Essay on Stress Biomarkers: Salivary Cortisol

The nursing profession, has for a long time, been considered one of the most stressful careers. Stress among nurses is substantially attributed to psychological demands of patients, physical labor, interpersonal relations, long working hours and shifts, among other pressures that are central to the day-to-day nursing practice. Thus in this study, silvery cortisol will be measured as a biomarker of stress from novel nurses during the beginning, middle and the end of their working shifts at the medical, surgical ward. Therefore, looking into the nurses incident reports for a whole month, his study is intended to determine whether there is are a relationship between stress and poor job performance.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Order now

Conceptual Definition of Stress and Its Link to Physiology

According to the elasticity theory in physics, stress is defined as the amount of pressure that is applied on a particular area (Kranner, Minibayeva, Beckett, & Seal, 2010). There is a linear relationship between stress and the affected object in the sense that, an increase in the force applied directly affects the length of the object until the object is completely bent when it is unable to withstand more pressure. Thus, it is in a similar regard that stress in human beings is directly related to their physiology. According to Hans Selye (2011), the father of General adaptation syndrome (GAS) theory, stress can be defined as the nonspecific biological response to changes in normal body equilibrium. This means that stress is a condition that causes the human system to respond to changes in its normal balance. Therefore, in his account, Selye contends that a stressor is something that is deemed as demanding, threatening and challenging. For this reason, stress varies in intensity with eustress or positive stress as a type of stress that is manageable and that which can lead to enhanced competence and growth. On the other hand, extreme, uncontrollable or overwhelming stress can be referred to as negative stress or distress. Kranner, Minibayeva, Beckett, & Seal (2010) point out that these levels of extreme stress are known to be destructive and can substantially affect the human physiology in regard to both physical and mental health.

According to the Anxiety and Depression Association of America (ADAA) (2017), stress is a temporary chemical reaction that resulted from a provoking situation. However, anxiety occurs as the long-term results of the perceived stress. Besides, when approached from a different theoretical perspective, there are three modes of stress, which include; Stress as a stimulant, reaction, or the effect of the two, which results to stress as an interaction between the environmental stimulus and human response (Papathanasiou, 2015). From a biological perspective, a stressor alters the normal psychobiological state of the human body system. This kind of alteration stimulates the hypothalamus to secrete corticotrophin-releasing hormone (CRH). CRH, in turn, triggers the anterior pituitary gland to secrete the adrenocorticotrophic hormone (ACTH) that initiates the adrenal cortex to release glucocorticoids, which when in the form of hormones, Glucocorticoids act as the cortisol in the human body. Cortisol, on the other hand, is an essential hormone that is necessary for releasing energy by metabolizing fat and protein to glucose and elevating it in the bloodstream (Clements, 2012). Throughout the day, the normal highest cortisol level would be upon waking up, and it gradually decreases to be at its lowest before bedtime. Therefore, with all these put into consideration, cortisol is therefore considered as an important biomarker of physiological stress (Inder, Dimeski, & Russell, 2012).

Literature Review and Stress Biomarkers

Recent studies in the field of behavioral biomedicine have increasingly addressed and examined the role that is played by acute stress as a contributing and predisposing factor of the human physiological being. Thus, so as to clearly understand the relationship between these two, research done in the recent years has made use of biological markers for the alteration in biological stress systems. A majority of stress related studies have highlighted their correlation with various salivary stress biomarkers as the primary indicators of stress reactions. Rocha, Martino, Grassi-Kassisse, & Souza (2013) contend that nurses view their working shifts as a kind of stressor due to reasons such as, difficulty in maintaining social balance, their working environment and the ethical inclination that is related to the nursing profession. For this reason, in recent years, a growing interest to examine the relationship between high occupational stress among nurses and their daily professional performances have emerged. A majority of these studies have revealed that severe occupational stress in the nursing career leads to low patient care, an issue that can substantially threaten the patients safety.

A qualitative study by Barland, et al. (2008) pointed that critical care nurses are often pressured due to inadequate time. This, in essence, leads to poor quality of care through incomplete tasks. Additionally, Hayes & Bonner (2010) highlight that work stress among hemodialysis nurses, which is highly attributed to multiple factors such as poor communication and heavy workload, significantly leads to poor patient outcomes. On the other hand, excessive levels of stress are known to lead to distraction as well as the inability to effectively complete a mortal task due to the stress impairment of concentration and memory.

When used as a physiological marker, salivary cortisol can concisely identify stress presence, and its levels among nurses at work since it reflects either active free and corticotrophin binding globulin (CBG) cortisol (Clements, 2012). Nevertheless, Salivary cortisol has a 10 fold lower concentration as compared to total serum cortisol (Inder, Dimeski, & Russell. 2012). In this particular study, salivary cortisol has been mostly measured by immunoassay methods. The nurses, therefore, collect the salivary cortisol by themselves using an instruction pamphlet which requires them to collect their salivary samples, three times, during their day shift which ought to be the 12-hour shift. Additionally, along with their number identification, the nurses being used as subjects will be given high absorption cotton rolls, which they are expected to chew for approximately 3 minutes.

