Writing your Research Report

Topic: The topic of the research final paper is open to the interests of the students. Students should find a question they would like to answer using the statistical techniques learnt in class.

To find the topic of your final report you need to start from a broad perspective looking at some general idea that you would like to explore. For example, let’s say that you would like to look at the relationship between interest rates and the economy. This is a very broad topic and you need to start doing research looking to specify your main research question. In figure 1 we can see all the different sub-topics, or more specific areas, in which we can divide our broad topic.

Figure 1

We could list more sub-topics than the ones we represented in Figure 1. However, we need to pick one so we can have a more focused research topic. Let’s assume that we choose to research the question regarding the impact of interest rates on the growth of construction in the United States. Once that we decided what our topic is going to be, we need to solve three main issues regarding our research project:

1. Review of literature: we need to research what other people have done previously. Especially, we need to find peer-reviewed publications of researchers that have worked in this specific area and look at their results. To find other research you should go to the website of the UNF Library and search for research papers in this specific area. The following is a guide on how to search the library at UNF:
   1. Enter the Library website and in that website you click on Databases by Subject

1. 1. Once you click that link a new page will open, which will show you all the different databases of research articles according to the disciplines of study. In our case, we will be interested in the Business (Finance, Investment, International, Management) and the Economics and Geography databases. The specific database will depend on the research topic you choose.

1. 1. In our specific example, we should click on the Economics and Geography link. There a list of databases will appear. You should select one of them. Let’s say that we pick EconLit.

1. 1. Once we picked EconLit, a new page will open, where we can start searching for research reports. Then, if we find one that we believe is germane to the selected topic, we can download it and read it and use it in our review of literature and reference sections.

It is important to remember that when we read other people’s work we are looking for the following:

1. How they addressed the research question
2. What data they used?
3. What kind of statistical technique they utilized?
4. What conclusions they reached?

This will allow us to move further in our research project and to be able to understand how to perform our task.

1. Data Availability: once we do a review of literature we should be able to tell what kind of data we need to do our research project. At this time, it is very important to be able to find out if the data is available and where we can find them. Many times a research project cannot continue because of the lack of datasets or because the information does not exist yet. It is very important that you can find the data. Useful sites to check out:
   1. Census Bureau: www.census.gov
   2. Bureau of Labor Statistics: www.bls.gov
   3. Bureau of Economic Analysis: www.bea.gov
   4. Federal Reserve Database: http://www.research.stlouisfed.org/fred2/
   5. U.S. Government Open Data: www.data.gov
   6. International Data (World Bank): http://data.worldbank.org/

1. Statistical Methodology: finally, after the review of literature is done and the dataset is located we need to determine what the methodology that we are going to use is. That means we need to decide which technique that we learnt in class is appropriated to answer the research question. Accordingly, you can use your review of literature to inform this decision, the textbook, class notes, etc.

Once you performed these three tasks you are ready to use excel to calculate your model and show your results. Accordingly, we are ready to write our research report.

Format Research Report

The following are the main sections of your research report and a short explanation of what the contents of each section should be:

1. Cover Page: contains the title, authors and class section.
2. Introduction: this is a short section of your paper, no more than one page. However, this is a very important part of your report, as this is the section that most people are going to read first. As a result, you need to make sure that people are convinced of the worthiness of your research. You should emphasize the following:
   1. Why is this research topic important? Why the reader should keep reading? Why should the reader care about this paper?
   2. What are the main findings of your research?
   3. Why these findings are important?
3. Review of literature: Explains the previous work on this topic, if any, and how the topic of this paper fits that body of work. You need to explain, very shortly what other people have found with regards to this research question and how their findings compare to your findings. By mentioning other people’s work you discuss the problem at hand and how other people have addressed this problem. If your research topic is about your company you need to discuss the nature of the problem and the different solutions that were offered and why you think that your empirical analysis could improve those proposed solutions. This section should have 2-3 pages.
4. Data: in this section you need to describe the data you found, show a table with the main statistics, like the mean and the standard deviation for each variable. Explain what the sources of your data are. This sections should be 2 pages at the most.
5. Methodology and results: In this section you need to proceed as follows: first, explain the statistical techniques that you are going to use to answer your research question. For example, if you are using a regression model you need to show the theoretical equation with the independent variables and why are you using the variables that you are using. Second, you need to show your results and do the tests to show that your model, if it is a regression model, satisfies the assumptions. If you introduced some modifications to satisfy the assumptions, then you need to explain those changes. Finally, you need to explain your results main results and conclusions. This section should be 4-5 pages long.
6. Conclusions: Explains what the results are and why they are important. This sections should be 1 page long.
7. References should be listed at the back of the paper.
8. Appendixes after the references (if needed)

Length and Format: The length of the paper is 12-15 pages (12 pages minimum), including title page, references and figures, but excluding appendixes.

