study suggest that nurses working the tertiary care hospital of Peshawar are facing stress due higher workload, majority of the nurses are facing severe stress while a very small number of nurses experience low level of stress, indicating a significant prevalence. Furthermore, this study also tries to find out the relationship between stress and coping strategies among nurses the results indicates a negative relationship between stress and coping strategies reveling that the stress will be increasing with a bad coping strategies. There is a vital need for the enhancement of coping strategies among the nurses specifically those working in these hospitals.\u003c/p\u003e","manuscriptTitle":"Relationship of Workload Stress and Coping Among Nurses Working in the Emergency Departments of Public Sector Tertiary Care Hospitals of Peshawar","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 14:57:44","doi":"10.21203/rs.3.rs-8570275/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"788ea6c9-3c46-4667-8474-12332d288480","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T11:27:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 14:57:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8570275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8570275","identity":"rs-8570275","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}