Additionally, the nurses are advised to refrain from smoking, eating or even brushing their teeth an hour before the collection of the samples. The sample should, the, be stored at a temperature of 4 0C until it is received at pathology, centrifuged at 3000 g for 10 min then stored at "80 0C until assayed.

Stress Biomarkers

According to Thoma et al. (2013), a stress biomarker can be defined as a measurable substance whose presence is significantly indicative of some stress-related phenomenon and symptoms. In this regard, salivary cortisol levels are used as the physiological index that gives an assessment of the stress levels among working nurses. While exhausting work hours, unsanitary conditions and patient related pressures are some of the stressors that potentially lead to stressful work situations for the nurses, Dickerson & Kemeny (2004) contend that not all stressors can cause cortisol elevation. However, those stressors which are directly related to evaluative tasks have a strong association with elevated cortisol levels. This is evidenced by the fact that nurses have proven to have higher salivary cortisol levels during their working shifts, as compared to the levels during their day offs (Rocha, et al., 2013).

Additionally, various scholars have increasingly argued that nurses experience higher levels of stress during their initial period of clinical practice, as compared to other periods (Sheu, Lin, & Hwang, 2002). While the relationship between stress and performance among nurses has been studied in the past, various studies have not made use of biomarkers. This, in essence, calls for the need to use scientific biomarkers among nurses population. Therefore, quantifying this effect is important in raising awareness of the problem so as to institute training which is essential in minimizing potential errors as well as safeguarding patient care.

References

The American Institute of Stress. (2011, October 6). What is stress? Retrieved February 6, 2017, from The American Institute of Stress, http://www.stress.org/what-is-stress/

ADAA. Stress. Retrieved January 26, 2017, from https://www.adaa.org/understanding-anxiety/related-illnesses/stress

Berland, A., Natvig, G. K., & Gundersen, D. (2008a). Patient safety and job-related stress: A focus group study. Intensive and Critical Care Nursing, 24(2), 9097. doi:10.1016/j.iccn.2007.11.001

Clements, A. D. (2012). Salivary cortisol measurement in developmental research: Where do we go from here? Developmental Psychobiology, 55(3), 205220. doi:10.1002/dev.21025

Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and Cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130(3), 355391. doi:10.1037/0033-2909.130.3.355

Elbuken, G., Karaca, Z., Tanriverdi, F., Unluhizarci, K., Simsek, Y., & Kelestimur, F. (2015). Does cigarette smoking affect serum total cortisol and salivary cortisol levels? Endocrine Abstracts. doi:10.1530/endoabs.37.ep729

Farquharson, B., Bell, C., Johnston, D., Jones, M., Schofield, P., Allan, J., Johnston, M. (2013). Nursing stress and patient care: Real-time investigation of the effect of nursing tasks and demands on psychological stress, physiological stress, and job performance: Study protocol. Journal of Advanced Nursing, 69(10), 23272335. doi:10.1111/jan.12090

Hayes, B., & Bonner, A. (2010). Job Satisfaction, Stress And Burnout Associated With Haemodialysis Nursing: A Review Of Literature. Journal of Renal Care, 36(4), 174179. doi:10.1111/j.1755-6686.2010.00194.x

Inder, W. J., Dimeski, G., & Russell, A. (2012). Measurement of salivary cortisol in 2012 - laboratory techniques and clinical indications. Clinical Endocrinology, 77(5), 645651. doi:10.1111/j.1365-2265.2012.04508.x

Kranner, I., Minibayeva, F. V., Beckett, R. P., & Seal, C. E. (2010). What is stress? Concepts, definitions and applications in seed science. New Phytologist, 188(3), 655673. doi:10.1111/j.1469-8137.2010.03461.x

Rice, V. H. (2000). Handbook of stress, coping, and health: Implications for nursing research, theory, and practice (2nd ed.). Thousand Oaks, CA: Sage Publications.

Rocha, M. C. P. da, Martino, M. M. F. D., Grassi-Kassisse, D. M., & Souza, A. L. de (2013). Stress among nurses: An examination of salivary cortisol levels on work and day off. Revista da Escola de Enfermagem da USP, 47(5), 11871194. doi:10.1590/s0080-623420130000500025

Sheu, S., Lin, H.-S., & Hwang, S.-L. (2002). Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice: The effect of coping behaviors. International Journal of Nursing Studies, 39(2), 165175. doi:10.1016/s0020-7489(01)00016-5

Thoma, M. V., La Marca, R., Bronnimann, R., Finkel, L., Ehlert, U., & Nater, U. M. (2013). The Effect of Music on the Human Stress Response. PLoS ONE, 8(8), e70156. doi:10.1371/journal.pone.0070156