The format of the page should be 1.5 spacing, font size 12 Times New Roman. The margins should be Right:1.25”, Left:1.25”, Top:1” and Bottom:1”

Format Standard: you can use any style: APA, MLA, Chicago, etc. The library has a great guide for citation styles at http://libguides.unf.edu/citationguide

Still stuck with your research report, get more help here:

Reason Versus Sentiment:

There has been a controversy started of late, much better worth examination, concerning the general foundation of morals; whether they be derived from reason, or from sentiment; whether we attain the knowledge of them by a chain of argument and induction, or by an immediate feeling and finer internal sense; whether, like all sound judgment of truth and falsehood, they should be the same to every rational intelligent being; or whether, like the perception of beauty and deformity, they be founded entirely on the particular fabric and constitution of the human species.

The ancient philosophers, though they often affirm, that virtue is nothing but conformity to reason, yet, in general, seem to consider morals as deriving their existence from taste and sentiment. On the other hand, our modern enquirers, though they also talk much of the beauty of virtue, and deformity of vice, yet have commonly endeavored to account for these distinctions by metaphysical reasonings, and by deductions from the most abstract principles of the understanding. Such confusion reigned in these subjects, that an opposition of the greatest consequence could prevail between one system and another, and even in the parts of almost each individual system; and yet no body, till very lately, was ever sensible of it.

The Case for Reason:

It must be acknowledged, that both sides of the question are susceptible of specious arguments. Moral distinctions, it may be said, are discernible by pure reason: Else, whence the many disputes that reign in common life, as well as in philosophy, with regard to this subject: The long chain of proofs often produced on both sides; the examples cited, the authorities appealed to, the analogies employed, the fallacies detected, the inferences drawn, and the several conclusions adjusted to their proper principles. Truth is disputable; not taste: What exists in the nature of things is the standard of our judgment; what each man feels within himself is the standard of sentiment. Propositions in geometry may be proved, systems in physics may be controverted; but the harmony of verse, the tenderness of passion, the brilliancy of wit, must give immediate pleasure. No man reasons concerning another’s beauty; but frequently concerning the justice or injustice of his actions. In every criminal trial the first object of the prisoner is to disprove the facts alleged, and deny the actions imputed to him: The second to prove, that, even if these actions were real, they might be justified, as innocent and lawful. It is confessedly by deductions of the understanding, that the first point is ascertained: How can we suppose that a different faculty of the mind is employed in fixing the other?

The Case For Sentiment:

On the other hand, those who would resolve all moral determinations into sentiment, may endeavor to show, that it is impossible for reason ever to draw conclusions of this nature. To virtue, say they, it belongs to be amiable, andvice odious. This forms their very nature or essence. But can reason or argumentation distribute these different epithets to any subjects, and pronounce before-hand, that this must produce love, and that hatred? Or what other reason can we ever assign for these affections, but the original fabric and formation of the human mind, which is naturally adapted to receive them?

The end of all moral speculations is to teach us our duty; and, by proper representations of the deformity of vice and beauty of virtue, beget correspondent habits, and engage us to avoid the one, and embrace the other. But is this ever to be expected from inferences and conclusions of the understanding, which of themselves have no hold of the affections, or set in motion the active powers of men? They discover truths: But where the truths which they discover are indifferent, and beget no desire or aversion, they can have no influence on conduct and behaviour. What is honourable, what is fair, what is becoming, what is noble, what is generous, takes possession of the heart, and animates us to embrace and maintain it. What is intelligible, what is evident, what is probable, what is true, procures only the cool assent of the understanding; and gratifying a speculative curiosity, puts an end to our researches.

Extinguish all the warm feelings and prepossessions in favour of virtue, and all disgust or aversion to vice: Render men totally indifferent towards these distinctions; and morality is no longer a practical study, nor has any tendency to regulate our lives and actions.

The Limited Role of Reason:

These arguments on each side (and many more might be produced) are so plausible, that I am apt to suspect, they may, the one as well as the other, be solid and satisfactory, and that reason and sentiment concur in almost all moral determinations and conclusions. The final sentence, it is probable, which pronounces characters and actions amiable or odious, praise-worthy or blameable; that which stamps on them the mark of honour or infamy, approbation or censure; that which renders morality an active principle, and constitutes virtue our happiness, and vice our misery: It is probable, I say, that this final sentence depends on some internal sense or feeling, which nature has made universal in the whole species. For what else can have an influence of this nature? But in order to pave the way for such a sentiment, and give a proper discernment of its object, it is often necessary, we find, that much reasoning should precede, that nice distinctions be made, just conclusions drawn, distant comparisons formed, complicated relations examined, and general facts fixed and ascertained.

Some species of beauty, especially the natural kinds, on their first appearance, command our affection and approbation; and where they fail of this effect, it is impossible for any reasoning to redress their influence, or adapt them better to our taste and sentiment. But in many orders of beauty, particularly those of the finer arts, it is requisite to employ much reasoning, in order to feel the proper sentiment; and a false relish may frequently be corrected by argument and reflection. There are just grounds to conclude, that moral beauty partakes much of this latter species, and demands the assistance of our intellectual faculties, in order to give it a suitable influence on the human mind.

Arguments Against Other Roles of Reason in Morality:

This partition between the faculties of understanding and sentiment, in all moral decisions, seems clear from the preceding hypothesis. But I shall suppose that hypothesis false: It will then be requisite to look out for some other theory, that may be satisfactory; and I dare venture to affirm, that none such will ever be found, so long as we suppose reason to be the sole source of morals. To prove this, it will be proper to weigh the five following considerations.

Approval as Not a Judgment About Fact Or Relations:

It is easy for a false hypothesis to maintain some appearance of truth, while it keeps wholly in generals, makes use of undefined terms, and employs comparisons, instead of instances. This is particularly remarkable in that philosophy, which ascribes the discernment of all moral distinctions to reason alone, without the concurrence of sentiment. It is impossible that, in any particular instance, this hypothesis can so much as be rendered intelligible; whatever specious figure it may make in general declamations and discourses. Examine the crime of ingratitude, for instance; which has place, wherever we observe good-will, expressed and known, together with good-offices performed, on the one side, and a return of ill-will or indifference, with ill-offices or neglect on the other: Anatomize all these circumstances, and examine, by your reason alone, in what consists the demerit or blame. You never will come to any issue or conclusion.

Reason Judges Either of matters or Fact or Relations:

Enquire then, first, where is that matter of fact, which we here call crime; point it out; determine the time of its existence; describe its essence or nature; explain the sense or faculty, to which it discovers itself. It resides in the mind of the person, who is ungrateful. He must, therefore, feel it, and be conscious of it. But nothing is there, except the passion of ill-will or absolute indifference. You cannot say, that these, of themselves, always, and in all circumstances, are crimes. No: They are only crimes, when directed towards persons, who have before expressed and displayed good-will towards us. Consequently, we may infer, that the crime of ingratitude is not any particular individual fact; but arises from a complication of circumstances, which, being presented to the spectator, excites the sentiment of blame, by the particular structure and fabric of his mind.

No New Fact Is Discovered:

When a man, at any time, deliberates concerning his own conduct (as, whether he had better, in a particular emergence, assist a brother or a benefactor), he must consider these separate relations, with all the circumstances and situations of the persons, in order to determine the superior duty and obligation: And in order to determine the proportion of lines in any triangle, it is necessary to examine the nature of that figure, and the relation which its several parts bear to each other. But notwithstanding this appearing similarity in the two cases, there is, at bottom, an extreme difference between them. A speculative reasoner concerning triangles or circles considers the several known and given relations of the parts of these figures; and thence infers some unknown relation, which is dependent on the former. But in moral deliberations, we must be acquainted, before-hand, with all the objects, and all their relations to each other; and from a comparison of the whole, fix our choice or approbation. No new fact to be ascertained: No new relation to be discovered. All the circumstances of the case are supposed to be laid before us, ere we can fix any sentence of blame or approbation. If any material circumstance be yet unknown or doubtful, we must first employ our enquiry or intellectual faculties to assure us of it; and must suspend for a time all moral decision or sentiment. While we are ignorant, whether a man were aggressor or not, how can we determine whether the person who killed him, be criminal or innocent? But after every circumstance, every relation is known, the understanding has no farther room to operate, nor any object on which it could employ itself. The approbation or blame, which then ensues, cannot be the work of the judgment, but of the heart; and is not a speculative proposition or affirmation, but an active feeling or sentiment. In the disquisitions of the understanding, from known circumstances and relations, we infer some new and unknown. In moral decisions, all the circumstances and relations must be previously known; and the mind, from the contemplation of the whole, feels some new impression of affection or disgust, esteem or contempt, approbation or blame.

Hence the great difference between a mistake of fact and one of right; and hence the reason why the one is commonly criminal and not the other. When OEdipus killed Laius, he was ignorant of the relation, and from circumstances, innocent and involuntary, formed erroneous opinions concerning the action which he committed. But when Nero killed Agrippina, all the relations between himself and the person, and all the circumstances of the fact, were previously known to him: But the motive of revenge, or fear, or interest, prevailed in his savage heart over the sentiments of duty and humanity. And when we express that detestation against him, to which he, himself, in a little time, became insensible; it is not, that we see any relations, of which he was ignorant; but that, from the rectitude of our disposition, we feel sentiments, against which he was hardened, from flattery and a long perseverance in the most enormous crimes. In these sentiments, then, not in a discovery of relations of any kind, do all moral determinations consist. Before we can pretend to form any decision of this kind, every thing must be known and ascertained on the side of the object or action. Nothing remains but to feel, on our part, some sentiment of blame or approbation; whence we pronounce the action criminal or virtuous.

Similarity Between Moral and Aesthetic Perception:

This doctrine will become still more evident, if we compare moral beauty with natural, to which, in many particulars, it bears so near a resemblance. It is on the proportion, relation, and position of parts, that all natural beauty depends; but it would be absurd thence to infer, that the perception of beauty, like that of truth in geometrical problems, consists wholly in the perception of relations, and was performed entirely by the understanding or intellectual faculties. In all the sciences, our mind, from the known relations, investigates the unknown. But in all decisions of taste or external beauty, all the relations are before-hand obvious to the eye; and we thence proceed to feel a sentiment of complacency or disgust, according to the nature of the object, and disposition of our organs.

Euclid has fully explained all the qualities of the circle; but has not, in any proposition, said a word of its beauty. The reason is evident. The beauty is not a quality of the circle. It lies not in any part of the line, whose parts are equally distant from a common centre. It is only the effect, which that figure produces upon the mind, whose peculiar fabric of structure renders it susceptible of such sentiments. In vain would you look for it in the circle, or seek it, either by your senses or by mathematical reasoning, in all the properties of that figure.

Attend to Palladio and Perrault, while they explain all the parts and proportions of a pillar: They talk of the cornice and frieze and base and entablature and shaft and architrave; and give the description and position of each of these members. But should you ask the description and position of its beauty, they would readily reply, that the beauty is not in any of the parts or members of a pillar, but results from the whole, when that complicated figure is presented to an intelligent mind, susceptible to those finer sensations. ’Till such a spectator appear, there is nothing but a figure of such particular dimensions and proportions: From his sentiments alone arise its elegance and beauty.

Again; attend to Cicero, while he paints the crimes of a Verres or a Catiline. You must acknowledge that the moral turpitude results, in the same manner, from the contemplation of the whole, when presented to a being, whose organs have such a particular structure and formation. The orator may paint rage, insolence, barbarity on the one side: Meekness, suffering, sorrow, innocence on the other: But if you feel no indignation or compassion arise in you from this complication of circumstances, you would in vain ask him, in what consists the crime or villainy, which he so vehemently exclaims against: At what time, or on what subject it first began to exist: And what has a few months afterwards become of it, when every disposition and thought of all the actors is totally altered or annihilated. No satisfactory answer can be given to any of these questions, upon the abstract hypothesis of morals; and we must at last acknowledge, that the crime or immorality is no particular fact or relation, which can be the object of the understanding: But arises entirely from the sentiment of disapprobation, which, by the structure of human nature, we unavoidably feel on the apprehension of barbarity or treachery.

No Distinctly Moral Relation:

Inanimate objects may bear to each other all the same relations, which we observe in moral agents; though the former can never be the object of love or hatred, nor are consequently susceptible of merit or iniquity. A young tree, which over-tops and destroys its parent, stands in all the same relations with Nero, when he murdered Agrippina; and if morality consisted merely in relations, would, no doubt, be equally criminal.

Conclusion:

Thus the distinct boundaries and offices of reason and of taste are easily ascertained. The former conveys the knowledge of truth and falsehood: The latter gives the sentiment of beauty and deformity, vice and virtue. The one discovers objects as they really stand in nature, without addition or diminution: The other has a productive faculty, and gilding or staining all natural objects with the colours, borrowed from internal sentiment, raises, in a manner, a new creation. Reason, being cool and disengaged, is no motive to action, and directs only the impulse received from appetite or inclination, by showing us the means of attaining happiness or avoiding misery: Taste, as it gives pleasure or pain, and thereby constitutes happiness or misery, becomes a motive to action, and is the first spring or impulse to desire and volition. From circumstances and relations, known or supposed, the former leads us to the discovery of the concealed and unknown: After all circumstances and relations are laid before us, the latter makes us feel from the whole a new sentiment of blame or approbation. The standard of the one, being founded on the nature of things, is eternal and inflexible, even by the will of the Supreme Being: The standard of the other, arising from the internal frame and constitution of animals, is ultimately derived from that Supreme Will, which bestowed on each being its peculiar nature, and arranged the several classes and orders of existence.

Essay on How Bitcoin works

ABSTRACT

Bitcoin is the simplest way to exchange money.

Bitcoinis a software-based online payment systemdescribed bySatoshi Nakamotoin 2008 and introduced asopen-source softwarein 2009.Payments are recorded in a publicledgerusing its ownunit of account,which is also calledbitcoin.Payments workpeer-to-peerwithout a central repository or single administrator, which has led theUS Treasuryto call bitcoin a decentralizedcurrency. Although its status as a currency is disputed, media reports often refer to bitcoin as acryptocurrencyordigital currency.

INTRODUCTION

Bitcoin uses peer-to-peer technology to operate with no central authority or banks; managing transactions and the issuing of bitcoins is carried out collectively by the network.Bitcoin is open-source; its design is public, nobody owns or controls Bitcoin andeveryone can take part. Through many of its unique properties, Bitcoin allows exciting uses that could not be covered by any previous payment system.

How does Bitcoin work?

As a new user, you canget startedwith Bitcoin without understanding the technical details. Once you have installed a Bitcoin wallet on your computer or mobile phone, it will generate your first Bitcoin address and you can create more whenever you need one. You can disclose your addresses to your friends so that they can pay you or vice versa. In fact, this is pretty similar to how email works, except that Bitcoin addresses should only be used once

Balances- block chain

The block chain is ashared public ledgeron which the entire Bitcoin network relies. All confirmed transactions are included in the block chain. This way, Bitcoin wallets can calculate their spendable balance and new transactions can be verified to be spending bitcoins that are actually owned by the spender. The integrity and the chronological order of the block chain are enforced with cryptography

Transactions- private keys

A transaction isa transfer of value between Bitcoin walletsthat gets included in the block chain. Bitcoin wallets keep a secret piece of data called aprivate keyor seed, which is used to sign transactions, providing a mathematical proof that they have come from the owner of the wallet. Thesignaturealso prevents the transaction from being altered by anybody once it has been issued. All transactions are broadcast between users and usually begin to be confirmed by the network in the following 10 minutes, through a process calledmining.

Processing- mining

Mining is adistributed consensus systemthat is used toconfirmwaiting transactions by including them in the block chain. It enforces a chronological order in the block chain, protects the neutrality of the network, and allows different computers to agree on the state of the system. To be confirmed, transactions must be packed in ablockthat fits very strict cryptographic rules that will be verified by the network. These rules prevent previous blocks from being modified because doing so would invalidate all following blocks. Mining also creates the equivalent of a competitive lottery that prevents any individual from easily adding new blocks consecutively in the block chain. This way, no individuals can control what is included in the block chain or replace parts of the block chain to roll back their own spends.

Bitcoin for Individuals

Mobile payments

Bitcoin on mobiles allows you to pay with a simple two step scan-and-pay. No need to sign up, swipe your card, type a PIN, or sign anything. All you need to receive Bitcoin payments is to display the QR code in your Bitcoin wallet app and let your friend scan your mobile, or touch the two phones together (using NFC radio technology).

Security and control over money

Bitcoin transactions are secured by military grade cryptography. Nobody can charge you money or make a payment on your behalf. So long as you take the required steps toprotect your wallet, Bitcoin can give you control over your money and a strong level of protection against many types of fraud.

Works everywhere, anytime

Just like with email, you don’t need to ask your family to use the same software or the same service providers. Just let them stick to their own favourites. No problem there; they are all compatible as they use the same open technology.

Fast international payments

Bitcoins can be transferred from Africa to Canada in 10 minutes. There is no bank to slow down the process, level outrageous fees, or freeze the transfer. You can pay your neighbours the same way as you can pay a member of your family in another country.

Zero or low fees

Bitcoin allows you to send and receive payments at very low cost. Except for special cases like very small payments, there is no enforced fee. It is however recommended to pay a higher voluntary fee for faster confirmation of your transaction and to remunerate the people who operate the Bitcoin network.

Protect your identity

With Bitcoin, there is no credit card number that some malicious actor can collect in order to impersonate you. In fact, it is even possible to send a payment without revealing your identity, almost just like with physical money. You should however take note that some effort can be required toprotect your privacy.

Bitcoin for Businesses

The lowest fees out there

Bitcoin’s high cryptographic security allows it to process transactions in a very efficient and inexpensive way. You can make and receive payments using the Bitcoin network with almost no fees. In most cases, fees are not strictly required but they are recommended for faster confirmation of your transaction.

Protection against fraud

Any business that accepts credit cards or PayPal knows the problem of payments that are later reversed. Chargeback frauds result in limited market reach and increased prices, which in turn penalizes customers. Bitcoin payments are irreversible and secure, meaning that the cost of fraud is no longer pushed onto the shoulders of the merchants.

Fast international payments

Bitcoins can be transferred from Africa to Canada in 10 minutes. In fact, bitcoins never have any real physical location, so it is possible to transfer as many of them anywhere with no limits, delays, or excessive fees. There are no intermediate banks to make you wait three business days.

No PCI compliance required

Accepting credit cards online typically requires extensive security checks in order to comply with the PCI standard. Bitcoin still requires you tosecure your walletand your payment requests. However, you do not carry the costs and responsibilities that come with processing sensitive information from your customers like credit card numbers.

Get some free visibility

Bitcoin is an emerging market of new customers who are searching for ways to spend their bitcoins. Accepting them is a good way to get new customers and give your business some new visibility. Accepting a new payment method has often shown to be a clever practice for online businesses.

Conclusion

We can Sendbitcoinfrom your computer, tablet, smart phone or other device, to anyone, anywhere in the world, day or night. Bitcoinis an innovative payment network and a new kind of money. Every informed person needs to know about Bitcoin because it might be one of the world’s most important developments.

REFERENCES

http://en.wikipedia.org/wiki/Bitcoin

https://bitcoin.org/en/

https://www.weusecoins.com/en/

Work related stress in healthcare Setting

Stress may be defined as the physical and emotional response to excessive levels of mental or emotional pressure, which may arise from issues in both the working and personal life. Stress may cause emotional symptoms such as anxiety, depression, irritability or low self-esteem, or even manifest as physical symptoms including insomnia, headaches, loss of appetite and difficulties concentrating. Individuals experiencing high levels of stress may experience difficulty in controlling emotions such as anger, and may be more likely to experience illness or consume increased quantities of alcohol (NHS Choices, 2015). In the UK a survey undertaken by the Health and Safety Executive (HSE) has estimated that in the year 2013-2014, 487,000 of work related illnesses (39%) could be attributed to work-related stress, anxiety or depression (HSE, 2014). Additionally the survey found that as many as 11.3 million working days were lost in the year 2013-2014 as the direct result of work-related stress (HSE, 2014).

Studies have shown that healthcare professionals, particularly nurses and paramedics, are at an increased risk of work-related stress compared with other professionals (Sharma et al., 2014). This is likely to be due to the innate long hours and high pressure of maintaining quality care standards in the job, as well as pressures caused by staff shortages, high levels of patient demand, a lack of adequate managerial support as well as the risk of aggression or violence towards nurses from patients, relatives or even other staff (Royal College of Nursing (RCN), 2009). Indeed, a 2014 survey of nursing staff by the RCN showed that up to 71% of staff surveyed worked up to 4 hours more than their contracted hours a week, 80% felt that work-related stress lowered morale, and that 72% reported that understaffing occurred frequently in their workplace. As a result of these issues, 66% of respondents in the survey considered leaving the NHS or the nursing profession altogether (RCN, 2014b). A separate report by the RCN suggested that over 30% of absence due to illness was due to stress, which was estimated to cost the NHS up to £400 million every year (RCN, 2014a).

In addition to the physical and emotional symptoms of stress previously discussed, studies in this area have shown that nurses experiencing high levels of work-related stress were more likely to be obese and have low levels of physical exercise, factors which increased the likelihood of non-communicable diseases and co-morbidities such as hypertension and type 2 diabetes (Phiri et al., 2014).

Stress and staff absence

Chronic stress has been linked to “burnout”(Khamisa et al., 2015; Dalmolin et al., 2014), or a state of emotional exhaustion under extreme stress related to reduced professional fulfilment (Dalmolin et al., 2014) and “compassion fatigue”, where staff have experienced so many upsetting situations that they find it difficult to continue empathising with their patients (Wilkinson, 2014). As previously discussed, reducing staffing levels contribute to stress in nursing staff, and in this way chronic stress within the workplace launches a self-perpetuating cycle of understaffing; increased stress leads to increased illness, more staff absence and increased understaffing. In turn, these negative emotions also reduce job satisfaction and prompt many staff to consider leaving the nursing profession, further reducing staffing availability for services (Fitzpatrick and Wallace, 2011).

Reasons for work-related stress amongst healthcare professionals

Studies amongst nursing staff have also reported stress occurring as the result of poor and unsupportive management, poor communication skills amongst team members, institutional and organisational issues (e.g. outdated or restrictive hospital policies) or bullying and harassment (RCN, 2009). Even seemingly minor issues have been reported as exacerbating stress amongst nursing staff, for example a lack of common areas to take breaks in, changing shift patterns, and even difficulty and expense of car parking (Happell et al., 2013).

Work related stress can particularly affect student or newly qualified nurses, who often report higher expectations of job satisfaction from working in the profession, they have worked hard and aspired to join, and are therefore particularly prone to experiencing disappointment on discovering that they do not experience the job satisfaction that they presumed they would do whilst training. Student and newly qualified nurses may also have clear ideas from their recent training on how healthcare organisations should be run and how teams should be managed, and may then be disillusioned when they discover that the reality is that many departments could in fact benefit from improvements and further training for more experienced staff in these areas (Wojtowicz et al., 2014; Stanley and Matchett, 2014). Nursing staff are also likely to, on occasion, find themselves in a clinical situation that they feel unprepared for, or do not have the necessary knowledge to provide the best possible care for patients, and this may cause stress and anxiety (RCN, 2009). They may also be exposed to upsetting and traumatic situations, particularly in fields such as emergency or intensive care medicine (Wilkinson, 2014).

Moral distress can also cause strong feelings of stress amongst healthcare professionals. This psychological state occurs when a discrepancy occurs between the action that an individual takes, and the action that an individual feels they should have taken (Fitzpatrick and Wallace, 2011). This may occur if a nurse feels that a patient should receive an intervention in order to experience best possible care, but is unable to deliver it, for example due to organisational policy constraints, or a lack of support from other members of staff (Wojtowicz et al., 2014). For example, a nurse may be providing end of life care to a patient who has recently had an unplanned admission onto a general ward but is expected to die shortly. The nurse may feel that this patient would benefit from having a member of staff sitting with them until they died. However, due to a lack of available staffing this does not happen as the nurse must attend to other patients in urgent need of care. If the patient dies without someone with them, the nurse may experiences stress, anger, guilt and unhappiness over the situation as they made the moral judgement that the dying patient “should” have had a member of staff with them, but were unable to provide this without risking compromising the safety of other patients on the ward (Stanley and Matchett, 2014). One large scale questionnaire based study in the USA on moral distress amongst healthcare professionals has shown that moral distress is more common amongst nurses than other staff such as physicians or healthcare assistants. The authors suggested that this may be due to a discrepancy between the level of autonomy that a nurse has in making care decisions, (especially following disagreement with a doctor, who has a high level of autonomy), while experiencing a higher sense of responsibility for patient wellbeing than healthcare assistants, who were more likely to consider themselves to be following the instructions of the nurses than personally responsible for patient outcomes (Whitehead et al., 2015).

Recommendations for policies to address work related stress

It is acknowledged that many individuals find that being asked to perform tasks that they have not been adequately trained or prepared for can be very stressful. As such management teams should also try to ensure as far as possible that individuals are only assigned roles for which they have adequate training and abilities, and support employees with training to improve skills where necessary (RCN, 2009).

Surveys have frequently reported that organisational issues such as a lack of intuitive work patterns, overloading of workloads and an unpleasant working environment can all contribute to work related stress. Organisations can reduce the impact of these by developing programmes of working hours with working staff and adhering to them, making any necessary improvements to the environment (e.g. ensuring that malfunctioning air conditioning is fixed), and that incidents of understaffing are reduced as much as possible (RCN, 2009). Issues such as insomnia and difficulty in adapting to changing shift patterns can also be assisted by occupational health, for example by encouraging healthy eating and exercise (Blau, 2011; RCN, 2005). For example, in 2005 the RCN published an information booklet for nursing staff explaining the symptoms of stress, ways in which it can be managed e.g. relaxation through exercise or alternative therapies, and when help for dealing with stress should be sought (RCN, 2005). More recently, internet based resources are available from the NHS to help staff identify if they need assistance, and how and why it is important to access it (NHS Employers, 2015).

Witnessing or experiencing traumatic or upsetting events is an unavoidable aspect of nursing, and can even result in post-traumatic stress disorder (PTSD). However, there are ways in which staff can be encouraged by their management teams and organisations to deal with the emotions that these circumstances produce, limiting the negative and stressful consequences of these events. This may include measures such as counselling or even peer support programmes through the occupational health departments (Wilkinson, 2014). Staff should also be encouraged to use personal support networks e.g. family, as this can be an important and effective source of support, however studies have shown that support within the work place is most beneficial, particularly if this can be combined with a culture where healthcare professionals are encouraged to express their feelings (Lowery and Stokes, 2005).

One commonly cited reason for work related stress amongst nurses is the incompetence or unethical behaviours of colleagues, and a lack of opportunity to report dangerous or unethical practice without fear of reprisal. Therefore it is important that institutions and management teams ensure that there is an adequate care quality monitoring programme in place, and a culture where concerns can be reported for further investigation without fear of reprisal, particularly with respect to senior staff or doctors (Stanley and Matchett, 2014).

It has been reported that in the year 2012-2013, 1,458 assaults were reported against NHS staff (NHS Business Service Authority, 2013). Violence and abusive behaviour towards nursing staff is an acknowledged cause of stress and even PTSD, and staff have a right to provide care without fear (Nursing Standard News, 2015; Itzhaki et al., 2015). Institutions therefore have a responsibility towards their staff to provide security measures such as security staff, workplace design (e.g. locations of automatically locking doors) and policies for the treatment of potentially violent patients e.g. those with a history of violence or substance abuse issues (Gillespie et al., 2013).

As previously discussed, nurses are more likely than other healthcare professionals to experience moral distress as the result of a discrepancy between the actions they believe are correct and the actions they are able to perform (Whitehead et al., 2015). However there are policies that can be introduced into healthcare organisations to reduce its occurrence, and the severity with which it can affect nursing staff. Studies have shown that nurses who were encouraged to acknowledge and explore feelings of moral distress were able to process and overcome these in a less damaging manner than those who did not (Matzo and Sherman, 2009; Deady and McCarthy, 2010). Additionally, it is thought that moral distress is less frequent in institutions and teams that encourage staff to discuss ethical issues with a positive attitude (Whitehead et al., 2015). For example, institutions could employ a designated contact person for staff to discuss stressful ethical issues with, or set up the facility for informal and anonymous group discussion, for example on a restricted access internet-based discussion board (Matzo and Sherman, 2009)

Conclusion

Work related stress is responsible for significant costs to the NHS in terms of staffing availability and financial loss from staff absence from stress itself or co-morbidities that can be exacerbated by stress (RCN, 2009), for example hypertension and diabetes (Phiri et al., 2014; RCN, 2009, 2014a). The loss of valuable and qualified staff from the profession is also a significant cost to health services, and of course exacerbates the situation by increasing understaffing further, which in turn increases stress for the remaining staff (Hyrkas and Morton, 2013). It can also exert a significant cost to healthcare professionals who experience it, in terms of their ability to work, their personal health, effects on personal relationships (Augusto Landa et al., 2008) and job satisfaction (Fitzpatrick and Wallace, 2011). However, organisations can implement recommendations to reduce work related stress, for example by encouraging a positive and supportive culture for staff by offering interventions such as counselling (Wilkinson, 2014; RCN, 2005). Furthermore, interventions such as encouraging the reporting of unsafe or unethical practice – a commonly cited source of stress amongst nurses (RCN, 2009; Stanley and Matchett, 2014) – may also contribute to improving the quality of patient care.

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